A Cross-Sectional Analysis of Health Behavior in School-Aged Children: The Qassim Study.

Background Childhood obesity is a worldwide public health epidemic. Sedentary lifestyles and unhealthy dietary patterns increased the rates of overweight and obesity among children. This study aimed to (1) estimate healthy behaviors (including dietary patterns and physical activity) and (2) determine the prevalence of overweight and obesity among Saudi school-aged children in the Qassim region, Saudi Arabia. Methods A population-based cross-sectional study was conducted among Saudi schoolchildren aged between five and 16 years old. The study group consisted of 339 children including 237 males and 102 females. Data were collected using a questionnaire based on the Health Behavior in School-Aged Children (HBSC) survey. Body mass index (BMI) for age and gender was computed for each child using the AnthroPlus 2007 software (World Health Organization {WHO}, Geneva, Switzerland). Statistical Package for Social Sciences (SPSS) version 23.0 (IBM SPSS Statistics, Armonk, NY) was used for data analyses. Results The prevalence of overweight and obesity among Saudi children was 46 (13.6%) and 81 (23.9%), respectively. Males consumed more soft drinks and energy drinks, whereas females consumed more fruit juice. As children grew older, the consumption of unhealthy food and beverages increased. Males engaged in more daily physical activity compared to females. Conclusion Saudi schoolchildren (aged 5-16 years) demonstrated significant gender-specific variations in dietary patterns and levels of physical activity. A significant proportion of Saudi children were overweight or obese. The study highlighted the complex relationship between age, school class, gender, and health behaviors among Saudi school-aged children. Policymakers and parents could benefit from the understanding of such complex relationships to promote healthy behaviors among school-aged children.

Beyond antipsychotics: the role of medication and nonmedication factors in female sexual dysfunctions in schizophrenia.

To date, few studies have investigated male sexual dysfunctions (FSDs) in schizophrenia in non-Western countries, with most studies focusing on the sexual side effects of antipsychotic medications. Therefore, we aimed to screen for FSD in a sample of Egyptian females with schizophrenia, compare them to controls and to investigate demographic and clinical parameters associated with FSD. We conducted a cross-sectional study of 72 medicated and unmedicated females with schizophrenia (27 unmedicated and 45 medicated) and 24 controls. They were assessed using the Female Sexual Function Index (FSFI) and data were collected for demographic and clinical parameters. We found that females with schizophrenia had significantly lower scores on the FSFI compared to controls and that 93.1% of females with schizophrenia reached the threshold for FSD (FSFI score ≤26), compared to 87.5% of controls. Medicated and unmedicated subjects did not differ significantly in most domains of the FSFI. Age, duration of illness, positive and negative syndrome Scale total, positive and negative symptom scores correlated significantly with the majority of domains of the FSFI. Rates of FSD are very high in both schizophrenia and controls and correlate in schizophrenia with a number of demographic and clinical parameters, suggesting that FSDs are not restricted to the side effects of medications. There is a need to screen for sexual function in routine practice, and for developing active strategies to tackle sexual dysfunctions.

Prevalence of smartphone addiction and its correlates in a sample of Egyptian university students.

BACKGROUND: Smartphone addiction is considered currently as a public health concern especially among university students. AIM: The study assesses the prevalence of smartphone addiction and its sociodemographic and psychiatric correlates among Egyptian university students. METHODS: A random sample of 1,380 undergraduate Egyptian university students from different universities were assessed using the smartphone addiction short scale, Beck depression Inventory, Beck anxiety Inventory, Pittsburgh sleep Quality Index, and Columbia suicide severity scale. RESULTS: About 59% are smartphone addicts without any gender difference, we find a highly significant relation between smartphone addiction and depression, anxiety, sleep disturbance, smoking, and suicide. CONCLUSION: our study adds to the existing literature regarding the magnitude of smartphone addiction and its relationship with different psychiatric disorders.

Role of traditional healers in the pathway of service for a sample of obsessive compulsive disorder patients in Egypt.

BACKGROUND: The diagnosis and treatment of an illness using traditional medicine is in most cases culture-specific and based on beliefs in the community. The majority of mentally ill patients prefer to attend to traditional healers because of the trust problems in the system, affordability, accessibility, and ease of the service. AIM: To assess the role of traditional healers among the pathway of psychiatric services of OCD patients, and to highlight its clinical correlates. METHODS: we assessed 93 patients with OCD after confirmation of the diagnosis with fifth version of MINI semi structured interview, using a questionnaire designed and accustomed by authors to assess help seeking behavior in OCD patients and its sociodemographic and clinical correlates. Type of symptomatology and its severity were assessed using Y-BOCS. RESULTS: A total of 39.8% sought traditional healers help, 94.6% were before psychiatric advice, main symptoms related to traditional healers seeking were religious and sexual obsessions. Main causes of traditional healers' preference were stigma of seeking psychiatric advice in 89.2% of cases, considering disease related to religion in 81.1%, considering that religious commitment help in treatment 75, 7%, and considering disease related to magic and superstitions in 45.9%. Religious origin of illness was the most statistically significant factor related to seeking advice at traditional healers. CONCLUSION: This study shows that a significant percentage of the patients suffering from OCD prefer to approach traditional healers first due to their own beliefs mainly religious, and society acceptance.

Rates of Alexithymia and Its Association With Smartphone Addiction Among a Sample of University Students in Egypt.

INTRODUCTION: Alexithymia is characterized by difficulties in describing feelings. Many studies have shown that there is a relation between alexithymia and different types of addictions. Nowadays, smartphone addiction is proposed to be a global problem. The current study focuses on the rates of alexithymia and its association with smartphone addiction in an Egyptian university. MATERIALS AND METHODS: This is a cross-sectional study that was conducted in Ain Shams University. A sample of 200 university students was surveyed using Toronto Alexithymia Scale (TAS) and Smartphone Addiction Scale - Short Version (SAS-SV). RESULTS: The results showed that 44 students (22%) had alexithymia. It was also found that around one third of the sample (N=65, 32.5%) met the criteria of smartphone addiction. There was a strong association between alexithymia and smartphone addiction (OR=4.33, 95% CI 2.15-8.74, p= < 0.001). CONCLUSION: This study supports existing literature indicating the strong association between alexithymia and smartphone addiction.

Role of traditional healers in the pathway to care of patients with schizophrenia in Egypt.

BACKGROUND: Traditional healers are considered one of the important stages in the pathway to care of schizophrenia patients because of the confidence in the system, affordability and accessibility of the service, exposing patients to hazardous management, delay in seeking psychiatric help and bad prognosis. AIM: To assess the pathway to care of schizophrenia patients and role of traditional healers into it, the sociodemographic and clinical correlates of those patients. METHODS: We assessed 232 patients with schizophrenia after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version using a questionnaire designed by authors to assess help seeking behavior in schizophrenia patients and its sociodemographic and clinical correlates. Positive and Negative Syndrome Scale to identify the presence and severity of symptoms. RESULTS: A total of 41.8% sought traditional healers first, 58.1% sought a psychiatric consultation first, main symptoms related to traditional healers seeking were hallucinations in 51.5%, delusions 29.9%, 9.28% bizarre behavior and 9.28% formal though disorder. Main causes of traditional healers' preference were society acceptance 30.39%, affordability 24.74% and accessibility 16.49%. CONCLUSION: This study shows that a significant percentage of the patients suffering from schizophrenia prefer to approach faith healers first due to their own beliefs, society acceptance, affordability and easy accessibility.

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses.

BACKGROUND: Although Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS. METHODS: We conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis. RESULTS: Participants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users. CONCLUSIONS: Our exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.

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

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

Plain packaging of waterpipe tobacco? A qualitative analysis exploring waterpipe smokers' and non-smokers' responses to enhanced versus existing pictorial health warnings in Egypt.

OBJECTIVE: Despite the global increase in waterpipe tobacco smoking (WTS) including in Egypt, few studies have assessed the effectiveness of waterpipe tobacco (WT) health warnings. Egypt has used pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) and has rotated these every two years since 2008. We explored in this qualitative study how participants perceived existing PHWs on WTPs, assessed how they interpreted novel plain packaging of WT featuring enhanced PHWs, and probed perceptions of how existing and novel sets would affect uptake or cessation of WTS. DESIGN: We conducted ten qualitative focus groups and ten in-depth interviews. We explored participants' views of the four existing PHWs (occupied 50% of the front and back of WTPs, displayed cancers, and featured colourful fruits and flavors) and four novel PHWs (occupied 80% of the front and back of WTPs, displayed different topical content, with plain packaging). Transcripts were analyzed using thematic analysis. SETTING: Rural Menoufia, urban and semi-urban Cairo, Egypt. PARTICIPANTS: 90 waterpipe smokers and non-smokers, men and women, aged 18 years or older. OUTCOMES: Perceived potential effect on WTS uptake or cessation, probing factors related to PHW content and WTP design. RESULTS: Participants in focus groups and in-depth interviews thought existing WT PHWs elicited affective responses, but found them unclear or unrealistic and thought the colourful packaging detracted from the warnings. In contrast, they thought novel and larger WT PHWs presented in plain packaging might prevent WTS initiation or trigger quit attempts. Participants regarded warnings featuring proximal health risks as most likely to be acceptable. CONCLUSIONS: Our exploratory study suggests larger WT PHWs featuring proximal risks and presented on plain WTPs could potentially deter experimentation with WT products among non-users and promote cessation among existing users.

Sleep profile in anorexia and bulimia nervosa female patients.

OBJECTIVE: Sleep wake cycle and eating patterns undergo major changes throughout life and have been proved to be very correlated. Eating disorder prevalence is increasing and sleep problems are very common among them. The current study is concerned with investigating the sleep pattern in anorexia and bulimia female patients using both subjective and objective assessment tools. METHODS: A cross sectional study of sleep patterns using structured sleep disorder questionnaire and full night polysomnography in 23 female patients with bulimia and anorexia, patients aged 18-45 years not on any treatment for a month at least, compared to a sex and age matched control group (20 participants), all cases were collected from the Institute of Psychiatry, Ain Shams University over 18 months interval. RESULTS: Significant affection of most domains of sleep measured by subjective and objective assessment tools in patients compared with the control group. DISCUSSION: Sleep is equally affected in bulimia and anorexia patients, confirming that sleep and eating disorders are highly correlated. Sleep may be a clinical marker in eating disorders.

Stop Turning a Blind Eye: Tobacco Smoking Among Egyptian Patients With Schizophrenia.

Background: Patients with schizophrenia have considerably higher rates of mortality than general population. Multiple factors may play a role in this. Despite being a major preventable cause of death, smoking is usually overlooked when dealing with patients with schizophrenia. Understanding the pattern of smoking, its severity, and the reasons to quit might be helpful in managing patients with schizophrenia and decreasing the mortality gap. Subjects and Methods: The study included smokers divided into two groups; the first included 346 patients with schizophrenia while the second group had 150 smokers with no mental illness. Both groups were assessed and compared regarding sociodemographic variables, pattern of smoking, severity of nicotine dependence, and motivation to quit smoking. Results: Earlier age of starting to smoke, higher number of cigarettes per day, and lower dependency scores were noted in patients with Schizophrenia. Positive correlation was found between positive symptoms and severity of dependence. Specific positive symptoms were correlated to number of cigarettes per day and time before first cigarette. Patients with Schizophrenia showed a significant difference in intrinsic reasons to quit (health concerns and self-control), which were also positively correlated to their positive symptoms score. Linear regression analysis for predictors of FTND score revealed that only age, sex, and schizophrenia were significant predictors of FTND score. Conclusion: Patients with schizophrenia smoke at earlier ages and smoke more cigarettes per day, yet, have less severe dependence than non-schizophrenic counterparts. Positive symptoms play a role in their smoking pattern and severity. Health concerns and self-control are their main motives to quit smoking.

Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt.

BACKGROUND: A large number of mentally ill patients prefer to visit non-medical practitioners such as traditional healers because of the confidence in the system, affordability and accessibility of the service. This may lead to delay in seeking psychiatric services and has prognostic impact. AIM: To assess the rate of bipolar affective disorder (BAD) patients seeking traditional healers, the sociodemographic and clinical correlates of those patients. METHODS: We assessed 350 patients with BAD after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version and assessment of functioning with Global Assessment of Functioning scale. They were assessed for percent, rate and timing of seeking traditional healers. RESULTS: In all, 40.8% sought traditional healers, with 34.9% more than four times. Of those, 62.2% were before seeking psychiatric services and 37.8% after. Lower educational level, less impairment of functioning and presence of hallucinations were significant correlates. CONCLUSION: This study shows that most of the patients suffering from mental illness prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers.

Psychiatric disorders among a sample of internally displaced persons in South Darfur.

BACKGROUND: The violent armed conflict in Darfur has been ongoing for years getting the attention of human rights activists and mental health professionals. AIM: The aim of this study was to assess psychiatric disorders in a sample of internally displaced persons (IDPs) in South Darfur. METHOD: A cross-sectional observational study, as a part of the 'Darfur Campaign' organized by Arab Federation of Psychiatrists, assessing psychiatric disorders in a sample of internally displaced women using the Structured Clinical Interview for DSM-IV (SCID-I) (clinical version). RESULTS: Up to 25.7% of participants had lost a close family member or more in the violent clashes. Psychiatric diagnoses were found in 62.2% of the participants. The most frequently reported was post-traumatic stress disorder (PTSD) reaching 14.9%, followed by depression 13.5% (among which 2.7% with psychotic features), while comorbid PTSD and depression reached 8.1% of participants. Patients with psychiatric diagnoses had an older age (36.6 years) (p = .024). Suffering from a psychiatric disorder was found to be associated with losing a family member in the conflict (p = .015), being 35.6% in patients with psychiatric diagnoses compared to 10.3% in those without losing a family member in the conflict (odds ratio (OR) = .7, 95% confidence interval (CI) = 1.25-18.28). CONCLUSIONS: This study used a standardized tool for diagnosing psychiatric morbidity among refugees in Darfur to give as much as possible an actual description of the problems and psychiatric morbidity caused by human-made disasters. This study can help to lead to a more detailed and specific mental health service program much needed by this population.

Correlates of psychiatric co-morbidity in a sample of Egyptian patients with bipolar disorder.

BACKGROUND AND OBJECTIVES: Bipolar disorder (BD) is a complex, chronic mood disorder involving repeated episodes of depression and mania/hypomania. Two thirds of patients with bipolar disorder have a comorbid psychiatric condition. This study aims to assess the prevalence of Axis I diagnosis with its socio-demographic and clinical correlates among a sample of Egyptian patients with bipolar disorder. METHODS: Out of the 400 patients who were enrolled in the study from number of governmental and private psychiatric hospitals in Cairo, Egypt, 350 patients diagnosed with bipolar affective disorders (157 females and 193 males) with age ranging from 18 to 55years were selected. Patients were assessed using the Structured Clinical Interview for DSM-IV Axis I disorder (Research Version) (SCID-I). RESULTS: Prevalence of psychiatric comorbidity among BD patients was 20.3% (71 patients) among which 63 patients (18%) had comorbid substance abuse and 8 patients (2.3%) had comorbid anxiety disorders. LIMITATIONS: The study was limited by its cross sectional design with some patients having florid symptoms during assessment, not having a well representative community sample. This might have decreased the reliability and prevalence of lifetime psychiatric comorbidity due to uncooperativeness or memory bias. The study group was composed of bipolar patients attending tertiary care service which limits the possibility of generalizing these results on different treatment settings. CONCLUSIONS: Substance abuse followed by anxiety disorders was found to be the most common psychiatric comorbidity. Family history of psychiatric disorders and substance abuse as well as current psychotic features were highly correlated with comorbidity.