The role of preoperative transfusion in sickle cell disease, a systematic review and meta-analysis

This systematic review and meta-analysis aimed to provide guidance on preoperative blood transfusion strategies for patients with sickle cell disease (SCD). We included all randomized controlled and observational studies exploring the clinical outcomes of preoperative blood transfusion among patients with SCD compared to the conservative transfusion strategy until 14/09/2022. Sixteen studies involving 3486 participants were analysed. The findings revealed a significantly higher bleeding rate in patients who received preoperative transfusion than those who followed a conservative strategy (RR = 4.32, 95% CI 1.75-10.68, P = 0.002, I2 = 0%). However, the two strategies had no significant differences in other clinical outcomes, such as acute chest syndrome, painful crisis, fever, neurological complications, thrombosis, ICU admission, and mortality. It is important to note that all the included studies had a moderate risk of bias. Preoperative transfusion in SCD was associated with a higher bleeding risk but a similar risk in other outcomes compared to conservative strategies. Notably, the increased bleeding risk observed seldom had clinical significance. We recommend individualizing management strategies, considering the overall positive impact of transfusions in reducing complications. Further high-quality studies are needed to refine recommendations.

From classrooms to controllers: how school closures shaped children's video gaming habits

OBJECTIVES

This study aimed to assess the impact of COVID-19-related school closures on screen time and video gaming habits among governmental school students in Qatar and explore the prevalence of Internet Gaming Disorder (IGD) within this context.

METHODS

A cross-sectional approach was employed, spanning two months from June to August 2022. A random sample of students aged 8-15 years was drawn from the national electronic health record system of Qatar. Telephone interviews with parents were conducted to collect data. The Parental Internet Gaming Disorder Scale (PIGDS) was used for IGD assessment.

RESULTS

Of 428 parents, 257 (60%) confirmed their child's engagement in video gaming during school closures. Participants averaged 11 years in age with 92 (35.8%) females and 165 (64.2%) males. Nationality included 62.6% expatriates and 37.4% Qatari locals. Average weekly screen time increased significantly from 19.7 ± 10.1 h to 31.9 ± 12.6 h during closure (p < 0.001). Video gaming time rose from 8.6 ± 8.6 h to 13.0 ± 12.4 h per week (p < 0.001). The prevalence of IGD was 8.6% (95% CI 5.4-12.7). Male students, expatriates, and those reporting increased video gaming time were more likely to develop IGD than their female and local counterparts.

CONCLUSION

The observed associations between video gaming increase and IGD highlight the need for focused interventions to address potential risks and promote healthier digital habits among this population.

COVID-19 lockdowns weigh heavily on youth: an analysis of the impact on BMI for Age Z scores in children and adolescents

BACKGROUND

The COVID-19 pandemic has significantly impacted the lifestyle and health of children and adolescents. This study aimed to assess the lifestyle changes brought about by COVID-19-related school closures and their impact on the Body Mass Index for Age Z (BAZ) scores of governmental school students in Qatar.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 targeting students aged 8-15 years. Data on lifestyle behaviors were gathered through telephone interviews with parents of selected students. The BAZ scores before and after school closures that were automatically calculated by the electronic health records system were extracted.

RESULTS

We completed 1546 interviews. We found a significant increase in unhealthy food categories, a reduction in physical activity and an increase in the screen time over the period of schools' closure. The BAZ increased significantly by 0.30 (95% CI 0.26-0.35). The increase in BAZ scores was significantly higher among male students and the younger age group compared to females and older counterparts, respectively. The student's age group, sex, nationality and change in physical activity were significant predictors of the change in BAZ scores.

CONCLUSIONS

School closures during the COVID-19 pandemic negatively impacted the lifestyle of students in Qatar and resulted in a significant increase in the BAZ scores.

Determinants of vaccine adherence among non-dialysis chronic kidney disease patients in Qatar

INTRODUCTION

Chronic kidney disease (CKD) is a global health problem. Reduced innate and adaptive immunological responses predispose CKD patients to infections. Despite the clinical and epidemiological importance of CKD and the great value of vaccination as a prophylactic measure, the utilization of recommended vaccines in Qatar has not yet been evaluated.

METHODS

We conducted a cross-sectional study to estimate the level of influenza, pneumococcal, and hepatitis B vaccination and the predictors of adherence to these recommended vaccines among non-dialysis CKD patients receiving renal ambulatory care in Qatar from 1 September 2020 to 30 April 2021. Complete vaccination was defined as receiving the three vaccines, and partial vaccination was defined as receiving one or two vaccines. The full and partial vaccination predictors were assessed using multivariate logistic regression and reported as odds ratio (OR) with p<0.05 indicating statistical significance.

RESULTS

416 non-dialysis CKD patients were included in our analysis. 73% were males; the mean age was 56 ± 15 years. More than 50% of the patients were from the Middle East, followed by 36% from Asia. Most patients had concurrent hypertension, concurrent diabetes mellitus, and were stage V CKD. Only 12% of the patients were fully vaccinated, while 73% received partial vaccination. The predictors of vaccination included age, gender, Asian origin, employment, living conditions, concurrent medical conditions, CKD stage, allergy to medications, and use of injectable medications. Only stage V CKD positively predicted adherence to full and partial vaccinations in non-dialysis CKD patients.

CONCLUSION

There is very low adherence to the recommended vaccines in CKD patients, with a prevalence of complete vaccination of 12% only. Increased public awareness about the importance of vaccination in CKD may improve the adherence rates among these patients in Qatar.

Prevalence and determinants of health literacy among the adult population of Qatar

Introduction

Health literacy (HL) is both a direct determinant and a mediator of health outcomes. Research on the prevalence and determinants of HL in terms of its functional, communicative, and critical domains is scarce in the state of Qatar and its surrounding regions. Thus, this study aims to fill the knowledge gap in this area, estimate the levels of functional, communicative, and critical health literacy among the general adult population, and identify its determinants in the state of Qatar.

Methods

An analytical cross-sectional study with a disproportionate stratified random sampling technique was conducted in 2022. A representative sample of phone numbers was obtained from the Cerner database at Hamad Medical Corporation and approached via well-trained data collectors. A socio-demographic and health-relevant factor questionnaire and the validated All Aspects of Health Literacy scale (AAHLS) were used to collect the data on functional, communicative, and critical HL and their determinants. Descriptive analysis, independent sample t-test, ANOVA, and linear regression were used and yielded the outcomes on HL levels as low, adequate, and high in percentages and the HL determinants.

Results

A total of 770 participants were included. The study found that 41.5%, 29.3%, and 29.2% of them have adequate, high, and low overall HL levels consecutively. People who participated in the study are older adult, are of Arabic ethnicity, are of Qatari ethnicity, have a lower level of education, have close relatives with a lower level of education, have a lower income, are non-migrants, are not living within a family, sought medical care within the last week, and who do not know if they have a chronic disease or do not have lower overall HL levels compared to the other groups. After linear regression analysis, only the participant's level of education and "last time sought medical care within last week" variable predict the overall HL score.

Conclusion

Almost half of Qatar's adult population has an adequate HL level, comparable to the HL levels in other regions, despite the limitation in comparison due to variation in context and the HL measurement tools used. The possible determinants are amenable factors to focus on while designing HL interventions and providing healthcare.

Computer vision syndrome among students during remote learning periods: harnessing digital solutions for clear vision

Aim

This study aimed to assess the prevalence of Computer Vision Syndrome (CVS) among children and adolescents in Qatar during the period of remote learning and explore the associated factors and discuss some digital health remedies that might reduce the risk.

Methods

We conducted an analytical cross-sectional study between June and August 2022 by collecting data via telephone interviews with parents of selected students utilizing the Computer Vision Syndrome Questionnaire (CVS-Q).

Results

We completed 1,546 interviews. The mean age of the students was (11 ± 2), male: female ratio was almost 1:1. About one quarter (368, 23.8%) of parents reported a previous diagnosis of visual disturbances among their children with over 88% of them wearing eyeglasses or medical contact lenses. The prevalence of CVS in our sample was about 8% (95%CI: 6.8-9.6). Mother's employment, having positive history of visual disturbances, and excess screen time were found to be significant predictors of CVS.

Conclusion

Health care providers in collaboration with teachers should provide parents with evidence-based strategies to prevent or minimize the digital eye strain among students. In the landscape of remote learning, the implementation of digital remedies emerges as a proactive approach to mitigate the risk of digital eye strain.

Sleep Quality Among People with Type 2 Diabetes Mellitus During COVID-19 Pandemic: Evidence from Qatar's National Diabetes Center

Purpose

Sleep disturbance is suspected to increase during the COVID-19 pandemic, and people with type 2 DM are known to have a higher risk of sleep disturbance. We aimed to determine the prevalence and determinants of sleep disturbance through Pittsburgh Sleep Quality Index (PSQI) during the COVID-19 pandemic.

Patients and Methods

We randomly selected two hundred eighty-eight people with T2DM from the outpatient clinics of the National Diabetes Centre in Qatar. We used Chi-square, Mann-Whitney, Spearman, and Point Biserial correlation tests to examine the association between sleep quality and the independent variables. Finally, we conducted multiple logistics regression to identify the predictors of poor sleep quality and set the alpha level at 0.05.

Results

In our sample, the mean age (±SD) was 51.4 (± 9.5) years, and 64.3% of the study participants were males. The median (IQR) duration of diabetes was 10 (11) years. Additionally, 6.3% of the participants were on insulin. The median HbA1c was 7.6% (2.4). Three in ten patients reported poor sleep quality (PSQI>5); (n=103; 35.8%). Poor sleep quality was statistically associated with young age, previous history of sleep disturbance, prior diagnosis of sleep disorders, high depression score, and high perceived stress score. After adjusting for confounders, only high depressive symptoms score and previous history of sleep disorder were significant predictors of poor sleep quality (p < 0.001), with adjusted odd ratios of (aOR = 1.421; 95% CI: 1.242-1.625) and (aOR = 3.208; 95% CI: 1.574-6.537), respectively.

Conclusion

The prevalence of poor sleep quality among people with T2DM during the COVID-19 pandemic is high. Physicians must screen for depression, stress, and previous history of sleep disorder to tackle poor sleep among T2DM.

The Triple "S" Impact of COVID-19: Nationwide Evidence of the Impact of the Stress Associated With Restrictive Measures on Substance Use, Sleep, and Social Connectedness in Qatar

OBJECTIVES

Countries worldwide implemented social and movement restrictions to contain the spread of coronavirus disease 2019 (COVID-19). Unfortunately, such restrictions have adversely impacted people's lifestyles. The goal of this study was to assess the impact of COVID-19-related restrictive measures on substance use, sleep, and social connectedness in Qatar's population.

METHODS

A web-based survey was conducted between January 2021 and February 2021 targeting adults ≥18 years of age who were residing in Qatar between March and August 2020.

RESULTS

A total of 1408 participants completed the survey. Of tobacco users in our sample, 36% reported increased tobacco use since the start of home confinement, while 41.6% of alcohol users reported decreased alcohol use. Concerning sleep, 46.1% reported an increase in average sleep duration per day (0.77 h mean increase, 95% CI: 0.66-0.88, P<0.001), and a third of participants reported poorer sleep quality. Of the participants, 39.6% felt socially disconnected. Perceived stress was found to be an independent predictor for increased use of tobacco, deterioration in sleep quality, and increased sleep duration during home confinement.

CONCLUSIONS

Restrictive measures related to COVID-19 resulted in both positive and negative impacts on the lifestyle of Qatar's population. Emphasis should be placed on encouraging people to adopt healthy strategies for coping with various stressors that arise during future home confinement measures. It is also necessary to address the persistence of adverse consequences in the postpandemic era.

A Sociodemographic Analysis of the Impact of COVID-19-Related Schools' Closure on the Diet and Physical Activity of Children and Adolescents in Qatar

OBJECTIVES

To assess the impact of the COVID-19-related closure of government schools in Qatar on children and adolescents' dietary habits and physical activities and associated sociodemographic factors.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 utilizing the national electronic health records system in Qatar to extract a sampling frame of students enrolled in governmental schools, specifically targeting students in 3rd to 9th grades, stratified by sex and developmental stage. A stratified sampling technique was employed to randomly select a proportionate number of students from each stratum, and data were collected through telephone interviews with the parents of selected students.

RESULTS

A total of 1546 interviews were completed by the end of the study. Of the included sample, 845 (54.7%) were between 8 and 11 years of age (middle childhood), while the rest were 12-15 years old (young teens and teenagers). Male to female ratio was almost 1:1. We found a significant decrease in the intake of vegetables, increases in the intake of soft drinks, fried food, fast food, and sweets, and a reduction in physical activity during schools' closure compared to before. Higher parental educational levels, maternal employment, and having a positive family history of obesity and/or overweight in first-degree relatives were significantly associated with adverse lifestyle changes during schools' closure.

CONCLUSION

The trends of lifestyle changes reported in this study during the periods of COVID-19-related schools' closure were found to be going in a health-compromising direction. These results underscore the importance of implementing targeted interventions to promote healthy lifestyles during such disruptions and emphasize the need to address lifestyle changes beyond emergencies and outbreaks to mitigate potential long-term health consequences, including the increased risk of non-communicable diseases.

Telephone versus face-to-face consultation on smoking cessation at primary health care centers in Qatar during COVID-19 pandemic

Smoking cessation leads to a reduction in risks of smoking-related morbidity and mortality. During the coronavirus 2019 (COVID-19) pandemic, smoking cessation services were interrupted. Providing smoking cessation counseling by telephone could be a convenient and safe alternative to traditional face-to-face service. However, the effectiveness of telephone smoking cessation counseling has not yet been thoroughly investigated. This study evaluated telephone smoking cessation counseling compared to face-to-face consultations during the COVID-19 era. In addition, it investigated the association between sociodemographic and health-related factors and cessation rates. A retrospective cohort design was used. Participants were randomly selected from two lists: (1) telephone counseling and (2) face-to-face counseling in smoking cessation clinics in five primary health care centers in Qatar between March 2020 and March 2021. Cessation rates were compared between the two groups at 1, 2, 4, 8, and 12 weeks. A multivariable logistic regression analysis was used to identify the significant associations with smoking cessation. Smokers who underwent telephone consultations had significantly lower quit rates at all follow-ups compared to those who attended face-to-face visits. At the 12-week follow-up, the adjusted odd ratio for quitting through face-to-face consultations was 1.96 (95% CI [1.15-3.35]) times higher than that achieved through telephone consultations. In addition to receiving face-to-face counseling, higher self-efficacy to cease smoking was an independent predictor of successful cessation. Providing smoking cessation counseling by telephone could be a safer but less effective mode of delivery versus traditional face-to-face encounters during the pandemic.

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study

Objective

To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar.

Methods

A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed.

Results

The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months.

Conclusion

The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

Effectiveness of influenza vaccination against SARS-CoV-2 infection among healthcare workers in Qatar

BACKGROUND

Some studies have reported that influenza vaccination is associated with lower risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and/or coronavirus disease 2019 (COVID-19) morbidity and mortality. This study aims to estimate effectiveness of influenza vaccination, using Abbott's quadrivalent Influvac Tetra vaccine, against SARS-CoV-2 infection and against severe COVID-19.

METHODS

This matched, test-negative, case-control study was implemented on a population of 30,774 healthcare workers (HCWs) in Qatar during the 2020 annual influenza vaccination campaign, September 17, 2020-December 31, 2020, before introduction of COVID-19 vaccination.

RESULTS

Of 30,774 HCWs, 576 with PCR-positive tests and 10,033 with exclusively PCR-negative tests were eligible for inclusion in the study. Matching by sex, age, nationality, reason for PCR testing, and PCR test date yielded 518 cases matched to 2058 controls. Median duration between influenza vaccination and the PCR test was 43 days (IQR, 29-62). Estimated effectiveness of influenza vaccination against SARS-CoV-2 infection> 14 days after receiving the vaccine was 29.7% (95% CI: 5.5-47.7%). Estimated effectiveness of influenza vaccination against severe, critical, or fatal COVID-19 was 88.9% (95% CI: 4.1-98.7%). Sensitivity analyses confirmed the main analysis results.

CONCLUSIONS

Recent influenza vaccination is associated with a significant reduction in the risk of SARS-CoV-2 infection and COVID-19 severity.

COVID-19 perceived stigma among survivors: A cross-sectional study of prevalence and predictors

Background and objectives

Perceived stigma related to infectious diseases is of public health importance and can adversely impact patients' physical and mental health. This study aims to identify the level of perceived stigma among COVID-19 survivors in Qatar and investigate its predictors.

Methods

An analytical cross-sectional design was employed. Four hundred and four participants who had a positive COVID-19 PCR test were randomly selected from medical records. The selected participants were interviewed to collect sociodemographic and health-related information. Perceived stigma was assessed using the COVID-19 perceived stigma scale-22 (CPSS-22) that was developed by the researchers. A descriptive analysis followed by a bivariate analysis investigated possible associations between the perceived stigma levels and independent variables. A multivariable analysis was performed using logistic regression to identify any significant associations with perceived stigma. The validity and reliability of the developed tool were also tested.

Results

The prevalence of COVID-19 perceived stigma was twenty-six percent (n = 107, 26.4%) at 95% CI [22.4-30.4]. Factors associated with higher COVID-19 perceived stigma were male gender, being a manual worker, non-Arabic ethnicity, low educational level, living alone, and being isolated outside the home. However, only occupation, ethnicity, and low educational level predicted COVID-19 perceived stigma in multivariable analysis. The CPSS-22 showed excellent reliability (Cronbach's alpha 0.92).

Conclusion

Perceived stigma was relatively common among participants. Designing programs and interventions targeting male manual workers and those of low-educational levels may assist policymakers in mitigating the stigma related to COVID-19.

Physical Activity among Primary Health Care Physicians and Its Impact on Counseling Practices

Introduction

Physical inactivity has been linked to various noncommunicable diseases and their related health problems. As primary health care physicians (PHCPs) play a crucial role in promoting health and preventing disease, this study aims to determine the extent of physical inactivity among PHCPs and its impact on their counseling practices.

Methods

A cross-sectional study was conducted across all primary health care centers in Qatar, targeting 511 physicians. A modified self-administered WHO stepwise tool was used to measure physical activity (PA) with another questionnaire to assess the counseling practices among PHCPs.

Results

Out of 511 physicians, 306 (59.9%) responded to the survey. The majority of the participants were male (58.1%) with an average age of 45.8 ± 7.9 years. The majority of PHCPs were from the UK (44.3%), while only 4.1% were Qatari. Family physician consultants made up 51% of the respondents, while 30.2% were general practitioners, and the average years of experience were 14 ± 8.3 years. Only 39.5% of the respondents met the WHO PA recommendations. 50.5% of the physicians were overweight, and 23.1% were obese. The median percentage of patients counseled about PA was only 60 [IQR: 40-80]%, and there was no link found between a physician's PA level and the percentage of patients they counseled on the subject.

Conclusion

Physicians reported a high prevalence of physical inactivity. Furthermore, the practice of counseling the public on PA was low. Interventions are needed inside and outside the workplace to improve the PA among PHCPs and their counseling practices.

The impact of telemental health interventions on maternal mental health outcomes: a pilot randomized controlled trial during the COVID-19 pandemic

Background

The lethal potential of COVID-19 was often emphasized and repeatedly brought to the attention of pregnant women, leading to a higher level of anxiety, depression, and COVID-19-specific phobia among this population. Furthermore, legislation forced social distancing and isolation to interrupt the infection cycle. Together these factors resulted in higher maternal mental health distress requiring intervention. Nevertheless, there is a lack of evidence regarding the impact of low-intensity psychosocial telemental interventions on maternal mental health outcomes. Therefore, the objective of this pilot study is to assess the efficacy of video low-intensity psychosocial telemental maternal intervention on COVID-19-specific phobia, antenatal depression, and anxiety among pregnant women. We hypothesized that the intervention arm would be superior to the control arm. A parallel design randomized interventional controlled trial with 1:1 randomization was conducted at the Women Wellness and Research Center. We enrolled fifty-eight pregnant women in their second trimester who spoke English or Arabic. We assessed antenatal anxiety, depression, and Covid-19-specific phobia at baseline (T₀), and thirty-three pregnant women completed the follow-up after four weeks (T₁). Pregnant women receiving psychotropic medications and follow up in mental health services were excluded.

Results

A low-intensity psychosocial telemental maternal session helps reduce antenatal anxiety. We found statistically significant differences in antenatal anxiety scores between the intervention (2.4 ± 2.2) and control (4.2 ± 1.6) groups (p = 0.013) with a large effect size of Hedges' g value (0.96, 0.22-1.74). The absolute risk reduction was 27.27 percent. However, the intervention had no statistically significant effect on reducing antenatal depression or COVID-19-specific phobia.

Conclusions

Low-intensity psychosocial telemental maternal sessions effectively reduce antenatal anxiety. While our findings are promising, further RCTs are needed to replicate these findings.

Trial registration

2a-ClinicalTrials.gov identifier: NCT04594525.. Registered on 20/October/2020; updated 9/March/ 2022. Available from: Maternal Telemental Health Interventions in Response to Covid-19* - Full Text View - ClinicalTrials.gov.

Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment

OBJECTIVES

It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs' compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection.

METHODS

A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation.

RESULTS

A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers' age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use.

CONCLUSIONS

Despite HCWs' high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.

Assessing research self-efficacy among primary health care physicians: a snapshot from Qatar

Background

Research self-efficacy is one of the crucial predictors of productively engaging in research activities emphasized by the Qatar National Vision 2030. Nevertheless, studies typically focus on research self-efficacy among students, neglecting physicians, despite the importance of research as competency in continuous professional development. Therefore, the objective of our study is to understand the level of research self-efficacy among physicians and its determinants. 

Methods

An analytical cross-sectional design was employed. We utilized an open survey through DACIMA Software that included questions related to Self-Efficacy in Research Measure (SERM) and possible determinants. One-hundred-twenty-two completed answers, and the response rate was 19.2%. Following descriptive analyses, a chi-square test was used to uncover the associations among variables, with significance set to p ≤ 0.05. Next, a logistic regression model was conducted to identify the predictors of a low research self-efficacy level. Finally, reliability and principal component analysis were applied on the SERM scale.

Results

Three-quarters of the sample reported insufficient research self-efficacy. The sociodemographic and professional factors did not significantly associate with insufficient research self-efficacy. However, participation in clinical guidelines proved to be a determinant of sufficient research self-efficacy.

Conclusions

Physicians must be encouraged to participate in clinical guidelines to improve their research self-efficacy level.

The story behind the first few cases of monkeypox infection in non-endemic countries, 2022

Starting May 6, 2022, a rising number of monkeypox cases started to be detected in different countries where the disease is not endemic. About 24 countries reported cases by May 28 mostly in Europe. Most of the reported cases so far were among young men particularly men who have sex with men or had a travel history to countries where cases are being registered. In this rapid review we summarized the story behind the first few cases of monkeypox virus infection in non-endemic countries and the prevention measures implemented so far by countries to contain the spread of the disease.

Histopathological Findings in COVID-19 Cases: A Systematic Review

The ongoing coronavirus disease 2019 (COVID-19) pandemic has turned into one of the most serious public health crises of the last few decades. Although the disease can result in diverse and multiorgan pathologies, very few studies have addressed the postmortem pathological findings of COVID-19 cases. Active autopsy findings amid this pandemic could be an essential tool for diagnosis, surveillance, and research. We aimed to provide a comprehensive picture of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) histopathological features of different body organs through a systematic review of the published literature. A systematic search of electronic databases (PubMed, ScienceDirect, Google Scholar, medRxiv, and bioRxiv) for journal articles of different study designs reporting postmortem pathological findings in COVID-19 cases was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for conducting the review. A total of 50 articles reporting 430 cases were included in our analysis. Postmortem pathological findings were reported for different body organs: pulmonary system (42 articles), cardiovascular system (23 articles), hepatobiliary system (22 articles), kidney (16 articles), spleen and lymph nodes (12 articles), and central nervous system (seven articles). In lung samples, diffuse alveolar damage (DAD) was the most commonly reported finding in 239 cases (84.4%). Myocardial hypertrophy (87 cases, 51.2%), arteriosclerosis (121 cases, 62%), and steatosis (118 cases, 59.3%) were the most commonly reported pathological findings in the heart, kidney, and the hepatobiliary system respectively. Autopsy examination as an investigation tool could lead to a better understanding of SARS-CoV-2 pathophysiology, diagnosis, and management, subsequently improving patient care.

Knowledge and Perceived Effectiveness of Infection Prevention and Control Measures Among Health Care Workers During the COVID-19 Pandemic: A National Survey

BACKGROUND

Being the first line of defense against COVID-19 infection, health care workers (HCWs) are at an increased risk of getting infected. Infection prevention and control (IPC) measures were deemed to be instrumental in protecting them and their patients against infection.

PURPOSE

To assess HCWs' knowledge of IPC measures and their perceived effectiveness in protecting against COVID-19.

METHODS

A national web-based survey was conducted in different health care sectors in Qatar.

RESULTS

A total of 1757 HCWs completed the survey. HCWs believed in applying stricter IPC precautions while dealing with confirmed COVID-19 cases than with suspected cases. Males and physicians were more likely to have high perceived effectiveness of IPC measures than females, nurses, and pharmacists. Higher proportions of HCWs believed in the effectiveness of hand hygiene than most types of personal protective equipment.

CONCLUSION

Further research is recommended to assess the impact of HCWs' knowledge and perceived effectiveness of IPC measures on their compliance.

The Impact of Changes in Work Arrangements During COVID-19 Pandemic on the Lifestyle of Qatar's Working Population

OBJECTIVES

To explore the impact of changing work arrangements during COVID-19 on diet, physical activity, body weight, and sleep of Qatar's working population.

METHODS

A web-based survey targeting working adults who were residing in Qatar during the period of home confinement was conducted.

RESULTS

About 47% of 1061 participants reported weight gain. Higher proportions of participants reported consuming more fatty foods (P = 0.007), more sugary foods (P = 0.001), and greater increase in screen and sitting/reclining times (P < 0.001) among the work from home (WFH) group. Participants with higher adverse dietary changes score were more likely to report weight gain in both the WFH (adjusted OR 1.38, 95% CI 1.28 to 1.49), and working regularly groups (adjusted OR, 1.31, 95% CI 1.20 to 1.43) with P < 0.001.

CONCLUSION

Qatar's working population experienced adverse lifestyle changes which were more prominent among those who shifted to WFH.

Impact of staying at home measures during COVID-19 pandemic on the lifestyle of Qatar's population: Perceived changes in diet, physical activity, and body weight

Countries worldwide imposed different swift protective measures such as movement restrictions and staying at home measures to mitigate the spread of COVID-19. Despite the benefits gained from such measures in containing the spread of the infection, adverse lifestyle consequences happened. In this study we aimed to assess the impact of staying at home measures imposed during COVID-19 pandemic on dietary behaviors, physical activity, and body weight in Qatar's population. A population based cross sectional survey was conducted between December 2020 and February 2021 targeting adults ≥18 years. A total of 1408 participants completed the survey in four languages. Concerning the overall diet perception, 27.8%, and 33.2% perceived that their overall diet has become less healthy, or healthier respectively, since the start of staying at home measures. Almost half of all participants reported weight gain. Participants reported increased sitting/reclining time (1.94 h/day mean increase), screen times (2.05 h/day mean increase) with p < 0.001, and decreased exercise time (0.11 h/day mean reduction) with p < 0.001. The ordinal logistic regression analysis showed that the numbers of unhealthy dietary behaviors adopted by participants, and adverse changes in exercise, setting/reclining and screen times were significantly associated with weight gain. The results of this study indicate that peoples in Qatar have experienced adverse lifestyle changes with regard to their diet, physical activity, and body weight. More emphasis should be put on encouraging people to maintain healthy lifestyle behaviors during home confinement measures that might be imposed during any public health crises or any potential future outbreaks.

Impact of COVID-19 related home confinement measures on the lifestyle, body weight, and perceived glycemic control of diabetics

Background

People with Diabetes Mellitus are at high risk of encountering COVID-19 infection and are more vulnerable to the negative repercussions of this infection. In this study we aimed to explore the impact of COVID-19 related home confinement measures on physical activity, dietary habits, body weight and perceived glycemic control of adults with type 2 Diabetes Mellitus (T2DM) in Qatar.

Methods

A cross sectional web-based survey was conducted between January and February 2021 targeting adults ≥18 years with T2DM.

Results

Over 40% of the participants reported unhealthy dietary changes. We found a significant increase in the sitting/reclining, and screen times. One third of the participants reported weight gain, while one fifth reported poorer glycemic control since the start of home confinement measures. We found that reporting at least one unhealthy dietary change (p < 0.001) and being a female (p = 0.002) were significantly associated with reporting greater weight gain. Participants who reported five unhealthy dietary behaviours were more than seven times more likely to perceive poorer glycemic control during home confinement measures compared to those who did not report any unhealthy changes (OR: 7.27, 95%CI 1.60–33.5, p = 0.011).

Conclusion

Adults with T2DM experienced adverse lifestyle changes during COVID-19 related home confinement measures. Further research is needed to investigate the persistence of such changes in the post pandemic era.

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One third of the participants reported weight gain.

•

Participants reported a significant increase in each of the sitting/reclining and screen times.

•

The perceived glycemic control varied among the participants.

Compliance and barriers to the use of infection prevention and control measures among health care workers during COVID-19 pandemic in Qatar: A national survey

AIM

To assess health care workers' compliance with infection prevention and control measures in different health care sectors in Qatar during COVID-19 pandemic.

BACKGROUND

Being the first line of defense against COVID-19 infection, health care workers are particularly at increased risk of getting infected. Compliance with infection prevention and control measures is essential for their safety and the safety of patients.

METHODS

A web-based national survey was conducted between November 2020 and January 2021 targeting all health care workers in governmental, semi-governmental, and private health care sectors.

RESULTS

Of 1757 health care workers, 49.9% were between 30-39 years of age, majority (47.5%) were nurses. Participants reported a significant increase in the median self-rated compliance scores during the pandemic compared to before it (p<0.001). During the pandemic, 49.7% of health care workers were fully compliant with personal protective equipment (PPE) use, 83.1% were fully compliant with hand hygiene. Overall, 44.1% were fully compliant with infection prevention and control measures (PPE and hand hygiene). Nationality, health sector, profession, and frequency of interactions with suspected or confirmed COVID-19 cases were significantly associated with compliance with overall infection prevention and control measures. The most reported barriers were work overload, and shortages of PPE and handwashing agents.

CONCLUSIONS

Compliance of health care workers with infection prevention and control measures needs further improvement.

IMPLICATIONS FOR NURSING MANAGEMENT

Frequent quality checks, provision of adequate supplies, and behavior change interventions are recommended strategies for hospital and nursing administrators to improve health care workers' compliance.

Maternal low-intensity psychosocial telemental interventions in response to COVID-19 in Qatar: study protocol for a randomized controlled trial

Introduction

As COVID-19 is spreading, new psychological health problems are suspected to be emerging among pregnant women. Higher maternal mental health distress, including perinatal anxiety, depression, and COVID-19-specific phobia, is supposed to be increasing during the pandemic, which impacts pregnant women’s health and their infants and calls for intervention. Due to the social distancing protocols posed by the pandemic, telemental health interventions have fast become the most common form of psychosocial support for maternal mental health. However, there is no evidence of the effectiveness of maternal low-intensity psychosocial telemental interventions in improving mental health outcomes. The trial’s objective is to evaluate the clinical efficacy of telemental low-intensity psychosocial interventions in pregnant and postpartum women attending the Women Wellness and Research Centre in Qatar in the era of the COVID-19 pandemic.

Methods and analysis

The clinical trial is randomized in which pregnant women will be assigned equally through block randomization between two arms: (1) a control group and (2) an intervention group. The primary endpoint is the perinatal psychological distress, including perinatal depression, anxiety, and COVID-19 phobia in their third trimester; the secondary, tertiary, fourth, and fifth endpoints will be in the postnatal period (3–5 weeks, 2–4 months, 5–7 months, and 8–10 months). This trial involves pregnant women in their second trimester with no mental health illness history who communicate in English and Arabic and consent to participate. A sample size of 58 (29 participants per arm) is targeted.

Discussion

This study will provide recommendations about the efficacy of low-intensity psychosocial maternal telemental interventions to be implemented as a preventive service.

Trial registration

2a-ClinicalTrials.gov NCT04594525. Registered on October 20, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05339-w.

The psychological impact of COVID-19 on health care workers working in a unique environment under the umbrella of Qatar Red Crescent Society

OBJECTIVES

to determine the levels of depression, anxiety, and stress among healthcare workers (HCWs) working in a unique male-dominated environment under the umbrella of Qatar Red Crescent, and to explore the associated factors during COVID-19 pandemic in Qatar.

METHODS

a cross-sectional study utilizing a web-based survey was conducted in the period between 15 November 2020 and 22 December 2020. Depression, anxiety, and stress were determined using the 9-items patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder (GAD-7) scale, and the 22- item impact of event scale revised (IES-R), respectively. We conducted multivariable logistic regression analysis to determine the predictors of mental health outcomes among HCWs.

RESULTS

the proportions of the participants reporting symptoms of depression, anxiety, and stress were 12.4 (95%CI: 9.3-16.1), 14.2 (95%CI: 10.9-18.1), and 18.5% (95%CI: 14.8-22.7) respectively. Arabs had significantly more severe anxiety levels than non-Arabs (p = 0.031), HCWs with high COVID-19 risk perception experienced more severe mental health outcomes (p < 0.001). The multivariable logistic regression showed that high risk perception was independently associated with depression (adjusted OR 4.62, 95%CI: 2.00-10.68), anxiety (adjusted OR 4.90, 95%CI: 2.24-10.68), and stress (adjusted OR 3.067, 95%CI: 1.62-5.79) with p < 0.001. Compared to nurses, technicians and paramedics were more likely to report anxiety symptoms with (adjusted OR 2.97, 95%CI: 1.23-7.17, p = 0.015), and (adjusted OR 5.48, 95%CI: 1.86-16.12, p = 0.002) respectively. Having a relative or a friend died of COVID-19 infection was significantly associated with depression symptoms (adjusted OR 2.54, 95%CI: 1.21-5.36, p = 0.014). Not living with family was significantly associated with the presence of different mental health outcomes.

CONCLUSION

relatively lower rates of mental health outcomes in this study compared to others could have several explanations related to the unique characteristics of our target population and their working environment. Ensuring proper mental health support for HCWs is highly recommended.

Screening for antenatal depression and its determinants among pregnant women in Qatar: revisiting the biopsychosocial model

BACKGROUND

Screening for antenatal depression and its determinants is highly recommended. However, there is no consensus on a standard conceptual framework to approach pregnant women in a primary health care setting. The prevalence of antenatal depression and significant determinants are unknown in Qatar, a gap that we propose to fill.

METHODS

An analytical cross-sectional study with a probability sampling technique was employed. Enrolling eight-hundred participants from primary health care centers. The screening was performed through a valid and reliable screening instrument 'Edinburgh Postpartum Depression Scale.' In addition to the proposed Comprehensive Biopsychosocial Model, participants were asked about their predisposing profile, biological risk, and other suggested modifiable variables.

RESULTS

Twenty-one percent reported minor depressive episodes (n = 167, 20.9%) at a 95% confidence interval [18.2-23.8]. Previous use of mental health medications, fear of giving birth, concern about appearance, low perceived social support, and low resilience level showed to be associated with antenatal depression. The logistic regression analyses revealed that the Comprehensive Biopsychosocial model forecast 89% of antenatal depression predictors provided Area Under the Receiver Operating Characteristic Curve of 0.89 at a 95% confidence interval [0.85 to 0.92].

CONCLUSIONS

Antenatal depression is common among pregnant women in Qatar, and preventive interventions must target the determinants revealed. From a clinical perspective, the use of the proposed model may aid in the standardization of the screening process.

Death certification status in Eastern Mediterranean Region: A systematic review

A death certificate is an important public health surveillance tool that affects the quality of morbidity and mortality statistics. This systematic review examines death certification in the Eastern Mediterranean Region, uncovers the methodological qualities of published studies, the common errors committed by certifiers, and physicians' knowledge in filling out death certificates. We searched three databases, finding 19 studies, the majority of which reported errors in the underlying cause of death. Fewer than 25% of physicians reported training on filling out death certificates. Complexity of the cases and lack of training were reported as common difficulties facing physicians leading to errors.

Generalized and pregnancy-related anxiety prevalence and predictors among pregnant women attending primary health care in Qatar, 2018-2019

Background

Cumulative evidence suggests that early identification of anxiety in pregnancy is important, given that antenatal anxiety has been linked to morbid outcomes in expecting mothers and their offspring. However, the burden of antenatal anxiety is not yet known in Qatar. This research aims to measure the prevalence and determinants of generalized and pregnancy-related anxiety among pregnant women.

Methods

Eight hundred pregnant women completed a structured interview and self-administrated questionnaires after being selected through probability sampling from nine primary healthcare centers distributed across Qatar. We subjected the data to Binary and Multiple Logistic Regression Analysis. Furthermore, we conducted a Confirmatory Factor Analysis for the utilized scales.

Results

Out of eight hundred participants, 26.5% reported high pregnancy-related anxiety, while 16.4% had a generalized anxiety disorder. A high level of perceived social support and resilience was shown to mitigate generalized and pregnancy-related anxiety. However, we revealed that different determinants influence the two types of anxiety.

Limitations

There is no recognized optimal cut-off point to distinguish ‘high risk’ in pregnancy-related anxiety scales.

Conclusions

Pregnancy-related anxiety is more prevalent than generalized anxiety among pregnant women in Qatar, indicating that stakeholders must include screening for pregnancy-related anxiety in Qatar's clinical guidelines. Tailored interventional studies could focus on increasing resilience and social support to decrease the burden of antenatal anxiety.

Addictive behaviors, cardiovascular and metabolic comorbidities in North African psoriatic patients: case-control study

We propose to study the epidemiological aspects of North African psoriasis and determine the cardiovascular comorbidities and addictive behaviors associated with psoriasis. This is a North African case-control study which was conducted over a five year period (October 2008 through August 2013), involving 671 psoriatic patients and 1,242 controls identified in various Algerian, Tunisian and Moroccan university hospitals. For each patient, epidemiological characteristic, addictive behaviors, and cardiovascular pathologies associated with psoriasis were noted. Six hundred and seventy one psoriasis patients and 1,242 controls were included in this study. The average age was 47.24 years and the M/F sex-ratio was 1.11 (354 men and 317 women). Statistical analysis showed that psoriasis patients were more likely to develop addictive behaviors than controls (smoking p<10-5 and alcohol consumption: p < 10-5), together with dyslipidemia (30.1% of patients p < 10-5), obesity (23.8% of patients p < 10-4), hypertension (22.3% of patients p < 10-5), diabetes (21.7% of occurrences p < 10-5) and metabolic syndrome (37.4% of patients p<10-5). The relative risk for developing psoriasis was 1.9 in hypertensive patients, 1.7 in diabetic patients, 3.9 in dyslipidemic patients, 1.8 in obese patients, 2.6 in those with metabolic syndrome, 2.1 in smokers and 2.8 in alcoholics. Our work confirms the high incidence of addictive behaviors and of cardiovascular and metabolic comorbidities during the North-African psoriasis, hence the need for a multidisciplinary comprehensive care based on a guideline suited to the characteristics of North-African psoriatic patients.

Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar

OBJECTIVES

The current study aimed to validate and determine the psychometric properties of the Arabic versions of the Beck Depression Inventory-II (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS) in Qatar.

DESIGN

A cross-sectional study design was employed.

SETTING

Antenatal care (ANC) clinics at nine primary healthcare centres.

PARTICIPANTS

Pregnant women (n=128) aged 15-46 years in different trimesters of pregnancy, attending the ANC clinics as well as capable of reading and writing in the Arabic language.

RESULTS

A total of 128 participants were enrolled. On conducting the receiver operating characteristic (ROC) analysis, the EPDS showed a larger area under the curve at 0.951 than the BDI-II tool (0.912). Using Youden's index, a score >13 on the EPDS (87% sensitivity, 90% specificity) and >19 on the BDI-II (96% sensitivity, 73% specificity) allowed for the greatest division between depressed and non-depressed participants.

CONCLUSION

To address the under-recognition of antenatal depression, physicians at primary healthcare centres in Qatar should be encouraged to utilise the EPDS to screen pregnant women seeking ANC services.

ABO hemolytic disease of newborn : Does newborn's blood group a risk factor?

BACKGROUND

Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunization has become the leading cause of the newborn hemolytic disease. It is estimated that 15-25 % of all pregnancies are concerned by ABO incompatibility.

AIM

Neonatal blood group B seems to be more predisposing to acute hemolysis and severe hyperbilirubinemia. We propose to find if the newborn's blood group B represents a risk factor for severe hemolysis and/or severe hyperbilirubinemia.

METHODS

We conducted a comparative study in the pediatrics department "B" of the Children Hospital of Tunis. We collected retrospectively the medical files of the newborn hospitalized for ABO alloimmunization (January 2011 - March 2014), then we compared two groups, OA group with OA alloimmunization and OB group with OB alloimmunization. A significant threshold was fixed to 0.05.

RESULTS

We collected 98 cases of newborn ABO hemolytic disease. Both groups, OA and OB, were similar for the onset of jaundice, age of hospitalization, initial hemoglobin and indirect bilirubin levels. There were no statistically significant difference in the severity of hyperbilirubinemia and the use of exchange transfusion for the two groups. However, transfusion was statistically more frequent in the OB group compared to OA group (81.6‰ vs 10.2‰, p = 0,039, OR=2.9, 95% IC (1.1 - 7.8)).

CONCLUSION

OB alloimmunization seems to induce more active hemolysis than OA one, with no difference for severe hyperbilirubinemia in both groups.

Multidisciplinary approach to obesity: Aerobic or resistance physical exercise?

Background

An integrated treatment based on dieting, physical training and cognitive-behavioural psychotherapy is an effective tool to reduce obesity and its consequences. However, the feasibility of this approach is problematic. This study aims to compare two multidisciplinary programs used to improve weight loss.

Methods

Fifty-two obese individuals were subjected to an Enhanced Lifestyle Counselling associated with, according to their own choice, dieting (N = 11), or dieting + aerobic training (n = 18), or dieting + resistance training program (n = 23). The study experiment spanned 16 weeks divided into two phases. The first phase lasted 04 weeks and was oriented to enhance motivation and establishing changes in behaviours related to dietary and sedentary lifestyle. The second phase lasted 12 weeks and was oriented to add aerobic or resistance training. Body compositions, cardiovascular disease risk factors, and cardio-respiratory fitness were assessed.

Results

Data demonstrated that all obesity treatment programs were able to improve all studied variables. Weight loss levels were -6.03 ± 2.08, -10.5 ± 2.33, and -9.37 ± 1.99 kg in Dieting, DAT and DRT groups, respectively. Our results noted also that exercise training could play an important role in reducing obesity and its consequences. Nevertheless, modifications were more important in DRT at the explosivity and muscle strength and in DAT at fat percentage, aerobic capacity, SA, and CVR factors.

Conclusion

The current evidence noted that both multidisciplinary weight loss programs were efficient in the treatment of obesity and its comorbidity. Moreover, the use of aerobic exercises was more effective in reducing body fat and improving cardiorespiratory fitness. However, using resistance exercises appeared to be more appropriate to enhance the muscle potential.

[Patients’ adaptation strategies for colostomates with a self image disturbance after a month of surgery.]

BACKGROUND

the establishment of a colostomy is a difficult time for the patient since it undergoes physical, psychological and social changes resulting in the modification of the body self-image. Purpose and Framework : this study aims to identify adaptation strategies for colostomates who have a disturbance of self-image after a month of surgery depending on the Roy Adaptation Model.

METHODS

a descriptive quantitative study was realized with a sample of 70 patients with colostomy in the department of surgery Farhat Hached and Sahloul Hospital in Sousse. To collect data, an auto-questionnaire (OAI-23) was used after a revalidation in Arabic. The descriptive statistics and the regressions united and multivariated were used to analyze the data.

RESULTS

our study shows that 85.7 % of the participants always feel sick, and why 57 of them (81,4 %) can't get over the shock of having a stoma 82.9 % are still angry.

DISCUSSION

the results are discussed from the reference frame then the recommendations were formulated followed by some limits.

CONCLUSION

the improvement of the adaptation process of colostomized patients should be an ongoing concern of all stakeholders.

Device-vigilance and environment of the medical practice

INTRODUCTION

The Device-vigilance (DV) manages incidents or risk of incidents related to the use of medical devices (MD). In Tunisia, absence of a regulatory framework organizing DV is the major obstacle to caregivers' involvement in this system.

OBJECTIVE

1/Compare knowledge, attitudes and practices of our UHC's physicians regarding the establishment of DV system (medical versus surgical) and 2/Detect effect of healthcare's environment on risk's perception linked to the use of MD.

METHODS

It is a descriptive cross-sectional and comparative study type knowledge, attitudes and practices; among all physicians of our UHC who are users of MD during their practice. A self-administered pre-established pre-tested questionnaire has been established. Data seizure and analyzing was performed using SPSS software20.0. Test adopted was the X2 (Pearson)(p<0.05) with correction using Yates or exact test Fischer.

RESULTS

A statistically significant difference in favor of physicians exercising in medical services is reported for the knowledge of standardized reporting form's existence(p=0.04). Physicians practicing in surgical services report incidences and risk of incidences regarding MD use significantly more than their colleague of medical services. For attitudes, surgical physicians perceive the responsible of the reporting as any caregiver (p=0.007).As for the practices, they are for the presence of MD's organized management in the service of exercise(P<10-4).

CONCLUSION

At any healthcare environment, lack of knowledge, inadequacy of the attitudes and readjustment of practices among our physicians must be filled. The promulgation of regulatory texts is necessary in order to promote DV's sector of and to ensure the safety of both patients and caregivers.

[Safety evaluation of anticancer drugs circuit in a regional hospital in Tunisia]

Introduction

Parmi les événements indésirables, ceux liés au circuit des médicaments occupent une place importante et risquent de causer un préjudice grave aux patients. Dans ce contexte, nous avons mené cette étude dans l'optique de décrire et d’évaluer le circuit des médicaments anticancéreux dans un hôpital régional tunisien.

Méthodes

Il s'agit d'une étude évaluative du risque lié aux médicaments anticancéreux, type « visite de risque » menée sur une période de 15 jours au cours de l'année 2014 au service de cancérologie de l'hôpital régional de Gafsa (Tunisie). Cette méthode d’évaluation est inspirée de celle conduite par le projet « SECURIMED » développé par le Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA), en France.

Résultats

Dans notre étude, l'observation du circuit des médicaments anticancéreux a révélé certaines insuffisances. On a noté que la répartition des missions des différents acteurs est sujette parfois à des glissements de tâches. Un manque important ainsi que une inadéquation aux normes au niveau des équipements nécessaires pour la préparation et la protection des professionnels manipulant ces médicaments ont été également décelés.

Conclusion

La sécurisation du circuit des médicaments devrait être une priorité inscrite dans l'ensemble des démarches nationales et partagée par tous les intervenants et ce dans l'optique d'atteindre un objectif prémium: la qualité de la prise en charge globale et la sécurité des patients.

Prevalence of overweight in schools in the rural region of Hazoua (Tozeur)

Background Overweight in schools is a worrisome public health problem because they increase medium and long term risks of morbidity and mortality especially with an increased risk of persistence of obesity in adulthood. Aim To estimate the prevalence of overweight among school children and to identify its associated risk factors. Methods this is a descriptive cross-sectional study conducted among school students aged less than 18 years in the area of "Hazoua" (Tozeur). The references of BMI used for overweight and obesity are those of IOTF. The French BMI references are used to establish the prevalence of underweight. Data entry and analysis was performed using SPSS 20. Results Our sample included 445 students. The average BMI was 18.73±3.4 kg/m2. The prevalence of Underweight was 9.7%, while overweight and obesity have been reported among 6.7% of students. Overweight was significantly associated to gender and the practice of sport outside school. Conclusion Obesity in schools in the community of Hazoua is now lower than that reported in other studies. In contrast, we detected a problem of underweight, which deserves as much attention. Intervention programs should be established and whose objectives are to improve students' skills in terms of eating behavior and physical activity, these actions require collaboration at all levels.

Bishop Score vs. ultrasound cervical length in the prediction of cervical ripening success and vaginal delivery in nulliparous women

AIM

The aim of this paper was to compare the predictive value of Bishop Score and sonographic measurement of cervical length for predicting cervical ripening success and vaginal delivery in nulliparous women with low Bishop Score.

METHODS

A prospective observational study including 77 nulliparous pregnant women at exactly 41 weeks of gestation with a Bishop Score ≤ 5. Cervical measurement was performed by transvaginal ultrasonography and Bishop Score was determined by digital examination. All patients had cervical ripening with Prostaglandins prior to labor induction with oxytocin.

RESULTS

Cervical ripening was successful in 63 patients (81%) and vaginal delivery occurred in 51 women (66.2%). Multiple logistic regression analysis demonstrated cervical length assessed by transvaginal sonography as the only independent predictor of successful cervical ripening and vaginal delivery. The best cut-off point was 34.6 for predicting successful cervical ripening and 32.5 mm for predicting vaginal delivery. The chance of vaginal delivery was 90% when initial cervical length was < 32.5 mm and 50% when cervical length was >32.5 mm.

CONCLUSION

Compared with the Bishop score, ultrasound cervical length measurement is a better predictor of cervical ripening success and vaginal delivery in nulliparous women at 41 weeks of gestation with an unfavorable cervix.

[Evaluation of the use of the partograph in a maternity of a university hospital]

Introduction

La mortalité maternelle est un problème majeur de santé mondiale. Une grande proportion de ces décès serait évitable par des soins adéquats, une aide à l'accouchement, la disponibilité des soins d'urgence et l'utilisation des outils d'aide à la décision tels que le partogramme. L'objectif était d’évaluer l’écart entre ce qui est censé être fait et ce qui est fait réellement pour les différents paramètres situés dans le partogramme au sein d'une maternité de 3^ème niveau et élaborer des recommandations pour la mise en place d'un plan d'action.

Méthodes

Il s'agit d'une étude descriptive rétrospective par audit clinique, effectuée sur un échantillon de 400 dossiers obstétricaux des parturientes ayant accouchées dans la maternité du CHU Farhat Hached durant l'année 2011. Le référentiel utilisé est celui réalisé par l'Agence Nationale d'Accréditation et d'Evaluation en Santé en l'an 2000, concernant la qualité de la tenue du partogramme.

Résultats

La majorité des critères d’évaluation portant sur la présentation du partogramme était conforme. Deux critères concernant la variété de la présentation et le rythme cardiaque fœtal étaient non conformes parmi ceux portant sur la surveillance du fœtus. Plusieurs critères en rapport avec la surveillance de la mère étaient non conformes. Aucun des critères portant sur les traitements administrés et les marqueurs d’évènements n'est conforme. Les critères portant sur la naissance et la surveillance immédiate qui étaient non conformes sont: le début des efforts expulsifs, le mode d'accouchement, l’état du périnée, la délivrance et la révision utérine.

Conclusion

La véritable démarche de l'audit clinique se doit d'aller au-delà du recueil et de l'analyse des données, le but final étant l'amélioration des pratiques.

Identification of soluble and membrane antigenic markers of acquired toxoplasmosis by immunoblot

The overall performance of quantitative assays in the detection of anti-Toxoplasma IgG is satisfactory, but discrepancies between assays are not uncommon especially when IgG concentrations are close to the limit of detection of the tests. The purpose of our study was to identify soluble and membrane antigens extracted from Toxoplasma gondii tachyzoites by immunoblot to select the most relevant antigenic bands to be used for qualitative serodiagnosis of acquired toxoplasmosis. We selected five relevant bands (98, 36, 33, 32 and 21 kDa) with soluble antigens and four relevant bands (42, 35, 32 and 30 kDa) with membrane antigens which gave high sensitivity and/or specificity in immunodiagnosis. The association on the same blot of at least three of the five relevant bands in the soluble antigen immunoblot showed the highest sensitivity/specificity (97.4%/99.0%, respectively). Our results indicate that immunoblot using soluble tachyzoite extract with simultaneous detection of at least three of the five bands (98, 36, 33, 32 and 21 kDa) represents a valuable test for serodiagnosis of acquired toxoplasmosis and should be further evaluated as a confirmatory test for sera which give discrepant results in quantitative assays.

Effects of Ramadan on physical capacities of North African boys fasting for the first time

INTRODUCTION

Most of the literature related to the effects of Ramadan fasting on physical performance has focused on adults, and only three studies have examined its impact on children's physical performance.

AIMS

To examine the effects of Ramadan fasting on first-time fasting boys' performance in short-term explosive exercises [vertical and horizontal jump tests (VJT and HJT), 20-m and 30-m sprints and medicine-ball throw (MBT)], as well as in sub-maximal endurance [6-min walking distance (6MWD) measured during the 6-min walk test (6MWT)].

METHODS

Eighteen Tunisian boys [mean±standard deviation (SD) of age and body mass (BM): 11.9±0.8 y and 55.4±18.2 kg, respectively] were included. The experimental design comprised four testing phases: 2-weeks before Ramadan (BR), the end of the second week (R2) and the fourth week (R4) of Ramadan, and 10-12 days after the end of Ramadan (AR). At each phase, boys performed two test sessions in the afternoon (15:00-17:00 h) interrupted by 48 h of recovery (first test session: BM, VJT, HJT, and 20-m and 30-m sprint tests; second session: MBT and 6MWT). The study was conducted during the summer of 2012 from July 5 to August 29.

RESULTS

6MWDs (m) were significantly shorter during R2 (652±101) and R4 (595±123) compared to BR (697±86) and came back to baseline values AR. BM (kg) mean±SD did not significantly change during R2 (52±15) and during R4 (53±15) compared to BR (55±17), and short-term explosive performances were unchanged throughout the study.

CONCLUSION

In non-athletic children, first-ever Ramadan fasting impairs sub-maximal aerobic capacity but has no effect on BM or short-term explosive performance.

[The diagnosis of COPD is recommendation dependent]

BACKGROUND

Different spirometric criteria are recommended to diagnosis chronic obstructive pulmonary disease (COPD): -American Thoracic Society/European Respiratory Society (ATS/ERS), Global initiative for chronic Obstructive Lung Disease (GOLD): a post bronchodilator (PBD) ratio between the 1st second Forced Expiratory Volume and Forced Vital Capacity (FEV1/FVC) < 0.70; -Thoracic Society of Australia and New Zealand (ANZTS): a PBD FEV1/FVC < 0.70 and a PBD FEV1 < 80%; -British Thoracic Society (BTS): a before BD (BBD) FEV1/FVC < 0.70 and a BBD FEV1 < 80%; -Old criterion retained, till 2010, by the French Society of Pneumology (SPLF): a PBD ratio between FEV1 and slow vital capacity < 0.70.

AIM

To determine, according to the different recommendations, the percentage of smokers having COPD among a population of smokers of more than 40 Packets/Year (PY) addressed for plethysmography.

METHODS

The plethysmographic data of 531 consecutive stable male smokers that underwent reversibility testing (400 µg of Salbutamol®) were analyzed.

RESULTS

The mean ± SD of age, cigarettes consumption, PBD FEV1 (%), were, respectively, 61 ± 11 Yr, 64 ± 20 PY and 52 ± 21%. The percentages of subjects having COPD according to the above criteria were 75.5% (SPLF old criterion); 71.2% (ATS/ERS, GOLD); 70.8% (BTS) and 69.7% (ANZTS).

CONCLUSION

The diagnosis of COPD depends on which guidelines are used for defining the disease. This forms a barrier to early diagnosis, affects public health decisions and wrong planning strategies.

Validation of the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) in Tunisian adolescents and young adults

AIM

The study aimed to examine whether the Arabic version of the Comprehensive Assessment of At Risk Mental States (CAARMS) has good construct validity, concurrent validity and reliability.

METHODS

Validity was established on a sample of 58 Tunisian adolescents and young adults aged between 16 and 30 years. These subjects were divided into three groups according to the CAARMS scores: ultra-high risk positive subjects (UHR (+) ) (n = 22), ultra-high risk negative subjects (UHR (-) ) (n = 25) and subjects meeting the criteria of a first-episode psychosis (FEP) (n = 11). For construct validity, we used the convergent validity. We used the Positive and Negative Syndrome Scale (PANSS) concomitantly with the CAARMS. For concurrent validity, we studied the correlation between symptoms of the CAARMS and their equivalents in the PANSS. The CAARMS reliability was conducted by the study of interrater reliability.

RESULTS

The UHR (+) group was shown with intermediate scores of PANSS between the two groups UHR (-) and FEP. That confirms a good construct validity of the Arabic version of the CAARMS. We noted a correlation between the scores in positive and negative sections measured by the CAARMS and their corresponding level of the PANSS. These results show that the CAARMS has a good concurrent validity with the PANSS. For the reliability study, we noted a good correlation between the two raters with a Pearson coefficient ranging from 0.55 to 0.90.

CONCLUSION

Analysis of the results of construct validity, concurrent validity and reliability of the CAARMS indicates that this version translated into Arabic is valid and reliable.

[The morbidity diagnosed among the elderly in primary care at the sanitary region of Sousse]

BACKGROUND

Nowadays, the ageing of the population became a societal frequent problem throughout the world. In Tunisia, the part of the elderly of 60 years old and over is estimated at 17,7 % in 2029. This ageing is at the origin of important health problems, in particular the increase of the frequency of the chronic diseases.

AIM

To identify the Sociodemographic characteristics of the consultants of 65 years old and over, and to describe the morbidity diagnosed in this age group in the primary health care centers of the sanitary region of Sousse.

METHODS

We conducted a cross-sectional descriptive study in 86 primary health care centers in Sousse over 1 year (2002-2003). Medical records for 3 weeks per season were randomly selected. The International Classification of Primary Care (ICPC) was used to code recorded data.

RESULTS

2198 consultations were collected, elderly person presents on average 1,22 (± 0,55) morbid states by consultation. The main diseases identified in order were cardiovascular (26,2%), breathing (20,8%), osteo-articular (14,8%). Psychological and social disorders accounted for only 0,4% of cases. The major health problems were uncomplicated hypertension (22,4%), acute bronchitis / bronchiolitis (9,2%), diabetes mellitus type 2 (7,9%) and osteoarthritis of knee (4,7%).

CONCLUSION

These results are important both to meet the needs of consultants and especially to better adapt the training to practice field.