Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis.

The exact factors predicting outcomes following traumatic brain injury (TBI) remain elusive. In this systematic review and meta-analysis, we examined factors influencing outcomes in adult patients with TBI, from 3 months to 1 year after injury. A search of four electronic databases-PubMed, Scopus, Web of Science, and ScienceDirect-yielded 29 studies for review and 16 for meta-analysis, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. In patients with TBI of any severity, mean differences were observed in age (8.72 years; 95% confidence interval [CI], 4.77-12.66 years), lymphocyte count (-0.15 109/L; 95% CI, -0.18 to -0.11), glucose levels (1.20 mmol/L; 95% CI, 0.73-1.68), and haemoglobin levels (-0.91 g/dL; 95% CI, -1.49 to -0.33) between those with favourable and unfavourable outcomes. The prevalence rates of unfavourable outcomes were as follows: abnormal cisterns, 65.7%; intracranial pressure above 20 mmHg, 52.9%; midline shift of 5 mm or more, 63%; hypotension, 71%; hypoxia, 86.8%; blood transfusion, 70.3%; and mechanical ventilation, 90%. Several predictors were strongly associated with outcome. Specifically, age, lymphocyte count, glucose level, haemoglobin level, severity of TBI, pupillary reaction, and type of injury were identified as potential predictors of long-term outcomes.

Misconceptions about traumatic brain injury among nursing students: A cross-sectional study.

AIM: This study aimed to evaluate nursing students' potential misconceptions about traumatic brain injuries and the relationship between these misconceptions and students' sociodemographic characteristics. BACKGROUND: Although traumatic brain injuries have severe consequences, misconceptions about traumatic brain injury are widespread among healthcare professionals. Studying misconceptions about traumatic brain injury among nursing students can help enhance nursing curricula for better traumatic brain injury care and rehabilitation. DESIGN: This is a cross-sectional observational study reported according to the STROBE guideline. METHODS: We conducted a survey among nursing students in Morocco using a questionnaire "Common Misconceptions about Traumatic Brain Injury". A total of 550 nursing students from multiple nursing institutes in different cities in Morocco participated in the study. We calculated the average percentage of misconceptions for 7 different questionnaire domains. To study the relationship between misconceptions and sociodemographic factors, we used a t-test for independent samples and ANOVA, considering the total score for each participant. RESULTS: Out of the 550 nursing students who participated in the study, most were female and the 20-21 years old category represented two-thirds of our sample. The domain related to "Amnesia" had the highest rate of misconceptions, followed by "Recovery", while the "brain damage" domain had the lowest rate of misconceptions. The overall mean score of misconceptions was higher than the value defined in our study as a reference cut-off. Interestingly, there were significant differences in the total score of misconceptions based on variables such as age, state of origin, city of the Institute and year of study. CONCLUSIONS: Misconceptions about traumatic brain injuries were prevalent among nursing students, which could have a negative impact on patient assessment, treatment and education. The findings indicate the need to improve the level of knowledge related to traumatic brain injury among nursing students and to strengthen the nursing curriculum in Morocco.

Lifestyle Habits Determinants of Health-Related Quality of Life in Moroccan College Students.

The transition to university is a critical period during which considerable life changes arise. Useful national data to design tailored interventions aimed at promoting health-related quality of life (HRQoL) among Moroccan students are lacking. The present study is aimed at filling this gap by investigating the levels and associated factors of HRQoL among a national sample of Moroccan university students. HRQoL was assessed using the EQ-5D-5L instrument. Data from 2759 university students were collected in a large, cross-sectional, web-based survey. All statistical analyses were conducted using the R software. The EQ-5D-5L findings showed that the majority of students rated level 1 (no problems) and level 2 (slight problems) for the "Mobility", "Self-Care", "Usual Activities", and "Pain/Discomfort" HRQoL dimensions. However, the "Anxiety/Depression" dimension was the exception; more than half (57.1%) of the students were slightly to extremely anxious or depressed. The levels of lifestyle habits were of concern among participants of this study. With respect to sedentary behaviors and physical activity, we found that approximately 80% of participants spent ≥2 h/day on different screen-based sedentary behaviors, and 60% were physically inactive. Lifestyle habits that were found to be associated with HRQoL are sleeping time, physical activity, leisure, hygiene, household activities, homework, and social media time. The multiple regression model explained 93% of the EQ-VAS score variance. The findings could be of great importance for researchers and policymakers interested in promoting health of university students.

Characterizing the progress in traumatic brain injuries research in North Africa: a systematic review.

Traumatic brain injury (TBI) represents a major health concern worldwide. Currently, systematic TBI studies in North Africa are lacking. Nevertheless, they are highly needed to ameliorate TBI outcomes and increase survival rates among TBI patients. Through this systematic review, we aimed to characterize the progress in TBI research in North Africa and analyse the literature on TBI in the region in the last two decades. A review of North African articles was performed over 22 years (2000-2021) and the required data were collected using keywords: "traumatic brain injury", "traumatic brain damage", "traumatic head injury", and "traumatic head damage". Abstracts were screened, and selected eligible studies were reviewed independently by two reviewers. The review included 22 studies within the 59,204, 63,083, and 45,918 records that were identified between 2000 and 2021 through Scopus, Web of Science, and PubMed, respectively. The proportion of the total global TBI records that relate to North Africa was less than 1%. Overall, the indices show low progress in the number of new records occurring every year in North Africa and all the records in North Africa were produced after the year 2004. The results show that North Africa has witnessed a low production in TBI research, and the progress is far from being equal to other regions. Production of scientific publications, providing the required information and raising awareness about complications resulting from TBI on individuals and society in general, should be considered.

Modern drug self-medication and associated factors among pregnant women at Settat city, Morocco.

Purpose: The consumption of drugs during pregnancy without medical advice constitutes a risk for the mother and the fetus. It is a public health problem. This study aimed to assess self-medication practices among pregnant women, the most used medicines, and factors associated with this practice. Methods: A cross-sectional study was conducted using a structured questionnaire on pregnant women who were attending Settat health centers. A simple random sampling technique was used to select the study participants. Descriptive and inferential statistics were computed using the SPSS version 19. Results: Among 364 pregnant women, 118 (32%) practiced self-medication in modern medicine. Paracetamol was the most used medication, and nausea and vomiting were the most frequent symptoms reported by self-medicated pregnant women. Multivariate logistic regression analysis showed that women over 30 years old were four-fold more likely to practice self-medication than the other groups [AOR: 4.19; 95% CI (1.80-9.77)]. Similarly, unemployed women [AOR: 3.93; 95% CI (0.80-19.23)], those in third trimester [AOR: 2.63; 95% CI (1.29-5.36)], multiparous [AOR: 6.03; 95% CI (3.12-11.65)], without chronic illness [AOR: 2.84; 95% CI (1.26-6.41)], without therapeutic treatment [AOR: 10.1; 95% CI (2.81-37.03)] and who have attended ANC at least once, were more likely to practice self-medication than the other groups. Conclusion: The prevalence of modern drug self-medication among pregnant women in Morocco is classified as lower. Health professionals can exert positive pressure through education and information provided during ANC about OTC medications to significantly reduce the rate of self-medication.

Post-COVID-19 mental health and its associated factors at 3-months after discharge: A case-control study.

Background: Mental health disorders are among the most significant sequelae of the COVID-19 pandemic. Therefore, the aim of this study is to investigate the mental health status and associated risk factors of Moroccan COVID-19 survivors 3 months after hospital discharge. Methods: A case-control study was conducted from September 2021 to February 2022 on 824 participants. 213 were COVID-19 survivors and 611 were control group. Data were collected ether through an online anonymous survey. Anxiety and depression disorders were assessed using Hospital Anxiety and Depression Scale (HADS). Results: The average age of all participants was 55.17 ±â€¯16.44. Our findings highlighted higher prevalence of mental health disorders including anxiety and depression in COVID-19 survivors at 3 months after hospital discharge (HADS-A = 12.84; HADS-D = 10.91) compared to control group (HADS-A = 9.90; HADS-D = 8.27) (p < 0.001). Older patients, suffering from type 2 diabetes and kidney diseases, admitted to ICU, who stayed a long duration in the hospital, who had severe and longer duration of symptoms and who used Chloroquine, had higher levels of anxiety and depression after discharge. Conclusions: The present investigation highlights the need to develop a post-COVID-19 rehabilitation programs that can better manage the post COVID-19 impact and restore a good mental health for COVID-19 survivors. Also, to create preventative strategies to limit mental health disorders in COVID-19 survivors.

Health-Related Quality of Life of Moroccan COVID-19 Survivors: A Case-Control Study.

Background: Research on COVID-19 has mostly focused on transmission, mortality and morbidity associated with the virus. However, less attention has been given to its impact on health-related quality of life (HRQoL) of patients with COVID-19. Therefore, this study aimed to determine the demographic and clinical risk factors associated with COVID-19 and evaluate its impact on the HRQoL of COVID-19 survivors. Methods: A case-control study was carried out between September 2021 and March 2022 on 1105 participants. A total of 354 were COVID-19 survivors and 751 were the control group. The HRQoL was assessed using both EQ-5D-5L and SF-6D generic instruments. Results: The average age of all participants was 56.17 ± 15.46. Older age, urban area, tobacco use, presence of chronic diseases especially type 1 diabetes, kidney and cardiovascular diseases were significantly associated with COVID-19. The COVID-19 survivors had significantly lower HRQoL (EQ-VAS = 50.89) compared to the control group (EQ-VAS = 63.36) (p-value < 0.0001). Pain/ discomfort and anxiety/depression were the most negatively affected by COVID-19 (p-value < 0.0001). Conclusions: The findings from this study could help healthcare professionals and policy makers to better understand the HRQoL sequelae among the COVID-19 survivors and contribute to develop tailored interventions.

Simulation Based-Learning from Simple to Complicated Clinical Situations for Midwifery Students.

PURPOSE: A health professional's learning curriculum should lead to the acquisition of technical and non-technical skills. This study aims at demonstrating the impact of simulation-based learning (SBL) experience on the learning of midwifery students. PATIENTS AND METHODS: Using an experimental design, the experimental group (n=14) received pretest, high fidelity simulation, then a post-test. Whereas the control group (n=14) received pretest, revision of the theoretical course instead of simulation, post-test 1, high fidelity simulation, then a post-test 2. The first scenario was about a normal childbirth when the midwifery students were in their 2nd year. And then the second one was about immediate postpartum hemorrhage when the students moved to their 3rd year. RESULTS: During the simulation sessions, the experimental group had a higher mean score in the post-test than the control group. This indicated that the simulation significantly (p<0.001) increased the students' knowledge. Also, for both eutocic and dystocic delivery simulation experiments, students obtained higher score in the second simulation sessions (19.69 and 19.4 for eutocic and dystocic, respectively) than in the first session (11.23 and 9.12 for eutocic and dystocic, respectively; p<0.0001). CONCLUSION: These findings confirm that SBL offers an opportunity for learners to be immersed in an environment that is closer to reality, thus improving learning in a safe environment.

Health-related quality of life and behavior-related lifestyle changes due to the COVID-19 home confinement: Dataset from a Moroccan sample.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus initially appeared in Wuhan, Hubei Province, China has caused a novel coronavirus disease (COVID-19) [1]. The disease is rapidly spread around the world causing thousands of deaths and posing critical challenges for public health and clinical research in the world. The outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern. Nowadays, there are more than 18 millions of confirmed cases of coronavirus across the world with a total of 702,903 deaths [2]. In Morocco, there are 28,500 confirmed cases and 345 deaths. Forecasts for the cumulative number of confirmed, recovered, active and death cases were recently provided [3]. To manage the pandemic spread several countries adopted proactive and preventive measures including home confinement of the population. However, there is evidence that these measures, particularly home confinement, can cause unprecedented disruption in the well-being of the population. Being forced to stay at home and the daily activities' restrictions could impact the citizens' health-related quality of life (HRQoL) and behavior-related lifestyle. It has been reported that the COVID-19 pandemic has an impact on psychological behaviors [4], mental health [5] and anxiety/depression [6]. The Moroccan population was under home confinement from March 20, 2020. Assessing rapidly and simply the HRQoL during crisis such as the home confinement is a challenge of interest to provide speedy information to authorities which allow best management of damages yielding in crisis situation. The EQ-5D instrument is a generic questionnaire developed by the Euroqol group for measuring the HRQoL by combining five health dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) [7]. The EQ-5D instrument is translated into more than 300 languages and exhibit good reliability and validity in both patients and general population. Herein, we used the EQ-5D-5L instrument to assess for the first time the impact of the home confinement on the HRQoL. Also, we evaluated the changes in behaviors by asking some questions related to lifestyle before and during the home confinement. These data can help the Moroccan authorities and other countries to more understand the impact of this crisis on citizens and therefore to set up adequate protocols for managing the post-confinement or possible future crisis. We provided two datasets: (1) data we collected before confinement from a sample of 484 individuals describing their HRQoL [8] and (2) data we collected during the home confinement period from a sample of 537 individuals describing their HRQoL and behavior-related lifestyle.

The hidden Markov chain modelling of the COVID-19 spreading using Moroccan dataset.

The World Health Organization (WHO) declared in March 12, 2020 the COVID-19 disease as pandemic. In Morocco, the first local transmission case was detected in March 13. The number of confirmed cases has gradually increased to reach 15,194 on July 10, 2020. To predict the COVID-19 evolution, statistical and mathematical models such as generalized logistic growth model [1], exponential model [2], segmented Poisson model [3], Susceptible-Infected-Recovered derivative models [4] and ARIMA [5] have been proposed and used. Herein, we proposed the use of the Hidden Markov Chain, which is a statistical system modelling transitions from one state (confirmed cases, recovered, active or death) to another according to a transition probability matrix to forecast the evolution of COVID-19 in Morocco from March 14, to October 5, 2020. In our knowledge the Hidden Markov Chain was not yet applied to the COVID-19 spreading. Forecasts for the cumulative number of confirmed, recovered, active and death cases can help the Moroccan authorities to set up adequate protocols for managing the post-confinement due to COVID-19. We provided both the recorded and forecasted data matrices of the cumulative number of the confirmed, recovered and active cases through the range of the studied dates.

Improved RIDIT statistic approach provides more intuitive and informative interpretation of EQ-5D data.

BACKGROUND: EQ-5D is generic measure of health-related quality of life. Studies using EQ-5D generate ordinal data that are interpreted as categories ordered by severity. New analytic approaches taking into account the ordinal nature of the health dimension severity and leading to a better interpretation of EQ-5D data are needed to better elucidate differences in health-related quality of life. We propose utilizing the Improved RIDIT statistical method to analyze EQ-5D outcomes. METHODS: 556 Moroccan participants aged over 18 years representing four chronic diseases: back pain (n = 158), renal insufficiency (n = 56), diabetes (n = 82) or hypertension (n = 80) and healthy subjects (n = 180). All participants received the two EQ-5D versions. Two other published data sets were included. The first was extracted from a diabetic Spain study and the second was extracted from a clinical trial study. The Improved RIDIT analyses were carried out using an R statistic program we developed. RESULTS: Applying the Improved RIDIT on the EQ-5D data allowed estimating for the first time the ordinal odds, the Absolute Risk Reduction (ARR) or the Absolute Risk Increase (ARI) and the Number Needed to Treat. The ARI values estimated for Moroccan patients showed that (i) hypertension increased anxiety/depression by 66% and reduced mobility by 65%; (ii) back pain increased pain/discomfort by 69%; (iii) renal insufficiency impacts mobility (ARI = 57%, oddsordinal = 9.95) and usual activities (ARI = 44%, oddsordinal = 6.41) and (iv) diabetes acts only on anxiety/depression (ARI = 50%, oddsordinal = 4.8). Also, we demonstrated that the approach works well in clinical trials. CONCLUSIONS: Improved RIDIT provides more intuitive and informative interpretation of the EQ-5D data by (1) taking into account the level severity; estimating (2) the odds ordinal, (3) the ARR/ARI and the NNT; (4) analyzing the five dimensions of the EQ-5D separately, which gives clinical teams more precision in understanding the treatment/pathology impacts on the health status and completes the EQ-5D data analysis based on score utilities.