Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis.

BACKGROUND: Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services. METHODS: We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. RESULTS: Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers. CONCLUSIONS: The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

Prevalence and predictors of depression, anxiety, and stress among refugees in Egypt.

BACKGROUND: Many Refugees show multiple distressing psychological and mental health problems associated with stressful and adverse conditions in host countries. Even though Egypt is one of the top five destination countries hosting refugees and asylum-seekers in the MENA region, there is a lack of studies investigating mental health problems among refugees in Egypt. This study aimed to assess the prevalence and predictors of depression, anxiety, and stress symptoms among refugees living in Egypt. METHODS: A total of 398 refugees aged 18 and above were interviewed from migrants'/refugees' community centers in Giza, Alexandria, Dakahlia, and Damietta governorates. A predesigned structured interview questionnaire was used to collect socio-demographic and migration-related variables. The Arabic Version of Depression Anxiety Stress Scales (DASS-21) was used to assess the presence and severity of the three negative emotional states. RESULTS: Nearly two-thirds of the participants were Syrian (66.4%). The majority resided in Alexandria and Giza governorates (75.9%), were females (73.4%), and were married (71.1%). The most reported migration difficulty was housing (41.5%). Anxiety symptoms were reported among 63.3% (95% CI: 58.59%- 68.05%) of sampled refugees, followed by depression (61.3%, 95% CI: 56.52%-66.10%), and stress symptoms (51.5%, 95% CI: 46.56%-56.36%). Results of regression analysis showed that; female gender predicted anxiety (aOR 2.419, 95% CI: 1.485-3.941, p < 0.001) and stress (aOR 2.053, 95% CI: 1.197-3.519, p = 0.009), while younger age groups (18-25 yr. and 26-50 yr.) compared to the older age group (51 yr. and older) predicted depression (aOR 4.529, 95% CI: 1.696-12.097, p = 0.003 and aOR 2.177, 95% CI: 1.270- 3.733, p = 0.005, respectively) and stress (aOR 4.334, 95% CI: 1.556-12.074, p = 0.005 and aOR 1.808, 95% CI: 1.023-3.193, p = 0.041, respectively). Residence in Alexandria, housing, and employment difficulties predicted anxiety (aOR 2.354, 95% CI: 1.420-3.902, p < 0.001, aOR 1.726, 95% CI: 1.073-2.778, p = 0.025, and aOR 3.044, 95% CI: 1.248-7.425, p = 0.014, respectively), depression (aOR 1.949, 95% CI: 1.163-3.266, p = 0.011, aOR 1.666, 95% CI: 1.036-2.681, p = 0.035, and aOR 3.216, 95% CI: 1.321-7.828, p = 0.010, respectively), and stress (aOR 2.450, 95% CI: 1.431-4.195, p < 0.001, aOR 1.911, 95% CI: 1.187-3.078, p = 0.008, and aOR 4.482, 95% CI: 1.867-10.760, p < 0.001, respectively). CONCLUSION: Mental health problems are prevalent among the refugee population in Egypt that are compounded by the difficult post-migration socio-economic situation. Multisectoral attention towards refugees' mental health is urgently needed.

Prevalence and predictors of undiagnosed type 2 diabetes and pre-diabetes among adult Egyptians: a community-based survey.

BACKGROUND: The global prevalence of abnormal glycemic level comprising diabetes mellitus (DM) and pre-diabetes (PDM) is rapidly increasing with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. Identification of people at risk became much easier with the use of risk charts than the traditional methods. The current study aimed to conduct a community-based screening for T2DM to estimate the prevalence of undiagnosed DM and to assess the AUSDRISK Arabic version as a predictive tool in an Egyptian context. METHODS: A cross-sectional study was conducted among 719 Adults aging 18 years or more and not known to be diabetics through a population-based household survey. Each participant was interviewed to fill demographic and medical data as well as the AUSDRISK Arabic version risk score and undergo testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). RESULTS: The prevalence of DM and PDM were 5% and 21.7% respectively. The multivariate analysis revealed that age, being physically inactive, history of previous abnormal glycemic level and waist circumference were the predictors for having abnormal glycemic level among the studied participants. At cut off points ≥ 13 and ≥ 9, the AUSDRISK respectively discriminated DM [sensitivity (86.11%), specificity (73.35%), and area under the curve (AUC): 0.887, 95% CI: 0.824-0.950] and abnormal glycemic level [sensitivity (80.73%), specificity (58.06%), and AUC: 0.767, 95% CI: 0.727-0.807], p < 0.001. CONCLUSIONS: Overt DM just occupies the top of an iceberg, its unseen big population have undiagnosed DM, PDM or been at risk of T2DM because of sustained exposure to the influential risk factors. The AUSDRISK Arabic version was proved to be sensitive and specific tool to be used among Egyptians as a screening tool for the detection of DM or abnormal glycemic level. A prominent association has been demonstrated between AUSDRISK Arabic version score and the diabetic status.

Patients' satisfaction after bilateral thoracoscopic sympathicolysis.

Background: Palmar hyperhidrosis is a distressing condition implicating individuals' social life and self-esteem. Surgery has proven to be highly effective with excellent safety profile. However, compensatory hyperhidrosis (CH), a relatively common adverse event of the procedure, is sometimes problematic in a few patients. Patients and Methods: A questionnaire, including Hyperhidrosis Disease Severity Scale (HDSS), was designed to assess the overall satisfaction of patients who underwent bilateral endoscopic thoracic sympathectomy between November 2018 and July 2021. They were requested to respond to the questionnaire before surgery and during the follow-up visits. Results: Sixty-three patients were recruited, 37 males and 26 females. The age of the participants ranged from 6 to 27 years (mean 17.05 ± 5.55 years). Most patients reported a positive impact on their professional and social life. Two patients experienced significant compensatory hyperhydrosis impacting their daily life. There was a significant improvement of the HDSS score after surgery. Around 95.2% of the participants (n = 60) had three-point improvement indicating 80% reduction of sweat production. Conclusion: : Bilateral endoscopic thoracoscopic sympathectomy has shown a high success rate with low adverse events. CH, however, remains a significant cause of morbidity in few patients. Therefore, continuous evaluation of patients' satisfaction is of utmost importance to help improve our understanding to risk factors and prevalence of CH, improve our techniques to minimise its occurrence and treat patients with distressing symptoms. These data will guide surgeons when counselling patients to make insightful decisions based on the benefits and risks of the procedure.

Combining COVID-19 and seasonal influenza vaccines together to increase the acceptance of newly developed vaccines in the Eastern Mediterranean Region: a cross-sectional study.

BACKGROUND AND AIM: The World Health Organization (WHO) recommended the concomitant administration (co-administration) of inactivated seasonal influenza and coronavirus disease 2019 (COVID-19) vaccines, encouraging the practice for the 2021-2022 flu season. This study aimed to assess the acceptance of simultaneously receiving the seasonal influenza vaccine (SIV) and the COVID-19 vaccine in a single administration to reduce vaccine rejection towards the COVID-19 vaccination. METHODS: An online-based cross-section survey was conducted from 1 September to 9 November 2022, in the Eastern Mediterranean Region (EMR) through distributing the survey on different social media platforms, including Facebook, Twitter, LinkedIn and WhatsApp. We used the multi-level model to assess the variation of vaccine countries across EMR countries. RESULTS: In total, 3300 participants were included in this survey from 11 countries distributed in the EMR. More than one-third (40.7%) were aged 18-25 years, 60.6% were females, 54.0% had a university degree, 43.1% had previous COVID-19, and 41.9% had relatives or friends who died from COVID-19. In total, 43.3% accepted this combination because it is less costly (9%), safer (18%), more effective (17%), and has fewer doses (19%). Rejection of this combination was due to fear of side effects (31%), and no studies have been published on their effects (31%). There was a significant difference across countries, which accounted for 6% of the variance in the log-odds of accepting the combined vaccination. Multi-level analysis revealed that being male, African and losing a family member or friend from COVID-19 increased the acceptance of the theoretical combined vaccines. Additionally, the number of doses taken of the COVID-19 and influenza vaccines separately significantly affected the combined vaccine acceptance. However, previous COVID-19 infection and older age reduced the odds of accepting the combined vaccines. Occupational level, social status and educational level didn't significantly affect the acceptance odds. CONCLUSIONS: We can conclude that combining SIV and COVID-19 vaccines in one shot increased the overall acceptance of COVID-19 vaccines among vaccine rejectors.

How can imported monkeypox break the borders? A rapid systematic review.

BACKGROUND: Monkeypox was designated as an emerging illness in 2018 by the World Health Organization Research and Development Blueprint, necessitating expedited research, development, and public health action. In this review, we aim to shed the light on the imported cases of monkeypox in attempt to prevent the further spread of the disease. Methodology An electronic search in the relevant database (Web of Science, PubMed Medline, PubMed Central, Google scholar, and Embase) was conducted to identify eligible articles. In addition to searching the grey literature, manual searching was carried out using the reference chain approach. RESULTS: A total of 1886 articles were retrieved using the search strategy with 21 studies included in the systematic review. A total of 113 cases of imported monkeypox were confirmed worldwide. Nineteen patients mentioned a travel history from Nigeria, thirty-eight infected cases had travel destinations from Europe, fifty-four cases traveled from European countries such as; Spain, France, and the Netherlands, one case from Portugal, and another one from the United Kingdom (UK). All reported clades of the virus were West African clade. Nine studies showed the source of infection was sexual contact, especially with male partners. Six studies mentioned the cause of infection was contact with an individual with monkeypox symptoms. Two studies considered cases due to acquired nosocomial infection. Ingestion of barbecued bushmeat was the source of infection in three studies and rodent carcasses were the source of infection in the other two studies. CONCLUSION: The development of functioning surveillance systems and point-of-entry screening is essential for worldwide health security. This necessitates ongoing training of front-line health professionals to ensure that imported monkeypox is properly diagnosed and managed. In addition, implementing effective health communication about monkeypox prevention and control is mandatory to help individuals to make informed decisions to protect their own and their communities' health.

Systematic Review on the Efficacy, Effectiveness, Safety, and Immunogenicity of Monkeypox Vaccine.

BACKGROUND: The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines. METHODS: An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar. RESULTS: A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox. CONCLUSIONS: Vaccines can be used to prevent mpox and effectively control its spread.

Arabic version of the Australian type 2 diabetes risk assessment tool (AUSDRISK): translation and validation.

OBJECTIVE: The current study aimed to translate the Australian Type 2 Diabetes Risk Assessment tool (AUSDRISK) into the Arabic language and evaluate the reliability and validity of the resultant Arabic version among Egyptians. The AUSDRISK was translated into Arabic language using the World Health Organization (WHO) forward and backward translation protocol. Using the WHO cluster sampling, a sample of 18+ years 719 Egyptians was randomly selected through a population-based household survey. Each participant was interviewed to fill the AUSDRISK Arabic version risk score and undergo confirmatory testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). Test-retest reliability and convergent validity were computed. RESULTS: Most of the study participants were physically active (60.5%) and females (69.3%). The Arabic version of the AUSDRISK reflected statistically significant perfect positive correlation (r = 1 and p < 0.01) for test re-test reliability as well as a significant moderate positive correlation with each of FPG (r = 0.48, p < 0.01) and OGTT (r = 0.52, p < 0.01) for the criterion-related (convergent) validity. The recalibrated noninvasive AUSDRISK Arabic version proved to be a simple, reliable, and valid predictive tool, and thereof, its employment for opportunistic mass public screening is strongly recommended. This can reduce diabetes mellitus Type 2disease burden and health expenditure.

Seroprevalence of Hepatitis A, B and C Among a Sample of Refugees in Egypt: An Exploratory Survey.

BACKGROUND: Estimating the prevalence of infectious diseases, including viral hepatitis, among refugees is important for evaluating their health needs and predicting the burden on the health system of the host country. This study aimed at estimating the seroprevalence of viral hepatitis among refugees in Egypt. METHODS: This cross-sectional study involved a heterogeneous group of 501 refugees. Enzyme-linked immunosorbent assays were used to detect IgG antibodies against hepatitis A virus (HAV), B virus (HBV) surface antigen (anti-HBsAg), C virus (HCV), and HBV surface antigen (HBsAg). RESULTS: Anti-HAV was the most prevalent marker (n = 482, 96.2%), followed by anti-HBs (n = 142, 28.3%) and HBsAg (n = 21, 4.2%), while only four refugees (0.8%) had positive anti-HCV IgG. Anti-HBs was higher in males (p < 0.05). Older refugees and non-working subjects had significantly higher seropositive rates of anti-HAV (p = 0.051 and p = 0.023, respectively), while students and those below 15 years of age had higher rates of anti-HBs (p < 0.05). Positive HBsAg results were associated with history of hepatitis (p < 0.001). Obese participants were more likely to be positive for HBsAg (p = 0.025) and anti-HBs (p < 0.05). Sudanese refugees had significantly higher rates of anti-HAV antibodies (p = 0.049), while Yemini refugees had significantly higher rates for HBsAg (p = 0.019) positivity. Residents of Dakahlia had significantly higher rates of anti-HAV (p = 0.008) and anti-HBs (p < 0.05). None of the studied risk factors was significantly associated with anti-HCV. CONCLUSION: Refugees in Egypt have poor immunity against HBV with intermediate to high HBV and low HCV prevalence rates. Despite that 65% of refugees received the HAV vaccine, almost all had IgG anti-HAV, denoting previous infection.

A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients.

One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34-51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.

COVID-19 Vaccine Booster Dose Acceptance: Systematic Review and Meta-Analysis.

The World Health Organization (WHO) recommended coronavirus disease 2019 (COVID-19) booster dose vaccination after completing the primary vaccination series for individuals ≥18 years and most-at-risk populations. This study aimed to estimate the pooled proportion of COVID-19 vaccine booster dose uptake and intention to get the booster dose among general populations and healthcare workers (HCWs). We searched PsycINFO, Scopus, EBSCO, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, Web of Science, Google Scholar, and ScienceDirect according to PRISMA guidelines. From a total of 1079 screened records, 50 studies were extracted. Meta-analysis was conducted using 48 high-quality studies according to the Newcastle-Ottawa Scale quality assessment tool. Using the 48 included studies, the pooled proportion of COVID-19 vaccine booster dose acceptance among 198,831 subjects was 81% (95% confidence interval (CI): 75-85%, I2 = 100%). The actual uptake of the booster dose in eight studies involving 12,995 subjects was 31% (95% CI: 19-46%, I2 = 100%), while the intention to have the booster dose of the vaccine was 79% (95% CI: 72-85%, I2 = 100%). The acceptance of the booster dose of COVID-19 vaccines among HCWs was 66% (95% CI: 58-74%), I2 = 99%). Meta-regression revealed that previous COVID-19 infection was associated with a lower intention to have the booster dose. Conversely, previous COVID-19 infection was associated with a significantly higher level of booster dose actual uptake. The pooled booster dose acceptance in the WHO region of the Americas, which did not include any actual vaccination, was 77% (95% CI: 66-85%, I2 = 100%). The pooled acceptance of the booster dose in the Western Pacific was 89% (95% CI: 84-92%, I2 = 100), followed by the European region: 86% (95% CI: 81-90%, I2 = 99%), the Eastern Mediterranean region: 59% (95% CI: 46-71%, I2 = 99%), and the Southeast Asian region: 52% (95% CI: 43-61%, I2 = 95). Having chronic disease and trust in the vaccine effectiveness were the significant predictors of booster dose COVID-19 vaccine acceptance. The global acceptance rate of COVID-19 booster vaccine is high, but the rates vary by region. To achieve herd immunity for the disease, a high level of vaccination acceptance is required. Intensive vaccination campaigns and programs are still needed around the world to raise public awareness regarding the importance of accepting COVID-19 vaccines needed for proper control of the pandemic.