Psychometric properties of the Benign and Malicious Envy Scale: A cross-cultural study in the Arab Maghreb countries.

BACKGROUND: The Benign and Malicious Envy Scale (BeMaS) is designed to assess the trait of envy and evaluate individual differences in people's tendency to experience benign or malicious envy towards superior comparison standards. OBJECTIVE: This study aimed to examine the factor structure of the BeMaS in Arab culture through exploratory and confirmatory factor analysis and to ensure the measurement equivalence of the benign and malicious envy scale across three countries in the Arab Maghreb region (Algeria, Tunisia, and Morocco). METHODS: The study was conducted on a sample of 1047 students from various universities across three countries, Algeria (n = 401), Tunisia (n = 289), and Morocco (n = 357), and implemented a cross-sectional study design. The study involved individuals aged 18-64 (M = 22.00, SD = 4.79). Most were females (64.4 %, n = 674), with substantial male representation (35.6 %, n = 373). All participants completed the Arabic BeMaS. RESULTS: The confirmatory factor analysis results indicated that the Arabic BeMaS has a two-factor structure for the total sample and each subsample. However, some modifications were necessary in the Tunisian sample. The overall results suggest that the two-factor structure of the BeMaS is valid and reliable in the Arab context. At the same time, differences between the three groups suggest cultural differences despite similarities in language, geographic proximity, and shared customs and traditions. Additionally, the results highlight the need for further research into envy, particularly within Arabic culture. Religious and cultural traditions may significantly influence how envy is experienced and perceived, making such cultural differences important to investigate. CONCLUSION: In summary, this study contributes to our measurement of Envy in the Arab context by validating BeMaS and highlighting the importance of cultural factors in measuring and explaining envy. However, further research is needed to deepen our understanding of this complex emotion in different cultural and social contexts.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers.

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers' wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82-0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness-in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Obstacles of Online Learning Facing Nursing Students after the COVID-19 Pandemic.

Background: After the COVID-19 pandemic, the online style of instruction started to replace the traditional style in Jordan. Aims: This study aims to (1) assess the nursing students' perceived obstacles to online learning in Jordan; (2) explore significant relationships between participants' characteristics and their perceived obstacles; and (3) assess for significant differences in the perceived obstacles based on participants' characteristics. Methods: A cross-sectional, descriptive design was utilized in this study. A convenient sample of 325 nursing students responded to a self-reported questionnaire utilizing Google Forms. Both descriptive and inferential statistics were used to analyze the dataset using the SPSS software. Results: The mean scores of the obstacles to online learning were 2.94 (SD = 0.95) for the academic obstacles subscale, 2.90 (SD = 0.83) for the technological obstacles subscale, and 3.25 (SD = 1.00) for the administrative obstacles subscale. Significant associations were found between participants' characteristics and perceived obstacles to online learning. For instance, the type of university was significantly associated with academic (r = -0.32, p < 0.01), technological (r = -0.21, p < 0.01), and administrative obstacles (r = -0.32, p < 0.01). Furthermore, significant differences were found in the perceived obstacles based on the participants' demographic and studentship-related characteristics. Conclusions: According to their perceptions of online learning, nursing students in Jordan face three types of obstacles: academic, technical, and administrative. Decision-makers should intervene to enhance the online learning experience by overcoming the reported obstacles.

Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study.

BACKGROUND: Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure. AIM: The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI. DESIGN: This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data. METHODS: A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis. RESULTS: Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'. CONCLUSION: It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

Prevalence of stress and types of coping strategies among adolescents (14-18 years) in collectivist communities.

BACKGROUND: Stress is highly prevalent among adolescents and might lead to maladaptive coping. METHODS: This cross-sectional study assessed the prevalence of stress and determined the types of coping strategies used by adolescents; and identified the predictors of stress levels among this cohort. The study recruited 1344 participants, aged 14 to 18 years, in schools. The study used the DASS-42 and the Brief COPE Inventory Scale for data collection. The findings of this study showed that more than two-thirds of adolescents suffer from stress, and moderate, severe, and extremely severe were 22.8%, 43.0%, and 16.8%, respectively. The most used coping behaviors among these adolescents were religious factors, with a Mean ± SD of (Mean 6.28 ± 1.16), followed by instrumental support (Mean 6.17 ± 1.18). The stress level has a significant negative correlation at (p < 0.001) with active coping (r = -0.183**), self-distraction (r = -0.190**), acceptance (r = -0.140**) and religion (r = -0.097**; P < 0.001). Binary logistic regression analyses revealed that the whole model had R2 (0.232); p < 0.005 and shows that those aged 15 had an odd of 0.272 to develop stress more than those at 18. Fathers' and mothers' education levels strongly influenced adolescents' stress levels. Those with an income between <500 and 500-750 Jordanian Dinars had an odds ratio of 5.241 and 3.514 of developing stress, respectively, compared to their counterparts. APPLICATION TO PRACTICE: This study highlights the significance of developing health intervention programs and counseling services for managing adolescents' psychological well-being and provides valuable insights for policymakers on addressing mental health issues.

Transcriptional responses of cytokines, immunoglobulin A, and nitric oxide genes in 1-day-old chicks post Salmonella typhimurium infection: An experimental study.

Background: Salmonella has become one of the hazards prevalent foodborne pathogens causing different diseases in chickens. However, Salmonella typhimurium (ST), a nonhost-specific serovar, is a major avian agent that causes severe disturbance in young chicken wellness. Aim: The occurrence of Salmonella in chickens and their antimicrobial resistance were explored in this study. In addition, the immune response of 1-day-old broiler chicks, against multidrug resistant (MDR) ST infection, was also assessed at 4 and 24 hours post infection (pi) in the cecum and spleen, representing their mucosal and systemic immune responses, respectively. Methods: A total of 375 samples from 130 diseased and apparently healthy broiler and layer chickens were randomly collected for Salmonella isolation, identification, and resistance profile evaluation, from farms and different clinical laboratories. The immune response of 1-day-old broiler chicks, Ross 308, against in-vivo ST infection was ascertained through the evaluation of heterophile phagocytosis and s expression of cytokines, immunoglobulin A and other immune-regulating genes in the cecum and spleen. Twenty-four, 1-day-old nonvaccinated broiler chicks were used and divided into two groups. The chicks in the infected group were orally inoculated with 0.5 ml of 2 × 108 colony forming units (CFU)/ml of MDR ST suspension, while those in the control group were taken nutrient broth. Results: Seven out of 130 (5.38%) examined chickens were positive for Salmonella. All isolates (100%) were resistant to amoxicillin-clavulanic acid (AMC), cefazolin (CZ), cefoxitin (FOX), ciprofloxacin (CIP), nalidixic acid (NA), tetracycline (TE), fosfomycin (FOS), and colistin (CT) with multiple antimicrobial resistances (MARs) index range of 0.72-0.83, where none of them was resistant to meropenem (MEM). The results of immune response revealed that chicks infected with ST showed significantly different phagocytosis percentages and index values compared to controls. According to the real-time quantitative polymerase chain reaction (RT-qPCR) results, the transcription of IL-8, iNOS, IL-18, IgA, and IFN-γ for chicks infected by ST showed a significantly increased trend (p < 0.01) with increasing chicken age and was higher in the cecum than spleen compared to controls (p < 0.05) during 24 hours after infection. Conclusion: The findings indicated a strong mucosal immune response in the chicks after the ST challenge, which reflects humoral and cellular responses. Our insight recommended the occurrence of a natural immune response stimulator at 1 day age to face the infection, and this can prevent the resistance transfer, with efficient control measures.

A narrative inquiry into the communication experiences of mothers caring for children with cancer in Jordan.

BACKGROUND: This study aims to investigate the parenting experiences of mothers who care for children with cancer in Jordan and specifically focuses on the communication experiences of mothers who care for children with cancer. METHODOLOGY: A qualitative research design employing a narrative inquiry methodology was adopted; it employed the implementation of twenty semi-structured interviews with the mothers of children with cancer recruited from one pediatric hospital located in Amman, Jordan. FINDINGS: The findings of this study reveal that the majority of mothers attempted to conceal or delay any discussion regarding the diagnosis with their child, particularly during the immediate post-diagnosis period. Additionally, the mothers expressed that their relationships with the parents of children diagnosed with the same illness contain positive and negative aspects. Finally, most mothers participating in this study praised the role of hope in helping them cope with the challenging health condition of their children. CONCLUSIONS: The findings of this study reveal that mothers would withhold diagnostic information from their children for several reasons: firstly, they wished to safeguard their children from feelings of distress; secondly, they perceived that their children were too immature to fully comprehend the seriousness of their diagnosis; and, finally, they desired to protect their children from unnecessary fear and negative emotions. PRACTICAL IMPLICATIONS: Pediatric cancer care requires effective communication between physicians, pediatric nurses, caregivers, and children; clear and accurate communication between healthcare providers and parents of children with cancer ensures that they fully understand the diagnosis and can make values-based decisions.

Timing of Deep and REM Sleep Based on Fitbit Sleep Staging in Young Healthy Adults under Real-Life Conditions.

Sleep timing is controlled by intrinsic homeostatic and circadian components. The circadian component controls the chronotype, which is defined by the propensity to sleep at a particular clock time. However, sleep timing can be significantly affected by external factors such as the morning alarm clock. In this study, we analysed the timing of deep and REM sleep as well as the composition of REM sleep using Fitbit sleep staging in young healthy adults (n = 59) under real-life conditions. Sleep stage percentiles were correlated with the timing of total sleep in time after sleep onset for the homeostatic component and in clock time for the circadian component. Regarding the circadian component, the phase of total sleep is most strongly associated with the phases of early deep sleep and REM sleep. Furthermore, a stronger phase relationship between deep and REM sleep with total sleep is associated with greater consolidation of REM sleep. Chronotype-dependent sleep loss correlates negatively with the strength of the phase relationship between deep sleep and total sleep. In conclusion, the interaction of the circadian component of sleep timing with the timing of sleep stages is associated with REM sleep quality. In particular, the interaction of the circadian component of sleep timing with deep sleep seems to be more vulnerable to external factors.

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain.

AIM: Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN: This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS: Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS: Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION: CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE: At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life.

The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.

Effects of the Light/Dark Phase and Constant Light on Spatial Working Memory and Spine Plasticity in the Mouse Hippocampus.

Circadian rhythms in behavior and physiology such as rest/activity and hormones are driven by an internal clock and persist in the absence of rhythmic environmental cues. However, the period and phase of the internal clock are entrained by the environmental light/dark cycle. Consequently, aberrant lighting conditions, which are increasing in modern society, have a strong impact on rhythmic body and brain functions. Mice were exposed to three different lighting conditions, 12 h light/12 h dark cycle (LD), constant darkness (DD), and constant light (LL), to study the effects of the light/dark cycle and aberrant lighting on the hippocampus, a critical structure for temporal and spatial memory formation and navigation. Locomotor activity and plasma corticosterone levels were analyzed as readouts for circadian rhythms. Spatial working memory via Y-maze, spine morphology of Golgi-Cox-stained hippocampi, and plasticity of excitatory synapses, measured by number and size of synaptopodin and GluR1-immunreactive clusters, were analyzed. Our results indicate that the light/dark cycle drives diurnal differences in synaptic plasticity in hippocampus. Moreover, spatial working memory, spine density, and size and number of synaptopodin and GluR1 clusters were reduced in LL, while corticosterone levels were increased. This indicates that acute constant light affects hippocampal function and synaptic plasticity.

Postcardiotomy extracorporeal membrane oxygenation in patients with congenital heart disease; the effect of place of initiation.

BACKGROUND: Postcardiotomy extracorporeal membrane oxygenation (ECMO) in pediatric patients can be affected by the place of initiation, either in the operating room (OR) or the pediatric cardiac intensive care unit (PCICU). This study aimed to characterize and compare patients who had postcardiotomy ECMO initiation in the OR or PCICU and evaluate risk factors for hospital mortality. METHODS: This retrospective study included 103 patients who required postcardiotomy ECMO support after the repair of congenital cardiac lesions from 2010 to 2022. Patients were grouped according to the place of ECMO insertion into two groups. Group 1 (n = 69) had ECMO insertion in the OR, and Group 2 (n = 34) had ECMO insertion in the PCICU. RESULTS: Cardiac arrest occurred significantly more often in patients with ECMO insertion in the PCICU (21 (61.76%) vs. 13 (18.84%); p < 0.001). Pre-ECMO lactate levels, pH, VIS, base deficit, and PaO2 did not differ between the groups. Re-exploration for bleeding was significantly higher in Group 1 (32 (46.38%) vs. 8 (23.53%); p = 0.03). Cannula repositioning (4 (11.76%) v. 2 (2.90%); p = 0.09) and mechanical ventilation time were nonsignificantly higher in Group 2 (19.5 (10-31) vs. 11 (5-25) days; p = 0.07). No difference in mortality was found between groups (42 (60.87%) vs. 23 (67.65%), p = 0.50). By multivariable analysis, elevated lactate on ECMO and low pH before ECMO were associated with mortality. CONCLUSIONS: ECMO insertion in the OR has a comparable mortality rate to PCICU insertion. Pre-ECMO low pH and high lactate during ECMO could predict mortality.

Egyptian propolis extract for functionalization of cellulose nanofiber/poly(vinyl alcohol) porous hydrogel along with characterization and biological applications.

Bee propolis is one of the most common natural extracts and has gained significant interest in biomedicine due to its high content of phenolic acids and flavonoids, which are responsible for the antioxidant activity of natural products. The present study report that the propolis extract (PE) was produced by ethanol in the surrounding environment. The obtained PE was added at different concentrations to cellulose nanofiber (CNF)/poly(vinyl alcohol) (PVA), and subjected to freezing thawing and freeze drying methods to develop porous bioactive matrices. Scanning electron microscope (SEM) observations displayed that the prepared samples had an interconnected porous structure with pore sizes in the range of 10-100 µm. The high performance liquid chromatography (HPLC) results of PE showed around 18 polyphenol compounds, with the highest amounts of hesperetin (183.7 µg/mL), chlorogenic acid (96.9 µg/mL) and caffeic acid (90.2 µg/mL). The antibacterial activity results indicated that both PE and PE-functionalized hydrogels exhibited a potential antimicrobial effects against Escherichia coli, Salmonella typhimurium, Streptococcus mutans, and Candida albicans. The in vitro test cell culture experiments indicated that the cells on the PE-functionalized hydrogels had the greatest viability, adhesion, and spreading of cells. Altogether, these data highlight the interesting effect of propolis bio-functionalization to enhance the biological features of CNF/PVA hydrogel as a functional matrix for biomedical applications.

Mortality, Intensive Care Unit Admission, and Intubation among Hospitalized Patients with COVID-19: A One-Year Retrospective Study in Jordan.

COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients' demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Creative Art Therapy for Improving Depression, Anxiety, and Stress in Patients with Stroke: A Quasi-Interventional Study.

Introduction: Creative art therapy is a psychotherapeutic approach used to enhance the mental health status of patients. Objectives: This study aimed to evaluate the effect of creative art therapy on the levels of depression, anxiety, and stress in Jordanian patients following stroke. Methods: One-group pretest-posttest design was used; it included four sessions of creative art therapy which were conducted as two sessions for two weeks. This study recruited 85 participants who were within three months poststroke diagnosis. The Depression, Anxiety, and Stress Scale was used to assess the levels of psychological reactions pre and post creative art therapy intervention. Results: The data showed that there was a statistically significant improvement in the levels of depression (t = 37.98; p < .001), anxiety (t = 20.59, p < .001), and stress (t = 35.52, p < .001) post-intervention. There was a statistically significant improvement in the study-related psychological aspects following creative art therapy. Conclusion: The findings of this study suggest that creative art therapy is a valuable method to complement other types of treatments among patients with stroke, resulting in positive patient mental health outcomes. Creative art therapy could be used as a psychotherapeutic approach to manage mental health complexities among patients with stroke. Health policymakers are invited to use the findings of this study to establish tailored counselor services using this new psychotherapeutic approach.

Physician's Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and abstracts of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for eligibility, which resulted in 30 studies being included in the final reviews and subsequent analyses. Among them, the prevalence of physicians' burnout rate ranged from 6.0-99.8%. This wide variation could be due to the heterogeneity among burnout definitions, different applied assessment tools, and even cultural factors. Further studies may consider other factors when assessing burnout (e.g., the presence of a psychiatric disorders, other work-related and cultural factors). In conclusion, a consistent diagnostic indices for the assessment of burnout is required to enable consistent methods of scoring and interpretation.

Novel electrospun fibers as carriers for delivering a biocompatible Sm(iii) nanodrug for cancer therapy: fabrication, characterization, cytotoxicity and toxicity.

The current study represents the successful fabrication and characterization of a Sm(iii) nano complex based on 2-cyano-N'-((4-oxo-4H-chromen-3-yl)methylene)acetohydrazide (CCMA). The fibrous Sm(iii) nanocomplex has been fabricated by the electrospinning technique. SEM analysis of the electrospun fibers has revealed that the fibers have a uniform structure and smooth surface without observing Sm(iii) nanocomplex crystals, i.e. the Sm(iii) nanocomplex has been well incorporated into the fibers. In vitro antitumor activity against two carcinogenic cell lines (HepG-2 and E.A.C.) as well as in vivo toxicity of pure Sm(iii) nanocomplex and its electrospun fibers have been detected. The biological results have shown that there is a significant antitumor activity with low toxicity of the pure Sm(iii) nanocomplex and its electrospun fibers with respect to different standard antitumor drugs. Also, the electrospun fibers recorded higher cytotoxicity (IC50 = 0.1 µM (Hep-G); 0.09 µM (E.A.C)) and lower toxicity (LD50 = 350 mg kg-1) than the pure ones. The in vitro release rate of the Sm(iii) nanocomplex from electrospun fibers has also been detected. The results have shown that the burst releasing of the Sm(iii) nanocomplex is about 22% after 1 h at the beginning, then a cumulative release increased gradually over the following hours. All results demonstrate the potential use of the Sm(iii) nanocomplex as a potent antitumor drug and its electrospun fibers as superior drug carriers for the treatment of tumors.