Factors associated with acculturative stress among international medical students in an Egyptian university.

BACKGROUND: International students frequently face difficulties that are specific to the typical college experience, in addition to facing other factors of acculturative stress, including cultural differences, language barriers, and comfortability in accommodation. AIM: The study aims to measure the prevalence of acculturative stress among first-year international students enrolled at Faculty of Medicine in an Egyptian University and aims to reveal the factors that are associated with acculturative stress in these students. METHODOLOGY: A cross-sectional study was conducted on 422 international students in the academic year 2021-2022, using the Acculturative Stress Scale for International Students (ASSIS). The factors associated with acculturative stress were examined using the following criteria: comfort in accommodation, student adjustment to college, language proficiency, and academic pressure. RESULTS: This study showed that 28.7% of the international students were "above the warning sign" of acculturative stress (above 109). The major stressors of acculturative stress among international students were the non-specific concerns, homesickness, and perceived discrimination, while the least reported stressors were fear and guilt. International students who scored in the "above the warning sign" in the (ASSIS) were mostly females (35.3%) and non-Arab students (37.8%). Having a friend or a family member living in Egypt significantly reduced the level of acculturative stress. Moreover, the ASSIS total score showed a negative correlation with the scores for overall language proficiency, comfort in accommodation, academic adjustment, and student adjustment to college. CONCLUSION: Acculturative stress among the studied groups is influenced by several factors, including nationality, English and Arabic language proficiency, academic adjustment, and comfort of living. That being said, the most significant stressor is the country of origin, which is defined in terms of nationality or language proficiency. Consequently, resources that ensure the sustainability and growth of international students throughout their educational process must be made available to a multicultural environment in order to support and retain those students. CLINICAL TRIAL NUMBER: Not applicable.

Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study.

BACKGROUND: Rapid response teams (RRTs) help in the early recognition of deteriorating patients in hospital wards and provide the needed management at the bedside by a qualified team. RRT implementation is still questionable because there is insufficient evidence regarding its effects. To date, according to our knowledge, no published studies have addressed the effectiveness of RRT implementation on inpatient care outcomes in Egypt. OBJECTIVE: We aimed to assess the impact of an RRT on the rates of inpatient mortality, cardiopulmonary arrest calls and unplanned intensive care unit (ICU) admission in an Egyptian tertiary hospital. METHODS: An interventional study was conducted at a university hospital. Data was evaluated for 24 months before the intervention (January 2018 till December 2019, which included 4242 admissions). The intervention was implemented for 12 months (January 2021 till December 2021), ending with postintervention evaluation of 2338 admissions. RESULTS: RRT implementation was associated with a significant reduction in inpatient mortality rate from 88.93 to 46.44 deaths per 1000 discharges (relative risk reduction (RRR)=0.48; 95% CI, 0.36 to 0.58). Inpatient cardiopulmonary arrest rate decreased from 7.41 to 1.77 calls per 1000 discharges (RRR, 0.76; 95% CI, 0.32 to 0.92), while unplanned ICU admissions decreased from 5.98 to 4.87 per 1000 discharges (RRR, 0.19; 95% CI, -0.65 to 0.60). CONCLUSIONS: RRT implementation was associated with a significantly reduced hospital inpatient mortality rate, cardiopulmonary arrest call rate as well as reduced unplanned ICU admission rate. Our results reveal that RRT can contribute to improving the quality of care in similar settings in developing countries.

Perceived efficacy of existing waterpipe tobacco warning labels versus novel enhanced generic and waterpipe-specific sets.

INTRODUCTION: Since 2008, Egypt has four existing generic bi-annually rotating warning labels (WLs) on 50% of the waterpipe tobacco packs (WTPs). The Ministry of Health Tobacco Control Unit proposed increasing WL size to 80%, removing colours and flavour imagery from WTPs, and plain packaging to help curb the rising epidemic of waterpipe tobacco smoking. Therefore, we measured the perceived efficacy of existing against novel enhanced (generic and waterpipe-specific) WTP WLs and the associated factors among Egyptian waterpipe smokers and nonsmokers. METHODS: A purposive quota sample of 2014 adults was surveyed in two rounds using face interviews. At each round, participants were randomly shown one of four existing WLs, then one of four novel WLs. Participants rated the perceived efficacy of existing and novel WLs regarding the salience, depth of processing, affective reactions, credibility, relevance, perceived harm and perceived behavioural control. Data were analysed using Generalized Estimating Equations. RESULTS: Participants rated novel WTP WLs with higher mean perceived efficacy scores than existing WLs for all measures, although both sets collectively scored modestly (59.7; 95% CI: 58.9-60.5 vs 53.0; 95% CI: 52.1-54.0, respectively; p<0.001). Relative to the existing WTP WLs, novel WLs were particularly able to induce higher salience, affective reactions, and depth of processing. Relative to the generic novel WTP WLs, waterpipe-specific WLs induced higher relevance, perceived harm, and affective reactions. Nonsmokers scored higher than waterpipe tobacco smokers, specifically for perceived behavioral control (65.0±32.5 vs 43.6±19.8, respectively; p<0.001). WTP WLs featuring proximal risks, such as dental effects (ß = 9.70; 95% CI: 7.00-12.40), fetal harm (ß = 9.42; 95% CI: 6.75-12.10), or toxic contents (ß = 9.14; 95% CI: 6.58-11.70) were strongly associated with participants' perceived efficacy scores. Among other independent factors, rural residence (ß = 24.09; 95% CI: 22.21-25.97), being a nonsmoker (ß = 10.51; 95% CI: 8.92-12.10), survey round 2 (ß = 6.96, 95% CI: 5.73-8.19), the novel WTP WL set (ß = 6.68; 95% CI: 6.19-7.17), and having higher education (ß = 6.31; 95% CI: 4.34-8.27) were highly associated with participants' perceived efficacy scores. CONCLUSIONS: Waterpipe-specific WLs on plain WTPs that feature proximal risks and address different population subgroups need to be developed in conjunction with awareness raising campaigns on WTS harms to reinforce the credibility of WTP WLs. Our findings suggest the proposed WTP WL enhancements by the Tobacco Control Unit may support a more effective WTP labelling policy within a comprehensive waterpipe-specific tobacco control framework.

Do pictorial health warnings on waterpipe tobacco packs matter? Recall effectiveness among Egyptian waterpipe smokers & non-smokers.

INTRODUCTION: Despite the global rise in waterpipe tobacco smoking (WTS), the effectiveness of waterpipe tobacco health warnings remain understudied, especially in countries with high WTS rates. Egypt has been employing waterpipe tobacco labelling for a decade, however, their effectiveness is unknown. Our overall aim was to measure the effectiveness of pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) through participant memory recall and to investigate whether they induced behavioural responses in waterpipe smokers and deterred uptake of WTS in non-smokers, examining the differentials of effectiveness among socio-demographic subgroups. SUBJECTS AND METHODS: We conducted two surveys including 1490 adult current waterpipe smokers, 73 former waterpipe smokers, and 451 non-smokers in Cairo and a rural village in Egypt between 2015-2017. Participants who noticed PHWs on WTPs were asked questions about salience, communication of health risks, public support, cognitive processing, and self-reported behavioural responses (current waterpipe smokers: reduce consumption, forgo a smoke, quit attempts; former waterpipe smokers: quit; non-smokers: deter WTS initiation). Univariate and multivariable statistical analyses were performed. RESULTS: Participants' mean age was 35 years, mostly males (90.4%), waterpipe smokers (74.0%) and rural residents (59.3%). Approximately two-thirds of participants noticed PHWs on WTPs. Salience was significantly less among females, urban residents and participants with high literacy. More than three-quarters of participants reported that WTS health risks were communicated through the warnings. At least half of participants cognitively processed the warnings: 56.3% thought of the warnings when WTPs were out of sight; non-smokers understood the warnings (83.2%) and discussed them with others (90.3%) significantly more than current (76.0% and 72.5%, respectively) and former waterpipe smokers (81.0% and 61.9%, respectively). Participants reported that PHWs on WTPs motivated 58.5% of waterpipe smokers to think about quitting; 64.5% to reduce their consumption; 42.2% to forgo a smoke; 24.5% to attempt to quit; 57.1% of former waterpipe smokers to successfully quit; and 59.3% of non-smokers to remain smoke-free. CONCLUSIONS: Findings suggest that inserting PHWs on WTPs is an effective waterpipe tobacco labelling policy. Countries with similarly high rates of WTS should consider adopting WTP PHWs within a comprehensive regulatory framework.