Effects of therapeutic patient education program on glycemic control and quality of life among children and adolescents with type 1 diabetes mellitus in Fez city, Morocco.

Context: Type 1 diabetes mellitus (T1DM) is a chronic disease, mainly observed in children or youth, with a significantly increased incidence in young children. Structured therapeutic patient education (TPE) is a must to help them manage their disease effectively and lead a healthy lifestyle. Aims: This study aimed to assess the effects of a structured TPE program on glycemic markers and quality of life (QOL) of T1DM children and adolescents in Fez city, Morocco. Settings and Design: It is a quasi-experimental study. Materials and Methods: One hundred T1DM children and adolescents, aged 8-18, participated in a TPE intervention at the pediatric department in a hospital center in Fez, Morocco. Glycemic markers were measured and QOL was assessed by a validated questionnaire. Statistical Analysis Used: Parametric and nonparametric tests were used and statistical significance determined by P < 0.05. Results: At 3 months' follow-up, both global and dimensional QOL mean scores improved significantly (P ≤ 0.0001), whereas glycosylated hemoglobin (HbA1c) decreased (10.28% vs. 10.62%), tough with no statistical significance (P = 0.160). Furthermore, a significant improvement was observed in the maximum preprandial (2, 11 g/L [1.51-2.58] vs. 2, 37 g/L [1.81-3.21], P = 0.001) and postprandial blood glucose levels (2, 50 g/L [1.90-3.27] vs. 2, 95 g/L [2.07-3.99], P = 0.001) after 3 months; with no significant change in their minimum. Conclusion: Although this TPE intervention was more effective in improving patients' QOL than their HbA1c, it is worth striving to implement regular TPE programs for T1DM pediatric patients and adjust them to achieve a better patients' glycemic markers levels.

Setting up and assessing a therapeutic education program for asthmatic patients.

BACKGROUND: Asthma is a major public health issue. It remains uncontrolled, despite the availability of effective treatments. Appropriate education programs are required to improve the situation. The study aims to design and assess an educational program based on asthma patients' perceived needs. MATERIALS AND METHODS: A cross-sectional prospective study was conducted in the pulmonology department of the Hassan II University Hospital in Fez. A convenience sample of asthma patients, whether hospitalized or not, was recruited. Two hundred and twenty adult asthma patients completed an educational needs survey (ENS). An asthma knowledge questionnaire for adult patients was used to assess the program on the criterion of improving asthma knowledge. Data collected by ENS was analyzed by standard descriptive statistics. The Student's T test for paired samples was used to compare the means of the Asthma Knowledge Questionnaire scores before and after therapeutic education. RESULTS: Most patients were married and residing in urban areas. The illiteracy rate was 50%. One patient was a regular smoker. 125 patients (56.82%) reported non-compliance to treatment. The pathophysiology of asthma (chronic airway inflammation, bronchial hyperreactivity, and bronchial obstruction), causes and complications, treatment (inhalation technique), asthma attacks and environmental management, lifestyle, and psychological support were the patients' main perceived educational needs. Based on these findings, an instructional program was created and evaluated with 30 patients. After the program, asthma knowledge increased significantly. CONCLUSION: Our results suggest that an educational intervention can improve asthma knowledge.

Evaluation of psychological distress is essential for patients with locally advanced breast cancer prior to neoadjuvant chemotherapy: baseline findings from cohort study.

BACKGROUND: patients with locally advanced breast cancer (LABC) are often treated by neoadjuvant chemotherapy (NACT). This study aims to determine the prevalence of psychological distress and their sociodemographic and clinical factors in patients recently diagnosed with LABC and before NACT. METHODS: A total of 209 LABC patients without metastatic localization were recruited between 2021 and 2022 in the oncology hospital at Fez. A structured questionnaire and the Hospital Anxiety and Depression Scale were used. A descriptive analysis and linear model were performed. RESULTS: a mean age of participants was 47.43 ± 9.45 years. The prevalence of depression, anxiety and psychological distress among participants was 59.62% (95% CI: 52.61-33.34), 47.85% (95% CI: 40.91-54.85), and 65.07 (95% CI: 58.19-71.52) respectively. Depression was associated to age (< 50 years) (AOR = 2.19; 95% CI = 1.13-4.23) and health insurance (AOR = 3.64; 95% CI: 1.18-11.26). Anxiety was associated to age (< 50) (AOR = 2.21; 95% CI: 1.18-4.13) and right breast cancer (AOA = 2.01; 95% CI: 1.11-3.65). Psychological distress was associated to chronic illness (AOR = 2.78; 95% CI: 1.32-5.85) and lymph node status (AOR = 2.39; 95% CI: 1.26-4.57). CONCLUSIONS: Based on the high prevalence of depression and anxiety it appears opportune to treat psychological distress among LABC patient candidates for NACT. Each psychological intervention should take into account sociodemographic and clinical factors found associated in our study. Psychological therapeutic interventions are crucial for LABC patients as early as the time of diagnosis and through subsequent steps in NACT to improve their overall mental health.

Educational needs of type 1 diabetes mellitus T1DM children and adolescents in Morocco: A qualitative study.

BACKGROUND: Type 1 Diabetes Mellitus T1DM is a chronic disease, mainly observed in children or young adults, with a significantly increased incidence in young children. To enable diabetic children and adolescents to lead a healthy life and manage their disease effectively, right from diagnosis, they must benefit from therapeutic patient education TPE whose first stage is an educational diagnosis. This study aimed to identify the educational needs of T1DM children and adolescents through an educational diagnosis. METHODS AND MATERIAL: A qualitative study was conducted with T1DM children and adolescents, aged 8 to 18, at the pediatric department. This qualitative study was conducted through semi-structured face-to-face individual interviews based on a guide with 20 participants in 2022. The internationally recognized ethical research principles were respected and ethical approval was obtained. Data analysis were carried out according to the principles of the reflexive approach of thematic analysis. RESULTS: The interviews' thematic analysis revealed five educational themes: Knowledge about T1DM and its complications risks, measures and attitudes for disease monitoring and therapy management, crisis and short-term complications management, diet and physical activity management, and adaptation of daily life to the disease and treatment constraints. CONCLUSIONS: The educational diagnosis is an essential TPE step to identify the educational needs of children and adolescents with T1DM, and to set up if needed, an educational program allowing them to develop the required skills. Hence, the health policy in Morocco should integrate the TPE approach systematically in T1DM patients' care.

Psychological Distress, Coping Strategies, and Quality of Life in Breast Cancer Patients Under Neoadjuvant Therapy: Protocol of a Systematic Review.

INTRODUCTION: Women with breast cancer eligible for neoadjuvant therapy (NAT) present a disorder of biopsychosocial variables and alteration of their quality of life. They cope with this changing by adopting psychological adjustment strategies, either passive or active. This systematic review aims to investigate the psychological distress, coping strategies, and quality of life in breast cancer patients under neoadjuvant therapy. METHODS: Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Wiley Online library represent the databases that were searched to identify relevant published articles until September 27, 2021. Full-text published articles, written in English and assessing the main outcomes (namely: psychological distress, coping strategies, and quality of life) in women with breast cancer under NAT will be included. Also, we will integrate papers dealing with the related bio psychosocial variables to the main variables. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. We will bring together the results of all of the included studies to draw conclusions based on the body of evidence. The narrative approach will be adopted to analyze the results and conclusions extracted and we would perform quantitative groupings if we have similar data. ETHICS AND DISSEMINATION: Ethical approval is not required as the proposed systematic review will not use primary data. The results of this review will be disseminated through publication in a peer-reviewed journal and conference presentation(s). PROSPERO registration number: CRD42021230300.

Validation of Mini-Mental Adjustment to Cancer scale in a Moroccan sample of breast cancer women.

BACKGROUND: The Mini-Mental Adjustment to Cancer Scale (Mini-MAC) instrument is commonly used worldwide by professionals of oncology, but the scale has not, up to date, been validated in Arabic and Moroccan context, and there is an absence of data in the Moroccan population. This study aims to validate the Mini-MAC, translated and adapted to the Arabic language and Moroccan culture, in women with breast cancer. METHODS: Data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 158). Then, this structure was confirmed in the validation sample (N = 203) using confirmatory factor analysis (CFA). RESULTS: Confirmatory factor analysis confirmed Watson's original structure underlying the Mini-MAC items: Helpless/Hopeless, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance, and Fatalism. Absolute, incremental, and parsimonious fit indices showed a highly significant level of acceptance confirming a good performance of the measurement model. The instrument showed sufficient reliability and convergent validity demonstrated by acceptable values of composite reliability (CR =0.93-0.97), and average variance extracted (AVE = 0.66-0.93), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio of correlations values were lesser than 0.85, indicating acceptable discriminant validity. CONCLUSIONS: reliability; and both convergent and discriminant validity tests indicated that the Arabic version of the Mini-MAC had a good performance and may serve as a valid tool measuring psychological responses to cancer diagnosis and treatment.

An investigation of the association between religious coping, fatigue, anxiety and depressive symptoms during the COVID-19 pandemic in Morocco: a web-based cross-sectional survey.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has triggered fear and distress among the public, thus potentiating the incidence rate of anxiety and depression. This study aims to investigate the psychological effect of quarantine on persons living in Morocco when the first COVID-19 cases were identified. The associations between anxiety, depression symptoms, and their predictors (sociodemographics, fatigue, and religious coping) were examined. METHODS: A web-based cross-sectional survey, with a total of 1435 participants (≥18 years) recruited anonymously, was conducted during the COVID-19 pandemic (from 3 to 30 April 2020). A structured questionnaire was used to assess psychosocial factors, COVID-19 epidemic-related factors, and religious coping. Religious coping, fatigue, and depression, and anxiety were measured by Brief Religious Coping Scale (Brief RCOPE), Chalder Fatigue Scale (CFS), and Hospital Anxiety and Depression Scale (HADS), respectively. A generalized linear model (logistic regression) was used to determine the predictive factors of depression and anxiety. RESULTS: The prevalence of anxiety and depression was 43.0% (n = 621) and 53.0% (n = 766), respectively. Both were associated with female gender, household income decline, tracking COVID-19 news, and fear to contract COVID-19 (aOR = 1.36 to 2.85). Additionally, 32.0% (n = 453) and 26.0% (n = 372) reported severe physical fatigue, and mental fatigue, respectively. Both latter factors were significantly and positively associated with depression as well as with anxiety. Depressive and anxious patients used more negative religious coping, while positive religious coping was slightly associated with depression. CONCLUSION: In this online survey of the general population in Morocco, anxiety and depressive symptoms are prevalent during the COVID-19 pandemic. Pandemic and psychosocial factors, such as female gender, income decline, infection fears, massive COVID-19 news exposure, negative religious coping, and fatigue were associated with increased risk of depression and anxiety symptoms. Psychosocial and financial support should be provided to the quarantined population.