Search

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting over 300,000 people worldwide. It is characterized by the progressive decline of the nervous system that leads to the weakening of muscles which impacts physical function. Approximately, 15% of individuals diagnosed with ALS have a known genetic variant that contributes to their disease. As therapies that slow or prevent symptoms continue to develop, such as antisense oligonucleotides, it is important to discover novel genes that could be targets for treatment. Additionally, as cohorts continue to grow, performing analyses in ALS subtypes, such as primary lateral sclerosis (PLS), becomes possible due to an increase in power. These analyses could highlight novel pathways in disease manifestation. METHODS: Building on our previous discoveries using rare variant association analyses, we conducted rare variant burden testing on a substantially larger multi-ethnic cohort of 6,970 ALS patients, 166 PLS patients, and 22,524 controls. We used intolerant domain percentiles based on sub-region Residual Variation Intolerance Score (subRVIS) that have been described previously in conjunction with gene based collapsing approaches to conduct burden testing to identify genes that associate with ALS and PLS. RESULTS: A gene based collapsing model showed significant associations with SOD1, TARDBP, and TBK1 (OR = 19.18, p = 3.67 × 10-39; OR = 4.73, p = 2 × 10-10; OR = 2.3, p = 7.49 × 10-9, respectively). These genes have been previously associated with ALS. Additionally, a significant novel control enriched gene, ALKBH3 (p = 4.88 × 10-7), was protective for ALS in this model. An intolerant domain-based collapsing model showed a significant improvement in identifying regions in TARDBP that associated with ALS (OR = 10.08, p = 3.62 × 10-16). Our PLS protein truncating variant collapsing analysis demonstrated significant case enrichment in ANTXR2 (p = 8.38 × 10-6). CONCLUSIONS: In a large multi-ethnic cohort of 6,970 ALS patients, collapsing analyses validated known ALS genes and identified a novel potentially protective gene, ALKBH3. A first-ever analysis in 166 patients with PLS found a candidate association with loss-of-function mutations in ANTXR2.

Displaced communities are at increased risk of poor mental health with limited resources for treatment. Self-compassion moderates the impacts of stressors on mental health in high-income country general population samples, but its impact has not been described among people who have experienced displacement and associated trauma. The aim of this study was to characterize the associations between self-compassion, mental health, and resilience in a sample of displaced Syrian adults living in Jordan. This is a cross-sectional study using four validated survey tools measuring self-compassion, resilience, mental health, and traumatic exposure. Syrian adults who presented to four different community organizations serving refugees within Amman, Jordan were invited to participate. A total of 272 displaced Syrians were included in the final analysis. A majority of those surveyed were positive for emotional distress (84.6%), depression (85.7%), and anxiety (76.5%). In univariate analysis there was a significant lower risk of emotional distress, depression, and anxiety, with both higher resilience and self-compassion. However, in the multivariate model only self-compassion remained significantly associated with less emotional distress, depression, and anxiety, independent of resilience and other covariates. Female gender, poor financial stability, and high levels of traumatic exposure were also identified as persistent predictors of mental health morbidity. The findings of this study suggest that self-compassion is associated with less distress, depression, and anxiety in displaced individuals; suggesting it might be protective against poor mental health. Self-compassion is a modifiable factor that can be utilized as a tool by healthcare professionals and communities caring for refugees to promote positive mental health outcomes.

BackgroundLiterature on colorectal cancer outcomes in individuals of Middle Eastern and North African (MENA) descent is limited. To address this gap, we estimated five-year colorectal cancer-specific survival by race and ethnicity, including MENA individuals, in a diverse, population-based sample in California.MethodsWe identified adults (ages 18-79 years) diagnosed with a first or only colorectal cancer in 2004 to 2017 using the California Cancer Registry (CCR), including non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic, and MENA individuals. For each racial/ethnic group, we calculated five-year colorectal cancer-specific survival and used Cox proportional hazards regression models to examine the association of race/ethnicity and survival, adjusting for clinical and socio demographic factors.ResultsOf 110,192 persons diagnosed with colorectal cancer, five-year colorectal cancer-specific survival was lowest in Black (61.0%) and highest in MENA (73.2%) individuals. Asian (72.2%) individuals had higher survival than White (70.0%) and Hispanic (68.2%) individuals. In adjusted analysis, MENA [adjusted HR (aHR), 0.82; 95% confidence interval (CI), 0.76-0.89], Asian (aHR, 0.86; 95% CI, 0.83-0.90), and Hispanic (aHR, 0.94; 95% CI, 0.91-0.97) race/ethnicity were associated with higher, and Black (aHR, 1.13; 95% CI, 1.09-1.18) race/ethnicity was associated with lower survival compared with non-Hispanic White race/ethnicity.ConclusionsTo our knowledge, this is the first study to report colorectal cancer survival in MENA individuals in the United States. We observed higher survival of MENA individuals compared with other racial/ethnic groups, adjusting for sociodemographic and clinical factors.ImpactFuture studies are needed to identify factors contributing to cancer outcomes in this unique population.

Countries worldwide are facing challenges with increasing the COVID-19 vaccination rates for children. This study examined associations between perceived knowledge, coping appraisal, threat appraisal, adaptive response, maladaptive response, and intention, and possible variance across parents (mother or father) and COVID-19-like symptoms experiences regarding parental intentions to vaccinate their children. A total of 836 Iranian parents with children between the ages of 6 and 12 y completed measures assessing perceived knowledge, coping appraisals, threat appraisals, intentions, adaptive responses, and maladaptive responses. Multigroup structural equation modeling revealed that perceived knowledge was positively associated with both coping and threat appraisals, coping appraisals positively associated with adaptive responses, maladaptive responses, and intentions to vaccinate, threat appraisals positively associated with adaptive and maladaptive responses, and adaptive responses positively associated with intentions to vaccinate. The invariance evaluation revealed no differences across parents or COVID-19-like symptoms experiences in parental intentions to get their children vaccinated. The findings suggest that cogent information regarding childhood COVID-19 vaccination may boost parents' knowledge influencing their appraisals, adaptive responses and intentions to vaccinate their children. Specifically, coping appraisals and adaptive responses appeared to be important mediators between knowledge and intentions to vaccinate. Furthermore, intentions to vaccinate children may not be strongly influenced by parental roles or COVID-19-like symptoms experiences. These findings may help multiple stakeholders promote COVID-19 vaccination rates among children, and countries should further examine ways of increasing rates based on their specific needs.

Objective: Genetic susceptibility to lung cancer is the subject of extensive research. We investigated whether polymorphisms in the microsomal epoxide hydrolase (EPHX1) gene is linked to lung cancer susceptibility in Jordanian patients., Methods: In this case-control study a total of 218 subjects from Jordan University Hospital and King Hussein Cancer Center were screened (108 lung cancer patients and 110 matched controls). Polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) was used to detect the two common polymorphisms in EPXH1 located in exons 3 and 4; namely, amino acid substitution from tyrosine to histidine at residue 113 of exon 3 (Tyr113His; low activity allele) and amino acid substitution from histidine to arginine at residue 139 of exon 4 (His139Arg; high activity allele)., Results: There was no significant difference in genotype distribution between control subjects and lung cancer patients. In addition, no differences were found when evaluated according to age, gender or tobacco consumption. For exon 3 the adjusted OR was 0.970 (95% CI 0.473 - 1.991) for the Tyr113/His113 genotype and 0.692 (95% CI 0.301 - 1.590) for the Tyr113/Tyr113 genotype, respectively.  For exon 4 the adjusted OR was 0.596 (95% CI 0.297-1.197) for the His139/Arg139 genotype and 0.882 (95% CI 0.117- 6.660) for the Arg139/Arg139 genotype, respectively. Logistic regression analysis did not show differences in EPXH1 distributions between patients and controls when categorized according to predicted microsomal epoxide hydrolase activity.  Therefore, common polymorphisms within EPHX1 do not appear to be significant risk factors for lung cancer development in the Jordanian population., Conclusion: No associations were observed between lung cancer risk and EPXH1 polymorphisms in the Jordanian population.

Objectives. To estimate the odds of having cognitive difficulties among Middle Eastern and North African (MENA) American adults and compare these odds with those of White, Black, Hispanic/Latino, Asian, American Indian or Alaska Native (AI/AN), and Native Hawaiian/Other Pacific Islander adults nationally and in the 4 states with the largest MENA populations (California, New York, Michigan, and Texas) after adjusting for sociodemographic factors. Methods. We analyzed 2017-2021 American Community Survey data (aged ≥ 45 years; n = 7 284 988), comparing presence of cognitive difficulties by race/ethnicity. Results. MENA adults had greater odds of reporting cognitive difficulties than did White (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.42, 1.56), Black (OR = 1.20; 95% CI = 1.14, 1.26), Hispanic (OR = 1.46; 95% CI = 1.39, 1.53), Asian (OR = 1.31; 95% CI = 1.25, 1.38), and AI/AN (OR = 1.07; 95% CI = 1.01, 1.14) adults. In all 4 states, odds of having cognitive difficulties were higher among MENA than Asian adults. Other racial/ethnic comparisons differed by state. Conclusions. A separate checkbox for MENA Americans approved by the Office of Management and Budget is important so health outcomes can be studied in more detail and funds can be allocated for research and resources at state and national levels. ( Am J Public Health . 2024;114(11):1265-1274. https://doi.org/10.2105/AJPH.2024.307803).

Arabic populations are underrepresented in large genome projects; therefore, the frequency of clinically actionable variants among Arabs is largely unknown. Here, we investigated genetic variation in 14,392 whole genomes from the Qatar Genome Program (QGP) across the list of 78 actionable genes (v3.1) determined by the American College of Medical Genetics and Genomics (ACMG). Variants were categorized into one of the following groups: (1) Pathogenic (P), (2) Likely pathogenic (LP), and (3) Rare variants of uncertain significance with evidence of pathogenicity. For the classification, we used variant databases, effect predictors, and the disease-relevant phenotypes available for the cohort. Data on cardiovascular disease, cancer, and hypercholesterolemia allowed us to assess the disease-relevant phenotype association of rare missense variants. We identified 248 distinct variants in 50 ACMG genes that fulfilled our criteria to be included in one of the three groups affecting 1036 genotype-positive participants of the QGP cohort. The most frequent variants were in TTN, followed by RYR1 and ATP7B. The prevalence of reportable secondary findings was 3.5%. A further 46 heterozygous variants in six genes with an autosomal recessive mode of inheritance were detected in 200 individuals, accounting for an additional 1.4%. Altogether, they affect 5% of the population. Due to the high consanguinity rate in the QGP cohort (28% in spouses and 60% in parents), P and LP variants both in genes with dominant and recessive inheritance are important for developing better treatment options and preventive strategies in Qatar and the Arabic population of the Middle East., Competing Interests: Competing interests The authors declare no competing interests. Ethics approval and consent to participate Ethical approval was provided by the institutional review board of the Qatar Biobank (QBB) Doha, Qatar (Protocol no. QF-QGP-RES-PUB-002). A signed consent was obtained from all participants by the QBB, and WGS data used in the current study was obtained from the QGP data., (© 2024. The Author(s).)

Background: Individual preferences have preceded the use of health care services, and it has been affected by different hospital attributes. This study aimed to elicit the Iranians' preferences in choosing hospitals using a discrete choice experiment., Methods: A discrete choice experiment (DCE) was conducted through face to face interviews with 301 participants. The DCE was constructed by six attributes were included based on a literature review, qualitative interviews, Focus Group Discussion (FGD) and consensus development approach: waiting time, quality of care, travel time, hospital type, provider competency, and hospital facilities. individuals' preferences for hospital attributes were analyzed using a mixed logit model, and interaction terms were used to assess preference heterogeneity among individuals with different sociodemographic characteristics., Results: Participants had strong and significant preferences for care delivered in hospitals with 'full' (β = 0.6052, p<0.001) or 'moderate' (β = 0.5882, p<0.001) hospital equipment and with 'excellent' provider competency (β = 0.2637, p<0.001). The estimated coefficients for the "waiting time of 120 minutes" (β = -0.1625, p<0.001) and the "travel time of 30 minutes" (β = -0.1157, p<0.001) were negative and significant. The results also show that the personal characteristics such as age, education level, and income significantly affected individual preferences in choosing a hospital., Conclusion: Considering people's preferences can be important given the more active role of today's patients in decision-making about their treatment processes. The results of this study should be taken into consideration by health policymakers and all stakeholders to be aware of differences in preferences of people and maximize their satisfaction. In this case, it is important to continuously involve people and consider their preferences in the design, topology, construction, and equipment of hospitals., Competing Interests: Authors declare that they have no competing interests., (Copyright: © 2024 Ranjbar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The Office of Management and Budget (OMB) is reviewing current minimum standards for collecting race/ethnicity data on federal forms. This review is extremely important for Middle Eastern and North African (MENA) Americans, who have been overlooked and unable to receive federal funding for their communities for decades. MENA individuals are defined as "White," which is particularly concerning given that research continues to identify that their health and lived experiences differ from Whites. From January to April 2023, the OMB requested public comments on a separate MENA checkbox. The purpose of this research was to describe public comments regarding the addition of the MENA checkbox on the US Census and other federal forms., Methods: A public comment period outlining changes to the collection of race/ethnicity data on the US Census and other federal forms opened in January 2023. Public comments were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned acceptance for health-related reasons., Results: There were 6700 comments reviewed. Most (73.88%) mentioned adding a MENA checkbox. Of those, 99.31% accepted adding the checkbox. Among the comments that accepted adding a MENA checkbox, 29.09% mentioned health, 44.75% mentioned linguistic/language services, and 44.75% mentioned education-related reasons., Conclusions: Overall, the comments reviewed demonstrated strong acceptance of the addition of a MENA checkbox on federal forms. These findings are encouraging, yet further review is needed to contribute to the OMB's final decision on whether to add the checkbox and uncover the health of this population., (© 2023. W. Montague Cobb-NMA Health Institute.)

Competing Interests: Declaration of Competing Interest L.E. Miller reports financial support from Boston Scientific. S. Bhattacharyya reports employment with Boston Scientific. M. Omar and M. Monga report no relevant conflicts.

Procrastination is the deliberate, unjustified postponing of an intended course of action despite its costs or unfavorable effects. The present study used a self-report online survey and collected data from a large convenience sample of the general adult population (N = 2,076; females = 55.73%; M age  = 35.1 years [SD ± 12.7]) with diverse demographics. Following the ring-curve distribution, the results indicated a 15.4% prevalence rate of procrastination among the Iranian community, which was significantly higher among women and divorced individuals and lower among nomadic individuals and those with higher academic degrees. A latent profile analysis demonstrated two distinct profiles, one for procrastinators (high scores on chronic procrastination, psychological distress, neuroticism, and extraversion; and low scores on general self-efficacy, self-esteem, satisfaction with life, openness, agreeableness, and conscientiousness) and one for non-procrastinators (demonstrating a reverse pattern compared to procrastinators). Moreover, additional network analysis suggested that the examined networks were invariant across procrastination status and gender. The results indicate that procrastination differs by demographic characteristics and is associated with a unique psychological profile. However, none of the aforementioned key study variables were considered a potential vulnerability for procrastinators due to the finding that all variables were peripheral and none were central in the examined networks. Therefore, relying on the differences in mean scores on psychometric scales does not appear to be an optimal way of determining the most important variables in a therapeutic context when treating procrastination., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The study aimed to evaluate the prevalence and pattern of long COVID-19 (LC) symptoms among individuals who had contracted COVID-19, to calculate the incidence of LC, and to provide insights into risk factors associated with developing LC in this population., Methods: This population-based cross-sectional survey was conducted in Fars province in 2023. Adult participants with a history of COVID-19 were recruited using a cluster random sampling method, alongside a control group with similar characteristics through the same methodology. Data were collected through in-person interviews using two researcher-developed data collection forms focused on demographic and clinical information., Results: A total of 2010 participants, comprising 1561 (77.7%) and 449 (22.3%) individuals with and without a previous history of COVID-19 were included. Among those with COVID-19 history, the prevalence of experiencing any symptoms was 93.7% (95% CI of 92.3%-94.8%) during the disease acute phase and 36.4% (95% CI of 34.0%-38.8%) after recovery. The incidence of symptoms specifically related to COVID-19, calculated by comparing the symptom rates between participants with and without a history of COVID-19, was found to be 13%. Factors such as older age, previous hospitalization for COVID-19, presence of cardiovascular disease, and use of steroids/chemotherapy were associated with LC symptoms., Conclusions: Our investigation sheds light on long-term aspects of COVID-19, demonstrating a significant prevalence of LC with diverse manifestations. It also underscores the importance of establishing standardized criteria and control groups in research on LC to address challenges related to heterogeneity and potential overestimation of symptoms., (© 2024. The Author(s).)

Hypothesis/purpose: The prevalence of trochlear dysplasia is common in different populations., Background: The prevalence of trochlear dysplasia in the general population, categorised by sex, race, age, and body mass index, has been sparse. This study aimed to define the prevalence of trochlear dysplasia based on the latter categories., Study Design: Cohort retrospective study., Methods: 1162 skeletal mature healthy femora were obtained from a CT-scan-based modelling system (SOMA). Thin slice CT scans were acquired exclusively for medical indications such as polytrauma (20%), CT angiography (70%) and other reasons (i.e. Total Joint Replacement) (10%). Trochlear dysplasia was measured using Pfirmann's method. Patient demographics such as age, race and sex were recorded., Results: The overall prevalence of trochlear dysplasia is 4.5% and is far more common in Asian female patients compared to Caucasian, African and Middle Eastern knees., Conclusion: Overall, the prevalence of dysplasia in the general population was determined to be 4.5%, with female patients being more likely to suffer from the condition. Patients of Asian and Caucasian race were more likely to have trochlear dysplasia, while Middle Eastern male patients displayed more dysplastic values than their female counterparts., (© 2024. The Author(s).)

Introduction: Diabetes mellitus (DM) is one of the leading causes of morbidity and mortality worldwide. It is a multifactorial disease that genetic and environmental factors contribute to its development. The aim of the study was to investigate the association of OX40L promoter gene polymorphisms with type 2 diabetes mellitus (T2DM) in Iranians., Materials and Methods: Three hundred and sixty-eight subjects including 184 healthy subjects and 184 T2DM patients were enrolled in our study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied to detect genotype and allele frequencies of rs3850641, rs1234313 and rs10912580. In addition, SNPStats web tool was applied to estimate haplotype frequency and linkage disequilibrium (LD)., Results: The distribution of tested polymorphisms was statistically different between the T2DM patients and healthy subjects (P < 0.01). rs1234313 AG (OR = 0.375, 95% CI = 0.193-0.727, P = 0.004) and rs10912580 AG (OR = 0.351, 95% CI = 0.162-0.758, P = 0.008) genotypes were associated with the decreased risk of T2DM in Iranians. Moreover, our prediction revealed that AAG (OR = 0.46, 95% CI= (0.28-0.76), P = 0.0028) and GAG (OR = 0.24, 95% CI= (0.13-0.45), P < 0.0001) haplotypes were related to the reduced risk of the disease. However, the tested polymorphisms had no effect on biochemical parameters and body mass index (BMI) in the patient group (P > 0.05)., Conclusion: Our findings revealed that OX40L promoter gene polymorphisms are associated with T2DM. Moreover, genotype and allelic variations were related to the decreased risk of T2DM in Iranians. Further studies are recommended to show whether these polymorphic variations could affect OX40/OX40L interaction or OX40L phenotype., (© 2024. The Author(s).)

Competing Interests: The authors declare no conflicts of interest.

Purpose: The purpose of this study was to explore pediatric physical therapists' (PTs') experiences including successes, challenges, and barriers with cross-cultural communication with Arabic-speaking Middle Eastern children and their families who require interpreter services., Methods: Eight PTs consented to participate in qualitative dyadic interviews. Transcription and interviews were conducted virtually in Microsoft Teams. Quality criteria included member checking for validity and trustworthiness and bracketing to minimize investigator bias. Inductive thematic analysis was used to identify meaning units and major themes., Results: The 6 themes that emerged were: fostering therapeutic relationships, practicing culturally sensitive care, communicating intentionally, experiencing successes, recognizing challenges, and tailoring a physical therapy plan of care. Representative quotations support each theme., Conclusions: Therapists perceive their experiences with Arabic-speaking children, families, and interpreters positively despite challenges related to cultural and language barriers. In sharing their experiences, therapists demonstrated self-reflection, openness to learning, and desire to build strong therapeutic alliances., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Objective: Activating mutation in Ubiquitin-specific peptidase (USP8) is identified to enhance cell proliferation and adrenocorticotropic hormone (ACTH) secretion from corticotroph pituitary adenoma. We investigated the USP8 variant status in a population of Iranian people with functional corticotroph pituitary adenoma (FCPA). Moreover, a systematic review was conducted to thoroughly explore the role of USP8 variants and the related pathways in corticotroph adenomas, genotype-phenotype correlation in USP8-mutated individuals with FCPA, and the potential role of USP8 and epidermal growth factor receptor (EGFR) as targeted therapies in PFCAs., Methods: Genetic analysis of 20 tissue samples from 19 patients with PFCAs was performed using Sanger sequencing. Moreover, a systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, web of Sciences, and Cochrane databases were searched. The last search was performed on 20 September 2023 for all databases., Results: In our series, we found two somatic mutations including a 7-bp deletion variant: c.2151&#95;2157delCTCCTCC, p. Ser718GlnfsTer3, and a missense variant: c.2159 C > G, p. Pro720Arg (rs672601311) in exon 14. The Systematic review indicated USP8 variant in 35% of corticotroph adenomas, with the highest frequency (25%) in 720 code regions, p. Pro720Arg. Data regarding the impact of USP8 mutational status on clinical characteristics and outcomes in FCPAs are inconsistent. Moreover, Pasireotide as well as inhibitors of EGFR such as Gefitinib and Lapatinib, as well as USP8 inhibitors including -ehtyloxyimino9H-indeno (1, 2-b) pyrazine-2, 3-dicarbonitrile, DUBs-IN-2, and RA-9 indicated promising results in treatment of corticotroph adenomas., Conclusion: Although the USP8-EGFR system has been identified as the main trigger and target of corticotroph tumorigenesis, more precise multicenter studies are required to yield more consistent information regarding the phenotype-genotype correlation and to develop effective targeted therapies., (© 2024. The Author(s).)

Objective: This study aims to assess the 10-year cardiovascular risk and physical activity among Syrians residing in England and compare them with the North West England population., Design: Cross-sectional study., Setting: Bilingual online questionnaire distributed through social media platforms from 21 June to 23 July 2023., Participants: Syrian individuals in England (aged 25-69, migrated post-2010) and residents of North West England within the same age bracket. All participants had no history of cardiovascular disease (CVD)., Primary and Secondary Outcome Measures: Primary outcome measures included differences in QRISK3 score, 10-year relative risk (RR), metabolic equivalent of task (MET) and self-reported physical activity between the two groups. Secondary outcome measures included subgroup analyses based on sex and age., Results: Of the 273 eligible participants (137 in the Syrian group and 136 in the Northwest England group), the QRISK3 score was twofold higher in the Syrian group (2.20, 5.50) than in the North West England group (1.20, 3.15) (p=0.042). The 10-year RR was approximately three times higher in the Syrian group (p<0.001), while MET was about twice as high in the Northwest England group (p<0.001)., Conclusions: Despite relocating to England, Syrians face substantially elevated cardiovascular risks attributed to an unhealthy lifestyle, including smoking, reduced physical activity, increased body mass index and diabetes, coupled with a strong family history of CVD in first-degree relatives under the age of 60. The study underscores the need for early assessment, risk factor identification and tailored interventions for this population. Raising awareness, particularly in the context of smoking, and promoting physical activity are crucial for mitigating cardiovascular risks. The findings emphasise the importance of culturally sensitive interventions to address the unique health challenges of Syrians in the UK., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Prostate cancer is a prevalent disease among men worldwide, exhibiting substantial heterogeneity in presentation and outcomes influenced by various factors, including race and ethnicity. Disparities in incidence, stage at diagnosis, and survival rates have been observed between Black men and those of other races and ethnicities., Objective: To compare prostate cancer outcomes between Black men and men with other race (Asian, Hispanic, Indigenous, Middle Eastern, White, Multiracial, and Other) in a universal health care system, with race and ethnicity self-reported., Design, Setting, and Participants: This was a prospective, observational cohort study of men diagnosed with prostate cancer between June 1, 2014, and August 28, 2023, who self-identified race and ethnicity. Participants included men who had been prospectively enrolled in the Alberta Prostate Cancer Research Initiative from the 2 major urology referral centers in Alberta (University of Alberta and University of Calgary). All men with prostate cancer enrolled in the initiative were included., Exposure: Race and ethnicity., Main Outcomes and Measures: The primary outcome was the stage and grade of prostate cancer at diagnosis. Further outcomes included age and prostate-specific antigen level at diagnosis, initial treatment modality, time from diagnosis to initial treatment, and prostate cancer-specific, metastasis-free, and overall survivals., Results: A total of 6534 men were included; 177 (2.7%) were Black, and 6357 (97.3%) had another race or ethnicity. Men who identified as Black were diagnosed with prostate cancer at an earlier age (mean [SD], 62.0 [8.2] compared with 64.6 [7.7] years; P < .001) and had a lower Charlson Comorbidity Index rating (14% compared with 7% ≤ 1; P < .001) compared with men of other races. Men who identified as Black had similar prostate-specific antigen levels at diagnosis, TNM category (74% vs 74% with T1-T2; P = .83) and Gleason Grade Group (34% compared with 35% Gleason Grade Group 1; P = .63). Black men had similar rates of prostate cancer-specific (hazard ratio [HR], 1.10; 95% CI, 0.41-2.97; P = .85), metastasis-free (HR, 0.88; 95% CI, 0.42-1.46; P = .44), and overall (HR, 0.55; 95% CI, 0.25-1.24; P = .15) survival., Conclusions and Relevance: The findings of this cohort study suggest that Black men, despite being diagnosed at a younger age, experience comparable prostate cancer outcomes compared with men of other races.

The COVID-19 pandemic has been stressful for individuals worldwide, including parents. Most research investigating stress during the pandemic has focused on single stressors in relation to outcomes and has been conducted in Western countries. Among parents from Middle Eastern and North African (MENA) countries, the present study used latent class analysis to identify specific subgroups of individuals based on combinations of stressful events experienced during the first two waves of the COVID-19 global pandemic. Whether individuals in these classes differed on levels of both adaptive (individual resilience, family cohesion) and maladaptive outcomes (depressive symptoms) was tested. Finally, perceived marital satisfaction was tested as a moderator of relations between class membership and adjustment outcomes. Participants were 545 parents (66.8% women, M age = 35.79 years) recruited online who indicated presence or absence of experiencing 21 stressors across domains such as a family member contracting COVID, increased caregiving burden, work-related stress, and child adjustment problems. Three latent classes were identified, with one group characterized by work and child adjustment stress, one by child adjustment stress only, and one by low levels of stress across domains. The two higher stress groups reported increased depression. No associations with positive outcomes were found. Martial quality was most important for impacting greater resilience for those individuals experiencing child adjustment stress. This study provides evidence that COVID-related stress had disproportionate impact across parents in MENA countries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The magnitude of suffering on both the Israeli and Palestinian sides of the current war is beyond comprehension. Political agendas, misinformation and bias related to the conflict are being seen far too frequently in healthcare and medical academia. We believe it is time for healthcare professionals to redirect our attention away from politics and use our medical training to advocate for peace, care, and the welfare of all people, regardless of which side of the conflict they fall into. Politics in the workplace, particularly when disseminated information is divisive and, at times, based on opinion rather than fact, risks significant harm to patients, their families, and healthcare staff, as well as to institutional reputation. If we genuinely care for the well-being of patients and staff, we must lead by example and prevent healthcare systems and medical journals from being hijacked by politics.

Objective: This study aimed to evaluate if and how race, ethnicity, and socioeconomic status (SES) are associated with the severity of menopause symptoms in a large, diverse sample of women., Methods: For this cross-sectional study conducted between March 24, 2019, and January 13, 2023, a total of 68,864 women were enrolled from the Evernow online telehealth platform. Participants underwent a clinical intake survey, which encompassed demographic information, detailed medical questionnaires, and a modified Menopause Rating Scale. The modified scale was adapted for ease of use online and is available in the supplementary material along with the full intake. Symptom severity was evaluated using a multivariate binomial generalized linear model, accounting for factors such as race, ethnicity, age, body mass index, smoking status, bilateral oophorectomy status, and SES. Odds ratios (OR) and CIs were calculated based on the linear regression coefficients., Results: Of the participants, 67,867 (98.6%) were included in the analysis after excluding outliers and those with unknown oophorectomy status. The majority of respondents identified as White (77.4%), followed by Hispanic (9.0%), Black (6.7%), two or more races/ethnicities (4.4%), Asian (1.2%), Indigenous/First Nations (0.8%), Middle Eastern (0.3%), and South Asian (0.2%). Notably, individuals identifying as Black (hot flashes OR, 1.91; 97.5% CI, 1.75-2.09; P < 0.001), Hispanic (skin/hair changes OR, 1.58; 97.5% CI, 1.45-1.71; P < 0.001), Indigenous/First Nations (painful sex OR, 1.39; 97.5% CI, 1.19-2.75; P = 0.007), Middle Eastern (weight changes OR, 2.22; 97.5% CI, 1.25-4.37; P = 0.01), or with two or more races/ethnicities (skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001) reported higher levels of symptom severity compared with their White counterparts. Conversely, Asian and South Asian participants reported lower symptom severity. Even after incorporating SES into the linear model, racial and ethnic groups with lower SES (Black, Hispanic, Indigenous, and multiple ethnicities) exhibited slight shifts in OR while maintaining high statistical significance (Black [hot flashes OR, 1.87; 97.5% CI, 1.72-2.04; P < 0.001], Hispanic [skin/hair changes OR, 1.54; 97.5% CI, 1.42-1.68; P < 0.001], Indigenous/First Nations [painful sex OR, 1.74; 97.5% CI, 1.17-2.70; P = 0.009], multiple ethnicities [skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001])., Conclusions: Our study suggests that the relationship between race and ethnicity and the severity of menopause symptoms is not solely explained by differences in SES but is itself an independent factor. Understanding and addressing social, cultural, and economic factors are crucial to reduce disparities in menopausal symptoms., Competing Interests: Financial disclosure/conflicts of interest: At the time of this study, Dr Leah Millheiser was chief medical officer of Evernow. Dr Eduardo Hariton is a paid medical advisor of Evernow. Dr Hariton holds other relationships with entities that are unrelated to the topic of this study and center around his work with startups in the fertility space. These entities include medical advisor positions at Alife Inc, Rescripted, Evernow, Fertilidad Integral, Oya Care, Cercle AI, Levy Health, and Ro/Modern Fertility. Dr Eduardo Hariton also hold board positions at Granata Bio and Azul Fertility. Alicia Jackson, PhD, is founder and CEO of Evernow. Jennifer L. Garrison, PhD, is chief science advisor of Evernow. Dr Jerrine R. Morris received consulting fees from Evernow in the past. Evernow is an online telehealth platform providing menopause treatment., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The Menopause Society.)

The global COVID-19 pandemic has disrupted daily routines and heightened stress levels worldwide, impacting various aspects of health, including sleep. This cross-sectional study conducted in Iran aimed to investigate the impact of Ramadan Intermittent Fasting (RIF) during the pandemic on sleep disturbances and associated risk factors in adults aged ≥ 18 years. Data was collected from Iranian participants observing RIF. A structured electronic questionnaire, translated into Persian, gathered information on sociodemographics, dietary habits, sleep parameters, physical activity, and more. The study assessed sleep quality, duration, and disturbances and conducted a thorough analysis to identify risk factors associated with sleep disruptions. The study revealed that 48% of the participants experienced sleep disturbances during RIF, with 21% reporting poor sleep quality and 46% having unusual sleep duration. Various factors were associated with an elevated risk of sleep disruptions, including body mass index, place of residence, income levels, cohabitation status, family history of obesity, hypertension, diabetes, heart disease, personal history of obesity, weight fluctuations, Shisha smoking, and unemployment. The results highlight the critical importance of health promotion strategies tailored to cultural contexts. This study advocates for enhanced health education initiatives focusing on sleep hygiene and stress management, especially during periods of significant lifestyle alterations like Ramadan amid a global pandemic. Such initiatives are vital in mitigating sleep disturbances and promoting overall well-being in populations facing unique health challenges., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Decentralized agriculture, improper monitoring of cultivation conditions, and leaching of contaminants into lands led to the contamination of crops with various potentially toxic elements (PTEs). However, it is essential to know more about the profile level and associated risk of these contaminants and their origin, especially in high-water content crops. This study aimed to investigate the concentration of PTEs in melons of one of Iran's southern cities and follow that health risk assessment in the target population for the first time. Results of the present study confirmed that although the mean concentration of some metals was lower than the safety standard (Cr: 4.6 ± 2 mg/kg and Pb: 7.4 ± 4 mg/kg), their nutritional value was unfavorable regarding some micronutrients (Cu: 88.8 ± 27 mg/kg and Zn: 480 ± 275 mg/kg). The highest metal concentration in cantaloupe was iron (1706.47 mg/kg, p-value<0.05), and nitrate concentration in all melon types was 2.59-524.54 mg/kg (p-value<0.05). Principal component analysis (PCA) with K-means clustering and the Positive Matrix Factorization (PMF) model have shown that contaminants in melons originated from human activities. So, excessive use of agricultural fertilizers is a possible source of nitrates in melons, which have 93 % of factor loading values. The health risk assessment also showed that melons' carcinogenic and non-carcinogenic risk using the deterministic method was lower than the permissible limit (HQ < 1, ILCR 1 in the children group for the 95th percentile. Furthermore, the level of certainty in the carcinogenesis risk for children, women, and men was estimated at 86.48 %, 64.67 %, and 61.30 %, respectively. Also, the consumption rate was determined as the most important parameter in the sensitivity analysis. As a consequence, there is a potential health risk for Iranians after the consumption of melon due to PTEs and nitrate levels that also originated from anthropogenic sources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to investigate the relationship between glycemic control and diabetes self-management (DSM) and other associated factors among adult Omanis with Type-1 Diabetes Mellitus (T1DM)., Methods: A cross-sectional, descriptive design was used to collect data among 210 adult Omanis with T1DM who were conveniently recruited. All tools were self-reported, whereas the HbA1c was collected from the patient's electronic medical records., Results: The HbA1c mean value was 8.6 ( SD  = 2.5), 30.5% had optimal glycemic control (<7.0). A significant negative relationship between HbA1c and DSM ( r  = - 0.191, p  = 0.006) and diabetes knowledge ( r  = - 0.153, p  = 0.026) was found. Furthermore, the mean HbA1c was significantly lower for persons with a single marital status, have higher education level, have children, are unemployed, were not admitted to the hospital in the last year, and have a health care professional as a family member. Additionally, marital status, level of education, DSM, and social support were significant predictors of glycemic control., Conclusions: The results suggested that better glycemic control could be achieved by optimizing DSM, social support, and diabetes knowledge. Sociodemographic factors should be considered when treating individuals with T1DM to reach good glycemic control.

Iran is located along the Central Asian corridor, a natural artery that has served as a cross-continental route since the first anatomically modern human populations migrated out of Africa. We compiled and reanalyzed the HVS-I (hypervariable segment-I) of 3840 mitochondrial DNA (mtDNA) sequences from 19 Iranian populations and from 26 groups from adjacent countries to give a comprehensive review of the maternal genetic variation and investigate the impact of historical events and cultural factors on the maternal genetic structure of modern Iranians. We conclude that Iranians have a high level of genetic diversity. Thirty-six haplogroups were observed in Iran's populations, and most of them belong to widespread West-Eurasian haplogroups, such as H, HV, J, N, T, and U. In contrast, the predominant haplogroups observed in most of the adjacent countries studied here are H, M, D, R, U, and C haplogroups. Using principal component analysis, clustering, and genetic distance-based calculations, we estimated moderate genetic relationships between Iranian and other Eurasian groups. Further, analyses of molecular variance and comparing geographic and genetic structures indicate that mtDNA HVS-I sequence diversity does not exhibit any sharp geographic structure in the country. Barring a few from some culturally distinct and naturally separated minorities, most Iranian populations have a homogenous maternal genetic structure., (© 2024 The Authors. Annals of Human Genetics published by University College London (UCL) and John Wiley & Sons Ltd.)

Objective: Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach., Design: Cross-sectional study., Setting: Lebanese governorates., Participants: 359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES)., Results: Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015)., Conclusions: Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating., (© 2024. The Author(s).)

This descriptive study was aimed at identifying the anxiety levels of Turkish people in the first three months of the pandemic, the coping methods they use to control this anxiety, and their knowledge and behavior about protection and prevention against COVID-19. The data were collected from 571 individuals. Of the individuals, 84.6% had anxiety. The anxiety levels of those who kept working during the pandemic were significantly higher than were the anxiety levels of those who did not ( p  < .05). The participants experienced a moderate level of anxiety, and they mostly used relaxation techniques, music therapy, and prayer/worship to cope with anxiety. The knowledge level of the individuals about COVID-19 was moderate.

Background: The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated., Methods: From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them., Results: From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps., Conclusions: mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use., (© 2024. The Author(s).)

The massive earthquakes experienced in August and November 1999 affected thousands of people in the Marmara region, the most densely populated and industrialized part of Turkey. The humanitarian and economic cost was so enormous, and these earthquakes have changed the Turkish disaster management system and the Turkish people's approach to disasters. Marmara earthquakes are also considered as a milestone in the provision of psychosocial services for disaster victims. This paper aims to review the psychosocial interventions targeting children, adolescents, and their families after the 1999 earthquakes in Turkey. The progression from initial responses to more organized psychosocial interventions is outlined. Conducting the interventions at schools has ensured that thousands of children, teachers, and parents are reached in the most efficient and effective way possible. The significance of the school context in designing psychosocial interventions is highlighted and implications of the lessons learned for traumatic experiences of children and parents are also explored. It is evaluated that these inferences obtained from the Marmara earthquake in Turkey can be used in disasters around the world., Competing Interests: Declaration of Competing Interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Rapid aging in American society will be disproportionately concentrated among the foreign-born. Immigrants in the United States (U.S.) are a heterogeneous population, yet little is known regarding their differences in disability later in life by region of origin. We use data from the National Health Interview Survey on respondents ages 60+ ( n  = 313,072) and employ gender-specific logistic models to predict reports of any activity of daily living (ADL) disability. After accounting for socioeconomic factors, compared to their U.S.-born non-Hispanic (NH) White counterparts, the odds of reporting ADL disability were higher among U.S.-born respondents that are Hispanic, NH Black, and NH Multiracial as well as respondents with Mexican, Puerto Rican, Cuban, Russian/former Soviet, Middle Eastern, East Asian, and South Asian origins. Also, Dominican, African, and Southeast Asian women-and European men-reported high odds of ADL disability. Our results highlight heterogeneity in the disability profiles of foreign-born older adults in the U.S.., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The relationship between MS and ethnicity has been understudied in the Middle East compared to the United States and Europe. As Iran as the highest prevalence of MS in the Middle East, we decided to investigate the demographic and clinical differences in people with MS (pwMS) from major ethnicities Iran., Methods: In a cross-sectional study using data from National Multiple Sclerosis Registry in Iran. PwMS from six provinces were chosen and interviewed for determining their ethnicity. Persians (Fars), Kurds, Lurs, Azeris and Arabs with a clear ethnic background were included. Recorded data from the registry was used to compare the demographic and clinical features., Results: A total of 4015 pwMS (74.2% female) were included in the study with an average age of 36.76 ± 9.68 years. Persians and Kurds had the highest percentage of pwMS in youngest and oldest age groups, respectively, with 2.9% and 5.7% (p<0.01). The highest average age of onset was seen in Persians (29.47 ± 8.89) and the lowest observed in Mazandaranis (26.82 ± 7.68, p<0.01). Azeris and Kurds had the highest proportions of pwMS diagnosed <18 and >55, at rates of 12% and 1.6%, respectively (p<0.01). There were statistically significant differences in distribution of phenotypes (p<0.01) and time to progression to secondary progressive MS (p<0.01) such that Persians had the highest rate of clinically isolated syndrome (CIS) at 19.3% and Arabs had highest rates of relapsing-remitting MS (86.2%) and secondary progressive MS (16.4%). Lurs, Azeris and Mazandaranis had significantly more patients progressing to secondary-progressive MS <5 years from diagnosis (p<0.01). There was a significant difference in number of relapses between the ethnicities (p<0.01) with Lurs having the highest proportion of participants reporting >4 relapses with 23.0% and Azeris having the highest percentage of pwMS reporting no relapse (53.0%). Kurds had the highest Expanded Disability Status Scale (EDSS) average at 2.93 ± 1.99 and Lurs had the lowest with 1.28 ± 1.25 (p<0.01). The differences in prevalence of positive family history for the whole cohort between ethnicities were significant (P=0.02), ranging from 12.8% in Kurds to 19.6% in Persians., Conclusion: We found Persians to have higher rates of pediatric MS and higher rates of CIS. Kurds and Lurs had higher and lower EDSS scores, respectively. Lurs and Persian had higher annual relapse rates. We also found lower rates of SPMS among Arabs and earlier progression to SPMS in Lurs, Azeris and Mazandaranis. Such differences highlight the importance of the potential role of ethnicities in diagnosis and prognosis of MS, especially considering their observation within the geographical limits of a single country., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Refugees are frequently shown to have worse mental health outcomes than non-displaced populations. This fact is commonly attributed to traumatic pre-displacement experiences. While important, the focus on trauma risks overlooking the role socioeconomic living-conditions in different arrival and transit contexts can play in determining refugees' mental distress. Building on the ecological model of refugee distress, we investigate how social ecological conditions relate to the mental distress of Syrians in Lebanon and Turkey. Both countries present important spaces of arrival and transit for millions of displaced Syrians, each with a specific historical, political, social and economic context., Methods: The empirical analysis is based on data gathered in early 2021 in face-to-face surveys among displaced Syrians in Lebanon (N = 1127) and Turkey (N = 1364). Individual mental distress is evaluated using the Patient Health Questionnaire (PHQ-8) score as the dependent variable in a multivariate regression analysis., Results: Social ecological factors do not only differ in their extent of deprivation between Lebanon and Turkey. They also differ in their relationship with individual mental health outcomes. In Lebanon, limited access to the health care system and having family in the same city are major risk factors for elevated mental distress, whereas in Turkey, these are low education, poverty, unemployment as well as employment as day laborer. Discrimination and social isolation emerge as relevant predictors in both countries., Conclusion: Based on this analysis, we argue that a context-specific understanding of mental distress amidst the social ecology refugees face in countries of refuge and transit is necessary. This approach needs to be pursued to provide adequate support and alleviate refugees' mental distress both, in the country of first refuge and after possible onward migration. In addition to clinical implications, the study particularly highlights the important role anti-discrimination and social inclusion policies could play in promoting refugee mental health., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization.  Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis. What is Known: • Children who have chronic diseases are the group that is most affected by wars. • The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF). What is New: • Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. • Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees., (© 2024. The Author(s).)

This study aimed to investigate parents' PDs that could be associated with children and adolescents' EDs. We studied association of parental PDs with offspring EDs in age group 6-18 years in a nationally representative sample of Iranians with 27,111 children and adolescents and their parents. We used a multistage random cluster sampling method. We used Millon Clinical Multiaxial Inventory-Third Edition and Persian present and lifetime version of Kiddie Schedule for Affective Disorders and Schizophrenia to measure parental PDs and children and adolescents' EDs, respectively. We used descriptive statistics and binary logistic regression analysis methods to analyze the data. Maternal but not paternal PDs were significantly associated with EDs in offspring. Maternal antisocial, borderline, schizoid, histrionic, and compulsive PDs were significantly associated with EDs in offspring by 32.06, 4.66, 4.32, 3.15, and 1.71 odd ratios, respectively. Of EDs in offspring, anorexia nervosa and binge ED were significantly associated with maternal PDs., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This family-based study was conducted in a group of Iranians with Type 1 diabetes (T1D) to investigate the transmission from parents of risk and non-risk HLA alleles and haplotypes, and to estimate the genetic risk score for this disease within this population. A total of 240 T1D subjects including 111 parent-child trios (111 children with T1D, 133 siblings, and 222 parents) and 330 ethnically matched healthy individuals were recruited. High-resolution HLA typing for DRB1/DQB1 loci was performed for all study subjects (n = 925) using polymerase chain reaction-sequence-specific oligonucleotide probe method. The highest predisposing effect on developing T1D was conferred by the following haplotypes both in all subjects and in probands compared to controls: DRB1*04:05-DQB1*03:02 (Pc = 2.97e-06 and Pc = 6.04e-10, respectively), DRB1*04:02-DQB1*03:02 (Pc = 5.94e-17 and Pc = 3.86e-09, respectively), and DRB1*03:01-DQB1*02:01 (Pc = 8.26e-29 and Pc = 6.56e-16, respectively). Conversely, the major protective haplotypes included DRB1*13:01-DQB1*06:03 (Pc = 6.99e-08), DRB1*15:01-DQB1*06:02 (Pc = 2.97e-06) in the cases versus controls. Also, DRB1*03:01-DQB1*02:01/DRB1*04:02|05-DQB1*03:02 and DRB1*03:01-DQB1*02:01/DRB1*03:01-DQB1*02:01 diplotypes conferred the highest predisposing effect in the cases (Pc = 8.65e-17 and Pc = 6.26e-08, respectively) and in probands (Pc = 5.4e-15 and Pc = 0.001, respectively) compared to controls. Transmission disequilibrium test showed that the highest risk was conferred by DRB1*04:02-DQB1*03:02 (Pc = 3.26e-05) and DRB1*03:01-DQB1*02:01 (Pc = 1.78e-12) haplotypes and the highest protection by DRB1*14:01-DQB1*05:03 (Pc = 8.66e-05), DRB1*15:01-DQB1*06:02 (Pc = 0.002), and DRB1*11:01-DQB1*03:01 (Pc = 0.0003) haplotypes. Based on logistic regression analysis, carriage of risk haplotypes increased the risk of T1D development 24.5 times in the Iranian population (p = 5.61e-13). Also, receiver operating characteristic curve analysis revealed a high predictive power of those risk haplotypes in discrimination of susceptible from healthy individuals (area under curve: 0.88, p = 5.5e-32). Our study highlights the potential utility of genetic risk assessment based on HLA diplotypes for predicting T1D risk in individuals, particularly among family members of affected children in our population., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The establishment of Reference Intervals (RIs) for Hemoglobin A1C and other hemoglobin subfractions (A1A, A1B, F, LA1C, A0) is of utmost importance in screening, diagnosing, and monitoring diabetes and other hemoglobin abnormalities through the application of high-pressure liquid chromatography (HPLC) technique. Because there are no locally established RIs for these parameters, it is essential to establish RIs specific to the Saudi population to accurately diagnose and monitor diabetic individuals and identify abnormal levels in hemoglobin subfractions., Methods: As part of the IFCC global multicenter study of laboratory reference values, a cross-sectional study was conducted in Saudi Arabia. The study involved recruiting a total of 381 healthy adult subjects (>18 years, BMI 28.3 ± 6 kg/m2). Blood samples were analyzed for A1C, biochemical and other immunoassay parameters. The need for RIs based on sex, age, and BMI was determined using the standard deviation ratio (SDR) through a 3-level nested ANOVA., Results: Based on the threshold of SDR≥0.4, RIs for A1C and other Hb subfractions were not partitioned by sex or BMI, but partitioned by age (<45 & ≥45 years) for A1C, LA1C, A0 and F. Spearman's correlation between glucose, insulin, and C-peptide showed a positive association with different hemoglobin subtractions of A1B, F, A1C, and LA1C. The RIs were obtained by using the parametric method and the latent abnormal values exclusion (LAVE) principle was applied on A1C., Conclusion: This study established RIs for A1C and other Hb subfractions for healthy adult Saudis. Age was found to be an important source of variation for most of the parameters including A1C. These findings will enhance the understanding and clinical decision-making concerning A1C and other hemoglobin subfractions. The elevated upper limit of RIs for A1C reflects the high prevalence of diabetes in the Saudi population specially in those with increased age., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Borai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The present research aimed to examine bullying among diverse Arab nationalities residing in Qatar across two separate studies. Study 1 examined how Arabic-speaking adolescents and adults describe and perceive bullying, participants ( N = 36) from different Arab nationalities (i.e., Egyptians, Qataris, Syrians, and other Arabs) were presented with three tasks in a focus group where they were asked questions about how they describe and perceive three scenarios without reference to the term "bullying". Findings indicated that (1) the majority of participants referred to the intention to cause harm and the imbalance of power in their descriptions, and (2) differences in describing the behaviours in the scenarios were notable when comparing Egyptians with the three other nationalities. Overall, participants frequently chose different Arabic terms (e.g., Ta'adi (تعدي)) in their descriptions of the scenarios. Interestingly, the term Tanammor (تنمُّر), which has been used in previous studies as the Arabic term for bullying, was chosen the least by the current sample. Study 2 examined how Arab-speaking students ( N = 117) describe bullying behaviour in seven scenarios using Arabic and English terms. The procedure was administered in English in the international schools, and Arabic in the independent schools. English-speaking students often used the term "bullying", whereas Arabic-speaking students often used behavioural descriptions (e.g., the term "solok sayea" (سلوك سيء) which translates to "bad behaviour"). These findings are discussed in relation to the definition and perspective of bullying among Arabic speakers. There is a need for further investigations to introduce a novel term for bullying within the Arabic language while considering cultural values, norms, and beliefs. This has the potential to promote heightened awareness and comprehension, enabling the formulation of customised intervention approaches, policies, and educational initiatives intended to prevent and alleviate bullying behaviours.

Introduction: Body dysmorphic disorder (BDD) causes distress due to one's negative appraisal of their body image. The development of BDD has been linked to the passive use of social media and photo-editing apps. People with BDD typically pursue cosmetic surgeries to remedy their perceived flaws. The dramatic increase in the use of photo-editing apps and their well-established effects on mental health is a public health concern., Purpose: To study the association between use of social media and the development of BDD and acceptance toward cosmetic surgeries (ACSS) among Saudis., Methods: An online, cross-sectional, validated survey conducted among Saudis 18 and older. Descriptive analyses were utilized for demographics and prevalence rates of main study variables. ANOVA was used to compare mean scores in BDD and ACSS among different demographic groups. Tukeys post-hoc test was done to identify the categories that were different when the ANOVA test showed a statistically significance. A p -value of <0.05 was considered statistically significant., Results: A total of 1,483 Saudi adults completed the questionnaire. Key results showed that BDD was found in 24.4 % of the sample. The percentage of participants with BDD who spent 4-7 h per day on Instagram and Snapchat (29%) was significantly higher than those who spent only less than an hour per day on these platforms (19%) ( p < 0.001). Individuals with BDD had a significantly higher risk of accepting cosmetic surgery compared to those without BDD ( p < 0.001)., Conclusion: A growing body of evidence suggests that social media may impact mental health in different ways. This study reveals that heavy use of these platforms is associated with negative appraisals about one's physical appearance, and it fosters one's tendency toward cosmetic surgery, especially among females., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ateq, Alhajji and Alhusseini.)

Background: The ophthalmology workforce is an integral component of any health care system. However, the demand for eye care has imposed a heavy burden on this system. Hence, this study aimed to estimate the trends, demographic characteristics, distribution, and variation between Saudi and non-Saudi ophthalmologists and the future challenges of the ophthalmology workforce in the Kingdom of Saudi Arabia (KSA)., Methods: This study was conducted in the KSA and included ophthalmologists practicing from 2010 to 2023. From the Saudi Commission for Health Specialties, we obtained the number, gender, nationality, and rank of ophthalmologists. The geographic distribution of ophthalmologists in the KSA was obtained from the Ministry of Health Statistical Yearbook 2021., Results: As of January 2023, the KSA had a total of 2608 registered ophthalmologists, with approximately 81.06 ophthalmologists per 1,000,000 people. Only 38% of all ophthalmologists in the country were Saudis. The percentage of Saudi female graduates increased from 13.3% to 37.2% over 12 years [Sen's estimator of slope for median increase per year = 1.33 (95% CI 1.22-1.57) graduates; trend test P < 0.001). Additionally, we found that the geographic distribution of ophthalmologists varied (test for homogeneity of rates, P < 0.0001), with the larger regions having a higher concentration of ophthalmologists than the smaller regions (75.6 in Riyadh versus 42.8 in Jazan per 1,000,000 people). However, the World Health Organization's target for the ophthalmologist-to-population ratio has been achieved in all 13 health regions of KSA., Conclusion: The recommended ophthalmologist-to-population ratio has been achieved in the KSA, and the number of Saudi ophthalmologists has almost doubled over the past 8 years. However, the majority of ophthalmologists are still non-Saudi, as Saudi ophthalmologists constitute approximately one-third of the ophthalmology workforce in the KSA. The geographical distribution of ophthalmologists varies, which might affect access to care in peripheral regions. In response to the growing demand for eye care in the KSA, several more effective measures might need to be considered., (© 2024. The Author(s).)

The purpose of this study is to establish and test a reference data set of dental development of Qatari subjects aged between 5 and 25 years. Radiographs of individuals aged between 5 and 25 years were re-used to establish a reference data set (RDS). A scheme comprising 8 tooth development stages (TDS) was used to assess all the teeth on the left side of the maxilla and mandible. The accuracy of dental age estimation (DAE) was tested with a separate sample of radiographs - the validation sample (VS) comprised 50 females and 50 males of known chronological age (CA). Dental panoramic tomographs (DPT) of 1,597 Qataris were assessed. The summary data for the individual TDS comprising the number (n-tds), mean ( x ¯ -tds), standard deviation (sd-tds), 0th%-ile (the minimum), 25th%-ile, 50th%-ile (the median), 75th%-ile, and 100th%-ile (the maximum) were used to estimate the age of the VS subjects using the simple average method (SAM). There is a significant difference in dental age of 4.8 months in the female group when compared to the CA. The difference in the male group is 4.5 months. This shows similar differences to assessments of other ancestral or ethnic groups., (© 2023. Crown.)

B-cell acute lymphoblastic leukemia (B-ALL), the most predominant type of ALL, is less common and incurable among adults. Regarding the pivotal role of NK cells in immune surveillance against hematological malignancies, studying the effective factors in regulating their function, particularly KIRs as the most important NK cell receptors and HLA-I molecules as their main ligands, is of importance. Since NK responses against malignant lymphoblasts are influenced by KIR signals, we did a case-control study on 154 adult patients with B-ALL and 181 healthy controls to investigate the correlation of KIR/HLA-I combinations with susceptibility to B-ALL in Iranians. The genotyping of KIR genes and HLA-I alleles was performed by PCR-SSP with 11 and 9 primer pairs, respectively. Our data revealed an increased frequency of activating (a)KIRs and aKIR/HLA-I combinations in our patients: KIR3DS1 (p = 0.009, OR = 1.81), Bx genotype (p = 0.038, OR = 1.81), KIR3DS1(+)/HLA-Bw4 Thr80 (+) (p = 0.004, OR = 3.61), and KIR3DS1(+)/HLA-B Bw4(+) (p = 0.037, OR = 1.76). The presence of inhibitory (i)KIRs in the absence of their cognate HLA-I ligands was also more frequent among the patients. However, the frequency of inhibitory combinations was more common in controls: KIR2DL1(+)/HLA-C2(+) (p = 0.027, OR = 0.57), KIR2DL2/3(+)/HLA-C1(+) (p = 0.004, OR = 0.5), and KIR3DL2(+)/HLA-A3/A11(+) (p = 0.0012, OR = 0.46). To sum up, the less inherited iKIR/HLA-I combinations might make individuals more susceptible to B-ALL because of inefficient education of NK cells., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation-that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures-is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope., (© 2024. The Author(s).)

Background: Mild cognitive impairment (MCI) is an intermediate stage between healthy cognition and dementia, particularly Alzheimer's disease. There is limited information on the prevalence of MCI among older Turkish adults. This study aimed to determine the prevalence and risk factors of MCI in Turkey., Material and Methods: A cross-sectional study was conducted with community-dwelling older people who were admitted to a tertiary geriatric outpatient clinic. Information on demographics and clinical variables was obtained. We used a neuropsychological battery to assess the cognitive domains in each subject. Participants who fell below 1.5 standard deviations on 1 or more of the 5 cognitive tests were considered MCI and were classified as either single domain MCI and multiple domain MCI. Risk factors were determined using univariate and multivariate logistic regression analyses., Results: A total of 259 participants were enrolled in this study. The mean age was 74.0 years (SD 7.1 years), 54% were women, and 48.3% had a low level of education (≤ 5 years). The overall prevalence of MCI was 52.1%, with 27.8% for single domain MCI and 24.3% for multiple domain MCI. The prevalence of MCI increased with age: 16.4% aged 65-74 years, 32.0% aged 75-84 years, and 40.9% ≥ 85 years. Advanced age and low educational level were risk factors for both single domain MCI (OR = 1.07; 95% CI: 1.02-1.13; p = 0.003 and OR = 3.18; 95% CI:1.7-6.1; p < 0.001) and multiple domain MCI (OR = 1.1; 95% CI:1.1-1.2; p < 0.001 and adjusted OR = 11.9; 95% CI:5.1-27.8; p < 0.001)., Conclusion: MCI was common in older Turkish people admitted to a tertiary hospital, especially in those with advanced age and low educational level., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Endometrial cancer (EC) constitutes more than half of all genital cancers in women, with an increasing incidence in different countries. Natural killer cells (NK cells) are kinds of innate immune cells that are controlled by sets of receptors, such as killer cell Ig-like receptors (KIRs), which can inhibit or activate NK cells. In this study, we evaluated the diversity and genetic association of KIRs in confirmed cases of endometrial cancer compared to healthy controls. A total of 151 women with EC and 167 age/race-matched healthy controls were analyzed for KIR genes. Demographic and histopathologic data were gathered in questionnaires, and 16 KIR genes along with two variants of KIR2DS4 (KIR2DS4fl and KIR2DS4del), were genotyped by usingsequence specific primers-polymerase chain reaction (SSP-PCR) method. A comparison between cases and controls revealed that although there were not any significant differences in A haplotype associated genes and also the variants of KIR2DS4 (p >0.05), B haplotype associated genes such as KIR2DS2 and KIR2DL2 decreased significantly in EC patients in comparison with healthy controls (p=0.03 and p=0.01, respectively). Furthermore, we found that EC mostly developed in cases with the AA genotype; however, the carriers of Bx and C4T4 genotypes were less frequent in patients with EC. Our results revealed that KIR2DS2 and KIR2DL2, along with Bx and C4T4 genotypes, have a protective impact against developing endometrial cancer in Iranians., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)