Health information management systems and practices in conflict-affected settings: the case of northwest Syria.

BACKGROUND: In conflict settings, as it is the case in Syria, it is crucial to enhance health information management to facilitate an effective and sustainable approach to strengthening health systems in such contexts. In this study, we aim to provide a baseline understanding of the present state of health information management in Northwest Syria (NWS) to better plan for strengthening the health information system of the area that is transitioning to an early-recovery stage. METHODS: A combination of questionnaires and subsequent interviews was used for data collection. Purposive sampling was used to select twenty-one respondents directly involved in managing and directing different domains of health information in the NWS who worked with local NGOs, INGOs, UN-agencies, or part of the Health Working Group. A scoring system for each public health domain was constructed based on the number and quality of the available datasets for these domains, which were established by Checci and others. RESULTS & CONCLUSIONS: Reliable and aggregate health information in the NWS is limited, despite some improvements made over the past decade. The conflict restricted and challenged efforts to establish a concentrated and harmonized HIS in the NWS, which led to a lack of leadership, poor coordination, and duplication of key activities. Although the UN established the EWARN and HeRAMS as common data collection systems in the NWS, they are directed toward advocacy and managed by external experts with little participation or access from local stakeholders to these datasets. RECOMMENDATIONS: There is a need for participatory approaches and the empowerment of local actors and local NGOs, cooperation between local and international stakeholders to increase access to data, and a central domain for planning, organization, and harmonizing the process. To enhance the humanitarian health response in Syria and other crisis areas, it is imperative to invest in data collection and utilisation, mHealth and eHealth technologies, capacity building, and robust technical and autonomous leadership.

Translation, cultural adaptation and linguistic validation of the postgraduate hospital educational environment measure into Arabic.

BACKGROUND: Assessment of the clinical learning environment (CLE) is an essential step that teaching hospitals routinely undertake to ensure the environment is conducive, learning-oriented and supportive of junior doctors' education. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an internationally recognized tool for assessing the CLE with evidence of high reliability and validity. Translation of PHEEM into other languages such as Spanish, Japanese and Persian enabled wider adoption of the instrument in the world. However, in Syria and other Arabic countries, a validated Arabic translation of PHEEM is still not available, making it difficult to adopt it and use it in Arabic contexts. This study aims to translate and culturally adapt the PHEEM from English into Arabic. METHODS: This study followed the structured translation and validation process guideline proposed by Sousa & Rojjanasrirat 2010. First, the PHEEM went through forward translation by three translators, then reconciled with the aid of a fourth translator. Afterwards, two professional bicultural and bilingual translators conducted back translation into English and compared it with the original version. This formed the Pre-final Version (PFV) which was then pretested for clarity on a sample of medical residents in Damascus, Syria. Following appropriate modifications, the PFV was sent to a panel of experts for a comprehensive review of language clarity and to assess content validity. RESULTS: A total of thirty-five medical residents were recruited. Ten items with language clarity issues were identified and modified according to the elicited suggestions. Thereafter, the modified PFV was presented to ten subject experts who identified three items in need of revision. The item-content Validity Index (CVI) was over 0.78 for all of the 40 items; the calculated scale-CVI was 0.945. DISCUSSION: This study provided the first linguistically valid Arabic translation of the widely used PHEEM inventory. The next step is to conduct a full psychometric analysis of the Arabic PHEEM to provide further evidence of validity and reliability.

Game-theoretic agent-based modelling of micro-level conflict: Evidence from the ISIS-Kurdish war.

This article delves into the dynamics of a dyadic political violence case study in Rojava, Northern Syria, focusing on the conflict between Kurdish rebels and ISIS from January 1, 2017, to December 31, 2019. We employ agent-based modelling and a formalisation of the conflict as an Iterated Prisoner's Dilemma game. The study provides a nuanced understanding of conflict dynamics in a highly volatile region, focusing on microdynamics of an intense dyadic strategic interaction between two near-equally- powered actors. The choice of using a model based on the Iterated Prisoner's Dilemma, though a classical approach, offers substantial insights due to its ability to model dyadic, equally-matched strategic interactions in conflict scenarios effectively. The investigation primarily reveals that shifts in territorial control are more critical than geographical or temporal factors in determining the conflict's course. Further, the study observes that the conflict is characterised by periods of predominantly one-sided violence. This pattern underscores that the distribution of attacks, and target choices are a more telling indicator of the conflict nature than specific behavioural patterns of the actors involved. Such a conclusion aligns with the strategic implications of the underlying model, which emphasises the outcome of interactions based on differing aggression levels. This research not only sheds light on the conflict in Rojava but also reaffirms the relevance of this type of game-theoretical approach in contemporary conflict analysis.

Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women.

Background: The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists. Purpose: To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD). Methods: 83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy. Results: PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment. Conclusion: In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.

The awareness of renal stones amongst Syrian refugees in northern Jordan.

Kidney Stone Disease (KSD) is a globally prevalent condition that can be effectively addressed through proper education. This study investigated the awareness of kidney stones among refugees residing in northern Jordan. A questionnaire was administered to 487 refugees of diverse ages and socioeconomic backgrounds. Notably, 97.3% of the respondents had not attended university, and 30.8% held unskilled jobs. Upon familiarizing themselves with the signs and symptoms of kidney stones, 16.22% of men and 12.32% of women reported experiencing such symptoms. This revealed a significant association, suggesting that men might be more susceptible to developing kidney stones than women due to a lack of medical follow-up and examination for men in the camp. However, 38.77% of individuals were uncertain whether they had kidney stones. Furthermore, 38.96% of refugees were unsure about which healthcare professional to consult when experiencing kidney stone symptoms. This report highlights a serious issue with refugees' knowledge of the symptoms, causes, and treatments for kidney stones. The results indicate that Syrian refugees face challenges in acquiring adequate disease awareness, potentially related to issues of migration and war, including low levels of education, limited income, living in camps, and difficulties accessing treatments when needed. Implementing additional policies is necessary to address these challenges among Syrian refugees; however, further studies are needed to validate these findings.

Barriers To Accessing Mental Health Services Among Syrian Refugees: A Mixed-Method Study. / Suriye Kökenli Siginmacilarin Ruh Sagligi Hizmetlerine Ulasmasini Engelleyen Etmenler: Karma Yöntemli Bir Çalisma.

OBJECTIVE: Although Syrian refugees have high rates of mental health problems due to war trauma, little is known on their degree of need for and contact with mental health services. Using a population sample of Syrian refugees living in Ankara, we assessed the perceived need for and contact with mental health services, as well as the barriers to access these services. METHOD: This was a cross-sectional mixed-method study of 420 Syrian refugees living in Ankara city center, using face to face interviews administered at the respondents' home by trained, Arabic-speaking interviewers. PTSD and depression were assessed using Harvard Trauma Questionnaire and Beck Depression Inventory, respectively. RESULTS: Of all the refugees in our sample, 14,8% (N=62) stated that they felt the need for mental healthcare since arriving in Turkey. The actual number contacting any mental health service was very low (1,4%, N=6). The most important barriers to accessing mental health services were reported by the respondents to be language problems and lack of information on available mental health services. Service providers and policymakers also reported similar topics as the most important barriers: low awareness about mental health problems, daily living difficulties, and language and cultural barriers. Multivariate analyses revealed that presence of medical or mental disorders and female gender predicted the perceived need for contacting services. CONCLUSION: Our results show that, although refugees report high rates of mental health problems, the perceived need for and actual contact with services are very low. To address this treatment gap, and to provide adequate care for refugees with mental health problems, common barriers (language and awareness) should be identified and dealt with.

Frequency of SARS-COV-2 infection and COVID-19 vaccine uptake and protection among Syrian refugees : COVID-19 Vaccine among Syrian Refugees.

It is aimed to examine the frequency of COVID-19 disease, the rates of COVID-19 vaccination and the vaccine effectiveness (VE) among Syrian refugees. It is a retrospective cohort study. Syrian refugees aged 18 years and above registered to a family health center in Sultanbeyli district in Istanbul were included. Vaccine effectiveness were calculated for both Pfizer BioN-Tech and CoronaVac (Sinovac) vaccines. The data of 2586 Syrian people was evaluated in the study. The median age of the participants was 34.0 years (min:18.0; max: 90.0). Of the participants 58.4% (n = 1510) were female, 41.6% (n = 1076) were male. In our study of the refugees 15.7% had history of COVID-19 infection. Refugees having full vaccination with Biontech and Sinovac have a significantly lower COVID-19 infection rate than those without vaccination (HR = 8.687; p < 0.001). Adjusted VE for Biontech, Sinovac, and both were 89.2% (95.0% CI:83.3-93.1), 81.2% (95.0% CI:48.72-93.1) and 88.5% (95.0% CI:82.7-92.3), respectively. The results of the study highlight the importance of vaccinations against COVID-19 pandemic, since both vaccines were highly protective in refugees.

The Segregation of p.Arg68Ter-CLDN14 Mutation in a Syrian Deaf Family, Phenotypic Variations, and Comparative Analysis with the GJB2 Gene.

Hearing impairment, a rare inherited condition, is notably prevalent in populations with high rates of consanguinity. The most common form observed globally is autosomal recessive non-syndromic hearing loss. Despite its prevalence, this genetic disorder is characterized by a substantial genetic diversity, making diagnosis and screening challenging. The emergence of advanced next-generation sequencing (NGS) technologies has significantly advanced the discovery of genes and variants linked to various conditions, such as hearing loss. In this study, our objective was to identify the specific variant causing hearing loss in a family from Syria using clinical exome sequencing. The proband in the family exhibited profound deafness as shown by pure-tone audiometry results. The analysis of the different variants obtained by NGS revealed the presence of a nonsense mutation within the CLDN14 gene. Through Sanger sequencing, we verified that this variant segregates with the disease and was not present in the control population. Moreover, we conducted a comprehensive review of all reported deafness-related CLDN14 mutations and their associated phenotypes. Furthermore, we endeavored to carry out a comparative analysis between the CLDN14 and GJB2 genes, with the objective of identifying potential factors that could explain the notable discrepancy in mutation frequency between these two genes.

Resilience and Positive Wellbeing Experienced by 5-12-Year-Old Children with Refugee Backgrounds in Australia: The Childhood Resilience Study.

Refugee research tends to be deficit based and focused on the risks threatening positive adaptation and wellbeing. High rates of mental (and physical) health issues have been reported for refugee adults and children, including intergenerational trauma. This study uses the new Child Resilience Questionnaire (CRQ), co-designed with refugee background communities, to describe resilience and positive wellbeing experienced by children of refugee-background. The Childhood Resilience Study (CRS) recruited 1132 families with children aged 5-12 years in Victoria and South Australia, Australia. This included the recruitment of 109 families from 4 refugee background communities: Assyrian Chaldean (Iraq, Syria), Hazara (Afghanistan), Karen (Burma, Thailand) and Sierra Leonean families. CRQ-parent/caregiver report (CRQ-P/C) scores were categorised into 'low', 'moderate' and 'high'. The child's emotional and behavioural wellbeing was assessed with the Strengths and Difficulties Questionnaire, with positive wellbeing defined as <17 on the total difficulties score. Tobit regression models adjusted for a child's age. The CRQ-P/C scores were not different for boys and girls of refugee background. Children of refugee-background (n = 109) had higher average CRQ-P/C scores than other CRS children (n = 1023) in the personal, school and community domains, but were lower in the family domain. Most children with 'high' resilience scores had positive wellbeing for both children of refugee-background (94.6%) and other CRS children (96.5%). Contrary to common stereotypes, children of refugee-background show specific individual, family, school and cultural strengths that can help them navigate cumulative and complex risks to sustain or develop their positive wellbeing. A better understanding as to how to build strengths at personal, family, peer, school and community levels where children are vulnerable is an important next step. Working in close collaboration with refugee communities, schools, policy makers and key service providers will ensure the optimal translation of these findings into sustainable practice and impactful public policy.

Organ Donation in Syria.

The first living donor kidney transplant in Syria was performed 44 years ago; by the end of 2022, 6265 renal transplants had been performed in Syria. Kidney, bone marrow, cornea, and stem cells are the only organs or tissues that can be transplanted in Syria. Although 3 heart transplants from deceased donors were performed in the late 1980s, cardiac transplant activities have since discontinued. In 2003, national Syrian legislation was enacted authorizing the use of organs from living unrelated and deceased donors. This important law was preceded by another big stride: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the law was enacted, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to <2% in 2007. Rates plateaued through 2010, before the political crisis started in 2011. Forty-four years after the first successful kidney transplant in Syria, patients needing an organ transplant rely on living donors only. Moreover, 20 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be factors inhibiting initiation of a deceased donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.

The impact of humanitarian aid on financial toxicity among cancer patients in Northwest Syria.

INTRODUCTION: The ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions. MATERIALS AND METHODS: This research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts. RESULTS: A total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress. CONCLUSION: The research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.

Treatment outcome at the pediatric stem cell transplantation center in Syria: A single-center experience.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a therapeutic approach known for its high success rates in treating various hematologic malignancies, hemoglobinopathies, immune deficiencies, and other disorders. Notably, pediatric HSCT commenced in Syria in 2021 amidst the prevailing crisis. This study aims to assess the demographic and clinical profiles of pediatric patients who underwent stem cell transplantation and to analyze treatment outcomes at Syria's inaugural pediatric HSCT center. METHODS: This study is a single-center retrospective analysis of 25 pediatric patients who underwent HSCT underage of 14 years in the National Stem Cell Center (HAYAT) in Damascus within the period 2021-2023. The databases were created based on data that were collected from patient medical records. RESULTS: In autologous patients, transplant-related mortality (TRM) was 0%, with 4 (57%) experiencing disease relapse, resulting in the death of one patient. Additionally, 3 (42.8%) of patients remain alive under second-line management. The overall survival rate was 6 (85.7%), and the disease-free survival rate was 16 (88%). In allogeneic patients, TRM was 5.5% (1/18). One allogeneic patient experienced disease relapse and subsequently died. The overall survival rate and disease-free survival rate were 16 (88%). CONCLUSIONS: The objective of this study was to assess the outcomes of pediatric HSCT patients who have undergone transplantation thus far. Given the recent initiation of pediatric stem cell transplantation in Syria, our dataset provides a basis for comparison with international hematopoietic stem cell transplantation centers regarding treatment complications and outcomes, notwithstanding the challenges and crises faced within our country.

A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria.

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees.

Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.

Acute watery diarrhoea cases during cholera outbreak in Syria: a cohort study.

OBJECTIVES: The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria. DESIGN: Prospective, observational, cohort study. SETTING AND PARTICIPANTS: A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations. RESULTS: The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate. CONCLUSIONS: The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.

Psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia.

Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717-.856), whereas it was higher among Somali adolescents (.831-.887). The total score had medium-sized correlations with emotional problems (.303-.418) and low correlations with hyperactivity (.077-.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

We investigated the psychometric properties of the 8-item Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia living in Europe.We found support for the CRIES-8 as a suitable assessment tool for Afghan, Syrian, and Somali adolescents.The reliability of the CRIES-8 was low among Afghan and Syrian adolescents, whereas among Somali adolescents, reliability was higher.

The Impact of Inoculation of Two Strains of Rhizobacteria on Radionuclide Transfer in Sesbania Grandiflora.

Transfer factors of some naturally-occurring and artificial radionuclides from an agricultural soil to rhizobacteria-treated Sesbania grandiflora, a small leguminous tree, were studied. Two plant growth promoting rhizobacteria (PGPR) strains (SCR17 and PCE2) were used to carry out an agricultural experiment in pots in semi-arid region (Syria). The results showed the bacterial strain (SCR17) increased the transfer and accumulation of 238U and 40K in Sesbania grandiflora, while both bacterial strains showed no effect on the accumulation of 234Th, 226Ra, 210Po and 210Pb in the treated plants. The transfer factor of 137Cs from soil to rhizobacteria-treated Sesbania grandiflora was negligible. The values of the transfer factors of 234Th, 226Ra, 210Po and 40K were found to be within the global values, while the values of the transfer factors of 238U and 210Pb were found to be relatively higher. This study highlights the importance of using Phytoremediation by PGPR strains for radionuclides-contaminated soils. Therefore, this method is a promising technique for the restoration and rehabilitation of contaminated sites with radionuclides, as it is low cost, easy to apply, and environmentally friendly.

Exploring associations with depressive and anxiety symptoms among Syrian patients with ankylosing spondylitis undergoing biological treatment: A cross-sectional study.

People with ankylosing spondylitis (AS) are vulnerable group to experience mood disorders. It is crucial to identify factors that contribute to depression and anxiety in order to improve outcomes. This study seeks to determine the rates of depression and anxiety in Syrian AS patients, as well as identify potential predictors for these conditions. This cross-sectional study was conducted using convenience sampling at the Biological Treatment Unit of the Rheumatology Department of the Damascus Hospital. Data were collected from face-to-face interviews with patients using validated structural questionnaire. A multivariate linear regression model was used to investigate potential predictive factors of depressive and anxiety symptoms. Of the 103 patients, 49.5% showed clinically significant depressive symptoms, and 36.9 % showed clinically significant anxiety symptoms. Multivariate linear regression indicated that depressive and anxiety symptoms were predicted by job layoff, hip pain, positive history of mental distress, poor quality of life, severe fatigue, and high frequency of sleep disturbance with relatively high explanatory powers. depressive and anxiety symptoms were predicted by disease activity scores but with low explanatory power. This study demonstrated high levels of that depressive and anxiety symptoms among Syrian patients with AS undergoing biological treatment. Poor quality of life, severe fatigue, and high-frequency sleep disturbances are major predictive factors for depressive and anxiety symptoms. Screening for depression and anxiety holds significant importance in the comprehensive management of ankylosing spondylitis even in the context of concurrent biological treatment administration.

Temporal pattern of dental caries at the western flank of the Central Plateau of Iran, c. 2700 BCE - 1600 CE.

OBJECTIVE: To analyze the overall frequency and inter-tooth patterns of caries in three populations from ancient cemeteries located along the western border of the Central Iranian Plateau as a means to explore whether the populations of Iran had greater access to fermentable sugars after the establishment of the great empires. MATERIALS: Dental collections from Kafarved-Varzaneh (Early Bronze Age, MNI=66), Estark-Joshaqan (Iron Age, MNI=57), Tappeh Poustchi (Timurid and Safavid Period, MNI=34), together with comparative data from NE Syria. METHODS: Frequencies of dental caries per tooth categories, location and size of carious lesions are analyzed using Smith's Mean Measure of Divergence, Correspondence Analysis, χ2 and Kruskal-Wallis tests. RESULTS: There are minimal differences in overall frequencies of carious lesions at Iranian sites, regardless of the chronology, but notable differences at Syrian sites. The inter-tooth pattern at the Iron Age cemetery in Estark appears distinctly different than the other Iranian sites and the comparative samples from Syria. CONCLUSIONS: Divergent subsistence strategies may be linked with different inter-tooth patterns since people buried at Estark were mobile herders, while the other cemeteries were used by settled farmers. SIGNIFICANCE: This comprehensive research on dental caries in three chronologically diverse populations in Iran sheds light on the association between dental caries and subsistence strategies, and introduces the Smith's Mean Measure of Divergence to explore inter-tooth carious patterns, which may prove useful to other researchers seeking to understand the relationships between subsistence, diet, and the presence of carious lesions. LIMITATIONS: The studied sample size is relatively small and therefore its temporal/regional distribution produces low-resolution results. SUGGESTIONS FOR FURTHER RESEARCH: More systematic research on the patterns of dental caries is necessary to produce more fine-grained reconstructions of diet and subsistence in Iran and around the globe.