Cluster analysis of cancer knowledge, attitudes and behaviors in the Moroccan population.

BACKGROUND: Cancer has become a major health concern due to the increasing morbidity and mortality rates, and its negative social, economic consequences and the heavy financial burden incurred by cancer patients. About 40% of cancers are preventable. The aim of this study was to assess the knowledge, attitudes, and practices regarding cancer prevention, and associated characteristics to inform the development of targeted cancer prevention campaigns and policies. METHODS: We conducted a cross-sectional survey of adult patients at Mohamed Sekkat and Sidi Othmane Hospitals in Casablanca, Morocco. Data collection was conducted by two trained interviewers who administered the questionnaire in-person in the local language. An unsupervised clustering approach included 17 candidate variables for the cluster analysis. The variables covered a wide range of characteristics, including demographics, health perceptions and attitudes. Survey answers were calculated to compose qualitative ordinal categories, including a cancer attitude score and knowledge score. RESULTS: The cluster-based analysis showed that participants in cluster 1 had the highest mean attitude score (13.9 ± 2.15) and percentage of individuals with a high level of knowledge (50.8%) whereas the lowest mean attitude score (9.48 ± 2.02) and knowledge level (7.5%.) were found in cluster 3. The participants with the lowest cancer attitude scores and knowledge levels were aged 34 to 47 years old (middle age group), predominantly females, living in rural settings, and were least likely to report health professionals as a source of health information. CONCLUSIONS: The findings showed that female individuals living in rural settings, belonging to an older age group, who were least likely to use health professionals as an information source had the lowest levels of knowledge and attitudes. These groups are amenable to targeted and tailored interventions aiming to modify their understanding of cancer in order to enhance the outcomes of Morocco's on-going efforts in cancer prevention and control strategies.

Sexual and reproductive health and gender-based violence among female migrants in Morocco: a cross sectional survey.

BACKGROUND: Over the past decade, Morocco has increasingly become the chosen destination for a growing number of migrants from neighbouring countries and especially from Sub-Saharan Africa. The aim of this study is to describe the sexual and reproductive health (SRH), as well as sexual and gender-based violence (SGBV) among female migrants in Morocco. METHODS: This is a descriptive cross-sectional study conducted between July and December 2021. Female migrants were recruited from one university maternity hospital and two primary healthcare centres in Rabat. Data were collected using a structured face-to-face questionnaire, which included information about sociodemographic characteristics, SRH, history of SGBV and its impact, as well as the utilization of preventive and supportive SGBV services. RESULTS: A total of 151 participants were included in this study. The majority of participants (60.9%) were aged 18 to 34 years old and 83.3% were single. Many participants (62.1%) did not use contraceptives. More than half (56%) of the participants who were pregnant at the time of the study were receiving pre-natal care. About 29.9% of interviewed participants reported experiencing female genital mutilation, and a significant majority (87.4%) experienced SGBV at least once during their lifetimes, while 76.2% experienced SGBV during migration. The most commonly reported form of violence was verbal abuse (75.8%). Among the victims of SGBV, a minority have visited a health facility (7%) or filed a complaint (9%) in the aftermath of violence. CONCLUSION: Overall, our findings showed low contraception coverage, moderate access to prenatal care, high prevalence of SGBV, and low utilization of preventive and supportive SGBV services among migrant women in Morocco. Further studies are needed to understand the contextual barriers to access, and utilization of SRH care and additional efforts should be undertaken to strengthen SGBV prevention and support systems.

How Physicians in a Moroccan Tertiary Care Center Perceive Teleconsultation During COVID-19 Pandemic?

Background: Recent technological advances have paved the way for a new modality of medical practice known as teleconsultation. Positive perceptions about the benefits of teleconsultation and its acceptance by clinicians are key predictors of its uptake. The aim of this study was to assess knowledge, perceptions, and acceptability of teleconsultation among Moroccan physicians. Methods: This is a descriptive cross-sectional study conducted at the Cheikh Khalifa International University Hospital (HCK) of Casablanca, Morocco. Study participants answered an anonymous self-administered questionnaire designed based on similar studies. The questionnaire contained four sections related to demographic characteristics, knowledge about telemedicine and teleconsultation, perceptions about teleconsultation, and its acceptability by the study participants. Results: Of 486 eligible participants, a total of 212 completed the questionnaire. Approximately 96.7% had prior knowledge of teleconsultation. Most participants identified internet access (95.3%), data security (93.4%), and confidentiality (92.9%) as the main facilitators to the use of teleconsultation. The main barriers to the use of teleconsultation were internet access issues (98.6%), poor audio quality (96.2%), poor video quality (94.3%), and difficulty encountered by patients in expressing themselves and communicating with their physician (79.7%). The majority of participants (91.5%) believed that teleconsultation will be an integral part of future medical practice and about 70.8% thought that they would be able to allot time to teleconsultation in their current schedules. Conclusions: The findings of this study should be used by policy makers to remove barriers and promote enablers of teleconsultation use by physicians to bring health care closer to the Moroccan population.

Tobacco Use Among Dental Students in Morocco: Opportunities for Professional Cancer Education.

The study aimed to evaluate tobacco use, attitudes, knowledge, and perceptions about tobacco control policies and smoking cessation counseling among dental students in Morocco. This cross-sectional study was conducted at the Dentistry Faculty of the Mohammed VI University of Health Sciences of Casablanca, using the Global Health Professions Student Survey (GHPSS) tool. Participants completed a self-administered survey questionnaire, including information on socio-demographic characteristics, tobacco use, exposure to secondhand smoke, attitudes, behavior and cessation, curriculum, and training. A total of 426 dental students were included in the study. Over 15% of the participants were current smokers, and 31.2% had tried smoking at least once. About 29.3% reported having been exposed to secondhand smoke in family settings and 49.5% in other environments. The majority of the students had felt that health professionals were role models for their patients. However, only 20% had felt they had received formal training in smoking cessation approaches. More than 70% of smokers had tried to quit smoking in the past year; however, only 41.7% reported having received help or advice. It is crucial that education and public health officials join efforts to plan and carry out programs aimed at training dental students in evidence-based cessation counseling methods, in order to change their own smoking behavior and assist their future patients. Improving dental school curriculums with regard to tobacco use prevention and cessation is also a powerful means of alleviating the national burden of cancer.

Extended healthy lifestyle index and colorectal cancer risk in the Moroccan population.

PURPOSE: Little is known about the combined effect of different lifestyle factors on CRC incidence among populations living in developing countries. In this study, we sought to create an Extended Healthy Lifestyle Index (EHLI) and to investigate its association with CRC risk in the Moroccan population. METHODS: A large case-control study including 1516 cases and 1516 controls, matched on age, sex and center were recruited in 5 Moroccan university hospital centers between 2009 and 2017. EHLI scores, including 9 modifiable factors (smoking, alcohol consumption, physical activity intensity, BMI, fruit and vegetables consumption, drinks that promote weight gain, red and processed meat, relatively unprocessed cereals and/or pulses, and dairy products consumption) were assigned to lifestyle information derived from the participants. We assessed the score based on the answers on each of the nine lifestyle components as unhealthy/un-compliant (0 point), healthy/compliant (1 point) and 0.5 for partial compliance to the recommendation. Conditional logistic regression models were used to assess the association between the EHLI and CRC risk and to estimate multivariate ORs and their 95% confidence intervals (CIs). All potential confounder variables were considered. RESULTS: After adjusting for potential confounding factors, a significant decrease in the risk of overall CRC was observed when comparing the highest EHLI category with the lowest index category (0.39, 95% CI: 0.33-0.47). These results did not differ by colon or rectum subsite. CONCLUSION: Combined healthy lifestyle factors are associated with a significantly lower incidence of CRC in Moroccan populations. Prevention strategies should consider targeting of multiple lifestyle factors.

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review.

BACKGROUND: Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. METHODS: PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization's six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. RESULTS: From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. CONCLUSION: The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

Knowledge, Perceptions, and Satisfaction of Moroccan Women Towards a New Breast Cancer Screening Program in Morocco.

The purpose of this study was to evaluate the knowledge, perceptions, and satisfaction of Moroccan women who resided the Meknes-Tafilalt region regarding a newly implemented breast cancer screening program in the region. The study was conducted in 24 randomly selected health centers from Meknes-Tafilalt region, Morocco. We targeted all women who resided in the region of the program and who met the inclusion criteria to participate in the screening program. Data was collected through a face-to-face questionnaire. In this study, 318 women were included. Results revealed moderate knowledge of breast cancer and the screening program. Most of the participants (90.5%) had heard of the breast cancer screening program. Only 33.6% of women declared that they are well informed about the program. Fear emotions related to breast cancer were reported by 93.1% of participants. About 82% of women accept to repeat a screening test every 2 years. Recommending the breast cancer screening test to their family and friends was stated by nearly 90% of women. The majority of women (94.9%) expressed their satisfaction about the screening test activities provided by health centers. Our results showed a moderate level of knowledge about breast cancer, a very positive attitude, and high overall satisfaction towards the breast cancer screening program in the Meknes-Tafilalt region. These results can guide development of appropriate breast cancer prevention strategies and sensibilisation campaigns in Morocco.

The Past, Present, and Future of Professional Cancer Education in Morocco.

Cancer is the second leading cause of death in Morocco after cardiovascular diseases. Changes associated with societal and economic development, longevity of the population, and lifestyle changes contribute to increasing the burden of cancer in the Morocco. Despite the advances and achievements in cancer care in Morocco, more efforts are needed to better treat, control, and prevent cancer in Morocco. This manuscript illustrates the professional cancer education activities in Morocco over the past 10 years. The manuscript also illustrates the current cancer education and the needed future directions in the field in this middle-income country that is undergoing significant epidemiologic and lifestyle transitions and projections for increasing cancer incidence and mortality in the next few decades.

Facteurs prédictifs de la non-complétude vaccinale chez des enfants migrants de moins de 5 ans, Maroc.

INTRODUCTION: Despite several initiatives by the Moroccan health ministry to protect migrants' rights to health services, the vaccination of migrant children remains a public health issue. AIM OF THE STUDY: The objective of this study was to measure the vaccination coverage and identify the factors associated with the non-completion of vaccination of sub-Saharan migrant children under 5 years of age in the city of Casablanca. METHODS: Based on an analytical cross-sectional study, snow-ball sampling was conducted and a questionnaire was given to sub-Saharan migrant mothers of children under 5. The results of the descriptive analyses and the Chi test led to the elaboration of a predictive model through a multivariate logistic regression. The information collected included socio-demographic characteristics, factors linked to accessibility to vaccination services, the mothers' knowledge and perception of vaccination. RESULTS: Approximately 57% of sub-Saharan migrant children under 5 were incompletely or non-vaccinated. The factors significantly associated with vaccination status after the multivariate analysis were the mothers' educational levels (4.895 [1.907-12.562]), professional status (0.411 |0.206-0.821]), knowledge about the advantage of vaccination (0.035 [0.004-0.309]), the vaccination calendar (6.854 [3.172-14.813]), the waiting period (0.115 [0.051-0.261]), administrative barriers (7.572 |2.004-28.617]) and psychological barriers (0.086 [0.043-0.170]). CONCLUSION: The vaccination status of migrant children under 5 years of age in the city of Casablanca remains a public health issue and requires better healthcare coverage in order to improve the vaccination situation in this vulnerable population.

Occupation and risk of female breast cancer: A case-control study in Morocco.

BACKGROUND: Breast cancer is the most frequent cancer among Moroccan women. Environmental and occupational factors may play a role in breast cancer etiology. This study aimed to investigate the association between occupation, industry, and breast cancer risk among Moroccan women. METHODS: A total of 300 breast cancer cases and 300 controls (matched by age and area of residence) were included in this study. Full occupational history was collected, with a detailed description of each job held for at least 6 months. Occupations were coded according to the International Standard Classification of Occupations (ISCO 08) and the Moroccan Analytical Classification of Professions (2001). Industries were coded according to the Statistical Classification of Economic Activities in the European Community (2008). Odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounders were estimated by using conditional logistic regression. RESULTS: An overall decreased risk of breast cancer was observed among women doing only household work (OR = 0.32; 95% CI = 0.18-0.55). An increased risk of breast cancer was observed among women in agricultural occupations, particularly those employed as agricultural laborers (ISCO 08 code: 921; OR = 2.91; 95% CI = 1.51-5.60) and the risk increased with duration of employment (P trend = .01). Analyses by industry corroborated these findings. CONCLUSIONS: Our findings suggest that occupational exposures may be associated with increased risk of breast cancer among female agricultural workers in this population. Further investigations, with advanced methods of occupational exposure assessment, are warranted to clarify the role of chemicals involved in this high-risk occupation and to suggest preventive actions and screening.

Adaptation and validation of a food frequency questionnaire (FFQ) to assess dietary intake in Moroccan adults.

BACKGROUND: To date, no culture-specific food frequency questionnaires (FFQ) are available in North Africa. The aim of this study was to adapt and examine the reproducibility and validity of an FFQ or use in the Moroccan population. METHODS: The European Global Asthma and Allergy Network (GA2LEN) FFQ was used to assess its applicability in Morocco. The GA2LEN FFQ is comprised of 32 food sections and 200 food items. Using scientific published literature, as well as local resources, we identified and added foods that were representative of the Moroccan diet. Translation of the FFQ into Moroccan Arabic was carried out following the World Health Organization (WHO) standard operational procedure. To test the validity and the reproducibility of the FFQ, 105 healthy adults working at Hassan II University Hospital Center of Fez were invited to answer the adapted FFQ in two occasions, 1 month apart, and to complete three 24-h dietary recall questionnaires during this period. Pearson correlation, and Bland-Altman plots were used to assess validity of nutrient intakes. The reproducibility between nutrient intakes as reported from the first and second FFQ were calculated using intra-class correlation coefficient (ICC). All nutrients were log-transformed to improve normality and were adjusted using the residual method. RESULTS: The adapted FFQ was comprised of 255 items that included traditional Moroccan foods. Eighty-seven adults (mean age 27.3 ± 5.7 years) completed all the questionnaires. For energy and nutrients, the intakes reported in the FFQ1 were higher than the mean intakes reported by the 24-h recall questionnaires. The Pearson correlation coefficients between the first FFQ and the mean of three 24-h recall questionnaires were statistically significant. For validity, de-attenuated correlations were all positive, statistically significant and ranging from 0.24 (fiber) to 0.93 (total MUFA). For reproducibility, the ICCs were statistically significant and ranged between 0.69 for fat and 0.84 for Vitamin A. CONCLUSION: This adapted FFQ is an acceptable tool to assess usual dietary intake in Moroccan adults. Given its representativeness of local food intake, it can be used as an instrument to investigate the role of diet on health and disease outcomes.

Risk factors affecting patients survival with colorectal cancer in Morocco: survival analysis using an interpretable machine learning approach.

The aim of our study was to assess the overall survival rates for colorectal cancer at 3 years and to identify associated strong prognostic factors among patients in Morocco through an interpretable machine learning approach. This approach is based on a fully non-parametric survival random forest (RSF), incorporating variable importance and partial dependence effects. The data was povided from a retrospective study of 343 patients diagnosed and followed at Hassan II University Hospital. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% 0.84-0.91), 77% (SE = 0.02; CI-95% 0.73-0.82) and 60% (SE = 0.03; CI-95% 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the BS. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.

Evaluating the Effectiveness of the COPD Assessment Test (CAT) in Screening for Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem that remains largely under-diagnosed, mainly due to the under-use of spirometry to establish the diagnosis. The aim of this study is to evaluate the effectiveness of the Moroccan Arabic dialect version of the COPD Assessment Test (CAT) in screening for COPD. Methods: This was a cross-sectional study carried out in primary care facilities in Morocco, involving participants aged 40 and over. The performance of CAT in detecting cases of COPD was measured with reference to the results of spirometry, considered to be the gold Standard. Results: A total of 477 participants were included in the study. The prevalence of COPD was 6.7%. Internal consistency of the Moroccan Arabic dialect version of the CAT was high, with a Cronbach's alpha of 0.89. The total score of the CAT and of each item was significantly higher in subjects with COPD than in those without (P=0.000). Significantly negative correlations were found between CAT total score and FEV1 (r = -0.33, p=0.000), CAT and FVC (r = -0.22, p=0.000), CAT and FEV1/FVC ratio (r = -0.22, p=0.000). The receiver operating characteristic curve showed an area under the curve of 0.93. A CAT score of 10 was the optimal cut-off value for COPD screening, with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.1%, 93.9%, 48.1% and 98.4%, respectively. Conclusion: The results of the present study showed that the CAT could be used as a screening tool for COPD. The use of this tool by healthcare professionals in primary care settings will improve and promote early diagnosis of this chronic disease.

Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews.

INTRODUCTION: The Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise and synthesise the available evidence on the burden and health outcomes, policies and access (barriers and facilitators) related to these mobile populations in the region. METHODS: Seven systematic reviews will cover three questions to explore the: (1) burden and health outcomes, (2) policies and (3) healthcare barriers and facilitators for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000-2023), reference-check relevant publications and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data by disease outcome if they are of sufficient volume and similarity. Where meta-analysis is not possible and where data are on policy or access, we will narratively synthesise the evidence using summary tables, figures and text. DISSEMINATION: We anticipate disseminating the findings through peer-reviewed publications, conferences and other formats relevant to all stakeholders. We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and protocols will be registered on International Prospective Register of Systematic Reviews.

Effects of physical activity and nutrient supplementation on symptoms and well-being of schizophrenia patients: An umbrella review.

BACKGROUND: Physical activity and nutrient supplementation have been acknowledged to have moderate effects on symptoms and treatment compliance of patients suffering from mental disorders. However, there is still a lack of consensus on whether these interventions are effective on schizophrenia clinical and quality of life outcomes. Our objective was to provide a comprehensive review of systematic reviews that addressed the effects of physical activity and nutrient supplementation on treatment compliance, symptoms and improving the well-being of patients with schizophrenia. METHOD: We carried out an umbrella review following Johanna Briggs Institute methodological guidance as follows: 1) Formulating a review question, 2) developing a search strategy, 3) systematic search in scientific databases (Medline, Cochrane Library, Science Direct), 4) study selection (title, abstract and full-text screening), 5) data extraction, 6) data charting and synthesis and 7) quality appraisal. RESULTS: Our search strategy yielded 2214 articles published between 1960 and 2023. Nine systematic reviews fitted our inclusion criteria. Our umbrella review suggests that yoga is effective on positive and negative symptoms, and well-being, whereas aerobics is only effective on positive symptoms. We also found that supplementing polyunsaturated fatty acids and trace elements reduced schizophrenia's negative symptoms. CONCLUSION: Our umbrella review highlighted moderate to low-quality evidence supporting the effectiveness of physical activity on negative and positive schizophrenia symptoms and the overall well-being of patients with schizophrenia. Our review findings support the need to promote physical activity and supplementation of micronutrients, a cost-effective strategy to promote healthy lifestyles in low and middle-income countries.

Gut acquisition of Extended-spectrum ß-lactamases-producing Klebsiella pneumoniae in preterm neonates: Critical role of enteral feeding, and endotracheal tubes in the neonatal intensive care unit (NICU).

BACKGROUND: Klebsiella spp. can colonize the intestine of preterm neonates, and over-growth has been associated with necrotizing enterocolitis, hospital-acquired infections, and late-onset sepsis. This could lead us to suggest that the clinical pertinence of intestinal colonization with ESBL in preterm neonates appears to be important. We conducted this study to characterize the genetic proprieties of ESBL-producing Klebsiella pneumoniae (ESBL-KP) under clinical isolates and to describe the risk factors for the intestinal tract acquisition event during hospitalization. METHODS: One hundred and thirteen premature infants were recruited from the neonatal intensive care unit (NICU). All newborns are issued from the birth suites of the pregnancy department. Two rectal swabs were planned to define K. Pneumoniae intestinal carriage status. ESBL-KP was confirmed by Brilliance ESBL selective chromogenic Agar. Antimicrobial susceptibility testing including phenotypic testing and genotypic detection of the most commonly described ESBL genes was done. Logistic regression models were performed to find the variables associated with the acquisition event of ESBL-KP. RESULTS: A total of 62 (54.86%) premature neonates were colonized with ESBL-KP. The rate of blaSHV, blaTEM, blaCTX-M1, blaCTX-M2, blaCTX-M9, and blaOXA-48 genes among the isolates was 82, 48, 93.5, 4.8, 11.2 and 3.22%, respectively. We found that ESBLs K. Pneumoniae isolates were 100% resistant to amoxicillin, clavulanic acid-amoxicillin, cefotaxime, ceftazidime, and gentamicin. The regression model is for a given significant association between the tract intestinal of ESBL-KP acquisition events and the use of enteral tube feeding (OR = 38.46, 95% CI: 7.86-188.20, p-Value: 0.001), and endotracheal tubes (OR = 4.86, 95% CI: 1.37-17.19, p-Value 0.014). CONCLUSION: Our finding supposes that the enteral feeding tube and endotracheal tube might have a critical role in colonizing the intestinal tract of preterm infants. This highlights the current status of both practices that will require updated procedures in the NICU.

Risk factors affecting patients survival with colorectal cancer in Morocco : Survival Analysis using an Interpretable Machine Learning Approach.

The aim of our study was to assess the overall survival rates for colorectal patients in Morocco and to identify strong prognostic factors using a novel approach combining survival random forest and the Cox model. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% = 0.84-0.91), 77% (SE = 0.02; CI-95% = 0.73-0.82) and 60% (SE = 0.03; CI-95% = 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index, while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the Brier Score. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.

Anxiety, Stress, and Depression Among Healthcare Professionals During the COVID-19 Pandemic: A Cross-Sectional Study in Morocco.

The COVID-19 pandemic has caused an enormous psychological impact worldwide. This study aimed to assess anxiety, depression, stress, and compensatory behaviors among Moroccan healthcare workers (HCWs) during COVID-19. This descriptive cross-sectional study was conducted using a snowball sampling strategy. This descriptive cross-sectional study was conducted using a snowball sampling strategy. Online surveys were sent to groups of HCWs working in Casablanca and Fez cities. Post-traumatic stress disorder (PTSD) was measured using the Impact of Event Scale revised (IES-R) scale, and the DASS-21 was used to measure anxiety, depression, and stress among participants. Compensatory behaviors used by HCWs to manage these symptoms were also investigated. The majority of participants (72.5%) experienced moderate to severe distress during the COVID-19 pandemic. The majority of participants (53.1%) reported symptoms of mild to extremely severe depression. Overall, nurses, female, and frontline HCWs experienced more stress, anxiety, and depression (P < .001). Leisure activities (29%), sport (19%), and drinking tea/coffee (19%) were the most common compensatory behaviors. Our findings suggest that psychological support and interventions targeting high-risk HCWs with heavy psychological distress are needed. It is of paramount importance to improve the psychological endurance and safeguard the mental and physical well-being of HCWs, who find themselves on the frontline of health and humanitarian crises, when they are needed the most.

Ramadan and Diabetes: What About Non-Fasting Patients with Diabetes?

Background: The management of diabetes during Ramadan is well codified. International guidelines recommend avoiding fasting for patients with the risk of complications. However, during Ramadan drastic changes occur in lifestyles habits. Our study aims to evaluate the impact of the month of Ramadan on the lifestyle habits and metabolic profile of non-fasting patients with diabetes. Patients and Methods: This observational cross-sectional study was carried out during 3 months of Ramadan in 2018, Ramadan 2019, and Ramadan 2021. We conducted 3 consultations (before, during, and after Ramadan). Before Ramadan, we collected anthropometric and metabolic parameters, and we assessed physical activity level and dietary intake. During Ramadan, we evaluated the occurrence of complications such as hyperglycemia and hypoglycemia, as well as we assessed physical activity level, dietary intake, and the number of meals. After Ramadan re-evaluate anthropometric and metabolic parameters. Results: We included 155 patients, 93.5% had type 2 diabetes and 6.5% had type 1 diabetes. We found that glycated hemoglobin, LDL cholesterol, and Triglyceride increased significantly after Ramadan (p-value <0.001). We also found that weight, body mass index, waist circumference. Caloric intake increased significantly during Ramadan (p-value <0.001); this increase concerned 61.3% of patients. In terms of metabolic parameters, diabetes was unbalanced in 52.6% of patients, hypoglycemia occurs in 20.9% of patients, and hyperglycemia was experienced by 37% of patients during Ramadan. We found that LDL cholesterol increased in 48.4% of patients, triglycerides increased in 60.6% of patients and serum level of total cholesterol increased in 55% of patients. Conclusion: Our study showed that during Ramadan risk of complications in patients with diabetes is not only related to fasting.

Factors determining membership in community-based health insurance in West Africa: a scoping review.

BACKGROUND: In many low-income countries, households bear most of the health care costs. Community-based health insurance (CBHI) schemes have multiplied since the 1990s in West Africa. They have significantly improved their members' access to health care. However, a large proportion of users are reluctant to subscribe to a local CBHI. Identifying the major factors affecting membership will be useful for improving CBHI coverage. The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa. METHODS: A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute. Several databases were searched (PubMed, ScienceDirect, Global Health database, Embase, EconLit, Cairn.info, BDPS, Cochrane database and Google Scholar) for relevant articles available by August 15, 2022, with no methodological or linguistic restrictions in electronic databases and grey literature. RESULTS: The initial literature search resulted in 1611 studies, and 10 studies were identified by other sources. After eliminating duplicates, we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts. Of the 71 full texts assessed for eligibility, 32 additional papers were excluded (not relevant, outside West Africa, poorly described results) and finally 39 studies were included in the synthesis. Factors that negatively affect CBHI membership include advanced age, low education, low household income, poor quality of care, lack of trust in providers and remoteness, rules considered too strict or inappropriate, low trust in administrators and inadequate information campaign. CONCLUSIONS: This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage. Coverage through CBHI schemes could be improved through communication, improved education and targeted financial support.