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☐ ☆ ✇ BMJ Open

Predicting depressive and anxiety symptoms among Lebanese and Syrian adults in a suburb of Beirut, Lebanon, during concurrent crises: nested cross-sectional study

Por: Shamas · H. · Ragi · M.-E. · Abi Zeid · B. · DeJong · J. · McCall · S. J. · CAEP Study Group · Germani · El-Jardali · Ghattas · M Melhem · DeJong · McCall — Mayo 11th 2026 at 13:14
Objective

This study aimed to develop prediction models for symptoms of poor mental health among Lebanese adults and adult Syrian refugees or migrants residing in a suburb of Beirut, Lebanon, separately.

Design

Nested cross-sectional study.

Setting

Sin-El-Fil, a suburb east of Beirut, Lebanon.

Participants

Lebanese and Syrian adults residing in low socio-economic status areas of Sin-El-Fil.

Primary and secondary outcome measures

Primary outcome was having depressive symptoms, ascertained through the Patient Health Questionnaire-9 where a total summative score of 10 or more indicated having depressive symptoms. Secondary outcome was having anxiety symptoms, ascertained through the Generalised Anxiety Disorder-7 where a total summative score of 10 or more indicated having anxiety symptoms.

Results

Of 1986 participants, 1322 (66.5%) were Lebanese adults, 664 (33.5%) were Syrian refugees or migrants. Among Lebanese adults and adult Syrian refugees or migrants, 324 (25.3%) and 289 (43.9%) had depressive symptoms, respectively. Having pain that impacts usual activity, having debt, not feeling safe at home and having none or one person to count on in difficult times were common predictors of depressive and anxiety symptoms among Lebanese adults and Syrian refugees or migrants. Not having a legal residency permit was also a predictor of depressive symptoms for Syrian refugees or migrants. Prediction models developed for depressive and anxiety symptoms among both nationalities had good performance measures.

Conclusions

The predictors of poor mental health included financial, health and social indicators for both Lebanese adults and Syrian refugees or migrants during the concurrent crisis in Lebanon. These models are most applicable in similar urban, crisis-affected and low-resource settings. Findings emphasise the need for social protection and financial support among populations with vulnerabilities.

☐ ☆ ✇ BMJ Open

Is metformin therapy in conjunction with lifestyle modifications more effective than lifestyle modifications alone in lowering the risk of gestational diabetes mellitus in pregnant women with metabolic dysfunction-associated steatotic liver disease (MASLD

Por: Jayaseelan · V. · Subbaiah · M. · Arikrishnan · K. · Govindarajalu · R. · Pulavarthi · S. · Nanda · N. · Nasreen Vadakkepeediyakkal · K. · Mohan · P. · Murugesan Sivagurunathan · G. · Musthafa · M. K. · Duraiswamy · M. · Pulikkot Suragi · S. — Diciembre 30th 2025 at 15:31
Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) and gestational diabetes mellitus (GDM) are prevalent metabolic disorders in pregnancy, posing significant risks to maternal and fetal health. This study evaluates the effectiveness of metformin, in combination with lifestyle modifications, compared with lifestyle modifications alone, in reducing the incidence of diabetes, pro-inflammatory liver markers, adverse maternal and neonatal outcomes and total gestational weight gain in pregnant women diagnosed with MASLD in the first trimester.

Methods

This parallel-arm, randomised controlled trial will recruit pregnant women (≤14 weeks of gestation) with confirmed MASLD from antenatal clinics of tertiary care public hospitals in Puducherry, India. Participants will be consecutively enrolled until a sample size of 296 is reached. Block randomisation will ensure balanced group allocation, with allocation concealment maintained using sequentially numbered opaque sealed envelopes. The intervention group will receive oral metformin (500 mg two times per day) alongside structured lifestyle modification counselling, while the control group will receive lifestyle modification counselling alone. Primary outcomes include GDM incidence, changes in pro-inflammatory markers, MASLD grading (assessed via liver function tests and ultrasound) and adverse maternal outcomes such as hypertensive disorders, polyhydramnios, genitourinary infections, caesarean delivery and postpartum haemorrhage. Neonatal outcomes assessed include macrosomia, stillbirth, intrauterine death, birth injury, shoulder dystocia, respiratory distress and neonatal hypoglycaemia. The secondary outcome is total gestational weight gain. Participants will be followed at 24–28 weeks, 34–36 weeks and post partum (within 6 weeks of delivery). Data collection will be conducted using a pretested structured questionnaire, with data entry and management performed using REDCap software. Statistical analysis will be conducted using STATA V.4, applying both intention-to-treat and per-protocol analyses. Effect sizes will be reported as proportions and relative risks with 95% CIs, ensuring robust statistical inference.

Conclusions

This study provides a rigorous framework to assess metformin’s role in managing MASLD and preventing GDM, thereby promoting favourable maternal and neonatal outcomes. Findings will contribute to improved clinical management, public health strategies and policy recommendations.

Ethics and dissemination

The study was approved by the JIPMER Institutional Ethics Committee (JIP/AEC/2023/01/011), and the findings will be disseminated through peer-reviewed journals and academic conferences.

Trial registration number

CTRI/2023/12/060930.

☐ ☆ ✇ BMJ Open

Role of e-health in addressing sarcopenic obesity: a scoping review protocol

Por: Nortoft · M. · Graungaard · S. · Iheme · G. O. · Karagianni · V. · Bereczky · R. · Ellegaard · L. · Boström · A.-M. — Noviembre 4th 2025 at 13:13
Introduction

The global burden of malnutrition is compounded by the challenges of obesity and sarcopenia, a combination known as sarcopenic obesity. This condition, defined by increased fat mass alongside declining muscle mass and function, poses significant health risks, including metabolic dysregulation and cardiovascular complications. Despite its growing prevalence and clinical importance, significant gaps remain regarding the application of e-health strategies to address sarcopenic obesity. This scoping review aims to map the current evidence on the use of e-health in addressing sarcopenic obesity in adults with overweight or obesity, identify barriers and facilitators to its implementation, and highlight areas for future research.

Methods and analysis

The scoping review will be conducted in accordance with established methodological framework by the Joanna Briggs Institute (JBI), employing a comprehensive three-step search strategy across multiple databases and grey literature sources, including PubMed, Embase, Cochrane, CINAHL, Web of Science and Scopus. The inclusion criteria, framed by the Population-Concept-Context (PCC) framework, will focus on studies involving adults with sarcopenic obesity and interventions using e-health approaches in various healthcare contexts. A data extraction form will be used to guide the data extraction. Findings will be synthesised narratively and in tabular form, comprehensively mapping the current evidence and identifying key areas for future research.

Ethics and dissemination

Ethical approval is not required as the review analyses publicly available data. Findings will be published in a peer-reviewed journal and presented at international conferences and scientific forums. The review will offer insights into e-health integration in sarcopenic obesity management, informing clinical practice, policy development and interdisciplinary collaboration.

Study registration

This scoping review was registered with the Open Science Framework registry on 17 September 2024 (https://doi.org/10.17605/OSF.IO/9ND5A).

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