Self-Perception of changes in lifestyle and wellbeing associated with social distancing during COVID-19 pandemic among medical students (the study in Lviv, Ukraine)

social distancing on lifestyle; 4) the scale of stress perception. Results : The cohort for the study consisted of 166 women and 107 men in the following age groups: from 17 to 24 — 92%, 25–31 — 4%, 35–44 — 2%, and over 45 years — 2%. Ethnic groups included Asian — 47%, Caucasian — 41%, African — 7%, Hispanic — 3%, and multiracial people — 2%. Social exclusion during COVID-19 was found to be caused by a change in the use of social media, more time spent on using them by all respondents. Among these, 88% acknowledge that social media have a great impact and 71% of responders learn basic information about the pandemic via social media. However, 52% doubt the reliability of the information. The feeling of anxiety, panic, which characterized the perception of stress caused by information on social media, was reported by 56% of respondents. Almost all respondents changed their lifestyle, which was characterized by physical inactivity and changed eating behavior. About 60% of respondents reported overeating in the evening and at night (19:00 — 5:00) and almost half of all respondents reported weight gain in the last year. All respondents know about the bene ﬁ ts of physical activity to overcome signs of psycho-emotional stress, but only about 10% of respondents exercise regularly. There were no di ﬀ erences in the responses from students belonging to the Caucasian group or other ethnicities. Conclusions. The lifestyle of student youth, their eating behavior, and psycho-emotional state are being modi ﬁ ed during COVID-19. Social media is an important informative factor in the context of social exclusion and the ﬁ ght against chronic stress.

Методи. Проспективне когортне дослідження було проведено за допомогою анонімного інтернет-опитування 273-х студентів-медиків ЛНМУ різних етнічних груп через гуглформи з оригінальною анкетою, яка включала такі запитання: 1) анкетна інформація (вік, стать, етнічна приналежність, сім'я, освіта, працевлаштованість, економічний стан); 2) стосовно використання соціальних медіа; 3) про вплив соціального дистанціювання на спосіб життя; 4) щодо перцепції стресу. Twitter [10,11]. COVID-19-related lockdown can pose additional stress for the lifestyle and wellbeing of individuals apart from the stress of contracting COVID-19 infection [12,13]. This global situation may adversely aff ect the individuals' lifestyle which in turn impacts their well-being. In such a situation, modern online social media resources started having an exceptional role in providing information via modern communication technologies [14]. At the same time, in COVID-19 times, social media could promote misinformation or incorrect interpretation of medical information, which causes panic, anxiety, depression in society [15,16]. However, despite it being a global issue, their impact on medical students' lifestyle and well-being, online academic learning, and working during the stay-at-home policy is still signifi cant.  [3,4]. In the global COVID-19-related crisis, the well-being and health of young adults who belong to medical students are the priority for society. Moreover, it has been widely proposed that during their highly demanding and intensive education in medical schools, these individuals are part of the population segment with a high risk of distress [5][6][7]. Our previous study indicated that medical students who were exposed to chronic stress and a sedentary lifestyle due to demanding academic learning had eating behavior disorders [8]. COVID-19 pandemic creates an unusual learning environment for future physicians due to the closure of medical facility departments, clinics, laboratories, university libraries, public places and limited access to other resources for education and clinical practice [9] with a shift of academic and social communication to online technological resources and social media platforms including Facebook, Instagram, and The self-assessment-based answers were graded on the 1-5-point scale (1-never, 2rarely, 3-sometimes, 4-often, 5-always). All questions of the online survey were required; therefore, there are no missing data in our study. The collected data were coded, cleaned, and analyzed by researchers confi dentially.

Statistical analysis
Obtained data were imported into an Excel sheet. The descriptive analysis of quantitative variables which represented the central tendency and qualitative variables were formatted in percentages. Statistical analysis was conducted using Wald's test and Chi-squared test using Excel sheets.   Unsurprisingly, remote and online education had adverse eff ects on lifestyle for 65% of responders. As expected, lifestyle changes included poor sleep quality, however, 68% of responders reported full nights of restful sleep.
In the study, moderate physical activity was reported by 51.4% of responders. Moreover, 82.1% of total participants tend to have suffi cient energy for work/study/daily activities. Additionally, 18.1% tend to consume tobacco and 28.4% -alcohol.

Eating behavior
Data obtained about self-estimation of participants have shown that 74.1% of total participants reported that their weight approached the ideal level for them, and 69.6% were keeping the nutritious diet.
The eating pattern during the quarantine/social distancing period changed in 64.6% of participants. Eating during night time (19:00-5:00) was reported by 59.7% with 51.1% of all participants admitting that it happened 7 times per week. Simultaneously, they reported having irregular patterns of eating during daytime -81.3% of all responders. Moreover, participants tend to eat their meals alone: breakfast -73.4%, lunch -67.7%, dinner -56.3%. In addition to changing eating patterns, 55.9% of all respond-ers confi rmed that they tended to overeat. Diff erences between lifestyle behavior factors by ethnicity were highest in the Asian group of participants.

Social Media
Participants who are students of LNMU pointed that social media had a signifi cant infl uence and served as a source of information about the COVID-19 pandemic, while 88.2% admitted they were checking social media frequently. Among all responders, other information sources were confi rmed by 68.7% of medical students. But when asked whether social media belonged to trustworthy sources, only 52.4% of responders said that they believed the news reported on social media. Also, 72% of responders reported their interest in local information and were checking local information about their town/country frequently. At the same time, 56.1% tend to feel anxiety when learning the latest pandemic-related information, while still preferring to use social media nonetheless -71.7%. We fi nd suggestive evidence that 61.2% of responders act according to health-related information on social media, 49.6% of them share information promoting a healthy lifestyle during COVID-19. Our results concerning the impact of ethnicity on the use of social media suggest that the largest ethnic group refl ecting the results were Asian participants.

Perceived stress scale
Our results have shown that 71.2% of total participants were upset when something happened unexpectedly, moreover, 66.9% felt unable to control things important to them. It was an interesting fact that 80.1% of responders confi rmed frequently feeling nervous and stressed during the pandemic. At the same time, 76.5% of total participants were able to control irritations, and 66.7% felt that they were on top of their workload to some extent.
When it comes to handling stressful situations: 82,7% of responders can control their emotions. What's important, 83.5% of all medical students view obstacles as temporary rather than permanent while exaggerating their importance -67.8%. Furthermore, 78.7% of responders can change their thinking to calm down, 65.6% of them tend to wait passively for events to develop rather than take charge, but 86.4% of medical students also look for solutions and coping mechanisms. We have also found that 72.1% of total participants reported having decision-making powers in their families.

Discussion
Th e outbreak caused by COVID-19 brings the new reality with social distancing, remote studying and working, fear for themselves, their family members and the population health (20)(21). Adaptation to such global dramatic changes in lives has been accompanied by changes in the modern population lifestyle and its prevalent factors, such as physical activity, sleep, and eating behavior [22][23][24]. Moreover, younger people have suff ered more than older ones [25][26][27]. Over the last decade, during the pre-COVID-19 times, the well-being and lifestyle of medical students was identifi ed as an important topic [28][29][30]. Recently, it had been recognized that, during COVID-19 times, undergraduate students suff ered more than non-student young people [31,32]. During COVID-19 lockdown, domestic and international medical students separated from their friends and university community facing considerable changes in their lifestyle, wellbeing, and education [33][34].
The importance of maintaining physical activity during COVID-19 for well-being was suggested widely [35][36][37]. Chronic stress and the formation of coping mechanisms to relieve it, without eliminating the cause itself, had an impact on mental health [38][39][40]. Students of LNMU are the target group to assess the infl uence of social distancing as a new stress factor, and their behavioral patterns changed in this new COVID-19-related environment. Despite knowing how to cope with the new reality associated with COVID-19, medical students faced increased levels of stress perception. Asian students were found to use social media as an information source and promotion tool to obtain and spread their knowledge about the COVID-19 pandemic. Asian participants also experienced greater changes in their eating behavior in comparison to other ethnic groups Th e biggest gender-related diff erences were demonstrated in methods of coping with irritations.
Positive answers showed that males were more capable of controlling irritations in life (Q31) while being predominant in the consumption of tobacco and alcohol (Q40-41) in comparison to females.
Taking into account the obtained results, we can summarize that COVID-19-related social distancing tends to have a signifi cant infl uence on medical students' lifestyle and well-being. All medical students of LNMU have an increased perception of stress and ways of coping with it while also experiencing decreased physical activity, sleep changes, and eating behavior. Students confi rm that they had unhealthy stress coping mechanisms that manifested in changed eating behavior. However, in the end, they knew how to overcome them by maintaining their weight and exercising moderately while staying on top of their workload in most cases (66.7 %). Additionally, students tend to fi nd information about the state of the world in times of pandemic via social media, with varying levels of trust in the information they obtain. When faced with an obstacle, they tend to feel overwhelmed at fi rst and wait for the solution to come but then they take charge and look for solutions.