Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

BACKGROUND

Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services.

METHODS

We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022.

RESULTS

Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers.

CONCLUSIONS

The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

How dentists in Egypt perceive their knowledge, attitudes, and barriers they face in providing oral healthcare to geriatric patients: a cross-sectional study

BACKGROUND

Geriatric dentistry is an understudied area in dental schools in Egypt. Our study aimed to assess the knowledge and attitudes of Egyptian dentists regarding geriatric oral health and identify barriers to delivering dental care to geriatric patients.

METHODS

We conducted an anonymous online cross-sectional study in November and December 2022, targeting dentists with varying levels of experience working in different Egyptian institutions. A 30-item questionnaire assessed the respondent's views on geriatric oral health, perceived knowledge, attitudes, and barriers. The Google form was distributed through emails and commonly used social media platforms.

RESULTS

A total of 421 dentists responded to this online questionnaire. Of the respondents, 44.9% were male, 45.0% were between 20 and 29 years old, and 31.5% worked in more than one dental setting. Multivariate analysis revealed that female sex negatively affected attitude β = -1.72 [95%CI,-2.43 - -1.11]. The proportion of older patients who visited the respondents' clinics per day (11-30%) and more than 30% increased perceived knowledge [β = 1.01 (95%CI, 0.41 -1.62), β = 1.50 (95%CI, 0.71-2.22)] and attitude [β = 0.70 (95%CI, 0.06-1.40), β = 0.73 (95%, 0.13-1.61)] while decreased the perceived barriers [β = -1.10 (95%CI, -1.91 - -0.32)] respectively. On the other hand, years of experience increased perceived knowledge only after 5-10 years [β = 1.02 (95%CI, 0.04-2.10)] and after more than 10 years [β = 1.30 (95%CI, 0.21-2.70)]. Governmental work only increased perceived barriers [β = 1.33 (95%CI, 0.10-2.54)], while living in the middle and west delta decreased perceived barriers [β = -0.91 (95%CI, -2.12 - -0.01 and β = -1.33, (95%CI, -2.22 - -0.40) respectively].

CONCLUSIONS

Our study highlights the need to improve the knowledge and attitudes of young dentists towards geriatric dentistry. Furthermore, working conditions in dental facilities, particularly in the government sector and Upper Egypt, need to be improved to reduce barriers to delivering dental care to geriatric patients.

Efficacy and safety of inhaled heparin in asthmatic and chronic obstructive pulmonary disease patients: a systematic review and a meta-analysis

Asthma and chronic obstructive pulmonary disease (COPD) are prevalent chronic respiratory disorders that cause significant morbidity and mortality. Some studies evaluated the use of inhaled unfractionated heparin (UFH) in the treatment of asthma and COPD. We aimed to synthesize the available evidence for the efficacy and safety of inhaled heparin in improving lung functions among asthmatic and COPD patients. A comprehensive search was performed using Pubmed, Embase, EBSCO, Scopus, Web of Science, Cochrane CENTRAL, WHO Clinical trials, clinicaltrials.gov, Iranian Clinical trials, Google Scholar, Research Gate, ProQuest Thesis, OVID, and medRxiv databases. Two independent reviewers included all pertinent articles according to PRISMA guidelines, and extract data independently. The two reviewers checked the quality of studies using the ROB2 tool. To determine the pooled effect estimate of the efficacy and safety of inhaled heparin, a meta-analysis was carried out using the R programming language. Publication bias was evaluated using Egger's regression test. The heterogeneity was explained using a meta-regression, and the quality of evidence was assessed by the GRADE approach. Twenty-six studies with a total of 581 patients were included in the qualitative analysis and 16 in the meta-analysis. The primary outcome was treatment success (improvement of lung function) that was measured by standardized mean differences (SMD) of the forced expiratory volume per second (FEV1) either per ml or percentage. Heparin has a large effect on both FEV1% and FEV1 ml when compared to the control group (SMD 2.7, 95% CI 1.00; 4.39; GRADE high, SMD 2.12, 95% CI - 1.49; 5.72: GRADE moderate, respectively). Secondary outcomes are other lung functions improving parameters such as PC20 (SMD 0.91, 95% CI - 0.15; 1.96). Meta-regression and subgroup analysis show that heparin type, dose, year of publication, study design, and quality of studies had a substantial effect. Regarding safety, inhaled heparin showed a good coagulation profile and mild tolerable side effects. Inhaled heparin showed improvement in lung functions either alone or when added to standard care. More large parallel RCTs are needed including COPD patients, children, and other types, and stages of asthmatic patients.

Quality of life among the Arab population two years after COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe consequences worldwide. Our study aims to assess the quality of life (QoL) domains and its determinants among the general population in Arab countries after two years of the COVID-19 pandemic.

METHODS

An anonymous online cross-sectional survey using the short version of World Health Organization QoL (WHOQOL-BREF) instrument was distributed among Arab adults in 15 Arab Countries.

RESULTS

A total of 2008 individuals completed the survey. Amongst them, 63.2% were 18-40 years and 63.2% were females, 26.4% had chronic disease, 39.7% confirmed having contracted COVID-19, and 31.5% had experienced the unfortunate loss of relatives due to COVID-19. The survey revealed that 42.7% reported good physical QoL, 28.6% were satisfied with psychological QoL, 32.9% had a sense of well-being in the social domain, and 14.3% had good QoL in the environmental domain. The predictors of physical domains were as follows: being a male (β = 4.23 [95%CI 2.71, 5.82]), being from low-middle income country (β = -3.79 [95%CI -5.92, -1.73]) or being from high-middle-income country (β = -2.95 [95%CI -4.93, -0.92]), having a a chronic disease (β = -9.02 [95%CI -10.62,-7.44]) having a primary/secondary education (β = -2.38 [95%CI -4.41, -0.054]), number of years of work experience ≥ 15 years (β = 3.25 [95%CI 0.83, 5.73]), income-per-capita [ranged from (β = 4.16 [95%CI -5.91, -2.40]) to (β = -11.10 [95CI%, -14.22, -8.11])], a previous COVID-19 infection (β = -2.98 [95%CI -4.41, -1.60]), and having relative died from COVID-19 (β = -1.56 [95%CI -3.01, -0.12]). The predictors of psychological domain were having a chronic disease (β = -3.15 [95%CI -4.52, -1.82]), a postgraduate education (β = 2.57 [95% CI 0.41, 4.82]), number of years of work experience ≥ 15 years (β = 3.19 [95%CI 1.14, 5.33]), income-per-capita [ranged from (β = -3.52 [95%CI -4.91, -1.92]) to (β = -10.31 [95%CI -13.22, -7.44])], and a previous COVID-19 infection (β = -1.65 [95%CI -2.83, -0.41]). The predictors of social domain were being a male (β = 2.78 [95%CI 0.93, 4.73]),  being single, (β =-26.21 [-28.21, -24.32]), being from a low-income country (β = 5.85 [95%CI 2.62, 9.13]), or from a high-middle-income country (β = -3.57 [95%CI -6.10, -2.12]), having a chronic disease (β = -4.11 [95%CI -6.13, -1.11]), and income-per-capita [ranged from (β = -3.62 [95%CI -5.80, -1.41]) to (β = -11.17 [95%CI -15.41, -6.92])]. The predictors of environmental domain were being from a low-middle-income country (β = -4.14 [95%CI -6.90, -1.31), from a high-middle-income country (β = -12.46 [95%CI -14.61, -10.30]), or from a low-income-country (β = -4.14 [95%CI, -6.90, -1.32]), having a chronic disease (β = -3.66 [95%CI -5.30, -1.91]), having a primary/secondary education (β = -3.43 [95%CI -5.71, -1.13]), being not working (β = -2.88 [95%CI -5.61, -0.22]), income-per-capita [ranged from (β = -9.11 [95%CI -11.03, -7.21] to (β = -27.39 [95%CI -31.00, -23.84])], a previous COVID-19 infection (β = -1.67 [95%CI -3.22, -0.21]), and having a relative who died from COVID-19 (β = -1.60 [95%CI -3.12, -0.06].

CONCLUSION

The study highlights the need for public health interventions to support the general population in the Arab countries and mitigate its impact on their QoL.

Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study

BACKGROUND

Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers' understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt.

METHODS

This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire.

RESULTS

A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18-40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients' group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0-4.0) vs. 3.0(2.0-4.0)) for general health, and (4.0(3.0-4.0) vs. 2.0(2.0-3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18-30 years had the highest environmental score compared with the other age groups (P = 0.021).

CONCLUSIONS

TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.

Oxygen Saturation in Hospitalized COVID-19 Patients and Its Relation to Colchicine Treatment: A Retrospective Cohort Study with an Updated Systematic Review

Background: Colchicine has been proposed as a cytokine storm-blocking agent for COVID-19 due to its efficacy as an anti-inflammatory drug. The findings of the studies were contentious on the role of colchicine in preventing deterioration in COVID-19 patients. We aimed to evaluate the efficacy of colchicine in COVID-19-hospitalized patients. Design: A retrospective observational cohort study was carried out at three major isolation hospitals in Alexandria (Egypt), covering multiple centers. In addition, a systematic review was conducted by searching six different databases for published studies on the utilization of colchicine in patients with COVID-19 until March 2023. The primary outcome measure was to determine whether colchicine could decrease the number of days that the patient needed supplemental oxygen. The secondary outcomes were to evaluate whether colchicine could reduce the number of hospitalization days and mortality rate in these patients. Results: Out of 515 hospitalized COVID-19 patients, 411 were included in the survival analysis. After adjusting for the patients' characteristics, patients not receiving colchicine had a shorter length of stay (median: 7.0 vs. 6.0 days) and fewer days of supplemental oxygen treatment (median: 6.0 vs. 5.0 days), p < 0.05, but there was no significant difference in mortality rate. In a subgroup analysis based on oxygen equipment at admission, patients admitted on nasal cannula/face masks who did not receive colchicine had a shorter duration on oxygen supply than those who did [Hazard Ratio (HR) = 0.76 (CI 0.59-0.97)]. Using cox-regression analysis, clarithromycin compared to azithromycin in colchicine-treated patients was associated with a higher risk of longer duration on oxygen supply [HR = 1.77 (CI 1.04-2.99)]. Furthermore, we summarized 36 published colchicine studies, including 114,878 COVID-19 patients. Conclusions: COVID-19-hospitalized patients who were given colchicine had poorer outcomes in terms of the duration of supplemental oxygen use and the length of their hospital stay. Therefore, based on these findings, the use of colchicine is not recommended for COVID-19-hospitalized adults.

Effectiveness and Safety of Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV) among Healthcare Workers: A Seven-Month Follow-Up Study at Fifteen Central Hospitals

BACKGROUND

During a pandemic, healthcare workers are at high risk of contracting COVID-19. To protect these important individuals, it is highly recommended that they receive the COVID-19 vaccine. Our study focused on evaluating the safety and efficacy of Egypt's first approved vaccine, the Sinopharm vaccine (BBIBP-CorV), and comparing these findings with other vaccines.

METHODS

An observational study was conducted in fifteen triage and isolation hospitals, from the 1st of March until the end of September 2021. The study included fully vaccinated and unvaccinated participants, and we measured vaccine effectiveness (using 1-aHR), the incidence rate of severely to critically ill hospitalized cases, COVID-19-related work absenteeism, and the safety of the vaccine as outcomes.

RESULTS

Of the 1364 healthcare workers who were interviewed, 1228 agreed to participate. After taking the hazard ratio into account, the vaccine effectiveness was found to be 67% (95% CI, 80-43%) for symptomatic PCR-confirmed cases. The incidence rate ratio for hospitalization was 0.45 (95% CI, 0.15-1.31) in the vaccinated group compared to the unvaccinated group, and there was a significant reduction in absenteeism among the vaccinated group (p < 0.007). Most adverse events were mild and well tolerated. Vaccinated pregnant and lactating mothers did not experience any sentinel adverse events.

CONCLUSION

Our study found that the BBIBP-CorV vaccine was effective in protecting healthcare workers from COVID-19.

Catastrophic Costs among Tuberculosis-Affected Households in Egypt: Magnitude, Cost Drivers, and Coping Strategies

Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization (WHO), calls for "zero" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household's annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis, p = 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis, p < 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.

Quality of life among health care workers in Arab countries 2 years after COVID-19 pandemic

Background

Assessment of the quality of life (QoL) among healthcare workers (HCWs) is vital for better healthcare and is an essential indicator for competent health service delivery. Since the coronavirus disease 2019 (COVID-19) pandemic strike, the frontline position of HCWs subjected them to tremendous mental and psychological burden with a high risk of virus acquisition.

Aim

This study evaluated the QoL and its influencing factors among HCWs residing in the Arab countries.

Methods

This was a cross-sectional study using a self-administered online questionnaire based on the World Health Organization QoL-BREF instrument with additional questions related to COVID-19. The study was conducted in three different languages (Arabic, English, and French) across 19 Arab countries between February 22 and March 24, 2022.

Results

A total of 3,170 HCWs were included in the survey. The majority were females (75.3%), aged 18-40 years (76.4%), urban residents (90.4%), married (54.5%), and were living in middle-income countries (72.0%). The mean scores of general health and general QoL were 3.7 ± 1.0 and 3.7 ± 0.9, respectively. Those who attained average physical, psychological, social, and environmental QoL were 40.8, 15.4, 26.2, and 22.3%, respectively. The income per capita and country income affected the mean scores of all QoL domains. Previous COVID-19 infection, having relatives who died of COVID-19, and being vaccinated against COVID-19 significantly affected the mean scores of different domains.

Conclusion

A large proportion of the Arab HCWs evaluated in this study had an overall poor QoL. More attention should be directed to this vulnerable group to ensure their productivity and service provision.

Translation and cultural adaptation of the WHO generic tuberculosis patient cost survey in an Egyptian context

Background: Tuberculosis (TB) represents a major health problem with a considerable proportion of patients subject to catastrophic health expenditure. This necessitates a valid tool for measuring TB-related expenditure for patients and their households so that appropriate measures can be enacted to lessen the financial burden. Aims: To translate and culturally validate the generic World Health Organization (WHO) tuberculosis patient cost survey in the Egyptian context. Methods: The instrument was translated and culturally adapted using forward translation, back translation, expert panel assessment, pretesting, cognitive interviewing, and appraisal by the developer. Results: A final Arabic version with modifications to 35 descriptors of the original tool was produced based on the results of expert committee meetings and cognitive interviews with patients. Twelve questions were modified, 13 response options were changed, 6 questions were added and 4 questions were removed. The pretesting of the tool demonstrated that the final version was a culturally sensitive tool to assess the costs incurred by TB patients in an Egyptian context. Conclusion: Policy-makers are encouraged to use this tool to assess the expenditure encountered by TB patients to set appropriate policies to reduce the patients’ financial burden.

A Meta-Analysis on the Safety and Immunogenicity of Covid-19 Vaccines

Objective:

The presented meta-analysis (MA) aims at identifying the vaccine safety and immunogenicity in published trials about SARS-CoV-2 vaccines.

Methods:

All relevant publications were systematically searched and collected from different databases (Embase, Scopus, EBSCO, MEDLINE central/PubMed, Science Direct, Cochrane Central Register for Clinical Trials (CENTRAL), Clinical Trials.gov, WHO International Clinical Trials Registry Platform (ICTRP), COVID Trial, COVID Inato, Web of Science, ProQuest Thesis, ProQuest Coronavirus Database, SAGE Thesis, Google Scholar, Research Square, and Medxriv) up to January 10, 2021. The pooled vaccine safety and immunogenicity following vaccination in phase 1 and 2 vaccine clinical trials, as well as their 95% confidence intervals (CI), were estimated using the random-effects model.

Results:

The predefined inclusion criteria were met in 22 out of 8592 articles. The proportion of anti-severe acute respiratory distress coronavirus 2 (SARS-CoV-2) antibody responses after 7 days among 72 vaccinated persons included in 1 study was 81% (95% CI: 70-89), after 14 days among 888 vaccinated persons included in 6 studies was 80% (95% CI: 58-92), after 28 days among 1589 vaccinated persons included in 6 studies was 63% (95% CI: 59-67), after 42 days among 478 vaccinated persons included in 5 studies was 93% (95% CI: 80-98), and after 56 days among 432 vaccinated persons included in 2 studies was 93% (95% CI: 83-97). Meta regression explains more than 80% of this heterogeneity, where the main predictors were; the inactivated vaccine type (β = 2.027, P = 0.0007), measurement of antibodies at week 1 (β = −4.327, P < 0.0001) and at week 3 of the first dose (β = −2.02, P = 0.0025). Furthermore, the pooled proportion adverse effects 7 days after vaccination was 0.01 (0.08-0.14) for fever, headache 0.23 (0.19-0.27), fatigue 0.10 (0.07-0.13), and 0.18 (0.14-0.23) for muscle pain.

Conclusion:

Immunogenicity following vaccination ranged from 63% to 93% depending on the time at which the antibody levels were measured.

Mental health of frontline healthcare workers exposed to COVID-19 in Egypt: A call for action

BACKGROUND

World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated with adverse mental health consequences.

AIMS

To evaluate mental health outcomes among Egyptian healthcare workers (HCW) treating patients with confirmed or suspected Coronavirus Disease 2019 (COVID-19) to direct the promotion of mental wellbeing, by screening for symptoms of anxiety, insomnia, depression and stress, and analyzing potential risk factors.

METHODS

This cross-sectional, hospital-based survey study collected demographic data and mental health measurements from 502 HCW dealing with COVID-19. HCW were surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different parts of Egypt, in April and May 2020.

RESULTS

Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A considerable proportion of HCW had symptoms of anxiety, insomnia, depression, and stress. Females were at higher risk of experiencing symptoms of severe anxiety (odds ratio [OR], 1.85; 95% CI, 1.12-3.05; p = .016), severe depression (OR, 2.013; 95% CI, 1.17-3.4; p = .011), and severe stress (OR, 2.68; 95% CI, 1.5-4.6; p < .001). Fever hospital workers were at higher risk of severe depression (OR, 1.52; 95% CI, 1.11-2.09; p < .01), compared to Quarantine hospital workers.

CONCLUSION

Ensuring proper mental health support for HCW is an important component of public health measures for addressing the COVID-19 epidemic and safeguarding the continuity of appropriate medical service.