Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Multi-ancestry genome-wide association analyses improve resolution of genes and pathways influencing lung function and chronic obstructive pulmonary disease risk

Lung-function impairment underlies chronic obstructive pulmonary disease (COPD) and predicts mortality. In the largest multi-ancestry genome-wide association meta-analysis of lung function to date, comprising 580,869 participants, we identified 1,020 independent association signals implicating 559 genes supported by ≥2 criteria from a systematic variant-to-gene mapping framework. These genes were enriched in 29 pathways. Individual variants showed heterogeneity across ancestries, age and smoking groups, and collectively as a genetic risk score showed strong association with COPD across ancestry groups. We undertook phenome-wide association studies for selected associated variants as well as trait and pathway-specific genetic risk scores to infer possible consequences of intervening in pathways underlying lung function. We highlight new putative causal variants, genes, proteins and pathways, including those targeted by existing drugs. These findings bring us closer to understanding the mechanisms underlying lung function and COPD, and should inform functional genomics experiments and potentially future COPD therapies

Personal, Familial, Psychosocial and Behavioral Characteristics of Arab Juvenile Delinquents: The Context of Jordan

Delinquency in adolescence is rooted in a complex multifaceted system that comprises several factors such as personal characteristics, family, school, peers, and community, all of which are embedded in the sociocultural context in which they are present. There is a paucity of research on juvenile delinquency and its risk factors across many regions, especially low- and middle-income countries, including Arab countries. This study aimed to develop an understanding of the personal, familial, and behavioral characteristics of Arab juvenile delinquents in the distinctive sociocultural context of Jordan. All juveniles who were incarcerated at the time of data collection (N = 197) were targeted using a convenience sampling approach from a total of 11 juvenile rehabilitation centers distributed over the northern, middle, and southern regions of the country. Anonymous surveys were used to collect data on juvenile delinquents’ personal, familial, psychosocial, and behavioral characteristics. A total of 186 juvenile delinquents completed the study questionnaire (9.7% females). About 52% were not attending school regularly, 32% had divorced, separated, or deceased parents, 6% reported receiving a diagnosis of mental illness, and 91% reported they never sought psychological support of any kind. Regarding substance consumption, 70% were smokers, 26% were alcohol consumers, and 15% were on drugs. About 12% spent more than 7 h on their cellphones, and 43% reported dedicating no time for physical activity. Theft was the most frequently reported offense (35%), followed by quarreling with peers (25%), and possession of drugs (9%). Approximately 42% reported that their friends encouraged them to cause trouble, while the majority (74%) reported that their school had no positive or negative influence on their behavior. Several behavioral problems were detected, with females showing significantly higher scores in impulsivity, inattention, emotional lability, and social problems compared to their male counterparts. Severity of the conduct problems was negatively associated with the length of engagement in physical activities, while both impulsivity and inattention scores were positively associated with the length of engagement in watching TV and using cellphones (all p < 0.05). Overall, these juvenile delinquents have unsatisfactory academic and schooling experiences, engage in unhealthy lifestyles and exhibit several behavioral problems. Differences in juvenile delinquency risk factors across different sociocultural contexts can influence prevention efforts. Comprehensive prevention strategies that reduce risk and develop protective factors need to target juveniles early in their development and consider factors related to their families, schools, peers, and communities

Personal, Familial, Psychosocial and Behavioral Characteristics of Arab Juvenile Delinquents: The Context of Jordan

Delinquency in adolescence is rooted in a complex multifaceted system that comprises several factors such as personal characteristics, family, school, peers, and community, all of which are embedded in the sociocultural context in which they are present. There is a paucity of research on juvenile delinquency and its risk factors across many regions, especially low- and middle-income countries, including Arab countries. This study aimed to develop an understanding of the personal, familial, and behavioral characteristics of Arab juvenile delinquents in the distinctive sociocultural context of Jordan. All juveniles who were incarcerated at the time of data collection (N = 197) were targeted using a convenience sampling approach from a total of 11 juvenile rehabilitation centers distributed over the northern, middle, and southern regions of the country. Anonymous surveys were used to collect data on juvenile delinquents&rsquo; personal, familial, psychosocial, and behavioral characteristics. A total of 186 juvenile delinquents completed the study questionnaire (9.7% females). About 52% were not attending school regularly, 32% had divorced, separated, or deceased parents, 6% reported receiving a diagnosis of mental illness, and 91% reported they never sought psychological support of any kind. Regarding substance consumption, 70% were smokers, 26% were alcohol consumers, and 15% were on drugs. About 12% spent more than 7 h on their cellphones, and 43% reported dedicating no time for physical activity. Theft was the most frequently reported offense (35%), followed by quarreling with peers (25%), and possession of drugs (9%). Approximately 42% reported that their friends encouraged them to cause trouble, while the majority (74%) reported that their school had no positive or negative influence on their behavior. Several behavioral problems were detected, with females showing significantly higher scores in impulsivity, inattention, emotional lability, and social problems compared to their male counterparts. Severity of the conduct problems was negatively associated with the length of engagement in physical activities, while both impulsivity and inattention scores were positively associated with the length of engagement in watching TV and using cellphones (all p &lt; 0.05). Overall, these juvenile delinquents have unsatisfactory academic and schooling experiences, engage in unhealthy lifestyles and exhibit several behavioral problems. Differences in juvenile delinquency risk factors across different sociocultural contexts can influence prevention efforts. Comprehensive prevention strategies that reduce risk and develop protective factors need to target juveniles early in their development and consider factors related to their families, schools, peers, and communities

Characteristics and treatment results of patients with gastroenteropancreatic neuroendocrine tumors in a tertiary care centre

Abstract Background Gastroenteropancreatic Neuroendocrine tumors (GEP-NET) are rare neoplasms with limited reported data from the Middle East. Our study aims to report the clinicopathological feature, treatment patterns, and survival outcomes of patients with GEP-NET from our part of the world. Methods Medical records of patients diagnosed with GEP-NET between January 2011 and December 2016 at a single center in Saudi Arabia were reviewed retrospectively, and complete clinicopathological and treatment data were collected. Patients’ survival was estimated by the Kaplan–Meier method. Results A total of 72 patients were identified with a median age of 51 years (range 27–82) and male-to-female ratio of (1.1). The most common tumor location was the pancreas (29.1%), followed by small bowel (25%), stomach (12.5%), rectum (8.3%), colon (8.3%), and appendix (6.9%). Forty-one patients (57%) had well-differentiated grade (G)1, 21 (29%) had G2, and 4 (6%) had G3. In five patients, the pathology was neuroendocrine carcinoma and in one it could not be classified. 54.2% of the patients were metastatic at diagnosis. Forty-two patients underwent surgical resection as primary management while 26 underwent systemic therapy, three patients were put on active surveillance, and one was treated endoscopically with polypectomy. The 5-year overall survival and progression-free survivals were 77.2% and 49%, respectively, for the whole group. Patients with G1 and 2 disease, lower Ki-67 index, and surgically treated as primary management had significantly better survival outcomes. Conclusion Our study suggests that the most common tumor locations are similar to western reported data. However, there seems to be a higher incidence of metastatic disease at presentation than in the rest of the world

A population study of clinically actionable genetic variation affecting drug response from the Middle East

Clinical implementation of pharmacogenomics will help in personalizing drug prescriptions and alleviate the personal and financial burden due to inefficacy and adverse reactions to drugs. However, such implementation is lagging in many parts of the world, including the Middle East, mainly due to the lack of data on the distribution of actionable pharmacogenomic variation in these ethnicities. We analyzed 6,045 whole genomes from the Qatari population for the distribution of allele frequencies of 2,629 variants in 1,026 genes known to affect 559 drugs or classes of drugs. We also performed a focused analysis of genotypes or diplotypes of 15 genes affecting 46 drugs, which have guidelines for clinical implementation and predicted their phenotypic impact. The allele frequencies of 1,320 variants in 703 genes affecting 299 drugs or class of drugs were significantly different between the Qatari population and other world populations. On average, Qataris carry 3.6 actionable genotypes/diplotypes, affecting 13 drugs with guidelines for clinical implementation, and 99.5% of the individuals had at least one clinically actionable genotype/diplotype. Increased risk of simvastatin-induced myopathy could be predicted in ~32% of Qataris from the diplotypes of SLCO1B1, which is higher compared to many other populations, while fewer Qataris may need tacrolimus dosage adjustments for achieving immunosuppression based on the CYP3A5 diplotypes compared to other world populations. Distinct distribution of actionable pharmacogenomic variation was also observed among the Qatari subpopulations. Our comprehensive study of the distribution of actionable genetic variation affecting drugs in a Middle Eastern population has potential implications for preemptive pharmacogenomic implementation in the region and beyond. 2022, The Author(s).PVJ is supported by faculty funding from the College of Health & Life Sciences, HBKU. Qatar Biobank and Qatar Genome Program are Research, Development & Innovation's entities within Qatar Foundation for Education, Science and Community Development. Funders had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.Scopu

Multi-ancestry genome-wide association analyses improve resolution of genes and pathways influencing lung function and chronic obstructive pulmonary disease risk

Funder: British Lung Foundation (BLF); doi: https://doi.org/10.13039/501100000351Funder: DH | National Institute for Health Research (NIHR); doi: https://doi.org/10.13039/501100000272AbstractLung-function impairment underlies chronic obstructive pulmonary disease (COPD) and predicts mortality. In the largest multi-ancestry genome-wide association meta-analysis of lung function to date, comprising 580,869 participants, we identified 1,020 independent association signals implicating 559 genes supported by ≥2 criteria from a systematic variant-to-gene mapping framework. These genes were enriched in 29 pathways. Individual variants showed heterogeneity across ancestries, age and smoking groups, and collectively as a genetic risk score showed strong association with COPD across ancestry groups. We undertook phenome-wide association studies for selected associated variants as well as trait and pathway-specific genetic risk scores to infer possible consequences of intervening in pathways underlying lung function. We highlight new putative causal variants, genes, proteins and pathways, including those targeted by existing drugs. These findings bring us closer to understanding the mechanisms underlying lung function and COPD, and should inform functional genomics experiments and potentially future COPD therapies.</jats:p