For the analysis of clinical effects, multiple imputation (MI) of missing data was shown to be unnecessary when using longitudinal linear mixed-models (LLM). It remains unclear whether this also applies to cost estimates from trial-based economic evaluations, that are generally right-skewed. Therefore, this study aimed to assess whether MI is required prior to LLM when analyzing longitudinal cost-effectiveness data.

Two-thousand complete datasets were simulated containing five time points. Incomplete datasets were generated with 10 percent, 25 percent, and 50 percent missing data in costs and effects, assuming a Missing At Random (MAR) mechanism. Statistical performance of six different methodological strategies was compared in terms of empirical bias (EB), root-mean-squared error (RMSE), and coverage rate (CR). Six strategies were compared: (i) LLM (LLM), (ii) MI prior to LLM (MI-LLM), (iii) mean imputation prior to LLM (M-LLM), (iv) complete-case analysis prior to seemingly unrelated regression (CCA-SUR), (v) MI prior to SUR (MI-SUR), and (vi) mean imputation prior to SUR (M-SUR). To evaluate the impact on the probability of cost-effectiveness at different willingness-to-pay [WTPs] thresholds, cost-effectiveness analyses were performed by applying the six strategies to two empirical datasets with 9% and 50% of missing data, respectively.

For costs and effects, LLM, MI-LLM, and MI-SUR performed better than M-LLM, CCA-SUR, and M-SUR, as indicated by smaller EBs and RMSEs, as well as CRs closer to the nominal levels of 0.95. However, even though LLM, MI-LLM, and MI-SUR performed equally well for effects, MI-LLM and MI-SUR were found to perform better than LLM for costs at 10 percent and 25 percent missing data. At 50 percent missing data, all strategies resulted in relatively high EBs and RMSEs for costs. In both empirical datasets, LLM, MI-LLM, and MI-SUR all resulted in similar probabilities of cost-effectiveness at different WTPs.

When opting for using LLM for analyzing trial-based economic evaluation data, researchers are advised to multiply impute missing values first. Otherwise, MI-SUR may also be used.

Patients’ EQ-5D health states are preferably valued using country-specific value sets. If value sets are not available, crosswalks may be used to estimate utility values. However, up until now the impact of using crosswalks instead of value sets on cost-utility outcomes remains unclear.

Trial-based cost-utility data were simulated for four conditions (depression, low back pain, osteoarthritis, and cancer), three levels of disease severity (mild, moderate, and severe), and three treatment effect sizes (small, medium, and large), resulting in 36 scenarios. For all scenarios, utility values were estimated using four scoring methods (EQ-5D-3L value set, EQ-5D-5L value set, 3L-to-5L crosswalk, and 5L-to-3L crosswalk) for three countries (the Netherlands, the United States, and Japan). Mean utility values, quality-adjusted life years (QALYs), incremental QALYs, and cost-utility outcomes (incremental cost-effectiveness ratios [ICER], probabilities of cost-effectiveness at willingness-to-pay [WTP] thresholds) were compared between value sets and crosswalks.

Differences between value sets and crosswalks ranged from -0.33 to 0.13 for mean utility values, from -0.18 to 0.13 for QALYs, and from -0.01 to 0.08 for incremental QALYs. Because of the small differences in incremental QALYs, ICERs between scoring methods were considerably different. For small effect sizes, at a WTP of EUR 20,000/QALY gained, the largest difference in the probability of cost-effectiveness was found for moderate cancer between the 5L value set and 3L-to-5L crosswalk (difference 0.63) using Japanese valuations. For medium effect sizes, the largest difference was found for mild cancer between the 3L value set and the 5L-to-3L crosswalk (difference 0.06) using Japanese valuations. For large effect sizes, the largest difference was found for mild osteoarthritis between the 3L value set and 5L-to-3L crosswalk (difference 0.08) using Japanese valuations.

Our findings indicate that reimbursement decisions may change depending on the use of crosswalks. Crosswalks are justifiable in absence of country-specific value sets but should not be considered a sustainable alternative for value sets.

Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses.

A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test.

In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics.

This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents. 1

While adult outcome in autism spectrum disorder (ASD) is generally measured using socially valued roles, it could also be understood in terms of aspects related to health status – an approach that could inform on potential gender differences.

We investigated gender differences in two aspects of outcome related to health-status, i.e. general functioning and self-perceived health status, and co-occurring health conditions in a large multi-center sample of autistic adults. Three hundred and eighty-three participants were consecutively recruited from the FondaMental Advanced Centers of Expertise for ASD cohort (a French network of seven expert centers) between 2013 and 2020. Evaluation included a medical interview, standardized scales for autism diagnosis, clinical and functional outcomes, self-perceived health status and verbal ability. Psychosocial function was measured using the Global Assessment of Functioning scale.

While autistic women in this study were more likely than men to have socially valued roles, female gender was associated with poorer physical and mental health (e.g. a 7-fold risk for having three or more co-occurring physical health conditions) and a poorer self-perceived health status. Psychosocial function was negatively associated with depression and impairment in social communication. Half of the sample had multiple co-occurring health conditions but more than 70% reported that their visit at the Expert Center was their first contact with mental health services.

To improve objective and subjective aspects of health outcome, gender differences and a wide range of co-occurring health conditions should be taken into account when designing healthcare provision for autistic adults.

The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs.

To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs.

Online surveys were distributed to a cohort at three phases (baseline, July to September 2020; phase 2, 6 weeks post-baseline; phase 3, 4 months post-baseline). Each survey contained validated assessments for depression, anxiety, insomnia, burnout and well-being. For each outcome, we conducted mixed-effects logistic regression models (adjusted for a priori confounders) comparing the risk in different groups at each phase.

A total of 1574 HCPs and 147 non-HCPs completed the baseline survey. Although there were generally higher rates of various probable mental health issues among HCPs versus non-HCPs at each phase, there was no significant difference, except that HCPs had 2.5-fold increased risk of burnout at phase 2 (emotional exhaustion: odds ratio 2.50, 95% CI 1.15–5.46, P = 0.021), which increased at phase 3 (emotional exhaustion: odds ratio 3.32, 95% CI 1.40–7.87, P = 0.006; depersonalisation: odds ratio 3.29, 95% CI 1.12–9.71, P = 0.031). At baseline, patient-facing HCPs (versus non-patient-facing HCPs) had a five-fold increased risk of depersonalisation (odds ratio 5.02, 95% CI 1.65–15.26, P = 0.004), with no significant difference in the risk for other outcomes. The difference in depersonalisation reduced over time, but patient-facing HCPs still had a 2.7-fold increased risk of emotional exhaustion (odds ratio 2.74, 95% CI 1.28–5.85, P = 0.009) by phase 3.

The COVID-19 pandemic had a huge impact on the mental health and well-being of both HCPs and non-HCPs, but there is disproportionately higher burnout among HCPs, particularly patient-facing HCPs.

Clostridioides difficile infection (CDI) is among the most common cause of healthcare-associated infections. Persons requiring maintenance hemodialysis (MHD) are at increased risk of CDI and associated mortality compared to persons not requiring MHD. Given the clinical impact of CDI among persons requiring MHD, we aimed to quantify the burden of CDI and trends over time in this patient population.

A systematic review and meta-analysis of studies reporting rates of CDI among persons requiring MHD in MEDLINE, Embase, Web of Science Core Collection, CINAHL, and Cochrane Central Register of Controlled Trials were performed. Searches were conducted on May 17, 2021, and March 4, 2022.

In total, 2,408 titles and abstracts were identified; 240 underwent full text review. Among them, 15 studies provided data on rates of CDI among persons requiring MHD, and 8 of these also provided rates among persons not requiring MHD. The pooled prevalence of CDI among persons requiring MHD was 19.14%, compared to 5.16% among persons not requiring MHD (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.07–9.16; P = .47). The linear increase in CDI over time was significant, increasing an average of 31.97% annually between 1993 and 2017 (OR, 1.32; 95% CI, 1.1–1.58; P < .01). The linear annual increase was similar among persons requiring and not requiring MHD (OR, 1.28; 95% CI, 1.13–1.45; P = .11).

Persons requiring MHD have a 4-fold higher risk of CDI compared to persons not requiring MHD, and rates of CDI are increasing over time in both groups.

Cannabis is among the most widely used substances in the world. it is associated with several mental health problems.

To assess self-esteem among a group of young Tunisian users of cannabis.

The total study sample was composed of 137 participants, who took part of a transversal descriptive study during two months (January and February 2020).

In our study population, the cannabis consumers were young adults aged between 18 and 35 years old, with a male predominance of 71%. Among those users, 65.9% were single and 29.7% dropped out of school or experienced academic failure. On a socio-economic level, we concluded to a rate of 5.8% (lower class), 60.9% (middle class) and 33.3% (upper class). Besides, 40.8% were employed. In total, 23.2% had a psychiatric history. Furthermore, the use of other substances was also prominent and frequent as follows: alcohol 72.5%, tobacco 74.6%, ecstasy 41.3% and 25.4% cocaine. The use of cannabis was considered as a means of indulgence and pleasure for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%. Self-esteem, among those cannabis users, was very low in 20% of cases, low in 38% of cases, medium in 15% of cases and high in 25% of cases.

These results lead us to question the relation between cannabis and self-esteem. The question that is evolved about the use of cannabis is the following: Is it used as a remedy or is it the cause of self-esteem deficiency?

No significant relationships.

Anxiety disorders are very common and burdensome mental illnesses worldwide, characterized by exagerated feelings of worry and fear. These disorders are highly comorbid with other conditions.

The aim of our study is to explore the physical and psychiatric comorbidities and their clinical correlates. The second objective is to identify the predictors of recurrence of anxiety disorders.

Our study concerned 436 outpatients who met DSM-V diagnostic criteria for anxiety disorders and were followed in the Department of Psychiatry of Monastir (Tunisia) between 1998 and 2017. Selective mutism and seperation anxiety were excluded for lack of cases.

Our results demonstrated that Generalized Anxiety Disorder (GAD) was significantly associated with cardiovascular comorbidity (OR=3.208). Social Anxiety Disorder (SAD) was significantly correlated to avoidant personality disorder (OR=17). Patients with suicide attempts are more likely to have a comorbid personality disorder (OR=11.606). Being married and having a later age of onset are predictors of having comorbid depressive disorder. Furthermore, being married, having an anxiety-anxiety comorbidity and a longer duration of untreated illness (DUI) are predictors of recurrence.

Our study highlights the fact that comorbidities (physical and psychopathological) call for a closer follow up due to the higher risk of recurrence, the higher risk of suicide attempts and the poorer treatment response.

No significant relationships.

Acute and chronic exposure to cannabis have been associated with neurocognitive deficits in executive function, including inhibitory control processes.

To research memory deficiency in the young consumers of cannabis in Tunisia.

this is a transversal descriptive study conducted during two months (January and February 2020). The research involved about 137 participants in the emergency department at the university hospital of Mahdia

In our study population, there was a noticeable male predominance of 71%. Hence, the age structure ranged between 18 years old and 35 years old. Among the latters, 65.9% were single, and 29.7% experienced school failure. In this sample, 23.2% had a psychiatric history. The average age of the first use of cannabis was between 18 and 25 years old in 70% of cases. Besides, a high percentage of association of other substances was found among cannabis users as follows: use of tobacco 74.6%, alcohol 72.5% ecstasy 41.3%, and cocaine 25.4%. The use of cannabis was considered as a means of indulgence for 66.7% of the study population, as an anxiolytic for 26.8%, and as a sedative for 23.9%. Additionally, the effect of cannabis use on working memory deficiency according to the functional impact assessment scale was: no deficiency in 19% of cannabis users, minimal in 34%, mild in 32%, moderate in 9%, fairly severe in 4%, very severe in 1%, and extreme in1% of cases.

The assumption of the effect of cannabis on memory and cognitive deficiency remains controversial and leads us to suggest further in-depth study of this subject.

No significant relationships.

The use of cannabis is likely to increase as regulations on its consumption are diminishing throughout the world.

to identify the prevalence of anxiety and depression symptoms in a group of cannabis users in Tunisia.

this a transversal descriptive study about 137 participants in the University Hospital Of Mahdia during 2 months.

In our study population , the consumers were young adults aged between 18 and 35 years old ,of whom 40.8% were professionally active, 23.2% had psychiatric history. Moreover, the use of other substances was regular among users as follows: tobacco among 74.6% of users, alcohol among 72.5% of users, ecstasy among 41.3% of users, cocaine among 25.4% of users. The use of cannabis was considered as a means of exultation for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%. Overall, the effect of cannabis use on anxiety and depression on the HAD scale showed the following results: probable anxiety in 53% of cases, probable state of depression in 72% of time.

The correlation between cannabis use, anxiety and depression remains unclear. Equally concluded, the assumption of self-medication by cannabis stills a topic of discussion.

No significant relationships.

The Burnout syndrome occurs preferentially in individuals subjected to intense stress conditions. The nursing staff in Obstetrics Gynecology is an example of this.

To assess the prevalence of Burnout and its determinants in the obstetrics gynecology service - Mahdia.

We conducted an analytical cross-sectional study carried out with the medical and paramedical staff of the gynecology-obstetrics department of the Taher Sfar Mahdia hospital during a period of 3 months.We used a pre-established self-questionnaire containing 2 parts: a part exploring the socio-demographic data of the population and a psychometric part evaluating Burnt out using the “Maslach Burnout” scale inventory ”.

Our sample consisted of 122 medical and paramedical personnel.The sex ratio was 4.3 (99/23), the mean age was 30.5 with values ranging from 25 to 55 years.Of the participants, 59 (48.3%) were single .Nine (7.4%) of the participants were smokers and 2 (1.6%) consumed alcohol.The majority of the population (96.7%) did not have a psychiatric history, 88 (80.3%) reported an organ history.A high level of burnout was noted in 64.8% of our population with 14.8% severe burnout. The presence of burnout was significantly associated with the consumption of psychoactive substances (p = 0.05) and professional rank (p = 0.04) .Nurses, residents and senior doctors werethose most at risk of developing burnout. It was also significantly related to the absence of other professional activities such as research (p = 0.05) and training continuing medical care (p = 0.05).

Psychological intervention strategies with these suffering health promoters would be desirable.

No significant relationships.

Adrenal insufficiency is a rare medical condition which can occur in children. Parents, being the primary support and support for the child, are generally involved in the care of their sick child.

To estimate the prevalence of anxiety symptoms and associated factors in parents of children with adrenal insufficiency.

This is an analytical cross-sectional case-control study over a period of 4 months in 2019, carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital. We used an anonymous questionnaire that included a socio-demographic fact sheet and the Hamilton anxiety scale for exploring anxiety symptoms.

A total of 38 parents of children with Adrenal insufficiency and 38 control parents participated in the study. The current age of the child was between 1 and 16 years old with an average of 9.1 and standard deviation of 4.22 For the assessment of anxiety, 55.3% of the parents had a score greater than 20 attesting to the presence of an anxiety symptomatology. In addition, only 26.3% of control parents presented anxious symptoms. There is a significant difference between the two populations (p = 0.010 OR = 3.459). Anxiety was associated with having a child with SI (OR=3.4), female gender (OR=4.2), unemployment (OR=6.33), and low socioeconomic status.

Parents have a considerable burden in the care and management of their child with a chronic illness, which takes time and a lot of patience. Detecting anxiety symptoms in this population will help them manage it.

No significant relationships.

Domestic violence is a critical global and social phenomenon.

- To describe the socio-demographic and clinical characteristics related to the abuser in the context of domestic violence. - To study risk factors for acting out in the abuser.

We conducted a descriptive cross-sectional study related to male abusers of their wives who consulted the Forensic Medicine Department of Taher Sfar Hospital in Mahdia between January 2020 and October 2020 for a forensic examination.

We collected 67 cases of domestic violence out of a total of 688 female consultants. The age of the abuser exceeded 35 years in 84% of cases. The average age of the abusers was 33.8 years. Almost half of the abusers had a primary school education. In 43% of the cases, the abuser was unemployed or had a job with a salary below the minimum wage. We found an association between domestic violence and the unfavorable professional status of the spouse. Only in 6% of the cases did the abuser have a psychiatric disorder. He had a history of chronic alcoholism in 35% of the cases and the use of illicit substances (cannabis) in 9% of the cases. Approximately one out of every two abusers (48%) was under the influence of alcohol at the time of the violent act. Alcoholism was associated with all forms of domestic violence. He had a criminal history in 30% of cases.

Our results provide real areas for reflection regarding the adoption of specific therapeutic strategies with domestic violence abusers.

No significant relationships.

Anxiety disorders represent one of the most common mental disorders following a chronic course.

The aim of our study is to determine the prevalence, incidence and clinical characteristics of these disorders.

We conducted a retrospective and descriptive study about 436 outpatients fulfilling the DSM-V diagnostic criteria for anxiety disorder and followed in the department of psychiatry of Monastir (Tunisia) between 1998 and 2017. Selective mutism and separation anxiety were excluded for lack of cases.

The overall prevalence was 5.51%. Panic Disorder was the most prevalent anxiety disorder subtype (3.2%). The incidence of anxiety disorders in the last years has increased from 3.31% in 1998 to 7.5% in 2017. The mean age at diagnosis was 37.76±12.87 years [16-77]. Female gender was the most prevalent in overall anxiety disorders with a sex ratio of 0.78, however, a significant male predominance was recorded in Social Anxiety Disorder (SAD) with a sex ratio of 1.85. Generalized Anxiety Disorder patients were more likely to have low educational level (OR= 1.879), to be laborers (OR=2.55), to be married (OR=2.418) and to have children (OR=2.564) whereas SAD patients were more likely to have higher education (OR=9.118), to be students (OR=5.565), to be single (OR=11.325) and have no children (OR=7.464).

This study highlignts the frequency of anxiety disorders and the fact that being a middle-age married woman with kids make oneself more prone to have an anxiety disorder. Specific attention should be paid to these anxiety disorders with early preventive programs.

No significant relationships.

Being the parent of a child followed for a chronic pathology can require different resources and coping skills.

to determine the adaptation strategies of the parents of children monitored for adrenal insufficiency in the face of their children’s pathology

We conducted a descriptive cross-sectional study carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital between February 2019 and April 2020. We used a pre-established questionnaire collecting sociodemographic data and the strategies of coping using the Brief-COPE Board.

A total of 38 parents of children with adrenal insufficiency and 38 control parents participated in the study. The Brief-Cope board’s study of Coping strategies revealed that the strategies most used by parents of children with Adrenal insufficiency were, in descending order: religion (92.1%), support emotional (73.7%), distraction (63.9%), behavioral disengagement and acceptance (57.9%), instrumental support (52.6%), expression of feelings (50%), positive reinterpretation (39.5%), blame (38.9%), denial and humor (36.8%), active coping and planning (36.1%). On the other hand, those used by the control population were in descending order: religion (94.4%), distraction (84.2%), blame (78.9%), acceptance (72.2%) %), emotional support (69.4%), humor (63.9%), behavioral disengagement (61.1%), active coping (47.2%), expression of feelings (44 , 7%), planning (41.7%), instrumental support (30.6%), positive reinterpretation (22%), denial (19.4%).

Psychological support for the parents of children with chronic illnesses would be necessary to prevent parental burnout and improve their ability to adapt to their experiences

No significant relationships.

Facebook use among Teenagers has become a very common phenomenon. Its use can resuly in Facebook addiction .

To estimate the prevalence of problematic Facebook use among a sample of school-going adolescents.

This is a cross-sectional and descriptive study carried out among 110 school-going adolescenthe at 2 state colleges in Sidi Bouzid. We used a pre-established self-questionnaire containing 2 parts: a part exploring the socio-demographic data of the adolescent and a psychometric part: Bergen Facebook addiction Scale.

Study participants had a mean age of 14.4 years with extremes of 12 to 17 years. The sex ratio (M / F) (46/64) of the participants was 0.71.In our population, 13 students (11.8%) were smokers. Two students (1.8%) consumed alcohol. Cannabis use was noted in only one student.The majority of students (102), or 92.7%, had been online for more than a year.The daily Facebook connection time was more than 4 hours for 20.9%. Boredom was the number one reason for logging into Facebook for 82 students (74.5%) followed by curiosity for 45 students (40.9%). Fifteen students (13.6%) were addicted to Facebook (score> 10 on the Bergen Addiction Scale.

Facebook can be a useful and interesting tool to maintain and develop a network of relationships and create new ones. Its problematic use or addiction to Facebook has become a new scourge of public health. Faced with the negative impact of this addiction, It would be necessary to rationalize this use.

No significant relationships.