Determining the health educational needs of people living with diabetes is essential in developing patient-centered, structured health education programs that aim to improve the outcome of diabetes care. To develop a tool for the identification of the health education needs of individuals living with diabetes in the Jazan Armed Forces Hospital (JAFH) and to standardize the questionnaire through the assessment of its reliability and validity. A cross-sectional design was used in the present work, which included 303 participants living with diabetes. The researchers and an expert panel in family medicine and endocrinology created a comprehensive and mutually exhaustive questionnaire covering every potential area of health education needs. It included a 15-item section with questions on a 5-point Likert scale for determining the participants' needs for health education. Cronbach's alpha was used to determine the Likert scale's reliability. Exploratory factor analysis was used to determine the Likert scale's construct validity. The total number of males was 123 (40.6%) and that of females was 180 (59.4%). Their mean ages were 55.9 ± 12.9, ranging from 18 to 94 years. The reliability of the 15-item Likert scale was 83%, and it increased to 90% when the redundant items (n = 5) were eliminated. The test had an 86% test-retest reliability when repeated. Also, the final 10-item Likert scale has significant face, content, and construct validity. Two components with eigenvalues over 1 (generic knowledge about diabetes, and diabetes and travel) could be extracted out of the 10-item Likert scale. The final 10-item Likert scale offers a good degree of validity and reliability for determining the health education needs of individuals living with diabetes. The two Likert scale components (general information on diabetes, and diabetes and travel) and their contributing items were identified from the questionnaire, which is standardized and helpful in both practice and research, in order to ascertain patients' needs and develop structured health education programs. The component "General information about diabetes" exhibited significant associations with the following items: diabetes risk factors and prevention; common oral agents for treating hypoglycemia; HbA1c (glycosylated hemoglobin) and normal blood glucose levels; and acute problems related to diabetes, such as hypoglycemia and diabetic ketoacidosis. On the other hand, diabetes and fasting; chronic complications of diabetes; and the significance of the yearly eye screening were the Likert scale items that contributed more to Component 2 (diabetes and travel).
There is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure. To compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes. A prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support. Delivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother's illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037). Women with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers' health.
The World Health Organization (WHO) stresses the importance of worldwide vaccine coverage of coronavirus-19 (COVID-19) vaccination. This study fills a critical gap in the literature by providing empirical evidence on the factors influencing COVID-19 vaccine hesitancy and inequity in the Middle East and North Africa (MENA) region. This study investigated the determinants of psychological antecedents and other factors behind COVID-19 vaccination and their role in vaccine coverage in MENA. An anonymous online cross-sectional survey was conducted in 11 MENA countries (Egypt, Sudan, Kuwait, Saudi Arabia, Morocco, Iraq, Yemen, Lebanon, Libya, Afghanistan, and Pakistan). The minimum required sample size from each country was 307, which was increased to 330 to accommodate a non-response rate of 7%. A multilevel logistic regression model was used to capture the clustering of observations in each country and estimate the explanatory variables' effects on each item of the 5C components of the psychological antecedents scale namely (confidence, constraints, complacency, calculation, and collective responsibility). The total number of respondents was 3630, 40.5% of them were between the ages of 18 and 25 years, 61.1% were females, 54.0% completed university education, 55.8% were unmarried, 19.5% had chronic diseases, 43.7% reported a previous COVID-19 and 42.4% had relatives who died from COVID-19. Much of the variation in the log of the odds in each item of the 5Cs was due to heterogeneity between different countries (intraclass correlation > 0.05). Therefore, this variability confirms the various effects of psychological antecedents on vaccination coverage, stimulating vaccination inequity among them. Increasing confidence in vaccines and collective responsibility towards relatives and the community is related to increasing acceptance of the COVID-19 vaccine. The reduction in complacency, calculations, and constraints was found to be associated with acceptance of the COVID-19 vaccine. This study is novel in shedding light on the importance of psychological determinants as hidden causes of vaccine inequities by using a multilevel logistic regression model for COVID-19 vaccination intention. The findings suggest that targeted interventions addressing socio-demographic factors, psychological antecedents, and accessibility barriers are essential to mitigate vaccine inequity and improve vaccination rates.
Health awareness plays a major role in determining the outcomes of serious medical conditions especially when response time is crucial. STEMI (ST-segment elevation myocardial infarction) patients are prone to serious compilations if they do not receive the appropriate treatment on time. Many factors affect the health awareness of the community, including educational level, previous exposure to similar situations, and exposure to health awareness materials. Those who do not know the symptoms of myocardial infarction will present late to the hospital and are exposed to a higher risk of complications. This study aims to assess the relationship between the health awareness of STEMI patients and the time of presentation to the emergency room (ER). A cohort observational study was conducted at the National Heart Institute in Egypt gathering data on 263 STEMI patients presenting for primary percutaneous intervention. All the demographic and clinical necessary data was collected by the researchers in the emergency room, catheterization lab, and during the hospital admission of the patient. This study is a part of our larger cohort study on the relationship between education/health awareness of patients and outcomes of myocardial infarction. Data from 166 eligible patients were analyzed showing a significant correlation between health awareness and time of presentation to the ER in STEMI patients (p < 0.05). Additionally, there was a significant correlation between educational level and time of presentation to the ER (p < 0.05). The mean time from chest pain to arrival at the ER was 9.5 h. That is far beyond the range recommended internationally. Males, smokers, and younger age patients were significantly more likely to present earlier than their counterparts (p < 0.05). Both educational level and health awareness of cardiac symptoms are associated with early presentation to the ER in STEMI patients. Developing health awareness activities targeting various population groups regarding cardiac symptoms and how to deal with them and including health education in different educational curricula are recommended.
BACKGROUND: Diabetes distress is highly prevalent among patients with type 2 diabetes mellitus (T2DM), and is consistently associated with poor self-care, medication nonadherence, and suboptimal glycemic control, leading to worse outcomes and reduced quality of life. Despite its clinical significance, routine screening is often overlooked in primary care and family medicine settings due to limited time and resources. Brief tools, such as the 2-item (DDS-2) and 4-item (DDS-4) Diabetes Distress Scales, offer practical alternatives to longer measures; however, validated Arabic versions are lacking. Given the high burden of T2DM in the Middle East and North Africa, culturally adapted and reliable screening instruments are necessary. This study evaluated the psychometric properties of the Arabic DDS-2 and DDS-4 among Egyptian patients with T2DM. METHODS: A cross-sectional study was conducted with 366 participants recruited from five urban family medicine settings in Port Said, Egypt. Internal consistency was evaluated using Cronbach’s α, and confirmatory factor analysis (CFA) was used to assess the one-factor structure of the Arabic DDS-4. Concurrent, convergent, and predictive criterion validity were assessed by examining correlations between the Arabic DDS-2 and DDS-4 and the 17-item Diabetes Distress Scale (DDS-17), Patient Health Questionnaire-9 (PHQ-9), General Medication Adherence Scale (GMAS), and glycated hemoglobin (HbA1c). Known-group validity was assessed through associations with sociodemographic and clinical characteristics. Criterion validity was evaluated using receiver operating characteristic (ROC) curves, with high diabetes distress defined by the DDS-17 cutoff (≥ 3). RESULTS: The Arabic DDS-2 and DDS-4 demonstrated strong internal consistency, with Cronbach’s alpha values of 0.728 and 0.904, respectively. CFA confirmed a one-factor structure for the Arabic DDS-4. The Arabic DDS-2 and DDS-4 showed very strong correlations with the DDS-17 (r = 0.910–0.953, p < 0.001), supporting strong concurrent validity. Both scales demonstrated moderate positive correlations with depressive symptoms (r ≈ 0.53–0.55, p < 0.001) and weak negative correlations with medication adherence (r ≈ − 0.31 to − 0.33, p < 0.001), indicating good convergent validity. Their weak correlations with HbA1c (r ≈ 0.19–0.21, p < 0.001) provided evidence of fair predictive validity. Known-group validity was confirmed by higher distress scores among patients with lower education, physical inactivity, failure to achieve glycemic targets, insulin use, complications, comorbidities, depressive symptoms, and poor medication adherence (all p < 0.05). The area under the curve (AUC) was higher for the DDS-4 (0.958) than for the DDS-2 (0.846), indicating stronger discriminative ability. The DDS-2 achieved excellent specificity (99.6%) and positive predictive value (98.6%), whereas the DDS-4 showed superior sensitivity (95.9%) and negative predictive value (98.9%). CONCLUSION: The Arabic DDS-2 and DDS-4 are reliable and valid instruments for screening diabetes distress in Arabic-speaking patients with T2DM. Their brevity makes them particularly useful in busy clinical settings, while their psychometric strength supports application in diverse healthcare contexts and research.
The COVID-19 pandemic posed a significant threat to public health, particularly mental well-being. Due to the rapid spread of the virus and quarantine restrictions, social media usage increased dramatically. Excessive and unregulated social media use may negatively impact mental health, contributing to heightened feelings of helplessness and anxiety. This study aimed to examine the relationship between the frequency and duration of social media use and symptoms of depression and anxiety among employees at Ain Shams University during the COVID-19 pandemic. A cross-sectional analytical study was conducted over 6 months, from September 1, 2021, to March 31, 2022, among 405 employees at Ain Shams University. A stratified random sampling method was employed in two stages. First, the university's faculties were categorized into four disciplines: humanities and social sciences, natural sciences, mathematics, statistics, computer science and engineering, and medical and health sciences. Second, two faculties were randomly selected from each discipline to ensure representative sampling. Data were collected using a structured questionnaire, which included the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scales to assess anxiety and depression levels. A total of 405 participants were enrolled, comprising 203 males and 202 females, with a mean age of 42.15 ± 10.72 years (range: 20.00-59.00). The majority (77%) held a university degree, and 68.9% were married. A history of COVID-19 infection was reported by 38.3% of participants, and 78.8% used social media to stay updated about the pandemic. Approximately, half of the participants accessed social media three to four times per day, spending an average of 2 to 3 h daily. According to the PHQ-9 scale, 40.7% of employees who accessed social media six or more times per day experienced severe depression symptoms. Similarly, based on the GAD-7 scale, 41.6% of employees who accessed social media six or more times daily reported severe anxiety symptoms. The findings suggest a concerning association between frequent COVID-19-related social media exposure and symptoms of depression and anxiety. These results highlight the potential mental health risks associated with excessive social media use, emphasizing the need for mental health awareness programs and strategies to combat misinformation during crises.
The Palestinian healthcare system has historically relied on referrals of patients to health facilities across Palestine's borders. Patients referred typically suffered from chronic conditions or congenital anomalies for which the governmental health facilities in Palestine lacked treatment or diagnostic options. The ongoing Israeli genocide on the Palestinian population has destroyed much of the health system and facilities in Gaza and caused tens of thousands of traumatic injuries that need referral abroad, on top of the cohort of patients with chronic conditions and congenital anomalies. Statistics published by the WHO-oPt show that 7,841 patients have been allowed medical evacuation and referral from Gaza between the start of the war in October 2023 and 29 September 2025. About two-thirds of all patients (n = 5,000. 63.8%) were medically evacuated before the Israeli military forces occupied the Rafah border crossing with Egypt on 7 May 2024, and 1,702 (21.7%) patients were evacuated between 19 January 2025 and 17 March 2025 as part of the ceasefire agreement. Egypt has received the majority of patients (n = 3,995, 51%) who have been medically evacuated. Excluding the two periods mentioned, a clear Israeli policy emerged since occupying the Rafah border crossing, which weaponized healthcare by preventing patients from Gaza from being medically evacuated to travel abroad to receive life-saving healthcare. The Israeli policy of weaponizing the referrals and medical evacuations has resulted in excess mortality that merits further research and quantification, as patients succumbed to their medical conditions or injuries while waiting to exit Gaza. Action needs to be taken by host countries to step up their efforts to receive more patients from Gaza and put more pressure on Israel to facilitate the safe evacuation process of these patients.
Despite the global decline in HIV infections and mortality worldwide, the HIV epidemic is still growing in the MENA region. In the region, People Living with HIV (PLWH) are facing many challenges related to cultural values, norms, and provided services which create significant obstacles to HIV prevention and control efforts. This study aimed to translate, culturally adapt, and validate the "2021 Louisiana Needs Assessment Questionnaire" for use among Egyptians and Arabic-speaking population. Arabic translation and cultural adaptation of the questionnaire passed through five stages. The questionnaire was translated forward and backward then an expert committee reviewed the translated version. Another expert committee reviewed the developed version after modification to assess the content validity using the Content Validity Index (CVI). The last step included a cognitive interview of a convenient sample of 50 adult PLWH in five consecutive rounds to assess subjects' understanding of questions and response items and their meanings. Modifications were carried out all through the translation and adaptation process of the questionnaire including used words, nomenclature of services, adding or omitting response items, and ordering of questions and response items. The synthesized Arabic-adapted questionnaire has adequate content validity and all questions are clearly understood by the studied subjects. The calculated Content Validity Index of all questionnaire items ranged from 0.82 to 1. The developed culturally adapted questionnaire has adequate content validity/semantic appropriateness. It can be used to assess the needs of PLWH in the MENA region with minor adaptations to fit each country. It can also be used to follow the outcome and impact of implemented programs and services. Further research is recommended to assess its psychometric properties.
Aluminum (Al) is the most abundant element in the Earth's crust. Occupational exposure to aluminum can lead to serious adverse health effects for workers in the aluminum industry. Genetic variations could be considered as contributing internal factors for the susceptibility of individuals to toxicities related to Al exposure. Different experiments have investigated genetic polymorphism variations in metabolic pathways, which could significantly modulate an individual's susceptibility to aluminum-induced toxicity. This study aimed to evaluate the effects of aluminum exposure on oxidant-antioxidant status, parathyroid hormone (PTH), and free testosterone levels. Also, to show whether an association exists between MTHFR A1298C (rs1801131) and CBS (844ins68) gene polymorphisms with the aforementioned biochemical parameters among occupationally exposed workers to Al. Urinary heavy metals (Al, Cd, Ni, Cr, Pb) were measured through ICP-MS in 95 workers in the aluminum industry and 90 control individuals. We also analyzed serum MT-1, MDA, PTH, free testosterone, and TAC using ELISA methods. CBS (844ins68) and MTHFR A1298C gene polymorphisms were performed by (PCR-RFLP). Revealed a significant rise in serum MT-1, MDA, and urinary heavy metals levels with reductions in TAC, Free testosterone, and PTH levels. A negative relation was found between serum TAC, duration of exposure, and between age and serum free testosterone levels. In workers, the association of the wild type of MTHFR A1298C genotype with a rise in serum MT-1 and MDA levels and a decrease in TAC was observed compared to the control, while the heterozygote genotype AC was associated with reduced serum free testosterone, TAC, and PTH levels among the workers group. Moreover, serum MT-1 showed a significant rise in NN genotype of the CBS gene with a decline in serum TAC and PTH levels, while Heterozygote NI recorded reduced TAC levels among the worker group compared to the control. Significant reduction in serum TAC was shown in the heterozygote NI among the worker group compared to the control. Association of wild-type and heterozygote genotype of both MTHFR A1298C (rs1801131) (AA and AC) and CBS (844ins68) (NN and NI) with reduced TAC levels among the worker group. Moreover, the AC genotype of MTHFR was associated with a decrease in the PTH and free testosterone levels among Al industry workers.
BACKGROUND: Type II Workplace violence (WPV), in which the healthcare staff is attacked by the patients or their relatives/friends, is a significant issue in healthcare, impacting healthcare quality, worker safety, and organizational performance. Although studied frequently, further studies are needed in non-university hospital settings and departments other than the emergency. This study aimed to estimate the prevalence of physical and verbal type II WPV against physicians, identify the circumstances of the last incidents, and evaluate existing preventive measures from the physicians’ perspective. METHODS: A descriptive cross-sectional design was used, recruiting a convenience sample of 324 physicians from one Health Insurance Organization (HIO) and one Ministry of Health and Population (MOHP) hospital in Alexandria (183 and 141 physicians, respectively). Data collection took place between August and November 2023 using a structured pre-validated self-administered questionnaire in English. The Statistical Package for Social Sciences (SPSS) version 25 was used for data analysis. RESULTS: Verbal and physical WPV were reported by 61.4% and 8.3% of participants, respectively. Exposure was significantly associated with age group (30–40), single physicians, and residents’ position (p < 0.05). The patient’s relatives were the main aggressors. Physical violence was more common during the evening, while verbal violence was frequent in the morning. Emergency departments (EDs) were the primary sites of violence. Prevalent triggers included refusal of treatment, patient conditions, work overload, and long waiting times. Most incidents went unreported due to negligence and ignorance of reporting procedures. The HIO hospital showed better security measures, workplace procedures, staff training, and organizational support, while the MOHP hospital had better adequacy of staffing and resources. CONCLUSION: WPV is highly prevalent among the studied physicians, particularly in emergency settings and among junior staff. Institutional adoption of OSHA-based WPV prevention protocols remains inadequate, highlighting the need for systemic reform.
The textile industry is the second risk factor for bladder cancer, after smoking. Previous studies focused on the impact of exposure to high concentrations of bladder carcinogenic chemicals in the textile dyeing industry on the elevation of bladder cancer biomarkers. This study aimed to evaluate bladder carcinogenic air pollutants in a textile dyeing factory and investigate its role and the role of serum 25-hydroxyvitamin D (25-OH vit. D) on cancer bladder biomarkers in exposed workers. A cross-sectional study was conducted. Particulate and vapor forms of polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) were monitored in the printing, dyeing, and preparing sections of a textile factory. Bladder tumor antigen (BTA), nuclear matrix protein 22 (NMP-22), and 25-OH vit. D were estimated in all the exposed workers (147 exposed workers) and in workers not occupationally exposed to chemicals (130 unexposed workers). Aromatic bladder carcinogenic compounds were either in low concentrations or not detected in the air samples of working areas. BTA and NMP-22 of exposed workers were not significantly different from the unexposed. However, 25-OH vit. D was significantly lower in the exposed than unexposed workers. There was a significant inverse correlation between 25-OH vit. D and duration of exposure in exposed workers. The mean levels of PAHs and VOCs were within the safe standard levels in the working areas. The non-significant difference in BTA and NMP-22 between the exposed and unexposed groups suggests the presence of occupational exposures to safe levels of bladder carcinogenic aromatics, while the significantly lower 25-OH vit. D levels among the exposed than the unexposed groups could suggest the potential association of 25-OH vit. D with occupational exposures to low levels of PAHs and VOCs, and this association was found to be inversely correlated with the duration of exposures. Accordingly, more specific predictor tests must be applied for early diagnosis of bladder cancer among the exposed workers.
BACKGROUND: The U.S. Environmental Protection Agency ranks indoor air quality as one of the most prominent environmental problems However, limited research has addressed indoor air quality in Egypt, particularly in highly sensitive environments such as hospitals. Moreover, traffic-related pollutants such as nitrogen dioxide (NO₂) are rarely investigated as risk factors in hospitals. Therefore, this study assessed the occupational exposure risks associated with traffic-related NO₂ in four public hospitals on different main streets in Alexandria, Egypt. METHODS: This study was carried out through indoor nitrogen dioxide sampling during the morning shifts in four public hospitals in Alexandria, Egypt. Hospitals were selected and categorized based on the traffic congestion levels of their main streets. The traffic congestion categories included heavy, moderate, and low congestion areas as well as on-sea road areas. One hospital was randomly chosen from each category. RESULTS: The results of the present study showed the highest NO₂ exposure recorded among hospital staff located in the heavy traffic area during hot months, whereas the lowest exposure observed was among on-sea hospital staff. The results indicated that outdoor traffic emissions were the primary source of indoor NO₂ exposure. The results showed a strong and statistically significant correlation with nearby traffic congestion. The risk of indoor nitrogen dioxide concentrations during hot and cold months was high at most indoor locations: 72.7% and 63.6% of locations in the heavy traffic hospital during hot and cold months, respectively. Moderate risk was observed at most of the locations at moderate traffic hospital (77.8%), the sea-road hospital (57.1%), and the low traffic hospital (54.5%) during both hot and cold months. CONCLUSIONS: This study concludes that NO₂ concentrations increase with traffic congestion, and the risk factor was found to be moderate to high at most of the measured indoor locations in the four hospitals. It is recommended to reduce NO₂ exposure among hospital staff and patients by utilizing mechanical ventilation systems with air filtration.
Delayed diagnosis and treatment can be detrimental not only to patients but also to the community, as such delays can perpetuate TB transmission. This presents a significant challenge in the ongoing efforts to eliminate TB from the community. The primary objectives of this scoping review were to map out research surrounding delays in TB care across the ten countries with the highest TB burden globally and to identify research gaps in this area. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) were adhered to in reporting this scoping review. Three databases: PubMed, DOAJ, and Scopus, were searched to collect articles published between 2004 and 2024, all in the English language. A total of eighty-one articles were included in this review. Out of 831 articles, following the eligibility criteria, 81 full-text open-access articles were deemed suitable for review. The findings indicate that delays in TB care are influenced by several factors, including patient-related, household and social, health system, economic, and occupational factors, as well as health-seeking behaviour. Significant variations in delay duration were observed across the reviewed studies. Myanmar recorded the longest median total delay of 170.6 days, while India and China reported median total delays ranging from 8 to 111 days. Due to resource constraints, Mozambique experienced the highest median health system delay of 150 days. There were a very limited number of studies conducted in the Democratic Republic of Congo, the Philippines, and Zambia. This scoping review found that delays in TB care in high-burden countries are influenced by a combination of patient, social, economic, and health-system factors, with significant differences in delay durations between different countries. These findings underscore the need for stronger health systems, targeted community education to encourage timely care-seeking, and stigma-reduction efforts to minimise delays and support TB elimination goals.
Climate change has emerged as a global environmental issue exacerbated by human activities. Specifically, greenhouse gas emissions and land-use changes have contributed to rising global surface temperatures and shifting weather patterns. These changes disrupt environmental and ecosystem balance, directly impacting human health. Worldwide, 3.6 billion people live in regions vulnerable to climate change, and it is projected that between 2030 and 2050, an additional 250,000 deaths annually will occur due to climate change-induced malnutrition, malaria, and diarrheal diseases. The health impacts of climate change vary between genders depending on biological, geographical, and socioeconomic factors, with women experiencing more severe negative effects. Reproductive health is significantly affected by rising temperatures, air pollution, extreme weather events, and changing meteorological conditions. Adverse reproductive outcomes (e.g., low birth weight, preterm birth, and congenital anomalies) are more frequently observed in women. Furthermore, climate change exacerbates hot flashes, increases the risk of cardiovascular diseases, and intensifies mental health disorders in postmenopausal women. Climate change has emerged as a global environmental issue exacerbated by human activities. Specifically, greenhouse gas emissions and land-use changes have contributed to rising global surface temperatures and shifting weather patterns. These changes disrupt environmental and ecosystem balance, directly impacting human health. Worldwide, 3.6 billion people live in regions vulnerable to climate change, and it is projected that between 2030 and 2050, an additional 250,000 deaths annually will occur due to climate change-induced malnutrition, malaria, and diarrheal diseases. The health impacts of climate change vary between genders depending on biological, geographical, and socioeconomic factors, with women experiencing more severe negative effects. Reproductive health is significantly affected by rising temperatures, air pollution, extreme weather events, and changing meteorological conditions. Adverse reproductive outcomes (e.g., low birth weight, preterm birth, and congenital anomalies) are more frequently observed in women. Furthermore, climate change exacerbates hot flashes, increases the risk of cardiovascular diseases, and intensifies mental health disorders in postmenopausal women. However, current literature remains limited in addressing the specific effects of climate change on women's health in low- and middle-income countries, as well as its influence during the menopausal period. Further research is needed to explore the intersection of climate change and socioeconomic disparities, particularly in vulnerable populations. Large-scale longitudinal studies focusing on region-specific risks and health outcomes are essential to develop targeted interventions and policies.
Video gaming is a popular leisure activity among adolescents. Those who play excessively are in danger of educational and social drawbacks and may become addicted to video gaming. Several published studies determined the prevalence of GD among children in specific Saudi regions. However, the current study assessed the national prevalence of video gaming disorder (GD) and its risk factors among school students in Saudi Arabia. A school-based survey was conducted among adolescents in all regions of Saudi Arabia during the academic year 2021-2022. A multistage stratified cluster sampling technique was used to select the school students. An Arabic-validated version of the 9-item dichotomous (yes/no) GD Scale based on the DSM-5 criteria was used to determine GD prevalence among the students. The score ranged from zero to nine (0-9). Participants who scored five or more were deemed as having GD. Students who scored less than five were classified as normal gamers (score 0-1) or risky gamers (score 2-4).  We recruited 5332 school students. Their mean age was 15.5 ± 1.7 years, and almost half of them were males (50.7%). According to the GD score, the prevalence of normal gamers was 39.08% (N = 1714), risky gamers 40.47% (N = 1775), and those with GD was, 20.45% (N = 897). Logistic regression was performed to determine the association between video gaming disorder and all the gathered variables, which include age, educational grade, sex, types of video gaming, and categories of video games played. The results showed that nationality, age, educational grade, sex, using only mobile devices to play, and playing puzzle and sports games were not associated with video gaming disorder. On the other hand, it was revealed that using tablets, game consoles, PCs; having multiple devices; and playing online, fighting, car racing, war, and adventure games were significantly linked to GD. The prevalence of GD was 20.45% among Saudi school students who play video games. Utilizing more than one type of gaming device and playing games in the fighting, war, and multiplayer categories via an online connection were significantly linked to having GD. To limit video gaming addiction, we encourage screening, diagnosing, and treating disordered video gamers early. In addition, governmental authorities and video game companies should discuss and revise numerous policy measures to minimize the accessibility of video games, limit the harms and risks related to them, and assist video gamers in becoming effective members of society.
While antimicrobial use (AMU) in human healthcare has received significant attention as a key driver of antimicrobial resistance (AMR), less emphasis has been placed on AMU practices and attitudes in animal husbandry. To address this gap, this study examines the patterns and underlying drivers of AMU on animal farms. A survey instrument was distributed to farm staff in 150 animal farms across 15 Egyptian governorates. Farms were selected from a list curated by a private platform specialized in Egypt's poultry and cattle industry. An online search was conducted to identify additional farms not included in the list or when the contact information was unavailable. The instrument covered key items related to AMU including types of antimicrobials used, indications, their perceived benefits, and the feed conversion ratio (FCR). Using the theory of reasoned action (TRA) as a guiding theoretical framework, this study assesses key factors influencing the AMU behavior of farm personnel. Out of 150 farm personnel invited to fill out the survey forms, 111 (74%) responded and agreed to participate. All surveyed personnel reported using antimicrobials, and almost two-thirds (65%) reported using them for non-therapeutic purposes. Non-therapeutic use of antimicrobials, however, had no impact on FCR across all farm types (poultry, cattle, and mixed). The most used antimicrobials were penicillins (81%), followed by macrolides (78%) and tetracyclines (72%). Half of the studied farms reported using colistin, with more than half of this segment (55%) reporting using it for non-therapeutic purposes. Farm personnel's AMU behavior was associated with the TRA constructs: perceived benefits of antimicrobials (attitude) and perceived AMU behavior in other farms (subjective norm). Antimicrobials are unanimously used in animal farms in Egypt, including those classified as last-resort options, such as colistin. Using antimicrobials for disease prevention or growth promotion did not decrease the FCR. Interventions that target the farm personnel's attitude and the subjective norm should be carried out to change their behavior regarding the use of antimicrobials. Egyptian guidelines for AMU in livestock are urgently needed, along with training to raise awareness of AMR and safer practices. The use of last-resort drugs like colistin should be banned in animal farming, and national surveillance systems should monitor AMU and AMR trends.
Cardiovascular disease (CVD) is the leading cause of death globally, with women at higher risk after menopause. This increased risk is attributed to both aging and hormonal changes. Prior research has established a link between CVD risk perception and adopting healthy behaviors to prevent CVD. This study aimed to assess the accuracy of self-perceived CVD risk in perimenopausal and postmenopausal women, and to identify factors that predict CVD risk underestimation among them. A cross-sectional study was conducted in the administrative sectors of Suez Canal University campus in Ismailia, Egypt, over a period of eight months starting in July 2022. A total of 390 eligible women (employees and workers) were randomly selected. Participants were interviewed to obtain data on demographics, medical history, self-perceived risk of CVD, self-perceived general health, awareness of factors that increase the risk of developing CVD, perceived stress, health literacy, numeracy, and self-perceived 10-year risk of developing major cardiovascular events. They also underwent measurements of blood pressure, weight, and height. The updated 2019 WHO/CVD risk non-laboratory-based prediction chart for the North Africa and Middle East Region was used to predict the 10-year risk of major cardiovascular events for the study participants. Risk accuracy was measured by comparing self-perceived CVD risk with predicted CVD risk. The ratio of self-perceived to predicted moderate/high CVD risk was 27.7% to 44.3%, respectively. The accuracy of CVD risk perception was 68.2%. Kappa analysis results showed fair and significant agreement between self-perceived and predicted CVD risk (kappa ± SE = 35.9 ± 4.1%, p < 0 .001). The proportion of women who underestimated their risks was 24.1%. Of those in the high-risk group, 93.3% underestimated their CVD risk, compared to 50.6% in the moderate-risk group. Factors that significantly predicted CVD risk underestimation included being married (aOR 14.5; 95% CI 1.4-149.9), low income (aOR 2.321; 95% CI 1.09-4.909), high BMI (aOR 4.78; 95% CI 1.9-11.9), hypertension (aOR 3.5; 95% CI 2-6.2), and old age (aOR 1.46; 95% CI 1.3-1.6). Approximately one-third of our study participants misperceived their CVD risk; of those who did, 75.8% underestimated it. Marital status, old age, low income, high BMI, and hypertension strongly predicted CVD risk underestimation. These findings identified the menopausal women subgroups that could benefit from targeted health interventions designed to reduce CVD risk underestimation and improve risk accuracy.
The rapid global increase in the older adult population presents unprecedented challenges and opportunities for healthcare systems worldwide. This demographic shift is accompanied by a growing prevalence of chronic conditions such as cardiovascular diseases, diabetes, dementia, and other geriatric syndromes, underscoring the urgent need for innovative, age-sensitive healthcare solutions. Traditional healthcare models often fall short in addressing the complex, multifactorial needs of older adults, highlighting the need for a transformative approach to care delivery and management that integrates personalization, continuity, and technological innovation. This article is a narrative review that synthesizes recent literature published within the last ten years, drawing from PubMed, Scopus, Web of Science, and Google Scholar to explore cutting-edge advancements in geriatric care, with a focus on telemedicine, mobile health (mHealth), artificial intelligence (AI), robotics, and wearable technologies. These innovations offer promising avenues to improve healthcare accessibility, enhance patient outcomes, and alleviate the burden on caregivers. For instance, telemedicine facilitates remote consultations, reducing hospital visits and ensuring continuity of care for individuals in remote or underserved areas. mHealth applications empower older adults to actively manage their health, monitor chronic conditions, and stay connected with caregivers. Robotics and AI-driven systems provide physical support, cognitive stimulation, and personalized care planning, thereby enhancing independence and emotional well-being. However, successfully integrating these technologies into geriatric care requires addressing several challenges, including technical limitations, data privacy concerns, and disparities in digital literacy. A major hurdle lies in ensuring that these solutions are user-friendly and tailored to the diverse physical and cognitive needs of older adults.
With the changing perception of Caesarean Section (CS) from a lifesaving to a routine procedure, non-medically indicated CS is increasing. This study assessed the prevalence, indications, and preference for CS among women attending primary health care (PHC) units in Port Said Governorate, Egypt. A cross-sectional study was conducted from December 2023 to February 2024 in six primary health care units across Port-Said Governorate, Egypt. Married women of childbearing age who had experienced at least one childbirth (primiparous and multiparous) were included. A total of 179 participants were recruited using multistage sampling, combining random selection of PHC units and consecutive sampling of eligible women. Data were collected using a validated structured questionnaire covering socio-demographics, obstetric history, last delivery experience, and preference for the next delivery. Statistical analysis was performed using SPSS v26, including univariate and multivariate logistic regression to identify factors associated with CS and delivery preference. A total of 179 women participated in the study. Of these, 68% had CS for their last delivery. The most frequently reported reasons for previous CS were fear of labor (56%), prolonged labor (18%), and long distance to the hospital (15.6%). Regarding future delivery preferences, (61.5%) of women expressed a preference for CS. The leading reasons cited were less pain (81.8% ), the belief that CS is safer for the baby (57.3%), and the knowledge of the time of delivery (32.2%). Multivariate logistic regression identified independent predictors for each outcome. Women with higher income [AOR 10.0, 95% CI 2.7-36.9, < 0.001] and those whose doctor suggested CS [AOR 19.2, 95% CI 5.5-67.1, p < 0.001] were more likely to have had a CS in their last delivery. In contrast, preference for CS in the next delivery was independently associated with higher husband education [AOR 12.1, 95% CI 1.2-124.3, p = 0.036] and a history of previous CS [AOR 14.7, 95% CI 6.2-34.6, p < 0.001]. Fear of labor and previous CS were the main drivers of past and preferred future CS deliveries, with non-medical factors outweighing medical indications. Findings highlight the need for educational interventions to support informed delivery choices.
Antibiotic resistance, a major global health concern, is primarily caused by the irrational use of antibiotics. Parents play a crucial role in antibiotic use by children, directly impacting their clinical outcomes. This study aimed to assess the pattern of antibiotic use among parents and its related factors. A cross-sectional study was conducted among 400 parents randomly selected from the pediatric outpatient clinics of Al-Zahraa University Hospital, Cairo. Data were collected using a structured interview questionnaire about sociodemographic data, antibiotic use patterns, parental knowledge and attitudes, common sources of information, and reasons for self-prescribing antibiotics. Out of the 400 parents surveyed, 87.7% were mothers with a mean age of 31.9 ± 7 years, 76% were highly educated, almost half were not working, 63% came from urban areas, and 95.2% had sufficient income. As for their children, 57.5% had male children; their average age was 5.5 ± 3.7 years. The misuse of antibiotics was prevalent among 37.2% (95% CI = 32.5-42.2%) of parents. When assessing parents' knowledge and attitude towards antibiotic use, 30.2% (95% CI = 25.8-35.0%) had good knowledge which was significantly more common among highly educated, working, and high-income parents, while the majority (72%, 95% CI = 67.3-76.3%) had a positive attitude. Having more and older children significantly increased the probability of antibiotic misuse, while a higher level of parental education and a positive attitude decreased the likelihood of such misuse (odds ratio (OR) was 1.31, 1.09, 0.52, and 0.11, respectively). Most parents obtained their information about antibiotics from physicians (92%) followed by experience from previous prescription (58.5%). Moreover, among inappropriate users, previous prescriptions and the parent's perception of the child's illness as a nonurgent condition were the most frequently cited reasons for the parents' self-prescription of antibiotics (76.5% and 69.1%, respectively). Approximately, one-third of surveyed parents demonstrated an inappropriate use of antibiotics. Despite possessing a highly positive attitude and a reasonable level of knowledge about antibiotics, parents often underestimate the potential adverse effects. Tailored measures to promote appropriate antibiotic use are therefore needed to combat the problem of antibiotic resistance.