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Background: Verbal fluency tasks are frequently used for neuropsychological assessment in clinical practice and research. It consists of two tasks namely category and letter fluency tests. Objective: To determine normative values in category (animals, vegetables, fruits) and letter fluency [Mim () “M”, Alif () “A”, Baa () “B”] tasks in Arabic language in 60 s. Methods: This study was a cross-sectional national survey and included 859 community-dwelling, cognitively intact Lebanese residents aged ≥55 years. Norms were presented according to age (55–64 years, 65–74 years, ≥75 years), sex and level of education (illiterate, no diploma, primary certificate, baccalaureate or higher). Results: Level of education had the most significant positive effect on verbal fluency tasks performance amongst Lebanese older adults. The negative effect of older age was more prominent in the category fluency task compared to the letter fluency task. Women outperformed men in vegetables and fruits categories. Conclusion: This study provides clinicians with normative scores of category and letter fluency tests, which can be used for neuropsychological assessment of older Lebanese patients being evaluated for cognitive disorders.

Objectives Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. Methods This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hotel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. Results Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. Conclusions Our study is a pilot study which for the first time investigates the implication of depression in a “spirituality-quality of life” association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

In April 2020, after decades of discussions and controversy, the Lebanese parliament voted a law legalizing the cultivation, production, and sale of cannabis for medicinal purposes. Although the law leaves several unanswered questions and awaits implementation, the symbolic nature of this step in recognizing a positive role of cannabis in the local economy is significant on a regional level. The Arab world has traditionally been conservative when it comes to all drugs-related policies. Cannabis is largely demonized with heavy sentences served to anyone suspected of using selling, let alone planting cannabis. Despite a few countries considered producers and consumers of substances, governing authorities have remained immune to the liberalization trend encountered in western countries. The social experiment taking place in Lebanon is fraught with risks, given the unstable political situation and chronic economic challenges. The reactions to the law have been mixed with several scientific bodies such as the Lebanese Psychiatric Society criticizing the absence of proper consultation of stakeholders. The absence of consistency in enforcing established drugs policies or seriously debating the decriminalization of cannabis use raises concerns over the establishment of a two-tier approach toward drugs, driven solely by economic imperatives.

Objectives:In the absence of a simple validated instrument to screen for cognitive impairment among illiterate Lebanese older adults, the aims of this study were to validate an Arabic version of the Test of Nine Images (A-TNI93) adapted by the Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l’Univesité Saint Joseph (GTD-USJ) for illiterate older Lebanese and to establish normative data.Method:A national population-based sample of 332 community-dwelling illiterate Lebanese aged 55 years and older was administered the A-TNI93 (GTD-USJ) scoring free and overall recall. The sample is part of a larger national sample (1342 participants) used to validate an Arabic version of the Mini-Mental State Examination already reported. Reproducibility, sensitivity, specificity, and area under the curve of the A-TNI93 (GTD-USJ) scoring to detect cognitive impairment according to Clinical Dementia Rating (CDR) as the gold standard were measured. Normative data were established among 188 cognitively normal participants.Results:A threshold score of six on free recall (FR) provided a sensitivity of 66.7% and a specificity of 90.5%. The area under the curve was 0.93. By taking either scores, that is, a FR ≤ 6 or a total recall ≤ 8, the A-TNI93 (GTD-USJ) slightly improved dementia case detection with a sensitivity of 70.8% and a specificity of 88%. Normative data illustrate the distribution of cognitive performance among illiterate older adults.Conclusions:Compared to the CDR requiring physician’s competence, the A-TNI93 (GTD-USJ) is a valid Arabic adaptation to screen for cognitive impairment among illiterate Lebanese older adults.

Objectives Our study aims to determine the prevalence of trichotillomania among medical students. Furthermore, we aim to determine the perception of trichotillomania in this population. Methods Our study is a cross-sectional study that aims to determine the prevalence and the perception of trichotillomania among medical students in, compared to a control population. The control population were non-medical students in the same university. The participants filled a questionnaire online, followed by a psychiatric assessment if needed to confirm the diagnosis. The questionnaire contained three parts that consist of demographic data, diagnostic criteria and two perception questions respectfully. All the individuals that had a positive questionnaire refused to undergo a psychiatric assessment. Consequently, our study is limited to the screening of trichotillomania. Results In total, 489 answers were recorded. The prevalence of trichotillomania in the general population was estimated at 2.2% (N = 11). A total of 215 medical students and 274 controls filled the form. The prevalence of trichotillomania in medical students was 0.9% (N = 2), whereas in the control population, the prevalence was estimated at 3.3% (N = 9). The difference was statistically insignificant (P = 0.123). Among medical students, all the positive questionnaires were females. In the control population, seven of them were females and two of them were males. In total, the sex ratio would be 4.5 females for one male when both populations are combined. All the individuals that had a positive questionnaire either refused to undergo a psychiatric assessment or did not answer call-backs. Regarding the perception of trichotillomania, almost three quarters of the responders think that it is due to anxiety. There was a statistical difference between the medical students and the control population regarding the answer to the proposition “It is a psychiatric disease”. Medical students (76.7%) tend to believe that more than the others do (48.9%) with a p-value less than 0.00001. In addition, the same difference is found when comparing medicals students that took psychiatric courses (86.2%) to those that did not (59.7%) with a p-value at 0.0001. Almost all students think trichotillomania is treatable. Conclusion The prevalence of trichotillomania among medical students is 0.9%. Medical students are not more or less affected by trichotillomania than other students. A screening tool must be considered for this disease, considering the lack. Medical students with psychiatric knowledge know more about trichotillomania than others. For this reason, awareness campaigns regarding this disease must be done to increase general knowledge.

Introduction: Recent studies conducted with bilingual populations have shown that bilingual children who do not stutter (CWNS) are often less fluent than their monolingual counterparts, which seems to affect the accuracy with which speech-language pathologists (SLPs) identify stuttering in bilinguals. That is, misdiagnosis appears frequently in bilingual children, and is more likely to occur with bilingual CWNS (false positives) than bilingual CWS (false negatives). Methods: The goal of the current study was to gain insight in the extent of this misdiagnosis. Speech samples of 6 Lebanese bilingual CWNS and 2 CWS were rated by Lebanese SLPs in an audio-only and audiovisual presentation mode. SLPs had to identify each child as stuttering or not and subsequently rate on a 6-point scale the stuttering severity for each child. SLPs also provided background information by means of a questionnaire. Results: The results showed that stuttering severity ratings (1) were on average significantly higher for CWS than for CWNS, (2) were for each CWS higher than for all but one of the CWNS, (3) varied significantly among the CWNS but not the CWS, (4) were not affected by the presentation mode, and (5) correlated positively with the percentage of stuttering-like disfluencies (SLD) and the mean number of iterations, but not with the percentage of other disfluencies (OD). Conclusion: Misdiagnosed bilingual CWNS are perceived by the SLPs as having a mild stutter, primarily based on the frequency of their disfluencies, but can be occasionally rated at par with CWS. Further research differentiating the disfluent speech of bilingual children who do and do not stutter is needed to reach a more adequate diagnosis of stuttering.

Resume Nous discutons des principes ethiques du traitement de substitution aux opiaces chez les toxicomanes. Nous insistons sur la preservation de la dignite de la personne humaine.

Objective: Research and study the Lebanese employers’ attitudes, toward recruiting candidates with a mental illness and toward their employees who suffer chronic mental illnesses (A CMI) and the factors that may play a role in affecting it. Methods: A combined cross sectional and retrospective study. Interviews conducted with a mix of 63 human resource managers and high executive employees to assess the integration of people with A CMI at the workplace, and the attitudes toward them. Results: Primarily, the engagement of an occupational physician or a social worker in the process, was associated with a reduction in stigma surrounding the subject matter. Moreover, hiring a candidate with A CMI was perceived as a social image improvement of the hiring company. However, A CMI employees were perceived as having lower efficiency and self-esteem, as well as a greater vulnerability to dismissal. Conclusion: The presence and engagement of an occupational physician, and/or a social worker, has been found to be the main positive stigma modulator against mental illness, in a corporate setting.

Resume Objectifs La psychiatrie se distingue du reste des specialites medicales par le caractere unique de ses pathologies, qui rend importante la reflexion ethique. Cette derniere peut etre affectee par une subjectivite et des influences diverses d’ou l’interet d’etudier l’attitude des psychiatres et internes en psychiatrie au Liban vis-a-vis de la contention et du consentement eclaire. Methodes Le recueil des donnees a ete realise apres envoi, d’un questionnaire, anonyme, sous forme de Google form, aux psychiatres et internes en psychiatrie par courrier electronique et messages telephoniques. L’analyse statistique a ete effectuee a l’aide des logiciel Microsoft Excel, SPSS et des tests statistiques suivants : test sur echantillon independant et test de Mann Whitney U. Resultats Quarante personnes ont repondu, parmi lesquelles on retrouve 19 hommes et 21 femmes, 16 internes en psychiatrie, 15 psychiatres universitaires et 9 psychiatres non universitaires. Bien que 70 % trouvent que la contention est une mesure peu frequente dans la pratique hospitaliere au Liban, 92,5 % la justifient en tant que mesure securitaire et 60 % en tant que mesure therapeutique. Quant au consentement, 90 % ont considere un patient en etat psychotique d’emblee inapte a consentir. Conclusions Dans notre echantillon, le recours aux mesures coercitives n’est pas frequent, le but de ces dernieres lorsqu’elles sont employees est largement securitaire. Aucune difference significative n’a ete constatee entre les differents sous-groupes, qui proviendraient donc d’une seule population.

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.

Patients undergoing cancer treatment as well as cancer survivors commonly describe behavioral alterations. As a matter of fact, neuropsychiatric adverse events (NPAEs) have been extensively described with older immunotherapies, especially with interferon alfa. However, there are little data investigating the NPAEs of immune checkpoint inhibitors (ICIs). Therefore, the aim of this study is to evaluate the safety profile of ICI in terms of NPAEs.This is a prospective, interventional, self-controlled study. Participants receiving ICIs as unique therapy, between February and December 2019, were evaluated at the beginning of their treatment protocol, at 1 month and finally at 3 months. During the three evaluations, disease and patients' characteristics were assessed, as well as NPAEs using the Brief Psychiatric Rating Scale (BPRS) questionnaire, the psychological stress due to cancer's burden using the Herth hope index, and the performance status (PS) using the Eastern Cooperative Oncology Group (ECOG) score.Forty-four patients were enrolled, of whom 24 patients completed their three evaluation visits. No changes in BPRS total score were found throughout the study period. However, two subscores of the BPRS, "motor retardation" (P = 0.008) and "tension" or "nervousness" (P = 0.002), increased starting the 1This study suggests that ICI could be responsible for motor retardation and increased tension starting the 1

This cross-sectional survey examines the prevalence rate of Autism spectrum disorder (ASD) in 818 children (16-48 months) across all Lebanese regions. Screening was done using the revised form of the Modified-Checklist for Autism in Toddlers. Based on the total score of items failed, children were classified into 3 categories of ASD risk (low, moderate and high). Phone calls follow-up interviews and clinical assessments for diagnosis ascertainment were conducted. Given the caregivers' reluctance to participate, the prevalence rate was estimated between 49 and 513 per 10,000 with a male predominance. Our prevalence estimation, even under restrictive assumptions, is higher than elsewhere in the Arab region. Anti- stigma interventions adapted to the socio-cultural context are needed prior to future research in the field.

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal syndrome classically encountered in patients receiving typical antipsychotic agents. However, many physicians have also reported the occurrence of NMS with atypical antipsychotics, notably with atypical presentations. In this report, we present a case in which a patient's antipsychotic regimen during a psychotic episode (which involved both typical and atypical antipsychotics) subsequently led to NMS. During his stay, the patient developed an altered level of consciousness, elevation of creatine phosphokinase, hemodynamic instability, and a fever. However, the patient did not have signs of rigidity, the cardinal sign of this syndrome. The authors concluded that patients could develop NMS without rigidity while receiving an antipsychotic. Given this presentation, the authors suggest that clinicians have a high level of suspicion for NMS to avoid misdiagnosis and subsequent adverse consequences. Hence, clinicians must be vigilant about atypical presentations of NMS without rigidity.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a structured interview that assesses the frequency and severity of each symptom of posttraumatic stress disorder (PTSD) in relation to a single traumatic stressor over a 1-month period, allowing the trained interviewer to infer a current or lifetime diagnosis congruent with the 5th Edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. This study evaluated the psychometric properties of the original English language CAPS-5 translated to French. Participants (

Purpose: Anorexia nervosa (AN) is a serious mental illness that is frequently accompanied with a history of childhood maltreatment (CM) which may constitute a specific ecophenotype of the eating disorder necessitating special assessment and management. Chronic stress inflicted by CM in patients with AN may manifest through increased low grade inflammation reflected by an increase in ratios from white blood cells count such as neutrophils to lymphocytes ratio (NLR) platelets to lymphocytes ratio (PLR) and monocytes to lymphocytes ratio (MLR). Methods: N=206 participants were evaluated in an eating disorders daycare unit in Montpellier, France between March 2013 and January 2020. CM was assessed using childhood trauma questionnaire (CTQ). AN clinical severity was assessed using eating disorder examination (EDE-Q). The MINI was used to assess other clinical characteristics. Results: NLR has been found to be higher in patients with AN and a history of CM (p=0.029) as well as in patients with AN and a history of emotional abuse (p=0.021) when compared to patients with AN and without a history of CM. In the multivariate analysis, emotional abuse (β=0.17; p=0.027) contributed significantly to NLR’s variability. Conclusion: NLR is a low grade inflammation marker that is influenced by multiple sociodemographic, clinical and biological factors in patients with AN. It is more directly affected by certain subtypes of CM, especially emotional abuse than by the presence or absence of a history of CM. Future studies may focus on mediators between CM and increased inflammation such as interoceptive awareness, emotional dysregulation, food addiction and stress-sensitization.Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies

Lebanon is struggling with a multilayered crisis following the COVID-19 breakout, the economic crisis, and the Beirut port explosion. The aim of this article is to assess the effect of these crisis on the characteristics of patients hospitalized in psychiatry. This is a retrospective study conducted at the psychiatric ward of Hotel Dieu de France in Beirut between January 2017 and march 2022. The population was divided into three groups according to specific time events indicating the start of a certain crisis. Data regarding patients' demographics, psychiatric history and their present hospitalization was collected. A total of 1655 patient files were included in the study. Overall, the rate of hospitalized women increased following the Beirut port explosion, together with the rate of patients younger than 18 years old. Moreover, during the COVID-19 breakout and the start of the economic crisis, alcohol use decreased, as well as the length of stay in the hospital. In conclusion, in the event of a multilayered crisis children and adolescents, as well as women are the most at risk of being affected in terms of mental health.

Une étude transversale, a été menée afin d’évaluer l’impact de la pandémie du coronavirus sur le niveau d’anxiété et la qualité du sommeil du personnel hospitalier d’un hôpital universitaire privé impliqué dans la réponse contre la pandémie au Liban, tout en identifiant les facteurs qui pourraient affecter ces symptômes. L’évaluation s’est effectuée à l’aide de questionnaires auto-administrés ; un auto-questionnaire qui inclut les données sociodémographiques, la nature du travail exercé à l’hôpital, des questions sur les facteurs affectant le niveau de stress, et des questions sur la consommation de substances. Des échelles d'auto-évaluation ont été utilisées ; l'Inventaire d'anxiété d'État-Trait (STAI) pour le dépistage des symptômes anxieux, et l'Indice de qualité du sommeil de Pittsburgh (PSQI) pour mesurer la qualité du sommeil. Un total de 628 personnels de santé a répondu au questionnaire. Parmi tous les participants, 503 (81,4 %) étaient des infirmiers/infirmières, 52 (8,4 %) des médecins et 63 (10,2 %) des internes. En ce qui concerne les caractéristiques des participants : 409 (66,2 %) avaient moins de 40 ans, 441 (71,4 %) étaient des femmes, 309 (55 %) étaient mariés, 333 (53,9 %) avaient un seul enfant, 428 (69,3 %) avaient un niveau universitaire, et 591 (95,6 %) ne présentaient pas une histoire psychiatrique. Les moyennes obtenues aux deux échelles étaient de 44,5 au STAI, et de 6,0 au PSQI. Parmi le total des participants, 61,5 % auront un score au STAI supérieur à 40, indiquant des symptômes anxieux modérés à sévères, et 48,4 % auront un score au PSQI supérieur à 5, indiquant une mauvaise qualité de sommeil. Les infirmiers/infirmières diplômés, les internes, les femmes et les participants plus jeunes présentent des scores significativement plus élevés au niveau des deux échelles que les autres catégories de participants. Les participants sans enfants, ceux ayant un niveau académique universitaire, et ceux ayant des antécédents psychiatriques présentent des scores significativement plus élevés uniquement en ce qui concerne la PSQI. Une proportion de 31,2 % de nos participants aura augmenté leur consommation d’alcool ou de substances (tabac, caféine, tranquillisants, cannabis ou autres). Parmi les facteurs liés à la COVID-19, le fait d'avoir des proches touchés par le virus (22,2 %), d'être excessivement exposé aux médias (12,9 %) et d'avoir augmenté la consommation de substances/alcool pendant la période de la pandémie (31,2 %) a été associé à des scores significativement plus élevés au niveau des deux échelles d’évaluation. Parmi les sources de stress liées à la pandémie rapportées, nous trouvons la peur d’être infecté ou d’infecter les autres dans 61,7 %, la peur que quelqu’un de leurs proches soit infecté des 45,6 %, la peur d’avoir un accès limité aux équipements médicaux dans 17 %, et la perte financière dans 16,3 %. Une analyse de régression logistique multivariée a permis d’identifier les facteurs suivants comme étant associés à un risque plus élevé de symptômes anxieux : sexe féminin, jeune âge, mauvaise qualité de sommeil et le fait de vivre avec des personnes âgées. La prévalence de symptômes anxieux et de troubles du sommeil dans notre étude s’avère supérieure à celles retrouvées dans la littérature, d’où la possibilité que nos résultats soient influencés de même par d’autres facteurs comme la crise socio-économique que le Liban traverse. Par ailleurs, l’étude actuelle a été faite pendant une période où la pandémie était toujours considérée comme « contenue », ce qui peut expliquer l’absence de différence entre les soignants exposés directement (travaillant avec des personnes atteintes du virus) et ceux exposés indirectement. Nos résultats contribuent à la meilleure compréhension de l’état psychologique des professionnels de santé impliqués dans la réponse aiguë à la pandémie du coronavirus au Liban. Des études prospectives sont nécessaires afin d’évaluer le possible impact psychologique à long terme dans cette population.

Background The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. Objective To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Demences de l'Universite Saint Joseph" (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55. Methods Study design: national cross-sectional survey. Study population 1,010 literate community-dwelling Lebanese residents aged 55 and above. Outcomes reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education. Results Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated. Conclusion In reference to the CDR, the A-MMSE(GTD-USJ) is a valid tool to assess cognitive status among Lebanese subjects aged 55 and above. Normative data will help clinicians in detecting cognitive impairment in this population.

Background: Antipsychotic-induced sexual dysfunction is a common complaint among patients with psychotic disorders. However, few papers have discussed its impact on treatment adherence.Aims: The ai...

Arabic speakers rarely seek the help of professional mental health providers while they heavily rely on religious leaders. However, little is known about the knowledge, beliefs, and attitudes of clerics regarding mental illness. A standardized questionnaire was administered to 115 Christian religious men. Clerics appeared to have an informed, scientifically based understanding of the causes of mental disorders and of the importance of medications in effective treatment. However, several stigmatizing attitudes were identified. Contact with the patients significantly reduced the discrimination. Fear of the unpredictable highlights the need to develop and implement targeted approaches that outreach clergy.

Arab countries provide a range of services accessible health care before entering the hospital or in emergency situations. There are a range of programs and pilot projects in this area, such as developing procedures and protocols governing the coordination between the actors and the provision of specialized units fixed or mobile to deal with issues of violence, and maternal and child health, and training programs for health workers and doctors to distinguish the signs and symptoms resulting from this violence, and training and assigning staff specializing in the early detection of symptoms of violence and reporting. Jordan has developed procedures and protocols, especially the Ministry of Health to deal with cases of domestic violence.

In undertaking investigations and planning interventions, it is important to recognize that there are a range of different kinds of abusive and sexually harmful behaviors towards children, including

International professional organizations have contributed to the global effort for the prevention of child abuse and neglect: identification of efficient procedures in respective backgrounds, increasing the knowledge base, reducing the acceptance threshold of CAN, thus enhancing the quality of national visions in terms of child oriented policies. In some areas of the Arab world, initiatives are hindered by armed conflicts, with many violations to the CRC, the EU Guidelines and the Geneva conventions. They are also challenged by unstable socio-political situations in many counties of the MENA region

Many Arab states are suffering from the devastating effects of political conflicts, occupation and wars within the region, and particularly in the last 3 years of disturbances. The region also faces challenges of decades-long political conflicts, including the on-going Arab-Israeli conflict, which have resulted in multiple occupations and wars and left the Arab region in a state of instability.

Child marriage is a formal marriage or informal union entered into by an individual before reaching the age of 18. The legally prescribed marriageable age in some jurisdictions is below 18 years, especially in the case of girls; and even when the age is set at 18 years, many jurisdictions permit earlier marriage with parental consent or in special circumstances, such as teenage pregnancy. In certain countries, even when the legal marriage age is 18, cultural traditions take priority over legislative law. Child marriage affects both boys and girls, though the overwhelming majority of those affected are girls, most of who are in poor socioeconomic situations.

States should build community confidence in the justice system by, inter alia, bringing all perpetrators of violence against children to justice and ensure that they are held accountable through appropriate “No matter whether violence against children occurs in the family, school, community, institution or workplace, health workers are the front line for responding to it. We must make our contribution to ensuring that such violence is prevented from occurring in the first place, and that where it does occur children receive the best possible services to reduce its harmful effects”. Anders Nordstrom, Acting Director-General, WHO an end to violence against children criminal, civil, administrative and professional proceedings and sanctions. Persons convicted of violent offences and sexual abuse of children, should be prevented from working with children.

This book collates and brings together the available information on CSA in the Arab region, as well as efforts to address the multiple types of CSAET and respond to the expanding burden of its diverse presentations. The purpose of the book is to show the quality of the work already done and the terrible plight of CSAET on children.

Sadly, in the context of numerous uprises and social conflicts, many countries halted the implementation of child protective acts and procedures, in relation with armed conflicts and social instability. Cases of child sexual abuse, trafficking and exploitation have increasingly been reported in media and an expanding social network in the Arab region, linking more armed conflicts, social instability and child trafficking.

Key elements of the definition of CSA typically include an act against a child including sexual touching or fondling, intrusion or penetration (genital contact), indecent exposure, or other forms of sexual acts in which children are used to provide sexual gratification for the perpetrator (English 1998). Child sexual abuse or child molestation is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Other forms of child sexual abuse include engaging in sexual activities with a child (whether by asking or pressuring, or by other means), indecent exposure (of the genitals, female nipples, etc.), child grooming, or using a child to produce child pornography.