Validation of the Levenson Self-Report Psychopathy (LSRP) scale in the non-institutionalized Lebanese population.

BACKGROUND: Psychopathy has been described as "the first personality disorder to be recognized in psychiatry". It has three core features: affective, interpersonal, and behavioral. The Levenson Self-Report Psychopathy (LSRP) scale is used to screen for and measure psychopathy. Our study aims to validate the LSRP as a tool to measure psychopathy in the non-institutionalized Lebanese population. METHODS: We surveyed Lebanese individuals residing in Lebanon and aged 18 through 65. It was a convenience sample collected via an online survey. 534 Lebanese participants completed the survey and were included in our analyses. Nearly 80% were female, 90% were college educated, and 60% were employed. We used exploratory graph analysis and confirmatory factor analyses to measure internal validity of the LSRP. We also used the HEXACO Personality Inventory-Revised (HEXACO-PI-R), the Subtypes of Antisocial Behavior Questionnaire (STAB), and the Short version of the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (S-UPPS-P) to measure external validity of LSRP. RESULTS: The exploratory graph analysis showed that the LSRP had a three-factor structure (Egocentric, Callous and Antisocial) in the Lebanese population. This three-factor structure (RMSEA = 0.05, CFI = 0.83, SRMR = 0.06) yielded a better fit than the two-factor, and three-factor Brinkley models. The LSRP was negatively correlated with the Honesty-Humility dimension of the HEXACO-PI-R and positively correlated with the STAB and S-UPPS-P subscales. CONCLUSIONS: The LSRP scale is a valid measure of psychopathy in the Lebanese non-institutionalized population, adding to the currently limited literature addressing psychopathy in the Arab World.

Effectiveness of a modified Balint group process on empathy and psychological skills employing Kirkpatrick's evaluation framework.

Background: To evaluate, using Kirkpatrick's evaluation model, a modified Balint group (BG) by adding 5-10 min at the end of the session, where the facilitators will debrief the residents about critical themes mentioned in the session. Methods: A quasi-experimental study with a mixed-method design was conducted among family medicine residents over 1 year, using focus groups and validated tools filled by residents and their corresponding patients. The residents' empathy through self and patient evaluation, psychological skills, and satisfaction with the educational activity were measured. Results: The focus group revealed that the residents were aware of the change and considered it a closure to the encounter, helping decrease some uncertainty. Most of the residents did not consider the change helpful. Using validated instruments, BG was ineffective at improving the residents' empathy and psychological skills. There was a statistically significant main effect of time on Psychological Medicine Inventory (PMI) scores, F (1,13) = 7.709, p = 0.016. Conclusion: Debriefing at the end of BG by the facilitators about key themes may help give the residents closure, decrease the uncertainty, and make them more aware of their feelings. Nevertheless, Balint groups are still not very well accepted by the residents, and they prefer direct feedback and support groups.

Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use.

BACKGROUND: The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. METHODS: Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. RESULTS: A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). CONCLUSION: This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills.

The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis.

BACKGROUND: The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions. OBJECTIVE: The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence. METHODS: We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. RESULTS: Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app-based intervention showed a significant weight loss of -1.99 kg (95% CI -2.19 to -1.79 kg; I2=81%) at 3 months and -2.80 kg (95% CI -3.03 to -2.56 kg; I2=91%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of -2.09 kg (95% CI -2.32 to -1.86 kg; I2=91%) and -3.77 kg (95% CI -4.05 to -3.49 kg; I2=90%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of -2.03 kg (95% CI -2.80 to -1.26 kg; I2=83%) and -2.63 kg (95% CI -2.97 to -2.29 kg; I2=91%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss. CONCLUSIONS: Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results.

Predictors of admission to an assertive outreach service for psychosis in Lebanon.

Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes. The suitability of this model of care outside the western context has not been fully established. We describe the characteristics of 45 patients enrolled in the Psychosis Recovery Outreach Program (PROP), a program developed at a leading psychiatric facility in Lebanon. We collected twelve-month data for patients and used logistic regression models to identify predictor variables for enrollment in the service compared to those receiving standard treatment. Patients were mostly males (77.8%), younger than 39 years (80%), of college or higher education (68.2%), and diagnosed with schizophrenia (46.7%) or schizoaffective disorder (48.9%). About one-quarter (22.7%) had a comorbid cannabis use disorder. A majority received more than one oral antipsychotic (75.6%) while half (51.1%) were maintained on a long-acting injectable (LAI) antipsychotic. The following variables were significant predictors of enrollment in PROP: having a comorbid cannabis use disorder (OR 2.83 [1.25 - 6.37]), being prescribed a LAI antipsychotic (OR 9.99 [4.93-20.24]) or more than one oral antipsychotic (OR 4.57 [2.22-9.39]), visiting the emergency department more than once (OR 8.7 [2.64-28.68]), and admission to the psychiatry unit (OR 13.91 [3.17-60.94]). In addition, those following up in PROP were younger and less likely to be in the oldest age group (over 54 years) [OR 0.11 (0.01-0.93)], less likely to be females (OR 0.39 [0.18-0.81]), and less likely to be diagnosed with "other psychotic disorder" as compared to schizophrenia (OR 0.14 [0.03 - 0.62]). Our findings highlight that the assertive outreach model of care is applicable to its target population in the context of psychiatric care in Lebanon, namely young individuals with psychosis, higher comorbidities and a severe course of illness.

Prevalence of Iron Deficiency (ID) without anemia in the general population presenting to primary care clinics: a cross-sectional study.

OBJECTIVES: There are no evidence-based recommendations to screen for iron deficiency in non-anemic patients, even though symptoms may be present. The aim of this study is to measure the prevalence of iron deficiency (ID) without anemia in the general population aged 18-50 presenting to primary care along with the incidence and time to develop anemia in the iron-deficient population. METHODS: A single-center retrospective chart review of patients who presented to family medicine clinics between June 2010 and March 2018 at the American University of Beirut Medical Center (AUBMC). Adults 18-50 years old, who had a CBC and ferritin levels ordered with the proximity of maximum four weeks, with an absence of current or previously documented anemia (back to 2007) defined as MCV less than 80 or hemoglobin (Hb) less than 12 in females and 13 in males were included. ID was defined as serum ferritin level below 30 ng/mL. RESULTS: A total of 1,784 adults aged 18-50 years were included. The prevalence of iron deficiency without anemia was 57.5% [95% confidence interval, 55.08% to 59.92%] among females and 7.6% [95% confidence interval, 3.77% to 11.43%] among males. Iron deficiency without anemia was significantly associated with the level of hemoglobin (Hb) among females (Chi-square, p < 0.001). Overt iron deficiency anemia developed within the 5 years follow up in 14% of females and 0.5% of males. There was a statistically significant association between iron deficiency and menorrhagia (Chi-square, P-value = 0.004), dizziness (Chi-square, P-value = 0.018), dyspnea/shortness of breath (Chi-square, P-value = 0.020), polycystic ovarian syndrome (Chi-square, P-value = 0.0256) and rheumatoid arthritis (Chi-square, P-value = 0.00278). CONCLUSION: Iron deficiency without anemia in childbearing females is common but only one-seventh of females developed anemia within 5 years. Guidelines should consider incorporating ferritin levels with CBC in the workup of patients presenting with symptoms suggestive of iron deficiency or anemia.