Chemical, biological, radiological, and nuclear (CBRN) incidents pose increasing transborder risks globally, necessitating enhanced health sector preparedness.

This study aimed to develop a comprehensive CBRN preparedness assessment tool (PAT), operational response guidelines (ORG), and tabletop simulation scenarios for the health sectors of the Middle East and North Africa (MENA) region.

A mixed-methods approach comprised a systematic review of the literature up to 2022 in English and French, modified expert interviews (MIM), and an online Delphi questionnaire. Content analysis was performed on interview data. Using R-Studio™, consensus metrics and artificial intelligence techniques, including natural language processing, sentiment analysis, and unsupervised machine learning (ML) clustering algorithms, were deployed for advanced data analysis across all phases.

The literature review identified 63 relevant studies illustrating various preparedness strategies. The MIM’s thematic analysis, reinforced by AI-driven content analysis, emphasized the need for stronger inter-regional cooperation facilitated by organizations such as WHO and standardized tabletop simulation training. A robust consensus was achieved on the proposed assessment tool and operational response guidelines. ML analysis identified distinct expert clusters, providing additional consensus perspectives.

The study emphasized the urgency for collaborative CBRN response strategies within MENA, valuing the innovative aspect of our suggested PAT, ORG, and simulation scenarios. This work advocates a dynamic, resilient approach to disaster medicine preparedness, which is crucial for regional security and global health resilience, especially in the MENA. It also highlights the significant role of AI analysis methods in enriching analytical outcomes in disaster medicine research and promoting data-informed preparedness strategies.

Clinical trials often struggle to recruit enough participants, with only 10% of eligible patients enrolling. This is concerning for conditions like stroke, where timely decision-making is crucial. Frontline clinicians typically screen patients manually, but this approach can be overwhelming and lead to many eligible patients being overlooked.

To address the problem of efficient and inclusive screening for trials, we developed a matching algorithm using imaging and clinical variables gathered as part of the AcT trial (NCT03889249) to automatically screen patients by matching these variables with the trials’ inclusion and exclusion criteria using rule-based logic. We then used the algorithm to identify patients who could have been enrolled in six trials: EASI-TOC (NCT04261478), CATIS-ICAD (NCT04142125), CONVINCE (NCT02898610), TEMPO-2 (NCT02398656), ESCAPE-MEVO (NCT05151172), and ENDOLOW (NCT04167527). To evaluate our algorithm, we compared our findings to the number of enrollments achieved without using a matching algorithm. The algorithm’s performance was validated by comparing results with ground truth from a manual review of two clinicians. The algorithm’s ability to reduce screening time was assessed by comparing it with the average time used by study clinicians.

The algorithm identified more potentially eligible study candidates than the number of participants enrolled. It also showed over 90% sensitivity and specificity for all trials, and reducing screening time by over 100-fold.

Automated matching algorithms can help clinicians quickly identify eligible patients and reduce resources needed for enrolment. Additionally, the algorithm can be modified for use in other trials and diseases.

Understanding adolescents perceptions of their weight status and the factors influencing these perceptions is pivotal for developing targeted interventions and policies to counteract the rising obesity trends.

This cross-sectional study aimed to determine the accuracy of weight status perceptions among Tunisian adolescents compared to objective metrics and to identify sociodemographic characteristics and life habits associated with the underestimation of weight status.

A cross-sectional, school-based study was conducted among a randomized sample of adolescents attending secondary schools in Sousse, Tunisia. A total of 1399 students participated, with anthropometric measurements taken, and a pre-tested Arabic questionnaire administered to gather sociodemographic data and perceived weight status, assessed using the Figure Rating Scale (FRS). The accuracy of perceived weight status was determined by comparing the measured weight status with participants; self-reported perceptions. We evaluated the association between body weight distortion and life habits which included regular physical activity, screen time (time spent on internet per day), number of fruits and vegetables consumed per day, and fast-food consumption.

The study achieved an 86.68% response rate, with over half of the participants being female (60.5%), and the average age being 17 years. The majority of adolescents (41%) perceived themselves as having normal body weight, while 34.5% perceived themselves as underweight, 16.6% as overweight, and 7.9% as obese. However, based on BMI categories, 72.6% had a normal measured weight, 20.4% were overweight, and 6.9% were obese. A substantial proportion of participants (45.6%) underestimated their weight status, with a significant proportion being objectively overweight or obese (26%). Furthermore, we found a significant association between the perception of weight accuracy with four correlates: gender, mother educational level, regular physical activity, and the number of fruits and vegetables consumed per day.

The findings revealed a disparity between perceived and actual weight status among Tunisian adolescents, with a significant underestimation of weight status, particularly among those who are overweight or obese. The results highlighted the crucial need for interventions that address weight perception inaccuracies and promote healthy weight awareness and management among adolescents in Tunisia. The study underscored the importance of further research to understand the development and progression of body weight underestimation throughout adolescence and the roles of lifestyle behaviors in shaping weight perceptions.

None Declared

Domestic violence is a major public health problem. The situation is alarming in Arab countries: the prevalence of domestic violence is 39.3% in Saudi Arabia, 55% in Morocco and 62.2% in Egypt.

In Tunisia, a national survey carried out by the national family planning office in 2010, published in July 2011, drew attention for the first time to the frequency of this phenomenon in Tunisia and the recurrent nature of this form of violence. Unfortunately, few studies have focused on domestic violence during pregnancy and its impact on the mental health of expectant mothers.

To study the prevalence of domestic violence during pregnancy among Tunisian women consulting in the context of medical expertise and its association with anxiety.

Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise following domestic violence at ‘Hedi Chaker hospital’,Sfax , from May 2021 until January 2022.

An anonymous survey was asked to these ladies, it included a section for collecting socio-demographic data.

The HADS questionnaire was used to screen for anxiety.

122 responses was collected. The average age of victims was 35.66 ± 9.94 years.

All the women in our population study were married, and each one was a victim of at least one form of violence. The majority (86.1%) had children. Most of them had secondary (44.3%) or university (31.1%) level education.

More than half of the women (63.9%) had no occupation.

Sixty-five women (53.3%) were assaulted during pregnancy, 43% of whom suffered from complications of varying severity.

Different consequences on pregnancy were reported with decreasing prevalence: 16.9% hospitalization in a gynecological ward, 13.8% abortion, 6.2% fetal death in utero and premature delivery in 4.6% of cases.

According to the HADS, seventy-six of women surveyed (62.3%) had anxiety symptoms.

Anxiety was significantly associated with exposure to violence during pregnancy (p=0.03).

Our results showed a significant incidence of domestic violence during pregnancy and a significant association with anxiety.

Different actions must be taken towards these anxious women such as: Identify a “referent” in maternity wards to screen for domestic violence and directing women to structures and shelters that can help and, above all, protect them.

None Declared

Type 1 diabetes mellitus (T1DM) patients are treated via insulin which could result in weight gain. Studies have coined a new term, “Diabulimia” which refers to the limitation or skipping of insulin doses, with the objective of weight control. A previous meta-analysis has found that eating disorders (ED) are significantly associated with T1DM (Mannucci, E et al. J Endocrinol Invest 2005; 417-9), while a more recent one, has shown an insignificant association between ED and T1DM on analysis of diabetes-adapted questionnaires only (Young V, et al. Diabet Med. 2013:189-198)

We aimed to re-analyze the association between ED and T1DM, whilst taking into account recently published literature and the type of questionnaire utilized.

A literature search of PubMed, Scopus, and Web of Science was conducted on 17th January 2023, using the key terms “ T1DM”, “Eating Disorders”, and “ Bulimia”. Only Observational controlled studies were included.

T1DM was associated with increased risk of ED compared to non-diabetic individuals (RR = 2.47, 95% CI = 1.84 to 3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18 to 6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18 to 1.98, p-value = 0.001), while no significant association was seen between T1DM and anorexia nervosa. Our sensitivity analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91 to 4.12, p-value <0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27 to 3.23, p-value = 0.003). Furthermore, the Eating Attitudes Test-26 (EAT) showed a significant increase in the dieting subscale (MD = 2.95, 95% CI = 1.84 to 4.06, p-value < 0.00001) and bulimia subscale (MD = 0.78, 95% CI = 0.12 to 1.44, p-value = 0.02) among T1DM patients. Additionally, the Bulimic Investigatory Test, Edinburg (BITE) showed a significant increase in the symptom subscale (MD = 0.31, 95% CI = 0.12 to 0.50, p-value = 0.001), however, no significant difference was detected between T1DM and controls in the severity subscale. Prevalence of insulin omission/misuse was 10.3% (95% CI = 8.1-13); diabetic females demonstrated significantly higher risk of insulin omission (RR = 14.21, 95% CI = 2.66 to 76.04, p-value = 0.002) and insulin misuse (RR = 6.51, 95% CI = 1.14 to 37.31, p-value = 0.04) compared with diabetic males. Analysis of other potentially unhealthy weight control behaviors showed insignificant associations between fasting, excessive exercise, dieting pills misuse, diuretics misuse, and T1DM.

T1DM patients are at higher risk of developing ED according to both generic and diabetes-validated questionnaires. Moreover, female diabetics are at higher risk of insulin misuse/omission. Subsequently, patients should be regularly screened and early psychiatric management is warranted.

None Declared

Medical students hold significant importance, as they represent the future of healthcare provision. This study aimed to explore psychological antecedents towards the monkeypox (mpox) vaccines among postgraduate and undergraduate medical students across countries.

A cross-sectional survey was conducted among medical students aged 18 years old and above in 7 countries; Egypt, Romania, Malaysia, and Yemen, Iraq, India, and Nigeria. We used social media platforms between September 27 and November 4, 2022. An anonymous online survey using the 5C scale was conducted using snowball and convenience Sampling methods to assess the 5 psychological antecedents of vaccination (i.e., confidence, constraints, complacency, and calculation, as well as collective responsibility).

A total of 2780 participants were recruited. Participants’ median age was 22 years and 52.1% of them were males. The 5C psychological antecedents of vaccination were as follows: 55% were confident about vaccination, 10% were complacent, 12% experienced constraints, and 41% calculated the risk and benefit. Lastly, 32% were willing to be vaccinated for the prevention of infection transmission to others. The Country was a significant predictor of confidence, complacency, having constraints, and calculation domains (P < 0.001). Having any idea about the mpox vaccine was linked to 1.6 times higher odds of being more confident [OR = 1.58 (95% CI, 1.26–1.98), P < 0.001] Additionally, living in a rural area significantly increased complacency [OR = 1.42 (95% CI, 1.05–1.95), P = 0.024] as well as having anyone die from mpox [OR = 3.3 (95% CI, 1.64–6.68), P < 0.001]. Education level was associated with increased calculation [OR = 2.74 (95% CI, 1.62–4.64), P < 0.001]. Moreover, being single and having no chronic diseases significantly increased the calculation domain [OR = 1.40 (95% CI, 1.06–1.98), P = 0.02] and [OR = 1.54 (95% CI, 1.10–2.16), P = 0.012] respectively. Predictors of collective responsibility were age 31–45 years [OR = 2.89 (95% CI, 1.29–6.48), P = 0.01], being single [OR = 2.76 (95% CI, 1.94 -3.92), P < 0.001], being a graduate [OR = 1.59 (95% CI (1.32–1.92), P < 0.001], having no chronic disease [OR = 2.14 (95% CI, 1.56–2.93), P < 0.001], and not knowing anyone who died from mpox [OR = 2.54 (95% CI, 1.39–4.64), P < 0.001), as well as living in a middle-income country [OR = 0.623, (95% CI, 0.51–0.73), P < 0.001].

This study underscores the multifaceted nature of psychological antecedents of vaccination, emphasizing the impact of socio-demographic factors, geographic location, and awareness, as well as previous experiences on individual attitudes and collective responsibility towards vaccination.