The Middle East and North Africa region accounts for the largest prevalence of type 2 diabetes (T2D). Qatar ranks top 10 for global T2D prevalence, with 17 percent in 2022. Also, 50 to 70 percent of the cardiovascular events occurred in T2D. We sought to estimate the future health and economic burden of cardiovascular disease (CVD) in T2D from 2023 to 2032.

A dynamic multistate model in people with T2D was constructed. The demographic profile of the population was based on Qatari citizens and residents with T2D aged 40 to 90 years in 2022. First CVD events (i.e., myocardial infarction [MI] and stroke) were calculated via the 2013 Pooled Cohort Equation using data from Primary Health Care Corporation. Recurrent CVD events were sourced from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Outcomes were MI and stroke, years of life lived, quality-adjusted life years (QALYs), total direct and productivity loss costs. Utility and cost model inputs were drawn from published sources. The model adopted a Qatari societal perspective.

The model estimates 123,524 non-fatal MIs (95% uncertainty interval [UI]: 116,923, 130,065), 70,466 non-fatal strokes (95% UI: 67,945, 73,476) and 15,410 CVD deaths (95% UI: 15,217, 15,794), respectively. T2D population accrued 4,834,146 (95% UI: 4,781,235, 4,881,695) total years of life lived and 3,817,246 (95% UI: 3,756,963, 3,870,616) total QALYs. Direct costs accounted for 59.52 percent of the total costs, with a projection of QAR43.59 billion (USD11.98 billion) (95% UI: QAR9.14 billion [USD2.5 billion], QAR134.20 billion [USD36.87 billion]), while the total indirect costs were expected to exceed QAR29.65 billion (USD8.14 billion) (95% UI: QAR2.40 billion [USD659.34 million], QAR113 billion [USD31.04 billion]).

This study highlights that the considerable rising burden of CVD in T2D in Qatar will impact not only the healthcare system but also the society overall. The findings may be used to prioritize strategies targeting T2D to prevent CVD burden.

The inappropriate use of antimicrobial agents has been associated with increased healthcare costs and the spread of multidrug-resistant organisms. We aimed to estimate the economic impact of the developed antimicrobial stewardship program (ASP), after five years of implementation, versus the preliminary ASP, upon implementation, in the cancer setting at the National Center for Cancer Care and Research (NCCCR) in Qatar.

The research investigated the economic benefits of employing a preliminary ASP versus a developed ASP from the perspective of a public healthcare hospital. Preliminary ASP was defined as the 12 months following the establishment of the ASP (i.e., 1 May 2015 to 30 April 2016), while developed ASP was defined as the most recent 12 months of ASP implementation (i.e., 1 February 2019 to 31 January 2020). Patient records were retrospectively reviewed. The total economic benefit of ASP maturity was calculated as the sum of the cost savings and the cost avoidance associated with the service, minus the operational cost.

A total of 1,000 patients were included in the study. The developed ASP was associated with substantial reduction in antimicrobial consumption and resource utilization. Total cost of resources to avoid during the developed ASP period was USD1,634,658, in contrast to USD4,923,024 during the preliminary ASP period, yielding a positive cost avoidance of USD3,288,366. Developed ASP incurred lower operating costs than preliminary ASP, resulting in positive change in operational cost of USD3,428. The benefit-to-cost ratio was 640. The net benefit due to ASP maturity was USD3,624,875. The robustness of the results is demonstrated by the sensitivity analysis.

This study underscores the benefits of ASP development in a cancer setting. The observed reductions in antimicrobial costs from reduced antimicrobial use and the added value of cost avoidance signify the positive impact of a well-developed ASP. These findings lend support to the broader implementation of comprehensive ASPs, which contribute not only to patient-care optimization but also to cost containment.

Diabetes has been shown to influence the individual’s work productivity in terms of both presenteeism (reduced productivity while at work) and absenteeism (absence from work because of illness). We sought to estimate the potential productivity gains associated with the modification of cardiovascular disease (CVD) risk in type 2 diabetes (T2D) over the next 10 years in Australia, from 2023 to 2032.

Dynamic models were structured to estimate productivity-adjusted life years (PALYs) lived by Australians aged 20 to 69 years. The model simulation was first undertaken assuming currently expected trends in the incidence of myocardial infarction (MI) and stroke in T2D (original cohort), as calculated using the 2013 PCE-ASCVD algorithm. Subsequent models were then re-simulated using hypothetical scenarios that reflected the potential benefits of CVD reduction using published trials. The model was also repeated assuming that the original cohort has no CVD. Differences in PALYs lived by the “original cohort” and the different cohorts with reduced CVD risk reflected the PALYs gained. Sensitivity analyses were conducted.

Using data from published studies, the model assumed a reduction of 50 percent in systolic blood pressure (SBP), a reduction of 50 percent in smoking, 50 percent increase in high-density lipoprotein cholesterol (HDL), and a reduction of 35 percent in incidence of T2D. Over the working lifetime, from 2023 to 2032, reducing SBP, smoking, and incidence of T2D led to the gain of 140,105, 333,127, and 998,805 PALYs, respectively. Further, increasing HDL and assuming the original cohort with T2D has no CVD are expected to lead to the gain of 71,623 and 889,455 PALYs, respectively. Sensitivity analyses confirmed the robustness of study findings.

The impact of CVD as a complication from T2D on work productivity is significant. Screening and prevention strategies tailored early in life are likely to exert a positive impact on health and work productivity.

Diabetes is a key risk factor for cardiovascular disease (CVD), with a two-to-four-times higher risk than that in non-diabetes. The health burden associated with CVD imposes a major economic concern on healthcare systems and on society. We sought to estimate the future burden of CVD in terms of health and economic outcomes in type 2 diabetes (T2D) from 2022 to 2031.

From Australian public healthcare and societal perspectives over the next decade, two dynamic models with annual cycles were designed to predict myocardial infarction (MI) and stroke in patients aged 40 to 90 years. First events at risk of CVD people were estimated using the 2013 pooled cohort equation, while recurrent events in existing CVD were acquired from the global Reduction of Atherothrombosis for Continued Health registry. Costs and utilities were obtained using public sources. Outcomes were fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total direct and indirect costs. An annual discount rate of 5 percent was used.

Over the next 10 years, the model projected a total of 83,618 non-fatal MIs (95% confidence interval [CI]: 83,170, 84,053) and 58,774 non-fatal strokes (95% CI: 58,458, 59,013). In terms of health outcomes, total years of life lived and QALYs were 9,549,487 (95% CI: 9,416,423, 9,654,043) and 6,632,897 (95% CI: 5,065,606, 7,591,679), respectively. In terms of economic outcomes, total direct and indirect were AUD9.59 billion (USD6.38 billion) (95% CI: AUD1.90 billion [USD1.26 billion], AUD30.45 billion [USD20.26 billion]) and AUD9.07 billion (USD6.03 billion) (95% CI: AUD663.53 million [USD441.61 million], AUD33.19 billion [USD21.96 billion]), respectively. The chronic costs of CVD contributed most of the total direct cost, while morbidity contributed most of the total indirect costs.

Our study shows that from 2022 to 2031, CVD as a complication from T2D will cause a significant impact on the Australian healthcare system and society. These estimates can be used to explore different strategies to optimize the control of risk factors for the prevention and management of CVD in T2D in Australia.

Job satisfaction is a fundamental pillar of the modern workplace. Recognizing the significance of job satisfaction and actively promoting it has become a strategic imperative in today’s work environment.

The present study aimed to assess job satisfaction and work ability among workers in a confectionery factory.

A cross-sectional study conducted in a Sfax confectionery factory included 200 workers. Data were collected between December 2022 and July 2023 using a pre-established questionnaire. This questionnaire encompassed an evaluation of socio-demographic and professional data, measuring the degree of professional satisfaction and the level of work ability using a visual analogue scale ranging from 0 to 10.

The gender ratio was 0.64. The mean age was 33.2 ± 8.8 years. Among our workers, 77.5% reported being satisfied with their work. The average perceived work ability score was 8.15 ± 2.087. Employees with higher levels of satisfaction were more likely to have increased work capacity (p = 0.000). Elevated job satisfaction not only boosts work capacity but can also reduce stress levels, improve overall mental well-being, and contribute to a healthier workplace environment. These factors collectively lead to higher work ability.

These findings emphasize the importance of prioritizing employee well-being to enhance overall productivity and company success. Fostering a work environment that prioritizes job satisfaction can lead to a more productive and successful workplace.

None Declared

Mental health is a critical factor influencing employee well-being and performance in companies. However, many factors within professional environments can either positively or negatively impact employees’ psychological well-being.

This study aims to assess mental health among workers in a confectionery factory and its association with job satisfaction.

We conducted a cross-sectional study among workers in a private confectionery in Sfax. Questionnaires and workplace assessments were collected over a period from December 2022 to July 2023 using a pre-established questionnaire. Mental health assessment was performed using the 21-item Depression, Anxiety, and Stress Questionnaire (DASS21). The degree of job satisfaction was assessed using a visual analog scale ranging from 0 to 10.

Our study included 200 participants, with 61% being female. Severe to very severe symptoms of depression, anxiety, and stress were found in 4.5%, 17%, and 10.5% of our participants, respectively. Among our workers, 22.5% reported being not very satisfied or not satisfied. Bivariate analysis revealed lower levels of satisfaction among the most anxious (p = 0.000), the most depressed (p = 0.000), and the most stressed (p = 0.000) workers.

The decline in mental health is closely linked to job dissatisfaction. Implementing measures to enhance employee job satisfaction and providing adequate support resources for mental well-being are essential steps to promote a healthier workplace and improve employee well-being.

None Declared

Among young medical practitioners, the exigencies of daily practice entail many challenges concerning both physical and mental dimensions. The study of the interplay between these two dimensions is crucial to provide the necessary care for this population.

This study aims to evaluate the prevalence of back pain and its association with mental health issues in young medical practitioners.

A cross-sectional study (January to April 2023) was conducted in the university interns and residents from Sfax. The Nordic questionnaire was used to evaluate back pain. The Generalized-Anxiety-Disorder (GAD -7) and the Patient-Health-Questionnaire (PHQ-9) were used to assess signs of anxiety and depression respectively.

Our population consisted of 404 young doctors. One-hundred and twenty were males with a sex-ratio of 0.42. Among them, 76 (18.8%) had surgical specialties. Mean age was 28.03±2.89, BMI’s mean was 23.65±3.98. Medical history was reported by 29.2% and psychiatric history by 4.9%. The median of the PHQ-9 and GAD-7 score were 3.5 (IQ: [1;6]) and 2 (IQ: [0; 5]). Signs of depression were found in 11.1% of the population whereas anxiety was found in 8.4% of them. Sixty-seven residents (16.6%) reported having back pain in the previous year. Neck pain, upper-back pain and lower back pain were experienced by 8.7%, 6.4% and 10.1% respectively.

Bivariate analysis showed that back pain was associated with PHQ-9 score (p=0.006), GAD-7 score (p=0.018) and it was not associated with BMI (p=0.769) neither with surgical specialties (p=0.824). Lower Back pain was associated with GAD-7 score (p=0.004).

Our study highlights the link between back pain and mental health problems in young doctors. Interventions englobing a better understanding of these two facets are needed to ensure an optimal care for this young population.

None Declared

trauma affects not the child but the whole family. how would the parents’ reaction to trauma influence the child’s resilience capacities?

study the mental health status of parents of children consulting the trauma and resilience unit.

Descriptive and retrospective study of 20 consultants in the trauma and resilience unit at Mongi Slim hospital between January and April 2022. The evaluation of depressive symptoms in children was made by Children's Depression Inventory (CDI). The Hamilton Depression and Anxiety Scales were used to assess anxiety and depressive symptomatology in the parents of the consultants.

The mean age of the children was 10.46±3.24.

The traumatic event was related to an assault in 75% of cases, 45% of which were intrafamilial, road accident and death of a relative in 10% respectively, 5% domestic violence.

Five consultants had a CDI score ≥8 and 15 had a score >10. Only parents of children with a CDI score>19 had moderate to severe symptoms according to hamilton scales.

The diagnosis of adjustment disorder was made in 45% of cases, post-traumatic stress disorder 20%, acute stress disorder 10% other 15%

The parents’ reaction to the tragedy would play a modulating role on the children’s resilience capacities. less anxious and depressed parents would help their child build his/her coping mecanisms.

None Declared

While women victims of intimate partner violence (IPV) suffer the burden of mental health issues (MHI), they face many challenges accessing mental health services (MHS).

We draw on the socioecological model and explore different level barriers for accessing MHS among women experiencing IPV.

We conducted a qualitative study in 2020-2021 at three levels: policy, practice and women’s experience. This included in-depth interviews with 19 policymakers from the Ministry of Health (MoH) and the Ministry of Social Welfare (MSW); four directors of shelters for women victims of IPV; 35 women (26 Arabs, 9 Jewish) attending shelters for women victims of IPV (age 22-50), and six focus groups with 26 social workers. Participants were asked about the barriers for utilizing MHS.

We identified complex multifaced barriers regarding the accessibility and quality of MHS among women victims of IPV. At the policy level, we identified structural organizational barriers related to the division of responsibilities between the two offices (MoH and MSW). These included lack of collaboration, funding and information transmission and insufficient communication mechanisms. At the practice level, shelters’ directors and social workers raised barriers, most of which were related to divisions in knowledge, terminology, and treatment approaches among mental healthcare providers and social welfare therapists. The women themselves raised issues related to stigma, lack of family support and continuity of MHS.

To improve MHS access, it is crucial to overcome the multiple barriers (individual, family, therapeutic and organizational) that are faced by women who are experiencing IPV.

No significant relationships.

The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one’s physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection.

We aimed to assess the interactions between COVID-19 infection and PD.

We conducted a litterature review through pubmed database, using the keywords :«COVID 19», «psychiatry», «mental disorders», « schizophrenia », « anxiety », « depression », «insomnia».

On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and post-traumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with pre-existing or subsequent mood disorders and sleep disturbances; or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia.

The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

No significant relationships.

Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes.

We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression.

We analyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry “B” department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used “Charlson Comorbidity Index Score” (CCIS), predicting 10-year survival in patients with multiple comorbidities.

Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%); dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001); dyspnea (p<0.001); lymphopenia (p<0.001); high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively).

This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

No significant relationships.

In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid.

We aimed to investigate the impact of BPD on course of illness in patients with BP.

We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.

The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).

Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.

No significant relationships.

Crystal House is a specialist CAMHS ID inpatient 5-bedded unit based in the Kingswood Centre, North West London - for children aged between 13 and 18 years with primary diagnosis of Intellectual Disabilities with or without additional concerns that warrant admission to hospital for purpose of assessment and management. Reporting this case, we wanted to highlight complexities of management of children presenting with neurodevelopmental conditions and history of trauma.

This is a case of a fourteen-year-old girl with established diagnoses of Moderate Intellectual Disability, Childhood Autism, Foetal Alcohol Syndrome and childhood trauma. She was admitted to our CAMHS ID Assessment and Treatment Unit with a nine- year history of self-injurious behaviour, suicidal ideation and voice-hearing experiences – after failed treatment in the community and in-patient treatment (including under restrictions of long-term segregation) on generic CAMHS unit. Her current treatment includes a person-centred Trauma- Informed Positive Behaviour Support Plan; individual and family therapy psychology sessions based on the principles of trauma-informed care and consultation with staff on trauma-informed care. She also undertook ADHD assessment, and we are in the process of optimising ADHD medication.

Trauma-Informed Positive Behaviour Support Plan was a new concept for the team. Therefore, this was supported by training and consultations with staff. The latter was introduced to create a psychologically oriented environment using trauma-informed care principals and helping the team understand what trauma means and how it affects the individual. ADHD assessment confirmed the diagnosis of ADHD which was followed by optimising ADHD medication.

Systemic and a person-centred approach is used for this child with concerning presentation and history of neurodevelopmental disorder and childhood trauma.

Nasal septal perforations are defects of the septum. Symptomatic patients failing conservative measures may be considered for surgery; however, the surgery is challenging. This study describes a technique involving mucosal advancement flaps and autologous or acellular porcine interposition grafts and assessed the long-term closure rate and symptom control.

This study looked at patients with symptomatic septal perforations who underwent surgery between 2005 and 2017. Symptoms were assessed pre- and post-operatively using a visual analogue scale. A literature search was performed for septal perforation repair techniques and outcomes.

A total of 95 per cent of patients had complete closure of their septal perforations, 90 per cent had complete symptom control. There were statistically significant differences between the pre- and post-operative mean visual analogue scale score for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001).

Surgical closure of nasal septal perforations with mucosal advancement flaps and an interposition graft is a reliable technique with excellent long-term outcomes.

Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty.

Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up.

Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43).

Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.