Graphical, statistical and index-based techniques integrated for identifying the hydrochemical fingerprints and groundwater quality of In Salah, Algerian Sahara.

Groundwater, a predominant reservoir of freshwater, plays a critical role in providing a sustainable potable water and water for agricultural and industry uses in the In Salah desert region of Algeria. This research collected 82 underground water samples from Albian aquifers to assess water quality and identify hydrogeochemical processes influencing mineralization. To achieve this objective, various methods were employed to evaluate water quality based on its intended uses. The drinking water quality index utilized revealed the water potability status, while the indicators of irrigation potability were employed to evaluate its quality for agricultural purposes. Additionally, an assessment of groundwater susceptibility to corrosion and scaling in an industrial context was conducted using several indices, e.g., Langelier index, Larson-Skold index, Ryznar index, chloride-sulfate mass ratio, Puckorius index, aggressiveness index, and the Revelle index. The findings of this study revealed that the groundwater quality for consumption fell into four categories: good (2.44%), fair (29.27%), poor (65.85%), and non-potable (2.44%). Concerning agricultural irrigation, the indexical results indicated that 15.85% of the waters exhibited adequate quality, while 84.15% were questionable for irrigation. Calculations based on various corrosion and scaling evaluation indices showed that most wells were prone to corrosion, with a tendency for calcium bicarbonate deposit formation. Furthermore, the hydrochemical study identified three water types: Na-Cl (53.66%), Ca-Mg-Cl (37.80%), and Ca-Cl (8.54%) waters. Analyses of correlation matrices, R-type clustering, factor loadings, Gibbs diagrams, scatterplots, and chloro-alkaline indices highlighted that the chemistry of the Albian groundwater is fundamentally impacted by a number of processes such as silicate weathering, evaporite dissolution, ionic exchange, and anthropogenic inputs, that played impactful role in the aquifer's water chemistry.

Therapeutic targets achievement in secondary prevention after myocardial infarction in a North African tertiary center.

INTRODUCTION: Despite the demonstrated efficacy of cardiovascular (CV) preventive measures, data from international literature indicate that control of CV risk factors (RF) remains insufficient in very high-risk patients. AIM: This study aimed to assess prevalence of achievement of recommended therapeutic targets for the major and modifiable CVRF 12 months after myocardial infarction (MI). METHODS: From 1st January to 30th April 2023, we collected consecutive patients with type 1 MI who had completed 12 months follow-up. Primary endpoint was prevalence of achievement of all recommended therapeutic targets of low-density lipoprotein cholesterol (LDL-C), diabetes mellitus (DM), arterial hypertension (HTN), and smoking. Targets and treatment goals were defined according to the 2021 European Society of Cardiology guidelines on CV disease prevention. RESULTS: 107 patients, mean age 58.8 ± 8.8 years, 74.8% male, were included. 42 (39.3%) patients had HTN, 50 (46.7%) were diabetics, 77 (72.0%) were smokers and eight (7.5%) had hypercholesterolemia. At 12 months, primary endpoint was achieved in 20 (18.7%) patients. 55 (71.4%) of 77 smoker patients were weaned. Blood pressure was at target in 26 (61.9%) among hypertensive patients. In DM patients, HbA1c target was achieved in 23 (46.0%) of them. 32 patients (29.9%) achieved the goal of LDL-C < 0.55 g/L. CONCLUSIONS: Secondary prevention of CV disease was suboptimal. Less than a fifth of patients achieved treatment target for most major and modifiable risk factors. Improvement in follow-up care and treatment after MI is needed.

Analysis of disease characteristics of a large patient cohort with congenital generalized lipodystrophy from the Middle East and North Africa.

BACKGROUND: Congenital generalized lipodystrophy (CGL) is a rare inherited disease characterized by a near-total absence of adipose tissue and is associated with organ system abnormalities and severe metabolic complications. Here, we have analyzed the disease characteristics of the largest CGL cohort from the Middle East and North Africa (MENA) who have not received lipodystrophy-specific treatment. METHODS: CGL was diagnosed clinically by treating physicians through physical assessment and supported by genetic analysis, fat loss patterns, family history, and the presence of parental consanguinity. Data were obtained at the time of patient diagnosis and during leptin-replacement naïve follow-up visits as permitted by available medical records. RESULTS: Data from 43 patients with CGL (37 females, 86%) were collected from centers located in eight countries. The mean (median, range) age at diagnosis was 5.1 (1.0, at birth-37) years. Genetic analysis of the overall cohort showed that CGL1 (n = 14, 33%) and CGL2 (n = 18, 42%) were the predominant CGL subtypes followed by CGL4 (n = 10, 23%); a genetic diagnosis was unavailable for one patient (2%). There was a high prevalence of parental consanguinity (93%) and family history (67%) of lipodystrophy, with 64% (n = 25/39) and 51% (n = 20/39) of patients presenting with acromegaloid features and acanthosis nigricans, respectively. Eighty-one percent (n = 35/43) of patients had at least one organ abnormality; the most frequently affected organs were the liver (70%, n = 30/43), the cardiovascular system (37%, n = 16/43) and the spleen (33%, n = 14/43). Thirteen out of 28 (46%) patients had HbA1c > 5.7% and 20/33 (61%) had triglyceride levels > 2.26 mmol/L (200 mg/dl). Generally, patients diagnosed in adolescence or later had a greater severity of metabolic disease versus those diagnosed during childhood; however, metabolic and organ system abnormalities were observed in a subset of patients diagnosed before or at 1 year of age. CONCLUSIONS: This analysis suggests that in addition to the early onset of fat loss, family history and high consanguinity enable the identification of young patients with CGL in the MENA region. In patients with CGL who have not received lipodystrophy-specific treatment, severe metabolic disease and organ abnormalities can develop by late childhood and worsen with age.

Taxonomic revision of the Stenodynerus fastidiosissimus species-group in Western Europe and North Africa (Hymenoptera: Vespidae: Eumeninae).

The fastidiosissimus species-group of Stenodynerus de Saussure, 1863 is revised in Western Europe and North Africa, combining morphological data and DNA barcoding. Six species are recognized: S. difficilis (Morawitz, 1867) stat. resurr. (= S. fastidiosissimus auct.), S. fastidiosissimus (de Saussure, 1855), S. laborans (Costa, 1882) stat. resurr., S. montanus Selis, sp. nov., S. muelleri (Dusmet, 1917) (= Stenodynerus gusenleitneri Giordani Soika, 1986 syn. nov.), and S. rufescens Giordani Soika, 1977 stat. nov. Lectotypes are designated for Odynerus fastidiosissimus de Saussure, 1855 and Odynerus insularis Andr, 1883 non Smith, 1859. A key for the identification of members of this species-group is provided. DNA barcodes are published for every species, representing the first available sequences for the fastidiosissimus species-group.

Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review.

BACKGROUND: Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions. OBJECTIVE: The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. DESIGN: Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe. RESULTS: In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder. CONCLUSION: Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.

The Use of Mobile Technologies to Promote Physical Activity and Reduce Sedentary Behaviors in the Middle East and North Africa Region: Systematic Review and Meta-Analysis.

BACKGROUND: The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region. OBJECTIVE: This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users' perspectives on these interventions as well as any other outcomes that might influence users' adoption and use of mobile technologies (eg, appropriateness and cultural fit). METHODS: A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools. RESULTS: In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users' perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users' perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes. CONCLUSIONS: The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region. TRIAL REGISTRATION: PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699.

Severity of environmental degradation and the impact on quality of life in Africa.

Considering the mounting impacts of environmental degradation on the global ecosystem, this study offers an empirical contribution to the debate on whether there exists a significant nexus between environmental degradation and quality of life in Africa. Towards this end, we employ several econometric techniques to account for cross-sectional dependence, causality, and also present results based on IV-Lewbel 2SLS regression. Using a sample of African countries, the results indicate cross-sectional dependence due to spill-over effects from common factors in Africa, while the panel cointegration test affirms that environmental degradation have long-term consequences for quality of life only in sub-Saharan African region. Moreover, our results reveal a unidirectional causality between environmental degradation variables and quality of life at both the continent and sub-Saharan African region levels while a bi-directional causality between these variables are revealed for North Africa. On this evidence, our conjecture is that increased mineral extraction, greenhouse gas emissions, and deforestation, amongst other factors, may be driving this result. Hence, improvement in environmental quality in the continent would have an increasingly beneficial effects on the well-being and survival of the populace. The varied impacts across regions also suggest that policy initiatives toward mitigating the effects of environmental degradation should consider regional dynamics of the continent.

Burden of colorectal cancer and its risk factors in the North Africa and Middle East (NAME) region, 1990-2019: a systematic analysis of the global burden of disease study.

OBJECTIVE: The geographical differences in incidence rates of colorectal cancer (CRC) and its burden due to modifiable risk factors warrant investigating the CRC burden and its risk factors in different regions. In the current study, we aimed to estimate the burden of CRC and the share of its risk factors in the North Africa and Middle East (NAME), from 1990 to 2019. STUDY DESIGN: Systematic review. METHODS: The rates of incidence, prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALYs) of CRC were estimated through the framework of the Global Burden of Diseases (GBD), Injuries and Risk Factors Study 2019 by age, sex, between 1990 and 2019. The CRC-related DALYs attributable to each lifestyle and metabolic risk factor was also estimated through a comparative risk assessment approach. RESULTS: In NAME region, the trends of incidence, prevalence, death, YLL, YLD, and DALYs of CRC were increasing, with higher rates in males than females over this period. High and high-middle socio-demographic index (SDI) countries had greater CRC DALYs rate compared with middle- and low-SDI countries in 2019, except for Palestine [434.66 (95% UI: 368.82, 503.88)]. In NAME region, like the global, dietary risk (33.18%), low whole grain intake (19.79%), and low intake of milk (15.77%) were the major contributing risk factors to DALYs due to CRC in 2019. CONCLUSIONS: Due to increasing trend of CRC burden and the considerable role of lifestyle and metabolic factors in its burden in NAME region, implementing fundamental strategies to minimize CRC burden and its risk factors is imperative.

The burden of dermatitis from 1990-2019 in the Middle East and North Africa region.

BACKGROUND: There are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI). METHODS: Publicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs). RESULTS: In 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8-3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6-143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70-74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level. CONCLUSION: The dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.

Impact of atmospheric deposition on the dynamics of ultraphytoplanktonic populations in the Gulf of Gabès during an intense dust event (MERITE-HIPPOCAMPE campaign).

The ultraphytoplankton composition and dynamics were assessed during a Saharan dust event occurring off the southern Tunisian coasts during the MERITE-HIPPOCAMPE Trans-Mediterranean oceanographic cruise. The composition of atmospheric dust was characterized in terms of nutriments and trace metals. Data-assimilative hydrodynamic model revealed no differences in the hydrological features along the sampling track and almost no water transport occurred during the period of atmospheric deposition. Dust deposition increased the growth rates and the productivity of the major phytoplanktonic cytometric groups, resulting in the highest surface biomass along the Mediterranean transect. One group, distinguished by low fluorescence and nanoplanktonic size, reacted to dust deposition within hours, exhibiting the highest growth rate and net productivity. The dust composition showed a substantial enrichment with organic phosphorous representing (56 % of Total phosphorus) and trace metals mainly Fe, Mn and V.

Lactation traits and reproductive performances of Sahraoui female camel in two breeding systems at Algerian Sahara.

The main objective of this study is to determine the impact of the camel livestock system on individual and herd performances of milk production, lactation curve, fats, and protein concentrations. For this purpose, 13 she-camels of Sahraoui breed from the south eastern Algeria and belonging and semi-intensive system (N = 6) and intensive system (N = 7) were studied. Recording and sampling of milk were carried out at regular intervals during a full lactation. The lactation curve was estimated using Wood's gamma function and the t-test of independent groups was carried out to compare lactation performances, lactation curve, and reproductive parameters. The overall average daily milk (DMY), fat (DFY), and protein (DPY) yield were 6.77 ± 0.82 kg/day, 4.15 ± 0.91%, and 4.49 ± 0.20%, respectively. The mean of total milk yield (TMY) was 2696.39 ± 343.86 kg during a mean lactation length (LL) of 398.38 ± 20.65 days. The peak of milk production (6.79 ± 0.68 kg) was reached at 93.9 ± 55.8 days after calving. The open day (DO) and inter-calving interval (ICI) recorded in this study were 348.38 ± 30.33 and 723.38 ± 30.33 days, respectively. There is no significant difference (p > 0.05) between intensive and semi-intensive breeding systems for TMY (2795.39 ± 261.88 kg vs. 2580.89 ± 414.43 kg), DMY (6.96 ± 0.66 kg vs. 6.55 ± 1.00 kg), and LL (402.14 ± 21.18 days vs. 394 ± 21.03 days). However, the total amount of fat was significantly higher in intensive system (182.02 ± 33.91 kg) and the DPY content was significantly higher in semi-intensive system (4.60 ± 0.13%). The parameters α, ß, and γ of lactation, fat, and protein curves between the two systems showed a highly significant difference (p < 0.01) for the parameters (α and ß) for the milk production curve, significant (p < 0.05) for the time to reach peak yield, and no significance for the other parameters. The corresponding values of the coefficient of determination (R2) were 0.62, 0.35 for milk yield (p > 0.05), 0.12, 0.13 (p > 0.05) for fat, and 0.03, 0.11 (p < 0.05) for protein, in the intensive and semi-intensive systems, respectively. In addition, DO and ICI were not significantly different between the livestock systems, but were higher in the intensive system than the semi-intensive system (337.17 ± 26.26 vs. 712.17 ± 26.26, respectively). The study concluded that the intensive system had a higher milk performance with a more efficient lactation curve. The incomplete gamma model (Wood) used in this study was inappropriate for estimating milk yield, but acceptable for fat and protein.

Spatiotemporal trends of cardiovascular disease burden attributable to low physical activity during 1990-2019: an analysis of the Global Burden of Disease Study 2019.

OBJECTIVES: The epidemiological trends of cardiovascular disease (CVD) burden attributed to low physical activity (LPA) across various regions and countries are poorly understood. Hence, we assessed the global, regional, and national spatiotemporal trends of LPA-related CVD from 1990 to 2019. STUDY DESIGN: We conducted a secondary analysis of the Global Burden of Disease Study 2019. The data on LPA-related CVD were examined with regard to sex, age, year, and Socio-Demographic Index (SDI). METHODS: We assessed the temporal changes in age-standardized mortality rate (ASMR) and age-standardized death rate (ASDR) using the estimated annual percentage change (EAPC) over a 30-year period. RESULTS: There were a staggering 0.64 million deaths and 9.99 million disability-adjusted life-years globally attributed to LPA-related CVD in 2019. The majority of the LPA-related CVD burden was observed in the population aged ≥80 years. It also indicated a high disease burden of LPA-related CVD in Central Asia, Arabian Peninsula, and North Africa. Although there has been a decline in ASMR and ASDR associated with LPA-related CVD on a global scale, the countries experiencing the most substantial increase in LPA-related CVD burden are Uzbekistan, Tajikistan, and Azerbaijan. The ASMR and ASDR remained stable in regions with low, low-middle, and middle SDI levels. The EAPCs of ASMR and ASDR were negatively linked with SDI in 2019. CONCLUSIONS: From 1990 to 2019, LPA led to a significant and escalating burden of CVD in certain regions, namely, Uzbekistan, Tajikistan, and Azerbaijan. It is imperative for governments and policymakers to implement regulatory measures and strategic interventions aimed at mitigating this burden.

Prevalence of metabolic dysfunction-associated steatotic liver disease in the Middle East and North Africa.

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is common and closely associated with type 2 diabetes (T2D). We assessed the prevalence of NAFLD/MASLD in the general population and among patients with T2D in the Middle East and North Africa (MENA) region. METHODS: We searched PubMed and Embase for English-language articles published between 1990 and 2023 according to PRISMA. Each country's NAFLD/MASLD prevalence in the general population and in T2D patients was predicted by using a multivariable meta regression model. Input data were extracted from our systematic review, GBD and NCD Risk Factor Collaboration. Confidence intervals were constructed by using prediction intervals with the delta method. RESULTS: Meta-analytic pooling estimated the prevalence of NAFLD/MASLD as 39.43% in the general population and 68.71% among T2D patients. NAFLD/MASLD prevalence has increased from 35.42% (2008-2016) to 46.20% (2017-2020). Using GBD-2019 dataset, it was predicted that there are 141.51 million cases of NAFLD/MASLD in the MENA region. The highest number of NAFLD/MASLD cases were expected in Egypt (25.71 million), followed by Türkiye (23.33 million) and Iran (19.85 million). Estimated NAFLD prevalence exceeded 40% in 10 of 21 countries with the top countries being Kuwait (45.37%), Egypt (45.0%), Qatar (44.4%), and Jordan (43.3%). Furthermore, it was predicted that there are 24.96 million cases of NAFLD/MASLD with T2D in the MENA region. CONCLUSIONS: In the MENA region, prevalence of NAFLD/MASLD is very high and growing, necessitating an urgent need for regional public policy to deal with this growing burden.

Safety and efficiency of COVID-19 vaccine in North Africa.

Background In the absence of a specific treatment for COVID-19, preventive measures have been implemented to control this pandemic and vaccination is one of them. However, it is crucial to verify the safety and efficiency of every vaccine. The aim was to determinate the predictive factors of side effects and reinfection after COVID-19 vaccine. Methods A cross-sectional study was conducted in February 2022 among Tunisians infected with COVID-19 between March 2020 and February 2022, using an online self-administered questionnaire. We conducted univariate and multivariate analyses using binary stepwise logistic regression. Results A total of 1541 was selected from 1911 individuals. Comorbidities affected a quarter of the population (22.3%). Before the initial infection, 39.3% had received full vaccination, and 8.7% had received partial vaccination. By February 2022, the majority (82.9%) had received at least two vaccine doses. The reinfection rate was 30.6%. All vaccines prior to the first infection was identified as a protective factor against reinfection. Inactivated virus vaccinations were less likely to induce adverse effects. Conclusion ach vaccine has its own set of advantages and disadvantages: mRNA-based vaccines had a higher incidence of side effects but all vaccines provided better protection against reinfection.

Burden and Epidemiology of Mental Disorders in the Middle East and North Africa from 1990 to 2019: Findings from the Global Burden of Disease Study

Background: Previous studies have mainly focused on individual mental disorders, and there is no study addressing the total burden of mental disorders in the Middle East and North Africa (MENA). Aims: To evaluate the burden of mental disorders in the MENA region from 1990 to 2019. Study Design: A cross-sectional study. Methods: We utilized global burden of disease data to examine the burden of 12 mental disorders from 1990 to 2019 across age groups, genders, and the 21 MENA countries. We collected data on prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALY), including both crude and age-standardized rates per 100,000 people. Results: The DALY rate of mental disorders in MENA countries increased by 13.88% from 1,747.92 per 100,000 people in 1990 to 1990.5 per 100,000 people in 2019. The highest percentage increases in the DALY rates of mental disorders were observed for bulimia nervosa (35.69%), other mental health disorders (34.58%), and schizophrenia (33.02%) from 1990 to 2019. However, the DALY rates for idiopathic developmental intellectual disability (-26.48%), conduct disorder (-23.91%), attentiondeficit/ hyperactivity disorder (-16.46%), and autism spectrum disorders (-4.12%) decreased in the MENA region from 1990 to 2019. In 2019, the highest DALY rates for idiopathic developmental intellectual disability, anxiety disorders, and major depressive disorder were observed in age groups ≤ 4 years, 5-19 years, and ≥ 20 years, respectively. The age-standardized DALY rate of mental disorders was the highest in Palestine (2,396.9 per 100,000), Iran (2,295.8 per 100,000), and Lebanon (2,126.0 per 100,000) compared with other MENA countries in 2019. Conclusion: There has been a slight increase in the burden of mental disorders in the MENA region between 1990 and 2019. National policies should prioritize evidence-based preventive measures and ensure accessible treatment options for mental health disorders in the population, especially in the MENA region.

Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis.

Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.

Social exclusion concepts, measurement, and a global estimate.

Multiple estimates exist of global monetary and multidimensional poverty, but populations at risk of social exclusion still lack a worldwide estimate. This paper fills this gap by providing the first estimates of the share and number of populations at risk of social exclusion worldwide. The paper contributes to the literature in three important respects. First, it develops a conceptual framework of social exclusion that emphasizes the relative, multidimensional, and dynamic features of exclusion. Second, it proposes a macro-counting methodology that allows measuring populations at risk of exclusion based on identity, circumstances, and socioeconomic conditions, while advancing a protocol to avoid double counting of individuals at risk of social exclusion. Third, the empirical strategy provides to the best of our knowledge, the first estimates of populations at risk of social exclusion by dimensions of exclusion on a global and regional scale. Overall, we estimate that between 2.33 and 2.43 billion people-roughly 32 per cent of the global population-are at risk of social exclusion. The South Asia and East Asia and Pacific regions contain 1.3 billion such people, with India and China alone home to 840 million of them. Meanwhile, 52 per cent of sub-Saharan Africa's population is vulnerable to exclusion, the greatest share of any region. Our findings have important policy implications. While antipoverty policies can support household consumption and smooth its volatility among the poor, they are unlikely to address social exclusion stemming from ethnic, racial, or gender discrimination. Therefore, addressing exclusion necessitates a suite of multiple interventions tailored to distinct groups and sustained over time.

A new small duckbilled dinosaur (Hadrosauridae: Lambeosaurinae) from Morocco and dinosaur diversity in the late Maastrichtian of North Africa.

In the Late Cretaceous, northern and southern hemispheres evolved distinct dinosaurian faunas. Titanosaurians and abelisaurids dominated the Gondwanan continents; hadrosaurids, ceratopsians and tyrannosaurs dominated North America and Asia. Recently, a lambeosaurine hadrosaurid, Ajnabia odysseus, was reported from the late Maastrichtian phosphates of the Oulad Abdoun Basin Morocco, suggesting dispersal between Laurasia and Gondwana. Here we report new fossils from the phosphates of Morocco showing lambeosaurines achieved high diversity in the late Maastrichtian of North Africa. A skull represents a new dwarf lambeosaurine, Minqaria bata. Minqaria resembles Ajnabia odysseus in size, but differs in the ventrally positioned jugal facet and sinusoidal toothrow. The animal is small, ~ 3.5 m long, but the fused braincase shows it was mature. A humerus and a femur belong to larger hadrosaurids, ~ 6 m long, implying at least three species coexisted. The diversity of hadrosaurids in Europe and Africa suggests a dispersal-driven radiation, with lambeosaurines diversifying to take advantage of low ornithischian diversity. African lambeosaurines are small compared to North American and Asia hadrosaurids however, perhaps due to competition with titanosaurians. Hadrosaurids are unknown from eastern Africa, suggesting Moroccan hadrosaurids may be part of a distinct insular fauna, and represent an island radiation.

Young evolutionary origins of dioecy in the genus Asparagus.

PREMISE: Dioecy (separate sexes) has independently evolved numerous times across the angiosperm phylogeny and is recently derived in many lineages. However, our understanding is limited regarding the evolutionary mechanisms that drive the origins of dioecy in plants. The recent and repeated evolution of dioecy across angiosperms offers an opportunity to make strong inferences about the ecological, developmental, and molecular factors influencing the evolution of dioecy, and thus sex chromosomes. The genus Asparagus (Asparagaceae) is an emerging model taxon for studying dioecy and sex chromosome evolution, yet estimates for the age and origin of dioecy in the genus are lacking. METHODS: We use plastome sequences and fossil time calibrations in phylogenetic analyses to investigate the age and origin of dioecy in the genus Asparagus. We also review the diversity of sexual systems present across the genus to address contradicting reports in the literature. RESULTS: We estimate that dioecy evolved once or twice approximately 2.78-3.78 million years ago in Asparagus, of which roughly 27% of the species are dioecious and the remaining are hermaphroditic with monoclinous flowers. CONCLUSIONS: Our findings support previous work implicating a young age and the possibility of two origins of dioecy in Asparagus, which appear to be associated with rapid radiations and range expansion out of Africa. Lastly, we speculate that paleoclimatic oscillations throughout northern Africa may have helped set the stage for the origin(s) of dioecy in Asparagus approximately 2.78-3.78 million years ago.