[Factors associated with the risk of developing eating disorders among medical students in Casablanca, Morocco]. / Facteurs associés au risque de troubles du comportement alimentaire chez les étudiants en médecine de Casablanca, Maroc.

INTRODUCTION: eating disorders (EDs) are particularly common among young adults, including students. The purpose of this study is to determine eating disorder prevalence among medical students in Casablanca and to assess the risk of developing EDs on the bases of associated factors including socioeconomic factors, clinical features, anxiety and depression. METHODS: we conducted a cross-sectional, descriptive and analytical study at the Ibn Rochd University Hospital and at the Faculty of Medicine and Pharmacy of Casablanca, Morocco, during the academic year 2016-2017. The survey involved a sample of 506 students. We used the SCOFF-F (Sick, Control, One Stone, Fat, Food, French version) questionnaire, a validated tool for eating disorders and the hospital anxiety and depression scale (HAD) for anxiety and depression. RESULTS: the SCOFF questionnaire found that 127 people out of 506 (25.09%) were likely to suffer from eating disorders. Age, educational level, weight-management tools, anxiety and depression were significantly associated with the risk of developing eating disorders among medical students. CONCLUSION: our results are in agreement with data from the literature concerning eating disorder rates in the student population and, more specifically, among medical students. Further, studies of a more heterogeneous population are needed to have a more global vision of the situation in Morocco.

Real-Time Monitoring System to Manage Mental Healthcare Emergency Unit.

OBJECTIVES: Real-time relevant information helps guide the healthcare decision-making process in daily clinical practice as well as the management and optimization of healthcare processes. However, proprietary business intelligence suite solutions supporting the production of decision-making information requires investment that is out of reach of small and mediumsized healthcare facilities or those with limited resources, particularly in developing countries. This paper describes our experience in designing and implementing a real-time healthcare monitoring system solution to manage healthcare emergency units. METHODS: Through the use of free Business Intelligence tools and Python data science language we designed a real-time monitoring system, which was implemented to explore the Electronic Medical Records system of a university mental health emergency unit and render an electronic dashboard to support health professional daily practice. RESULTS: Three main dashboards were created to monitor patient waiting time, to access the clinical notes summary for the next waiting patient, and to obtain insights into activity during the last 24 hours. CONCLUSIONS: The designed system could serve as a monitoring support model using free and user-friendly data science tools, which are good alternatives to proprietary business intelligence solutions and drastically reduce cost. Still, the key to success in decision-making systems is based on investment in human resources, business intelligence skills training, the organizational aspect of the decision-making process, and data production quality insurance.

Monitoring Mental Healthcare Services Using Business Analytics.

OBJECTIVES: Monitoring healthcare activities is the first step for health stakeholders and health professionals to improve the quality and performance of healthcare services. However, monitoring remains a challenge for healthcare facilities, especially in developing countries. Fortunately, advances in business analytics address this need. This paper aims to describe the experience of a low-income healthcare facility in a developing country in using business analytics descriptive techniques and to discuss business analytics implementation challenges and opportunities in such an environment. METHODS: Business analytics descriptive techniques were applied on 3 years' electronic medical records of outpatient consultation of the University Psychiatric Centre (CPU) of Casablanca. Statistical analysis was conducted to compare results over years. RESULTS: Over the 3 monitored years, the monthly number of computerized physician order entries increased significantly (p < 0.001). Physicians improved their personal recording over years. Schizophrenia as well as depressive and bipolar disorders were noted at the top of outpatient mental disorders. Antipsychotics are the most prescribed drugs, and a significant annual decrease in outpatient care wait time was noted (p < 0.001). CONCLUSIONS: Business analytics allowed CPU to monitor mental healthcare outpatient activity and to adopt its business processes according to outcomes. However, challenges mainly in the organizational dimension of the decision-making process and the definition of strategic key metrics, data structuration, and the quality of data entry had to be considered for the optimal use of business analytics.

[Evaluation of burnout syndrome among doctors in training at the Ibn Rochd University Hospital, Casablanca]. / L'évaluation du syndrome du Burnout chez les médecins en formation au CHU Ibn Rochd de Casablanca.

METHODS: We conducted a descriptive cross-sectional study of a sample of 300 physicians using self-administered questionnaire over the period 2013- 2014. Burnout has been operationally defined through a French translation of the Maslach Burnout Inventory (MBI). RESULTS: A total of 191 physicians participated in the study (response rate 63.7%) with a female predominance at 79.1% and an average age of 26.7 years (N = 3). The average scores of sub-dimensions of the MBI: emotional exhaustion, depersonalization and personal fulfilment were (33.7±10.7), (12.2±6.5) and (30.6±8.3) respectively. 31.8% of participants suffered from severe burnout. It was associated with communication problems within the healthcare team (p < 0.01), insufficient accompaniment (p < 0.05), dissatisfaction among seniors (p = 0.01), fear of making medical errors (p<0.05), use of a psychotherapist (p<0.001), use of psychotropic drugs (p = 0.001), anxiety disorders (p < 0.01), depression (p < 0.01) and suicidal ideation (p < 0.05). Protective factors were: sense of equity within the healthcare team (p < 0.01) and practice of leisure (p<0.05). Changing career direction was associated with severe burnout (p<0.05). CONCLUSION: These results are consistent with those of previous studies and justify the importance of a prevention program at different levels.

Prevalence of stress in Casablanca medical students: a cross-sectional study.

INTRODUCTION: Recently, an important literature data has reported that medical students experience stress more than students in other disciplines. In contrast, there is a significant shortage of the stress impact on the academic performance. The primary purpose of our study was to determine the prevalence of stress among Casablanca Medical students and to investigate if there is an association between stress and academic skills. METHODS: A total of 275 participants studying at Casablanca Medical School were included. The study was conducted using a self-administered, anonymous questionnaire, which included four subscales on academic skills perception (Academic competence, Test competence, Time management and Strategic study habits) and a Test Anxiety scale to assess the degree of stress related to exams among medical students. RESULTS: The overall findings showed that 52.7% of respondents were stressed by examinations, and the highest stress prevalence was among the fifth-year medical students. Measures of comparative stress degrees between male and female students did not show any statistical significant differences (p=0.34). Correlation analysis revealed negative association between stress and academic competence (-0.394), test competence (-0.426), time management (-0.240), strategic study (-0.183) respectively (p<0.001). CONCLUSION: Medical educators and psychologists have to increase clinical awareness of stress among medical students, by establishing strategies for stress management.

Synergistic effect of MTHFR C677T and F2 G20210A polymorphisms on ischemic stroke.

The predisposition to stroke might involve interactive effects among variants in several genes. We tested this hypothesis by examining the influence of polymorphisms in methylenetetrahydrofolate reductase (MTHFR) (C677T) and prothrombin (F2) (G20210A) as risk factors for stroke in Morocco. The polymerase chain reaction-restriction fragment length polymorphism methods were used to analyze DNA from 91 stroke patients and 182 controls. Association between the two polymorphisms and the risk of stroke was estimated by four-level models for the analysis of genetic interaction. Neither the MTHFR 677TT nor the F2 20210GA genotype showed any significant association compared to the MTHFR CC and F2 GG genotypes, respectively. An interactive effect between the MTHFR 677TT and F2 20210GA polymorphisms showed an increased risk of stroke. The odds ratios, in univariate and multivariate analysis, for the combined polymorphisms were 4.99 (95% CI, 1.75-14.2, P = 0.001) and 5.29 (95% CI, 1.63-17.1, P = 0.005), respectively.

Insight in schizophrenia: from conceptualization to neuroscience.

Lack of insight into illness is a prevalent and distinguishing feature of schizophrenia, which has a complex history and has been given a variety of definitions. Currently, insight is measured and treated as a multidimensional phenomenon, because it is believed to result from psychological, neuropsychological and organic factors. Thus, schizophrenia patients may display dramatic disorders including demoralization, depression and a higher risk of suicide, all of which are directly or indirectly related to a lack of insight into their illness, and make the treatment difficult. To improve the treatment of people with schizophrenia, it is thus crucial to advance research on insight into their illness. Insight is studied in a variety of ways. Studies may focus on the relationship between insight and psychopathology, may view behavioral outcomes or look discretely at the cognitive dysfunction versus anatomy level of insight. All have merit but they are dispersed across a wide body of literature and rarely are the findings integrated and synthesized in a meaningful way. The aim of this study was to synthesize findings across the large body of literature dealing with insight, to highlight its multidimensional nature, measurement, neuropsychology and social impact in schizophrenia. The extensive literature on the cognitive consequences of lack of insight and the contribution of neuroimaging techniques to elucidating neurological etiology of insight deficits, is also reviewed.

Prothrombin G20210A and factor V Leiden polymorphisms in stroke.

The molecular epidemiology of stroke is critically lacking in the developing world. We explored the relationships between genetics polymorphism and risk for ischemic stroke among the residents of Casablanca, Morocco. Ninety-one stroke patients matched 1:2 for their age, gender, and ethnic background to 182 healthy controls who were genotyped for the prothrombin G20210A mutation and factor V (FV) Leiden and were assessed for conventional risk factors for stroke. No significant association was found between prothrombin gene mutation with stroke (p = .054). Regarding stroke subtypes, significant relationships between patients with a large artery disease subtype of stroke and this mutation was found compared to controls (p = .046). As a genetic risk factor to develop this event, a strong association was observed when adjusted for conventional vascular risk factors (adjusted OR, 4.3; p = .029). No FV Leiden was found. We suggest that prothrombin mutation but not FV Leiden should be considered as a modest genetic risk factor for large artery disease stroke subtype in the Moroccan population.

[Wiscosin card sorting task in patients with schizophrenia and thier siblings]. / Test Wisconsin chez les patients souffrant de schizophrénie, et leurs frères et soeurs.

OBJECTIVE: This study's first objective was to confirm that patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function when compared to healthy control subjects. The second objective was to study the relation between Wisconsin card sorting task (WCST) performance and the persistence and severity of clinical symptoms, as well as different clinical dimensions. METHOD: Ninety subjects were involved in this study, divided in 3 groups of 30 each: one group of patients with schizophrenia, one group of their siblings, and a control group. Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS), and social functioning was measured by the Global functioning scale (GFS). The WCST was administered to all 3 groups. RESULTS: Patients with schizophrenia and their siblings had a significantly lower WCST performance than control subjects. Statistical analysis showed that the patient group had a significantly greater impaired WCST performance than the 2 other groups. Siblings also had a significantly lower performance than the control subjects. Furthermore, no significant relation was found between WCST performance and other variables, including age, gender, education, illness duration, treatment, and different PANSS and GFS scores. CONCLUSION: Patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function. These findings suggest that WCST performance can be considered a schizophrenia vulnerability marker in siblings of patients with schizophrenia.

Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia.

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called 'negative', 'positive', 'anxio-depressive', 'excitement', and 'disorganisation and others'. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.