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BACKGROUND: Internet gaming disorder (IGD) is a serious rising problem affecting people of all ages. Many researchers reported that students' addictive gaming behavior resulted in the loss of function and the development of psychological problems. In this study, we aimed mainly to measure the prevalence of internet gaming disorder among Mansoura University students and find its relationship with psychological well-being. METHODS: A cross-sectional observational study was carried out during the academic year (2021-2022) at the University of Mansoura. Students from four different faculties were included. Participants ages ranged from 18 to 25 years old. An online Google Form questionnaire gathering the tools (questionnaire of demographic and clinical data, Internet Gaming Disorder Short Form scale, Ryff's scale of psychological well-being) was distributed among them. RESULTS: In this study, 870 students were included. The age range was 18-25 years. They were divided into three groups: 315 normal gamers (36%), 500 risky gamers (58%), and 55 disordered gamers (6%), with no significant gender difference in each group (p-value = 0.138). A negative correlation was found between IGD and psychological well-being (r = -0.303). CONCLUSIONS: The prevalence of IGD was 6% among Mansoura University students. Participants in the theoretical faculties who started playing internet gaming at a younger age and spent more than 2 h per week playing and more than 3 h per week thinking about playing internet games were more likely to develop IGD. Whenever IGD scores increased, psychological well-being scores were found to decrease (r = -0.303).

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BACKGROUND: Defensive medicine (DM) is a deviation from medical practice that is induced primarily by a threat of liability. While the DM behavior is well studied in the developed countries, little is known in developing countries and never been evaluated in Jordan. OBJECTIVE: To evaluate the prevalence of DM practice in Jordan among physicians and to investigate reasons behind its practice and potential strategies to alleviate this practice. METHODS: In this Cross-sectional study, self-administered questionnaire was distributed to a sample of physicians in both public and private sectors in Jordan. The collection period was from Jan 2021 to June 2021. The prevalence of DM practice was estimated among the study sample. Frequency scores of different DM behaviors, reasons of DM behaviors, and effectiveness of strategies in changing DM behaviors were summarized as average frequency scores with standard deviations. Multivariable linear regression models were conducted to evaluate potential predictors of total assurance and avoidance behavior scores. RESULTS: A total of 175 Jordanian physicians completed the survey. The prevalence of adopting (or witnessing) DM behaviors among the study sample was 68% (n = 119). Diagnostic laboratory exams followed by prescribed medications were the most practiced behaviors in excessive rate during a typical working week. Unfavorable legislation for the physician was reported as the headmost reason for practicing DM, followed by pressure from the public and mass media opinion. Continuous update of knowledge, abilities, and performance and following specific protocols and/or appropriate clinical evidence and appropriate multidisciplinary and multi-professional communication were the most effective strategies that can mitigate DM behaviors. CONCLUSIONS: Defensive medicine practice is common among Jordanian physicians with concerns about increasing pattern in the future.

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Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease of infectious etiology in children. This study aims to compare cognitive impairment, and psychological status of treatment-naïve HCV children with control group. Treatment-naïve children with HCV and an equal control group of children of matched age and gender were recruited. Assessment included measures of children's cognitive functioning, behavior, depression and anxiety as well as laboratory investigations and liver biopsy. Overall 102 children of both genders were recruited; the majority was from rural areas and from middle social class. Their age ranged from 7 to 17 years old. Only 6.9% reported positive family history of Psychiatric disorders while 35.3% reported current Psychiatric disorder. The most frequent diagnosis in the sample was depression (16.7%). Depression scores correlated negatively with liver biopsy activity (p = 0.024) and positively with WBCS (p = 0.0024). Anxiety scores correlated positively with WBCS (p = 0.017). Verbal IQ, performance IQ and total IQ correlated with the social class and with the liver biopsy activity. Also it was found that higher depression scores can predict lower verbal IQ. Depression, social class and liver Inflammation are predictors of cognitive impairment in children with HCV.

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BACKGROUND: The prevalence of mental health disorders is increasing globally. Countries in South Asia, Southeast Asia and the Middle East regions carry high burdens of mental health need; however, there are relatively few mental health research publications from this region, suggesting inadequate research funds and a paucity of qualified research personnel. To increase and strengthen the pool of mental health researchers in India and Egypt, we conducted three psychiatric research programmes in these countries: the Training Program for Psychiatric Genetics in India (2002-2011), the Tri-National Training Program for Psychiatric Genetics (2009-2014) and the Cross-Fertilized Research Training for New Investigators in Egypt and India (2014-2019). A total of 66 trainees, including psychiatrists, psychiatric social workers, clinical psychologists and research psychologists, were supported in research development, which included didactic training, proposal development, hands-on research and manuscript preparation. METHODS: The aim of this study is to evaluate these three training programmes using the four-level Kirkpatrick Model of Training Evaluation that assesses reaction, learning, behaviour and outcomes. A descriptive analysis was used to explore the data collected throughout the duration of the three training programmes. Online surveys were crafted and sent to the mentors and trainees of the three programmes to supplement objective training data. RESULTS: In addition to positive changes in the areas of reaction, learning and behaviour, significant outcomes were demonstrated. As of the writing of this manuscript, the trainees published a total of 130 papers, 59 as first author. In addition, 26 trainees have co-authored papers with one or more trainees or mentors, which demonstrates successful research networking and collaboration. CONCLUSION: Our findings suggest that our training approach is a successful model for building independent mental health researchers. This is a critical step in the development of effective mental health interventions in low- and middle-income countries.

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Background Pharmaceutical promotion efforts should facilitate excellent quality patient care. However, there has been substantial debate about ethical principles related to pharmaceutical promotions. Objectives This study aimed to evaluate (i) attitudes toward pharmaceutical promotion among physicians in the private sector in Jordan, (ii) the impact of pharmaceutical promotion in influencing physicians' prescribing practices, and (iii) the prospect of academic detailing on this issue in Jordan. Setting The private health care sector in Jordan. Methods In this cross-sectional study, a self-administered questionnaire was distributed to a sample of physicians from the private health sector in Jordan during the period from December 2018 to March 2019. Descriptive statistics were conducted to describe physicians' attitudes toward pharmaceutical promotions, factors affecting prescribing practices, and perceptions toward academic detailing. Logistic regression models were performed to investigate predictors of acceptance and skepticism attitudes toward pharmaceutical promotion. Eisenberg model of physician decision-making was applied to evaluate factors influencing physicians' prescribing practice of promoted pharmaceutical products. Main outcome measure Attitudes toward pharmaceutical promotions, exposure to promoted pharmaceutical products, factors affecting physicians' prescribing practice of promoted pharmaceutical products, and their perceptions toward academic detailing and expected challenges. Results A total of 310 physicians completed the survey. The majority of physicians (73%) agreed that pharmaceutical companies provide valuable education on new pharmaceutical products. However, 66% of physicians agreed that lectures that are sponsored by pharmaceutical companies are often biased in favor of their products. Ninety-two percent of physicians agreed that drug samples were the most commonly offered promotional products by pharmaceutical companies. Being educated about the ethical principles related to pharmaceutical promotions among physicians was associated with higher likelihood of being skeptic about pharmaceutical promotional activities. Physicians' years of experience, payers' factors, environmental factors and participation in drug committees were significantly associated with high impact of marketing activities on physicians' prescribing practices (ORs of 1.2, 1.2, 1.49 and 0.43, respectively). The majority of participants in the current study reported positive attitudes toward applying academic detailing services in the future. Conclusions Education seems to play a crucial role in physicians' attitudes toward pharmaceutical promotion. Academic detailing is a promising strategy to counteract unethical marketing practice.

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BACKGROUND: Self-reported consanguinity is associated with risk for schizophrenia (SZ) in several inbred populations, but estimates using DNA-based coefficients of inbreeding are unavailable. Further, it is not known whether recessively inherited risk mutations can be identified through homozygosity by descent (HBD) mapping. METHODS: We studied self-reported and DNA-based estimates of inbreeding among Egyptian patients with SZ (n = 421, DSM IV criteria) and adult controls without psychosis (n = 301), who were evaluated using semi-structured diagnostic interview schedules and genotyped using the Illumina Infinium PsychArray. Following quality control checks, coefficients of inbreeding (F) and regions of homozygosity (ROH) were estimated using PLINK software for HBD analysis. Exome sequencing was conducted in selected cases. RESULTS: Inbreeding was associated with schizophrenia based on self-reported consanguinity (χ2 = 4.506, 1 df, p = 0.034) and DNA-based estimates for inbreeding (F); the latter with a significant F × age interaction (ß = 32.34, p = 0.0047). The association was most notable among patients older than age 40 years. Eleven ROH were over-represented in cases on chromosomes 1, 3, 6, 11, and 14; all but one region is novel for schizophrenia risk. Exome sequencing identified six recessively-acting genes in ROH with loss-of-function variants; one of which causes primary hereditary microcephaly. CONCLUSIONS: We propose consanguinity as an age-dependent risk factor for SZ in Egypt. HBD mapping is feasible for SZ in adequately powered samples.

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BACKGROUND: Schizophrenia (SZ) is associated with cognitive impairment that contributes to disability, but the cognitive dysfunction is relatively refractory to pharmacologic intervention. Though Valproate augmentation is reported to improve psychopathology among patients with SZ, its effects on cognitive functions have not been investigated systematically. METHODS: Using a randomized double blind placebo controlled design, the effects of Valproate or placebo as adjuncts to risperidone (RISP) treatment were evaluated among patients with early course SZ (N = 109). Domains of cognitive function, estimated using the Arabic version of the Penn Computerized Neurocognitive Battery, were the prime outcomes. Clinical severity and social function were secondary outcomes. We also explored the effects of valproate treatment on serological responses to Toxoplama Gondii (TOXO), a putative risk factor for cognitive dysfunction in SZ. RESULTS: There were no significant differences between Valproate and placebo (PLA) treated groups with respect to changes in cognitive functions, positive or negative symptom scores or daily function scores at the beginning and end of the study. No significant Valproate/PLA differences were noted on TOXO serostatus or TOXO-related cognitive dysfunction. CONCLUSION: Valproate treatment may not be beneficial for cognitive dysfunction in SZ or for TOXO infection.

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BACKGROUND AND OBJECTIVES: Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Our objective was to examine the possible demographical and clinical correlates for impulsive behavior in patients with schizophrenia. METHODS: Fifty-eight patients with schizophrenia and Seventy-seven healthy controls were recruited. Sociodemographic data were collected and they were subjected to the Barratt Impulsiveness Scale (BIS), Positive and Negative Syndrome scale (PANSS), and Trauma Assessment for Adults-Brief Revised Version (TAA). RESULTS: Correlations between impulsive behavior and psychosocial variables were examined. A significant association between level of impulsive behavior and severity of psychopathological symptoms was observed (P=0.0001). Young age (P=0.001), male patients (P=0.0001) and those with history of childhood sexual or physical abuse (P=0.0001), were more impulsive. Linear regression (step wise) analysis model showed that male sex (P=0.001), positive symptoms (P=0.006), and childhood physical abuse (P=0.001) were significant associations. CONCLUSION: Male gender, positive symptoms as well as history of physical and sexual abuse before 18 years of age are important predictors for high levels of impulsive behavior in schizophrenia patients.

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BACKGROUND: Hepatitis C virus (HCV) infection is associated with cognitive dysfunction in clinic-based studies. The risk could be attributed to factors such as antiviral medications, substance abuse, or coincidental infection. AIM: The aim was to evaluate cognitive function in relation to HCV antibody titers in a community-based sample of asymptomatic individuals at low risk for substance abuse. METHOD: Adults were ascertained from a community in Mansoura, Egypt, where HCV is endemic (n = 258). Cognitive performance was evaluated using the Arabic version of the Penn Computerized Neurocognitive Battery. Substance abuse and psychopathology were also assessed. Antibodies to HCV and Toxoplasma gondii (TOX), a common protozoan that can affect cognition, were estimated using serological IgG assays. RESULTS: The prevalence of HCV and TOX infection was 17.6% and 52.9%, respectively. HCV antibody titers were significantly associated with worse function in four cognitive tests for accuracy and three tests for speed, after adjusting for covariates (p < .05, beta coefficients, 2.1-3.2). TOX antibody titers were associated with impaired accuracy in one test. CONCLUSIONS: The association between HCV antibody titers and cognitive impairment is not mediated by antiviral treatment or substance abuse in this sample. Whether HCV has a causal role in the cognitive dysfunction should be investigated.

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INTRODUCTION: With the globalization of biomedical research and the advent of "precision medicine," there is increased need for translation of neuropsychological tests, such as computerized batteries that can be incorporated in large-scale genomic studies. Estimates of translational validity are obtained by administering the test in the original and the translated versions to bilingual individuals. We investigated the translation of a neuropsychological battery from English to Arabic and how practice effects influence translational validity estimates. METHODS: The Penn computerized neurocognitive battery (Penn CNB) includes tests that were validated with functional neuroimaging and provides measures of accuracy and speed of performance in several cognitive domains. To develop an Arabic version of the CNB, the English version was translated into Arabic, then back translated and revised. The Arabic and the original English versions were administered in a randomized crossover design to bilingual participants (N = 22). RESULTS: Performance varied by cognitive domain, but generally improved at the second session regardless of the language of the initial test. When performance on the English and Arabic version was compared, significant positive correlations were detected for accuracy in 8/13 cognitive domains and for speed in 4/13 domains (r = .02 to .97). When the practice estimates using linear models were incorporated, the translational validity estimates improved substantially (accuracy, r = .50-.96, speed, r = .63-.92, all correlations, p = .05 or better). CONCLUSION: While crossover designs control for order effects on average performance, practice effects, regardless of language, still need to be removed to obtain estimates of translational validity. When practice effect is controlled for, the Arabic and English versions of the Penn-CNB are well correlated, and the Arabic version is suitable for use in research.

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OBJECTIVES: To develop Arabic versions of English language questionnaires to estimate morningness/eveningness and sleep variables. METHODS: We translated the Composite scale of morningness (CSM) and the sleep timing questionnaire (STQ) [with added siesta questions] into Arabic; the Arabic versions were then back translated. The revised Arabic and the original English versions were next administered to bi-lingual Egyptians using a crossover design (n=25). The Arabic versions of both scales were subsequently administered to an independent Egyptian sample (n=79) and the siesta variables examined in relation to the CSM. RESULTS: Satisfactory correlations were present between the English and Arabic versions for total CSM scores (Spearman's ρ=0.90, p<0.001). All but one of the STQ variables were significantly correlated (Spearman's ρ=0.45-0.88, p≤0.05). In the Arabic version, the frequency of siesta naps per week was significantly correlated with the total CSM score, with evening types taking more naps (Spearman's ρ=-0.23, p≤0.05). CONCLUSIONS: Arabic versions of the STQ and CSM have been developed in Egypt, and are freely available. They can be used for behavioral research related to sleep and circadian function and can be adapted for use in other Arab speaking populations.

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OBJECTIVE: To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt. METHODS: BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables. RESULTS: Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37±0.9) and SZ patients (0.38±0.9) was significantly lower than for controls (1.04±1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8±1.57) was significantly higher than BP1 patients (1.14±1.31, p=0.02), but not significantly different from SZ patients (1.36±1.32, p=0.2). CONCLUSION: Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability.

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We have recently found that consanguinity is a risk factor for bipolar I disorder (BP1) and schizophrenia (SZ) in Egypt. Inbreeding has been associated with increased cellular stress and impaired physiological function in plants and animals. Previous studies have reported that telomere length (TL), an index of oxidative stress and cellular senescence is significantly reduced among patients with SZ or mood disorders compared with control individuals. Hence we evaluated TL as a possible mediator of the observed association between consanguinity and BP1/SZ risk. Patients with BP1 (n=108), or SZ (n=60) were compared with screened adult controls in separate experiments. TL was estimated using a quantitative PCR (qPCR) based assay. The inbreeding coefficient/consanguinity rate was estimated in two ways: using 64 DNA polymorphisms ('DNA-based' rate); and from family history data ('self report'). Significant correlation between TL and DNA based inbreeding was not observed overall, though suggestive trends were present among the SZ cases. No significant case-control differences in TL were found after controlling for demographic variables. In conclusion, reduced TL may not explain a significant proportion of observed associations between consanguinity and risk for BP1/SZ.

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BACKGROUND: In most developing countries, as in Egypt; postmenopausal breast cancer cases are offered a radical form of surgery relying on their unawareness of the subsequent body image disturbance. This study aimed at evaluating the effect of breast cancer surgical choice; Breast Conservative Therapy (BCT) versus Modified Radical Mastectomy (MRM); on body image perception among Egyptian postmenopausal cases. METHODS: One hundred postmenopausal women with breast cancer were divided into 2 groups, one group underwent BCT and the other underwent MRM. Pre- and post-operative assessments of body image distress were done using four scales; Breast Impact of Treatment Scale (BITS), Impact of Event Scale (IES), Situational Discomfort Scale (SDS), and Body Satisfaction Scale (BSS). RESULTS: Preoperative assessment showed no statistical significant difference regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects. CONCLUSION: Body image is an important factor for postmenopausal women with breast cancer in developing countries where that concept is widely ignored. We should not deprive those cases from their right of less mutilating option of treatment as BCT.

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