Non-communicable diseases in the Arab world

The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi Arabia

Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviors-related information, and (iv) exposure to and engagement with social media advertisements. The study's outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: "Are you on a healthy diet (such as a balanced diet, keto, or low carb)?" A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1-3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.

Social network enhanced behavioral interventions for diabetes and obesity: A 3 arm randomized trial with 2 years follow-up in Jordan

While obesity and diabetes are rising pandemics, few low-cost and effective prevention and management strategies exist, especially in the Middle East. Nearly 20% of adults in Jordan suffer from diabetes, and over 75% are overweight or obese. Social network-based programs have shown promise as a viable public health intervention strategy to address these growing crises. We evaluated the effectiveness of the Microclinic Program (MCP) via a 6-month multi-community randomized trial in Jordan, with follow-up at 2 years. The MCP leverages existing social relationships to propagate positive health behaviors and information. We recruited participants from 3 community health centers in Amman, Jordan. Participants were eligible for the study if they had diabetes, pre-diabetes, or possessed ≥1 metabolic risk factor along with a family history of diabetes. We randomized participants into three trial arms: (A Group) received the Full MCP with curriculum-activated social network interactions; (B Group) received Basic MCP educational sessions with organic social network interactions; or (C Group-Control) received standard care coupled with active monitoring and parallel screenings. Groups of individuals were randomized as units in a 3:1:1 ratio, with resulting group sizes of n = 540, 186, and 188 in arms A, B, and C, respectively. We assessed the overall changes in body weight, fasting glucose, hemoglobin A1c (HbA1c) and mean arterial blood pressure between study arms in multiple evaluations across 2 years (including at 6-months and 2-years follow-up). We investigated the effectiveness of Full and Basic MCP social network interventions using multilevel models for longitudinal data with hierarchical nesting of individuals within MCP classrooms, within community centers, and within temporal cohorts. We observed significant overall 2-year differences between all 3 groups for changes in body weight (P = 0.0003), fasting blood glucose (P = 0.0015), and HbA1c (P = 0.0004), but not in mean arterial blood pressure (P = 0.45). However, significant changes in mean arterial pressure were observed for Full MCP versus controls (P = 0.002). Weight loss in the Full MCP exceeded (-0.97 kg (P<0.001)) the Basic MCP during the intervention. Furthermore, both Full and Basic MCP yielded greater weight loss compared to the control group at 2 years. The Full MCP also sustained a superior fasting glucose change over 2 years (overall P<0.0001) versus the control group. For HbA1c, the Full MCP similarly led to greater 6-month reduction in HbA1c versus the control group (P<0.001), with attenuation at 2 years. For mean arterial blood pressure, the Full MCP yielded a greater drop in blood pressure versus control at 6 months; with attenuation at 2 years. These results suggest that activated social networks of classroom interactions can be harnessed to improve health behaviors related to obesity and diabetes. Future studies should investigate how public health policies and initiatives can further leverage social network programs for greater community propagation. Trial registration. ClinicalTrials.gov Identifier: NCT01818674.

Impact of the coronavirus (COVID-19) disease pandemic on healthy lifestyle behaviors in persons with and without disabilities in Qatar

Purpose

This study aimed to examine the impact of the COVID-19 pandemic on the lifestyle behaviors which included physical activity, sedentariness, healthy eating habits, sleep habits, and tobacco use in persons with and without disabilities in Qatar.

Methods

This cross-sectional study used a structured, online questionnaire. The collected data included demographics, mental health, physical health, eating habits, body weight, sleep, and nicotine intake. This study was conducted between September 25, 2020, and December 31, 2020.

Results

Seventy respondents from Qatar participated in the study. Pre-pandemic healthy lifestyle behaviors (physical activity, healthy diet, sleep, etc.) showed no significant differences between people with and without disabilities. However, perceived changes in mental and physical health and eating habits during the pandemic lockdown differed between people with and without disabilities. People with disabilities reported worsening mental health (64.7%), physical health (53%), and dietary habits compared to the pre-pandemic levels. Furthermore, the more severe the disability, the more significant is its impact on mental and physical health.

Conclusion

This study indicated that the pandemic has had a significant impact on the mental and physical health of people with and without disabilities in Qatar. These findings reveal how closely individuals with disabilities and their lifestyle choices are related to their mental and physical well-being. This will enable the development of specific interventions for similar situations in the future.

Knowledge and Awareness of Stroke among the Elderly Population: Analysis of Data from a Sample of Older Adults in a Developing Country

Background and Objectives: Stroke prevention has traditionally concentrated on research to improve knowledge and awareness of the disease in the general population. Since stroke incidents increase with age, there is a need to focus on the elderly, a high-risk group for developing the disease. This study aimed to examine the level of stroke awareness and knowledge, their predictors, and their source of information. Materials and Methods: A prospective cross-sectional study targeted Lebanese senior citizens aged 65 years and above. A total of 513 participants enrolled in the study through a self-administered survey distributed using a snowball sampling technique. Results: Most participants had appropriate baseline knowledge (more than 75% correct answers) of stroke, including risk factors, alarming signs, and preventive measures. Better knowledge of disease risks was significantly associated with having a university degree (ORa = 1.609; p = 0.029). Participants who had previous ischemic attacks showed significantly lower knowledge of the alarming signs (ORa = 0.467; p = 0.036) and prevention measures (ORa = 0.427; p = 0.029). Those suffering from depression had better knowledge of stroke alarming signs (ORa = 2.060.; p = 0.050). Seeking information from pharmacists, physicians, or the internet was not significantly associated with better knowledge of stroke risks, alarming signs, and preventive measures. Conclusions: The present study showed that seniors had fair knowledge of stroke, despite gaps in stroke prevention measures. Healthcare providers could play a leading role in improving public health by educating seniors to enhance awareness about prevention measures, detecting alarming signs, and acting fast to save a life.

Prevalence and Awareness of Obesity and Bariatric Surgeries in the Northern Borders Region, Saudi Arabia

Introduction Obesity is a complex health issue affecting millions worldwide, characterized by excessive body fat accumulation, often leading to various health complications. Bariatric surgeries are effective interventions for severe obesity, assisting patients in attaining substantial weight reduction and enhancing their overall well-being. This study aimed to assess obesity patterns and bariatric surgery prevalence in the Northern Borders region of Saudi Arabia to increase community knowledge and awareness about obesity and bariatric surgery. Methods This cross-sectional study included 386 residents in the Northern Borders region, Saudi Arabia. The participants completed a previously validated self-administered electronic questionnaire, and the confidentiality of the collected data was ensured. Results Nearly 58.3% of the participants (31-40 years), with a predominance of females, had a body mass index (BMI) >30, and 33.7% had undergone bariatric surgery. Most participants (92.5%) were aware that obesity is associated with significant medical issues, 98.2% appreciated that there is a surgical method to reduce weight, and 58.8% indicated that the procedure was not safe. Additionally, the majority of the respondents (57.0%) were not sure about the complications of weight-loss surgeries, and only 28.0% knew that surgeries for obesity and their complications may lead to death. Significant associations were found between age, education level, and BMI concerning the knowledge of obesity/bariatric surgery (p=0.003, 0.001, 0.002), respectively. However, gender and work status did not show such associations (p> 0.05). Conclusion Our study highlighted a lack of knowledge among the community regarding the safety, potential complications, and survival outcomes associated with obesity and bariatric surgery that could be due to ignorance and reluctance to pursue bariatric surgery to overcome morbid obesity. Significantly, the study found a relationship between age, education level, BMI, and knowledge of obesity and bariatric surgery.

A Survey Study on Knowledge and Attitude Toward the Ethics Committee and Research Ethical Practices Among Researchers From Kuwait

The integrity of research findings and the safety of participants who voluntarily consent to participate in research studies must be assured through ethical approaches. Additionally, ethical guidelines and the ethics committee protect participants from unfair practices by the research team. Therefore, this study aims to assess the knowledge and attitudes toward the ethics committee and research ethical practices among the researchers of a diabetes institute in Kuwait. An anonymous survey was conducted through an online questionnaire using Microsoft Forms. The study had a response rate of 86%. Among the 55 participants in this study, 43 (78%) had ethics training. Researchers involved in more than four research projects were shown to have a much higher awareness of the ethics committee and its role than researchers involved in no projects. Approximately 90% of researchers had training in research ethics and were knowledgeable about informed consent forms and assent, as well as additional protections for vulnerable populations. Ninety-eight percent of respondents were of the view that an ethics committee was necessary. Our study concluded that most of the researchers at the institute were aware of the role of the ethics committee, and ethical principles. However, we recommend that continuous and customized training on research ethics should be provided.

Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study

BACKGROUND

We evaluated the outcomes of a pilot SMS text messaging-based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait.

OBJECTIVE

The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns.

METHODS

SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding.

RESULTS

A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign.

CONCLUSIONS

SMS text messaging-based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots.

Factors Associated with Sedentary Behavior and Physical Activity Among People Living in Saudi Arabia - A Cross-Sectional Study

Background

A poor physical activity and sedentary behavior is common among individuals which can be detrimental to one's health. Furthermore, sedentary behavior is associated with metabolic disorders. Therefore, this study explored factors associated with sedentary behavior and physical activity among individuals in capital region of Saudi Arabia.

Methods

A cross-sectional web-based study was conducted over a period of 3 months in 2023 using prevalidated questionnaires, which address the sedentary behavior and physical activity and its factors. This study included among individuals aged from 19 to 50 years, living in Riyadh. Factors associated with outcome variables were identified using multiple linear regression analysis in SPSS.

Results

Of the 833 study participants, 569 (68.3%) and most were males aged between years 31-35 years old. Only 20.6% (n=172) of the activities that induced high levels of breathing or heart rate were vigorous-intensity activities among the respondents. The average number of sitting hours per day was 6.74 (SD=1.577). The regression model's findings showed a significant correlation between mean sitting time and education level (p=0.008), occupation (p=0.001), monthly income (p=0.029), and kind and status of physical activity (p=0.002). Similar to this, there was a significant correlation between age group (p=0.040) and physical activity status (p=0.001) and the amount of time spent engaging in vigorous-intensity activities at work on an average day.

Conclusion

The findings of this study confirmed that Saudi adults living in the Riyadh region spent a significant amount of time sedentary, and the most common factors associated with sedentary behavior were education, employment, monthly income, physical activity status, type of physical activity, and reasons for not practicing physical activity. The findings of this study can be used by healthcare providers and those associated with policymaking to improve health outcomes in healthcare settings.

"I tell you, getting data for this is hell"-Exploring the use of evidence for noncommunicable disease policies in Ghana

After several years of over concentration on communicable diseases, Ghana has finally made notable strides in the prevention of NCDs by introducing key policies and programmes. Evident shows that there is limited NCD-related data on mortality and risk factors to inform NCD policy, planning, and implementation in Ghana. We explored the evidence base for noncommunicable disease policies in Ghana. A qualitative approach was adopted using key informant interviews and documents as data sources. An adaptation of the framework method for analysing qualitative data by Gale and colleagues' (2013) was used to analyse data. Our findings show that effort has been made in terms of institutions and systems to provide evidence for the policy process with the creation of the Centre for Health Information Management and the District Health Information Management System. Although there is overreliance on routine facility data, policies have also been framed using surveys, burden of disease estimates, monitoring reports, and systematic reviews. There is little emphasis on content analysis, key informant interviews, case studies, and implementation science techniques in the policy process of Ghana. Inadequate and poor data quality are key challenges that confront policymakers. Ghana has improved its information infrastructure but access to quality noncommunicable disease data remains a daunting challenge. A broader framework for the integration of different sources of data such as verbal autopsies and natural experiments is needed while strengthening existing systems. This, however, requires greater investments in personnel and logistics at national and district levels.

Measuring public attitudes towards people living with chronic diseases in Arabic-speaking populations: adaptation and development of the Social Stigma Scale of Chronic Diseases (SSS-CD)

BACKGROUND

A large proportion of the population in Arab countries suffer from chronic diseases. According to the statistics by the Global Health Estimates, chronic illnesses contribute by 71% to total deaths in the Arab region. While chronic illnesses have been demonstrated to carry high levels of social stigma, it is only recently that little research attention has been given to this topic in the Arab world. It is well-established that the social stigma construct is culturally-dependent. Therefore, the lack of an Arabic measure highlighted the urgent need for developing a culturally adapted and valid instrument to assess social stigma toward people living with chronic diseases. In this study, we aimed to examine the psychometric properties of the Arabic translation, adaptation and development of "the Social Stigma Scale of Chronic Diseases" (SSS-CD).

METHOD

Fifteen items derived from the literature and assessing social stigma towards chronic diseases have been administered to 570 Arabic-speaking adults from the Lebanese general population (aged 24.59 ± 6.75years; 68.6% women). Items were translated into Arabic using a forward-backward translation method. Exploratory factor analysis (EFA) using a principal-axis EFA on the first split-half subsample, followed by a confirmatory factor analysis (CFA) tested on the model extracted from the EFA on the second split-half subsample, were conducted to examine the construct validity of the SSS-CD. Fit indices were deemed adequate if the normed model chi-square (χ²/df) ≤ 3, the Steiger-Lind root mean square error of approximation (RMSEA) ≤ 0.08, the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) ≥ 0.90.

RESULTS

Findings revealed that the 10-item SSS-CD has a unidimensional factor structure, with the following fit indices: χ²/df = 92.95/34 = 2.73, RMSEA = 0.077 (90% CI 0.059, 0.096), SRMR = 0.062, CFI = 0.939, TLI = 0.919. A good internal consistency was demonstrated by a McDonald's omega value of 0.73 for the total score. Findings also supported invariance across gender, with men exhibiting higher levels of social stigma attached to chronic diseases than women. All three dimensions of stigmatization (social, psychological and evolutionary stigmatization) were positively correlated with SSS-CD scores (Social self-interest [r = .40; p < .001], Evolutionary self-interest [r = .37; p < .001], Psychological self-interest [r = .42; p < .001]), demonstrating relatively strong convergent validity.

CONCLUSION

Our findings suggest that the SSS-CD has robust psychometric qualities. We thus preliminarily suggest that the scale is valid, reliable and suitable for use among Arabic-speaking people from the general population to measure public attitudes towards people living with chronic diseases. Providing this psychometrically sound measure will hopefully enable to foster research in this area in order to draw a clear overview of the prevalence and characteristics of social stigma attached to chronic diseases in Arabic-speaking communities. However, given that this was the first study to examine the psychometric properties of the SSS-CD, the present findings and conclusions should be considered tentative pending future cross-national validation studies.

Arabic translation and cultural adaptation of sedentary behavior, dietary habits, and preclinical mobility limitation questionnaires: A cognitive interview study

BACKGROUND

Developing global evidence on the influence of health-related behaviors (e.g., sedentary behavior, diet) and mobility limitations on health requires global consortia from diverse sets of countries. Thus, the purpose was to translate and culturally adapt (i) the Sedentary Behavior Questionnaire (SBQ); (ii) the Dietary Habits Questionnaire adapted from the Survey of Health, Aging and Retirement in Europe (SHARE) study; (iii) the Preclinical Mobility Limitation questionnaire for use in the Saudi Arabian context.

METHOD

50 adult Saudi participants (mean age 41.7±9.6, 48% female) participated in this study. We followed a systematic cross-cultural adaptation process that involved forward translation, synthesis, back-translation, expert panel, and pre-testing (cognitive interviewing). Four rounds of cognitive interviews were held with 40 participants for the SBQ, SHARE questionnaire, and the Preclinical Mobility Limitation questionnaire, an additional round was needed for the Preclinical Mobility Limitation questionnaire. Descriptive data (means ± standard deviations and frequencies with percentages) were reported for characteristics.

RESULT

With some minor changes to the questionnaires, the SBQ, Dietary Habits, and Preclinical Mobility Limitation questionnaires were translated and cross-culturally adapted into Arabic. 100% of the participants confirmed that the resulting Arabic versions of the SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaires were appropriate and fully understandable for Arabic speakers in communicating the intended meanings of the items in each. For example, item SBQ1, 'Watching television (including videos on VCR/DVD)' was changed to 'Sitting and watching television or videos (including smartphones, tablets)'.

CONCLUSION

The SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaire were successfully cross-culturally adapted into Arabic and are now ready for use in Saudi Arabian.

Assessment of health-related behaviors among medical students: A cross-sectional study

Background and Aim

Students sometimes participate in harmful activities that adversely influence their behaviors and well-being throughout college, which is one of the sensitive phases in an individual's life. Aim: To assess the health-related behaviors of university students.

Methods

A cross-sectional study that includes systematic randomly selected 383 students from various colleges of Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah Emirate, United Arab Emirates. A self-reported questionnaire included students' demographic traits and behaviors, including safety, medication intake, cigarette smoking, nutrition, physical activity, and health-related topics.

Results

Most participants were females (69.7%), 13.3% were obese while 28.2% were overweight. The data revealed a significant difference between male and female students regarding medication intake without prescription, nutrition, physical activity, and health-related topics. The data also revealed that the majority of the students were attempting to lose weight, and the former male smokers had fewer trials to quit the use of all tobacco products than females.

Conclusion

More than a quarter of participants were overweight, and the majority of students did not adhere to the guidelines for safety and nutritious eating. This study recognized significant health promotion opportunities for university students that can be carried out to establish a healthier youth for society.

Awareness and Perception of Anti-obesity Medications Among Al-Ahsaa, Riyadh, and Hail in Saudi Arabia Populations

INTRODUCTION

Obesity is the most prevalent medical disease afflicting low-, middle-, and high-income nations. Hence, the use of anti-obesity drugs is gaining popularity as an adjuvant treatment for this medical condition, along with diet and lifestyle modifications. Different medications have been approved for the treatment of obesity. So, it is of the utmost importance to know the community's perception and awareness on that matter.

METHODS

An analytical, cross-sectional study design was adopted for this study. The data was collected by distributing an electronic questionnaire to adult males and females aged between 18 and 60 years living in Hail, Riyadh, and Al-Ahsaa, Saudi Arabia. The questionnaire consisted of three sections. The first section dealt with demographic data; the second section included items for measuring the awareness and general perception of anti-obesity medications; and the last section included one item used to recognize the reasons for refusing to take anti-obesity medications.

RESULTS

A total of 1073 participants from Al-Ahsaa, Hail, and Riyadh completed the questionnaire. Out of the total, 55.6% had an overall good awareness level about anti-obesity medications. Regarding information about the drugs, 77.6% think that there is a certain body mass index (BMI) that allows the use of these medications; 31.4% reported a BMI of > 40. In addition, most participants think that these drugs can make them lose 3-8 kg per year. However, 69.3% and 64.5% think that anti-obesity drugs increase the risk of pancreatitis and thyroid tumors, respectively. Lastly, factors that are associated with a good overall awareness level are: females, participants living in Riyadh, post-graduate degrees, and work in the health care field.

CONCLUSION

The overall awareness of anti-obesity drugs was good, particularly in Riyadh, the kingdom's capital. However, the majority of the individuals who had low awareness of these medications would not take them if their doctors prescribed them, mainly due to their concern about the treatment's side effects.

Lifestyle and Dietary Patterns during the COVID-19 Lockdown in Bahrain: A Web-Based Cross-Sectional Study

Lifestyle factors such as dietary habits, perceived weight, sleep, and physical activity worsened during the COVID-19 pandemic. Through this study, we aimed to understand the impact of COVID-19 on these lifestyle factors in Bahrain. A cross-sectional study was conducted among 1005 adult Bahrainis. Data were collected online using a structured and validated questionnaire for the assessment of eating habits, physical activity, and lifestyle during the COVID-19 pandemic. Participants were snowballed through those who agreed to answer the online questionnaire. There was a higher consumption of fast food, and a higher dependence on takeaways during the COVID-19 pandemic. About 63.5% of the participants consumed >4 meals per day, compared to 36.5% before the COVID-19. About 30% reported consumption of sugar sweetened beverages from two to three times a day. Weight loss was predominantly observed in persons exercising 1-3 times a week. The consumption of sugar-sweetened beverages was also high, with about 19% reporting drinking sweet beverages once every day, 10.6% from two to three times a day, and 40.4% from one to four times a week. A higher proportion of the participants reported poor sleep quality during the pandemic (31.2%) compared to before (12.2%), and 39.7% of the participants reported feeling lazy. Screen time use also doubled during the pandemic, with participants spending more than five hours per day on screens for entertainment, which went from 22.4% before to 51.9% during the pandemic. The lifestyle and dietary habits changed drastically for our study participants during the pandemic. The increased reliance on processed fast food instead of healthier options is a challenge to be tackled in any future pandemic situation. Future research needs to focus on strategies to promote healthier lifestyle modifications during situations such as the COVID-19 pandemic.

Cardiovascular health research priorities in the United Arab Emirates

Background

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in the United Arab Emirates (UAE) and have been prioritized for intervention by healthcare authorities and clinicians.

Aim

To identify clinically relevant research priorities for the treatment and prevention of CVDs in the UAE.

Methods

This study used the nominal group technique to identify CVD-related research priorities. Participants were 37 experts from UAE hospitals, academic and research institutions, CVD associations, and paramedical organizations.

Results

Initially, 138 research topics were suggested by participating experts. These topics were then refined to identify the most important research priorities related to CVD prevention and treatment. The top research priority areas were: development of evidence-based, customized algorithms for CVD prevention and in-hospital emergency interventions; the availability, accessibility, and affordability of CVD treatment and rehabilitation; identification of relationships between CVDs, lifestyle factors, and mental health; efficacy and constraints in the management of cardiac emergencies; and epidemiological studies that trace CVD in the UAE.

Conclusion

The identified research priorities will guide a more informed research program for CVD treatment and prevention in the UAE. Funding opportunities and support for researchers should be prioritized for these identified research areas.

Evaluation of Young Adults' Physical Activity Status and Perceived Barriers in the Riyadh Region of Saudi Arabia

Background

Physical activity (PA) is any prolonged movement produced by muscular tissues that cause the muscles to exert force. Despite its beneficial effect, it is frequently neglected by individuals. The present study aimed to determine the PA among young adults living in Saudi Arabia.

Methods

This cross-sectional study was conducted among Saudi adults living in the Riyadh region of Saudi Arabia from June to August 2022 through a self-administered online survey. Global Physical Activity Questionnaire was used to assess the PA among participants. The data were analyzed using statistical software SPSS v. 26.0 (SPSS Inc., Chicago, IL, USA).

Results

Among the surveyed adult males were the predominant 67.8% (n= 240). Most of them were young, aged between 24 to 34 years 62.4% (n=221), and 37.6% (n=133) of them were between 35 and 44 years old. The current findings reported that 63% (n=223) of the adults had PA on weekly basis. Walking 45.2% (n=160) followed by bodybuilding 12.7% (n=45) was the most common type of PA identified among adults. The barriers identified for not practicing PA were lack of time 46.9% (n=166). With regard to a sedentary lifestyle, it was reported that 9.55 (SD= 4.887) hours per day are spent sedentary or in a constant sitting. The adults gender (p=0.046) employment (p=0.0001) and educational status (p=0.0001) was significantly associated with the type of PA engaged. Although being a female were shown more sitting behavior than males (p<0.047), similarly the nationality of the adults (6.67; SD=1.649) (p <0.001), education (p=0.028) and monthly household income (p =0.024) were significantly associated with the overall mean sitting behavior.

Conclusion

The findings of this study confirmed that Saudi adults yet posing highly sedentary behavior and physical inactivity, despite knowing the harmful outcomes of inactivity. Thus educating individuals about the importance of PA is warranted.

Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries

The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.

Osteoporosis Among Bahraini Women Based on Bone Mineral Density Measurements: A Retrospective Study

Objectives The objective is to estimate the prevalence of osteoporosis among women in Bahrain who are aged ≥18 years. Methods In this retrospective study conducted at Salmaniya Medical Complex, a total of 590 Bahraini women were enrolled. Their bone mineral density measurements were obtained through dual-energy x-ray absorptiometry (DEXA) performed between January 2017 and December 2017. Six sites were chosen as the measurement targets. Patients were diagnosed with osteoporosis if their T-score was > -2.5 according to the World Health Organization guidelines. Results Osteoporosis was diagnosed in 27.1% of the patients; 53.2% had osteopenia, 0.3% had severe osteoporosis, and 19.3% had normal bone conditions. The prevalence of osteopenia as well as osteoporosis increased with age. Conclusion Osteoporosis and osteopenia are common among Bahraini women. This study provides useful information on the prevalence of osteoporosis among Bahraini women. Major steps by health authorities in the country are needed to reduce morbidity and improve the quality of life.

Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: Findings from the global burden of disease study 2019

Objective

The purpose of this study was to investigate the burden of musculoskeletal (MSK) health conditions in Gulf Cooperation Council (GCC) countries based on the Global Burden of Disease (GBD) data.

Methods

The data for GCC countries were obtained from the 2019 GBD study to evaluate the burden of MSK disorders which include the following countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). The main outcome measures were age-standardized prevalence and years of life lived with disability (YLDs) associated with MSK disorders. The burden of MSK disorders attributable to the category of behavioral, metabolic, or environmental/occupational was reported to estimate the risk-attributable fractions of disease.

Results

MSK disorders prevalence ranked fifth in Kuwait, sixth in Bahrain, Oman, Qatar, and UAE, and seventh in Saudi Arabia among all the diseases in 2019. For all GCC countries, MSK disorders were ranked the second leading cause of disability as measured by YLDs for the years 1990 and 2019. The age-standardized prevalence of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE was 18.56% (95% UI: 17.51–19.66), 19.35% (18.25–20.52), 18.23% (17.14–19.36), 18.93% (17.81–20.06), 19.05% (17.96–20.22), and 18.26% (17.18–19.38), respectively. The age-standardized YLDs per 100,000 individuals of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE were 1,734 (1,250–2,285), 1,764 (1,272–2,322), 1,710 (1,224–2,256), 1,721 (1,246–2,274), 1,715 (1,230–2,274), and 1,681 (1,207–2,235), respectively. For risk factors, high body mass index (BMI) had the highest contribution to MSK disorders YLDs in most GCC countries (Bahrain, Kuwait, Oman, and Saudi Arabia), followed by the exposure to occupational ergonomic factors which had the highest contribution to MSK disorders YLDs in Qatar and UAE.

Conclusion

There was an increase in both age-standardized prevalence of MSK disorders and YLDs between 1990 and 2019 that was observed for all GCC countries. Some risk factors such as higher BMI and exposure to occupational ergonomic factors were highly associated with YLDs due to MSK disorders. The results of this study provide guidance for the potential nature of preventative and management programs to optimize the individual's health.

Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study

BACKGROUND

Physical inactivity is one of the major risk factors for non-communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self-reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017.

METHODS

This community-based cross-sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18-64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi-square test and Cochran-Armitage tests. The Mann-Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level.

RESULTS

Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). "Perceived change in the amount of physical activity" was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27-7.26). Common facilitators of physical activity were "psychological wellbeing"(49.7%) and "prevent diseases"(46.8%). The greatest barriers to physical activity were "time limitation"(43.4%) and "high cost"(57.8%).

CONCLUSION

This study revealed the physical activity level among Syrian refugees in Amman. The perceived facilitators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non-refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers.

Mapping the capacity of health promotion interventions for non-communicable diseases in Oman

Non-communicable diseases (NCDs) are chronic medical conditions that are, by definition, non-infectious, and non-transmissible among people and caused by a combination of genetic, physiological, environmental and behavioral factors. Affecting all age groups, regions and countries, NCDs cause 72% of deaths in Oman. Health promotion (HP) capacity development is considered fundamental to strengthening and sustaining action against NCDs. This study aimed to map the existing HP capacity for NCDs in Oman by assessing existing knowledge, skills, commitment, structure, systems and leadership and identifying gaps where further capacity is required. The current study used an adapted version of the World Health Organization capacity mapping tool for HP to assess the stage of development across eight HP capacity domains. Quantitative data were collected from 306 geographically dispersed participants across Oman via an online cross-sectional survey. Analyses revealed low scores in policies and plans, collaboration, partnership and professional development domains and even lower scores in the domains of program delivery, information systems and financing. We recommend Oman build and develop more capacity in all domains. The implications of findings are discussed in the context of the current HP policy and practice in Oman.

Magnitude and risk factors of chronic respiratory symptoms among municipal street sweepers in Dessie and Kombolcha City, Northeast, Ethiopia: Cross-sectional study

Objective:

Respiratory diseases are one of the main morbidities worldwide, especially in developing countries due to a lack of occupational safety and health measures. Therefore, this study aims to assess the prevalence and risk factors of chronic respiratory symptoms among street sweepers in Dessie and Kombolcha town, Ethiopia.

Methods:

A cross-sectional study design was used from 15 February to 16 March 2019 Gregorian calendar, among 392 participants. An interviewer-based questionnaire was used. Bivariable and multivariable logistic regression analyses were used, and variables with p value less than 0.05 in the final model were taken as associated factors.

Results:

The prevalence of chronic respiratory symptoms among street sweepers was 178 (45.4%) with the prevalence of cough 67 (16.54%), phlegm 60 (15.4%), wheezing 127 (32.3%), breathlessness 83 (21.3%), and chest pain 55 (14.3%). Respiratory symptoms were associated with not using face mask ( p < 0.001, adjusted odds ratio = 0.31, 95% confidence interval: 0.17–0.57), monthly income ( p = 0.013, adjusted odds ratio = 2.1, 95% confidence interval: 1.1–3.8), work experience ( p < 0.001, adjusted odds ratio = 3.6, 95% confidence interval: 2.1–6.2), previous sinusitis ( p < 0.001, adjusted odds ratio = 8.0, 95% confidence interval: 2.8–22), and educational status ( p < 0.001, adjusted odds ratio = 8.6, 95% confidence interval: 3.0–24.4).

Conclusion:

Respiratory symptoms were prevalent among street sweepers in Dessie and Kombolcha towns, Northeast Ethiopia. The non-use of respiratory equipment, educational status, working experience, and past sinusitis was identified factors.

Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study

Background

Noncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors.

Methods

Semi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes.

Results

Interviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination.

Conclusion

Effective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.

Gender Differences in the Attitudes and Management of People with Obesity in Saudi Arabia: Data from the ACTION-IO Study

Purpose

Several studies have investigated gender differences in various obesity-related outcomes. Females were found to have more accurate weight perception and reported more frequency of attempted weight loss. The objective of this study was to assess gender differences in the attitudes and management of people with obesity (PwO) in Saudi Arabia using data from the ACTION-IO study.

Patients and Methods

A survey was conducted in Saudi Arabia in June and July 2018 on adults with obesity (based on self-reported body mass index of ≥30 kg/m²).

Results

A total of 1000 people with obesity completed the survey; 565 (56.5%) were male (mean age of 36.9 years and mean BMI of 33.5 kg/m²) and 435 (43.5%) were female (mean age of 36.3 years and mean BMI of 34.5 kg/m²). The two most reported motivations for wanting to lose weight for both groups were to improve appearance (38%) and to have more energy (35%). Females were more likely to trust their health-care provider (HCP) advice about weight management when compared to males (87% females, 82% males, p = 0.059) and were more likely to have concerns regarding long-term safety associated with prescription weight loss medications (65% female versus 59% males, p = 0.043). On the other hand, males were more likely to seek their physician to prescribe weight loss medication if they hear of a new medication (55% males versus 46% females, p = 0.014), and more to believe that there are good options available for weight loss medications (74% males versus 67% females, p = 0.040). Also, more males prefer to take weight loss medications than to have a weight loss surgery (65% males, 59% females, p = 0.054).

Conclusion

Overall, this study increases our understanding on the attitudes of both females and males towards the management of weight loss and opens the discussion for gender-specific weight loss interventions.

Patterns and Associations of Physical Activity, Screen Time, Sleep, and Dietary Habits among Saudi Females Participating in Fitness Centers

This study was designed to investigate the level and associations of physical activity, sedentary behavior, sleep, and dietary habits among Saudi women attending fitness centers in Riyadh. A descriptive cross-sectional study was carried out from 12 fitness centers in Riyadh, Saudi Arabia. A total of 460 participants answered a two-part survey self-administered questionnaire, which included information about the demographic characteristics and lifestyle. The analysis found significant differences between the two groups in terms of age, weight, BMI, and combined prevalence of being overweight and obese. Compared with less active females, high active females showed significantly more favorable dietary habits (p < 0.05). Significantly higher values were observed for the total physical activity energy expenditure in METs-min/week (p = 0.028). Moreover, females with high screen time (>3 h per day) were younger, less active, slept longer, and had higher intakes of fast foods and chocolates/candy intake (p = 0.001). Overall, the participants were highly active, exceeding the recommended physical activity needed to enhance health. The analysis also showed sufficient sleep duration (>7 h/night) was significantly associated with the diet and nutrition of the participants. Health education programs are needed to reduce the risks of sedentary behavior, sleep problems, and dietary habits.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

Background

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries.

Methods

A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics.

Results

Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores.

Conclusion

Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.

Development of a nutrition management software based on selected Middle Eastern and Mediterranean dishes to support personalized diet and weight management

The nutrient composition of 50 commonly consumed Jordanian food dishes was determined to support the development of a novel nutrition management system designed to assist with dietary intake assessment and diet management. Composite dishes were selected by interviewing households located in the northern region of Jordan. For each dish, five different recipes were collected from experienced chefs and the typical recipe was formulated based on the average weights of ingredients and net weight of the dish. Proximate composition as well as vitamin and mineral contents were determined and related to ingredient composition and cooking conditions. The newly created food composition database was used to develop a user-centric nutrition management software tailored to reflect the characteristics of the Jordanian diet with representative items from this diet. This novel nutrition management system is customizable, enabling users to build daily meal plans in accordance with personalized dietary needs and goals.

Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes

PURPOSE

Cancer is the leading cause of morbidity and mortality worldwide. This work presents the Arab-world females' cancers (AFCs) statistics in 2020, compared with the 2018 AFCs statistics, the Arab-world male cancers statistics, and the world females' cancers (WFCs) statistics in 2020. This can help set the stage for a better policy for cancer control programs and improve outcomes.

MATERIALS AND METHODS

A descriptive review of the 2020 Global Cancer Observatory concerning AFCs was performed. Data on various cancers were compiled and compared among the countries in the region and WFCs.

RESULTS

A total estimate of 244,317 new cases and 132,249 deaths is reported in AFCs; representing 2.65% and 2.99% of WFCs, respectively, with an average crude incidence/mortality ratio of 116.2 (/100,000 population)/62.9 (/100,000 population) and an age-standardized incidence/mortality ratio of 137.7(/100,000 population)/77.2(/100,000 population) compared with 238.8(/100,000 population)/114.6(/100,000 population) and 186(/100,000 population)/84.2(/100,000 population) of WFCs, respectively. Five-year prevalent cases were 585,295; 2.28% of WFCs. In comparison to males, females accounted for 47.8% of the whole population, 52.9% in incidence, 46.9% in mortality, and 56.9% in the prevalence of patients with cancer. Mortality-to-incidence ratio (MIR) was 0.54 (range 0.39-0.62 in Arab countries, compared with 0.48 globally), and it ranged from 0.14 to 0.97 in the 30 AFC types. Breast cancer was the most common cancer in incidence and mortality, with an MIR of 0.39.

CONCLUSION

The 2020 descriptive analysis of the females' cancers in the Arab world revealed a relatively high MIR compared with females' cancers worldwide; a lower MIR compared with the males; and comparable MIR to 2018 one. We call for more in-depth studies to determine the causes of these differences that might translate into actionable interventions and better outcomes.

Co-payments and equity in care: enhancing hospitalisation policy for Palestine refugees in Lebanon

Background

This paper measures the impact of introducing a 10% co-payment on secondary care hospitalization costs for Palestine refugees living in Lebanon (PRL) in all UNRWA contracted hospitals, except for the Red Crescent Society. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand by hospital type, average length of stay and treatment costs.

Methods

With a complete population episode level dataset, we use multinomial logit, negative binomial, and linear models to estimate impacts on the different dependent variables, controlling for disease, patient and hospital characteristics.

Results

After the implementation patients were at least 4 pp (p <0.01) more likely to choose a Red Crescent Society hospital for secondary care, instead of one with co-payment. Average length of stay was not affected in general, despite the increase in control at all UNRWA contracted hospitals. Except for the decrease in UNRWA contribution, did not find a statistically significant impact of the co-payment on costs, nor for the provider or for the patient. Findings suggest that introducing a 10% co-payment for secondary hospital care had an impact on patients’ health care budget, leading to demand shifts towards cheaper options - i.e., patients had to chose care based on financial constraints rather than on their treatment preferences.

Conclusion

Before changing healthcare payment schemes in different types of hospitals, facilities offering free of charge treatment should be assessed and prepared for potential demand shifts to avoid overcapacity and the collapse of health care services for such a fragile population. In addition, exemptions from co-payments should be considered for patients with severe health conditions and financial constraints, who, according to our results, are the most likely to change their pattern of care due to an increase in treatment costs.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12913-021-07427-8).

Non-communicable diseases (NCDs) and vulnerability to COVID-19: The case of adult patients with hypertension or diabetes mellitus in Gamo, Gofa, and South Omo zones in Southern Ethiopia

BACKGROUND

A growing body of evidence demonstrating that individuals with Non-Communicable Disease (NCD) are more likely to have severe forms of COVID-19 and subsequent mortality. Hence, our study aimed to assess the knowledge of vulnerability and preventive practices towards COVID-19 among patients with hypertension or diabetes in Southern Ethiopia.

OBJECTIVE

To assess the knowledge and preventive practices towards COVID-19 among patients with hypertension or diabetes mellitus in three zones of Southern Ethiopia, 2020.

METHODS

A community-based cross-sectional study design was used with a multi-stage random sampling technique to select 682 patients with hypertension or diabetes mellitus from 10th -17th July 2020 at the three zones of Southern Ethiopia. Logistic regression analysis with a 95% confidence interval was fitted to identify independent predictors of knowledge and preventive practices towards COVID-19. The adjusted odds ratio (AOR) was used to determine the magnitude of the association between the outcome and independent variables. P-value <0.05 is considered statistically significant.

RESULTS

The Multi-dimensional knowledge (MDK) analysis of COVID-19 revealed that 63% of study subjects had good knowledge about COVID-19. The overall preventive practice towards COVID -19 was 26.4%. Monthly income (AOR = 1.42; 95% CI: 1.04, 1.94) significantly predicted knowledge towards COVID-19. Ninety-five percent of the study subjects knew that the COVID-19 virus spreads via respiratory droplets of infected individuals. One hundred and ten (16.2%) of study subjects correctly responded to the questions that state whether people with the COVID-19 virus who do not have a fever can infect the other. Knowledge about COVID-19 (AOR = 1.47; 95% CI: 1.03, 2.1) became the independent predictor of preventive practice.

CONCLUSIONS

In this study, the knowledge of the respondents towards the COVID-19 pandemic was good. But the preventive practice was very low. There was a significant gap between knowledge and preventive practices towards the COVID-19 pandemic among the study subjects. Monthly income was significantly associated with knowledge of COVID-19. Knowledge of COVID-19 was found to be an independent predictor of preventive practice towards COVID-19. Community mobilization and improving COVID-19- related knowledge and practice are urgently recommended for those patients with hypertension or diabetes mellitus.

Association between preventable risk factors and metabolic syndrome

The risk factors associated with metabolic syndrome (Met-S) including hypertension, hyperglycemia, central obesity, and dyslipidemia are preventable, particularly at their early stage. There are limited data available on the association between Met-S and preventable risk factors in young adults. We randomly selected 2,010 Saudis aged 18-30 years, who applied to be recruited in military colleges. All the procedures followed the guidelines of International Diabetes Federation. The results showed that out of 2,010 subjects, 4088 were affected with Met-S. The commonest risk factors were high blood sugar (63.6%), high systolic and diastolic blood pressures (63.3 and 37.3%), and high body mass index (57.5%). The prevalence of prediabetes and diabetes were 55.2 and 8.4%, respectively. Obesity, diabetes, hypertension, and hypertriglyceridemia were significantly associated with Met-S. The frequency of smoking was significantly linked with the development of Met-S. The prevalence of Met-S was found to be significantly higher in individuals with sedentary lifestyle. In conclusion, the results of this study clearly indicate that military recruits, who represent healthy young adults, are also prone to Met-S. The findings of this study will help in designing preventive measures as well as public awareness programs for controlling the high prevalence of Met-S in young adults.

Timing and types of fluids and foods first introduced in a representative sample of toddlers attending day care programs across Lebanon: Are parents following international recommendations?

BACKGROUND

Current WHO's recommendation for optimal infant feeding advises exclusive breastfeeding for 6 months. After this initial period, infants should receive nutritionally adequate and safe complementary food starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.

PURPOSE

This study examined the timing and types of fluids and foods first introduced in a representative sample of toddlers (n = 1051) from 79 daycares across Lebanon. Questionnaires were self-administered to parents of toddlers (12-36 months) with a participation rate of 67%.

RESULTS

Results showed that more than half of toddlers (55.7%) were introduced to infant formula within their first month of life. Around two-thirds received water as the first type of additional fluid (62.5%) with a mean age of 3.86 ± 2.15 months and fruits or cooked vegetables (69.7%) as the first types of food introduced with a mean age of 5.73 ± 1.56 months. Unfortunately, two-third (67.3%) were not breastfed after solid food introduction.

PRACTICE IMPLICATIONS

Our data on current suboptimal feeding practices in Lebanon shows the need to reinforce BF and CF practices recommendations and guidelines at the community, social and health system levels.

CONCLUSIONS

In the absence of specific recommendations and with the poor involvement of the various stakeholders, it was noted that more than half of the parents were not following the WHO recommendation concerning unnecessary fluid supplementation of infants and were introducing food before the recommended age of 6 months; moreover, only a minority of mothers continued breastfeeding after introducing food to their infants.

The Association Between Antipsychotics and Weight Gain and the Potential Role of Metformin Concomitant Use: A Retrospective Cohort Study

BACKGROUND

Obesity and its complications are associated with several adverse effects that may cause a serious impact on health. Antipsychotics-induced weight gain (AIWG) is one of the major, yet often neglected side effects of first and second generations antipsychotics. Importantly, several researches have shown metformin to be effective in managing weight gain especially, with AIWG. This study investigated the effect of antipsychotics use on weight gain and the theory of metformin concomitant use on the prevention of AIWG.

METHODS

A retrospective cohort review of the medical records of patients from the psychiatry outpatient clinics in the King Abdulaziz Medical city, a tertiary hospital in Jeddah from May 2016 to August 2021. The population of patients in Psychiatry section was 4,141. The sampling technique was a non-random consecutive sampling technique. Moreover, the included patients' records were divided to group 1 (patients on antipsychotics) and group 2 (patients using antipsychotics with Metformin).

RESULTS

According to the study criteria, 395 patients' records were included. A total of 309 (78%) patients were using antipsychotics without metformin, which in this study were depicted as group 1. In addition, a total of 86 (22%) were using antipsychotics with metformin, which in this study were assigned as group 2. Out of Group 1 patients (n = 309), only 67 patients experienced weight loss (21.68%), 43 remained with no weight change (13.92%), and 199 experienced weight gain (64.4%). Out of Group 2 patients (n = 86), 35 patients experienced weight loss (40.7%), 18 patients remained with no weight change (20.93%), and 33 experienced weight gain (38.37%). In addition, group 1 had a mean weight change of 2.5 kg, whereas group 2 had a mean weight change of -0.04 kg.

CONCLUSION

Statistical analysis revealed that patients on antipsychotics alone experienced weight gain, whereas the concomitant use of metformin showed reduction in the weight gain tendency. Thus, study outcomes indicate that concomitant use of metformin with antipsychotics might significantly reduce the AIWG.

Impact of Seasonality on Physical Activity: A Systematic Review

BACKGROUND

The purpose of this study was to collect and analyze the available scientific evidence of the impact of seasonality on physical activity (PA). PA refers to walking, biking, sports and/or active recreation.

METHODS

The search was performed in the following databases: PubMed, PEDro, Cochrane and Embase. All publications from January 2015 to September 2020 assessing seasonal variations on physical activity development in adults were selected.

RESULTS

A total of 1159 articles were identified, of which 26 fulfilled the selection criteria involving 9300 participants from 18 different countries. The results obtained suggest that seasonality affects PA independently of the countries, pathologies of the participants and the tool to collect PA information.

CONCLUSIONS

PA level varies across the seasons, with higher PA level in summer compared with other seasons, especially in winter. Sedentary behavior follows the opposite trend. Impact of seasonality variations should be considered in clinical research involving PA as a primary outcome as well as in interventions on PA promotion.

Risk Factors for Ischaemic Stroke in an Omani Community: A case-control study

Objectives

Stroke is recognised as the third most common cause of mortality and it has an increasing incidence in developing countries. Recognition and control of risk factors are of prime importance in the prevention of stroke. This study aimed to examine the characteristics of ischaemic stroke (IS) patients in Oman and quantify its various risk factors using a case-control model.

Methods

This case-control study was conducted from January 2012 to March 2013 at Sultan Qaboos University Hospital and Royal Hospital, Muscat. Adult Omani patients with IS who were admitted to either hospital were compared to age- and gender-matched controls. Demographic factors and frequency of various conventional risk factors were documented. Univariate and stepwise multivariate logistic regression analyses were performed to evaluate the risk factors associated with IS.

Results

A total of 255 patients and age-and gender-matched controls were included in this study. The mean age was 62.2 ± 13.2 years and 63.14% were male. Most cases (89.02%) were above 45 years of age. Cardio-embolism (31.76%) was the commonest mechanism of IS. Stepwise multiple logistic regression model revealed that family history of stroke was the strongest independent risk factor, followed by hypertension and high-density lipoprotein levels (odds ratio: 10.10, 5.17 and 3.34, respectively; P <0.01 each).

Conclusion

Cardio-embolism was the predominant mechanism of IS in this study. Family history of stroke, hypertension and reduced high-density lipoprotein were the leading independent risk factors. Strong emphasis on screening for risk factors, control of hypertension and lifestyle modification for those with a family history of stroke would be expected to emerge as the major stroke-preventive measures in Oman.

Fast Food Consumption, Liver Functions, and Change in Body Weight Among University Students: A Cross-Sectional Study

Background:

Over the past decades, the consumption of fast foods has increased worldwide and became favored by people of most age groups. The objective of this research was to assess the impact of fast foods on liver enzyme levels and body weight.

Methods:

A cross-sectional study was conducted at Yarmouk University/Jordan using survey questionnaire and enquired university students about their dietary habits, in addition to laboratory investigations of liver enzymes.

Results:

In the cross-tabulation analysis, only age and body mass index (BMI) were significantly associated with alanine aminotransferase (ALT) enzyme level. However, all differences between aspartate aminotransferase (AST) level and other variables were statistically insignificant. The AST/ALT ratio was calculated and revealed significant statistical association with BMI of participants (P = 0.001). Change in body weight during one year was significantly associated with eating fast food (P = 0.031), drinking beverages with fast food meals (P = 0.001), and ALT level (P = 0.026). However, this association was statistically insignificant with AST level.

Conclusions:

Fast food consumption among university students in Jordan was not significantly associated with increasing levels of ALT and AST liver enzymes. However, eating fast food and drinking soft drinks were associated with increasing body weight, which is expected to have adverse effect on liver functions in the long term.

Knowledge and Beliefs of Cancer Risk Factors and Early Cancer Symptoms in Lebanon: A Cross-sectional Survey Among Adults in the Community

Background

Lebanon has an increasing cancer burden. Sufficient knowledge of cancer risk factors and early cancer symptoms can help lower cancer burden by facilitating primary prevention and early diagnosis. This study (i) assessed Lebanese adults’ knowledge and beliefs of cancer risk factors and early cancer symptoms, (ii) analyzed whether knowledge was correlated with personal behavior, and (iii) assessed the presence of barriers that keep knowledge from turning into healthcare seeking behavior.

Methods

We performed a cross-sectional survey in the Lebanese adult population, consisting of a questionnaire administered during face-to-face interviews on a community-based non-probability sample (n = 726) that was frequency matched to national government estimates on age, level of education and gender.

Results

Recognition was high for carcinogens and protective factors (75%), but low for neutral factors (22%) which were often seen as carcinogenic. A quarter of participants (27.8%) could not name any early warning signs. For some risk factors, high knowledge scores were correlated with low-risk behavior, but this was not the case for cigarette smoking. The most frequent barriers for not seeking timely care were financial (57.0%) fear of finding illness (53.7%), and having other things to worry about (42.4%).

Conclusion

This study revealed important knowledge gaps which are likely to hamper primary prevention and early diagnosis. However, we also showed that high knowledge of risk was not always correlated with low-risk behavior. This, together with the barriers we found that kept people from seeking timely health care, emphasizes that efforts to lower cancer burden should not only focus on increasing knowledge.

Obesity, Lifestyle Behaviors, and Dietary Habits of Saudi Adolescents Living in Riyadh (ATLS-2 Project): Revisited after a Ten-Year Period

Objective: Undesirable lifestyle behaviors are associated with many adverse health outcomes. This study revisited the lifestyle behaviors, dietary habits, and overweight/obesity status of Saudi adolescents from Riyadh during the year 2019/2020. We report on the rationale, design, and methodology of the current study and provide preliminary findings of the changes that occurred between the two cross-sectional studies within the span of a ten-year period. Methods: A comparison was made between two cross-sectional studies, one conducted in 2009/2010 and the other in 2019/2020, using the same design, methods, and instruments. A multistage stratified cluster random sampling technique was used to select adolescents attending public and private secondary schools. Measurements included demographics, weight, height, waist circumference, physical activity (using valid questionnaire and accelerometer), sedentary time, sleep duration, and dietary habits. Results: The total number of participants was 1262 adolescents, of which 52.4% were male, with a mean (SD) age of 16.4 ± 0.95 years. About 41% of paternal and 39.1% of maternal education levels were university degrees. Over 37% of the families earned more than SAR 20,000/month. Body mass index and waist circumference of males was larger than that of females and the overall prevalence of overweight/obesity was 40.5% with significance (p < 0.001) difference between males (47.3%) and females (32.8%). Between 2009/2010 and 2019/2020 datasets, there were significant changes in age (p < 0.001), waist circumference (p < 0.001), screen time (p < 0.001), moderate-intensity physical activity (p < 0.001), vigorous-intensity physical activity (p < 0.001), total physical activity (p < 0.001), and consumption of breakfast (p = 0.015) and fruits (p = 0.002). Conclusion: The most notable change between the two studies was a significant reduction in the prevalence of physical inactivity among Saudi adolescents, which was due to increased levels of moderate-intensity physical activity among Saudi females, as a result of recent positive sociopolitical changes occurring in the country over the past four years. The findings provided rich information that can be used to explore trends in overweight/obesity, lifestyle behaviors, and dietary habits among Saudi adolescents over the past ten-year period.

Measurement and prevalence of adult physical activity levels in Arab countries

OBJECTIVES

This study aims to examine the reported prevalence of sufficient physical activity among adults in Arab countries and to determine the use of validated instruments for assessing physical activity.

STUDY DESIGN

This is a systematic literature review.

METHODS

This review follows recommendations outlined in the Meta-Analysis of Observational Studies in Epidemiology guidelines. The protocol for this study was preregistered with PROSPERO. Cross-sectional, cohort and intervention studies with a minimum of 300 adults aged ≥18 years assessing physical activity using a questionnaire or other self-report measure in the Arabic language were identified from seven electronic databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SPORTDiscu and PubMed). Databases were searched from 1st January 2008 to 17th September 2018. Descriptive analysis was performed using frequency and percentages. The prevalence of physical activity was calculated as the average prevalence for the reported percentages from the studies with similar tools.

RESULTS

Fifty studies involving 298,242 participants were included in this review. The mean (range) sample size was 5964.8.1 (323-197,681). Data were collected from participants in 16 of the 22 Arab countries. Great variation exists across the studies in determining whether adults were sufficiently active or not. Twenty studies reported usable data from the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire (moderate & high categories). In these studies, prevalence of physical activity ranged from 34.2 to 96.9%. It was not possible to compare the other studies owing to variation in instruments used to assess physical activity and in the case definition used for 'physically active'.

CONCLUSIONS

This study highlights the need for wider reporting of physical activity and the adoption of valid and reliable instruments to support the development of evidence-informed policy and programmes at both country and regional level. International tools need to be correctly validated, or context-specific tools must be developed to accurately measure physical activity.

Relationship between Physiological Health Status, Lifestyle Behaviors, and Cardiovascular Disease Among Adults in Two Arab Countries

Purpose:

Identify the relationships among participants’ lifestyle and their perceptions toward physiological health status.

Methods:

This is a cross-sectional research study. A convenience sampling was used to recruit 480 adult clients from Jordan and Saudi Arabia.

Results:

The majority of the participants (48.8%) rated their physiological health status as sub-optimal health. Significant positive associations were found between participants’ perceptions about physiological health status as ‘healthy’ and their positive lifestyle and low-risk behaviors for Cardiovascular Disease (CVD). Specifically, the associations were between not being smoker (χ2 = 4.17, p = 0.04), practicing physical activity (χ2 = 60.9, p < 0.001), eating ≥ 5 cups of fruits and vegetables daily (χ2 = 8.33, p = 0.004), and being normal/under-weight (χ2 = 65.5, p < 0.001).

Conclusion:

Perception about poor/sub-optimal physical health status is associated with many CVD risk factors. Using a brief screening tool to assess physical health status is recommended at each clinic visit. In addition, periodic physical assessment, full check-up, and follow-up with healthcare providers are highly suggested for those who perceived their physical health status as “poor” to prevent further CVD. Health education is pressingly recommended to improve the awareness of these Arab communities toward the prevention of CVD risk factors and enhancement of positive lifestyle behaviors.

Diabetes, hypertension and dyslipidemia medication prescribing in Qatari primary care settings: a retrospective analysis of electronic medical records

Background

Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice.

Methods

The study was undertaken in Qatar’s publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported.

Results

A total 81,569 individuals were included (18–29 years 2.4%; 30–39 years 11.7%; 40–49 years 25.4%; 50–59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%).

Conclusions

In Qatar’s primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-021-00353-4.

Mobile health apps use among Jordanian outpatients: A descriptive study

Our purpose in this descriptive cross-sectional study was to examine the prevalence of mobile health (mHealth) apps use, factors associated with downloading mHealth apps, and to describe characteristics of mHealth apps use among Jordanian patients in government-sponsored outpatient clinics. A total of 182 (41.6%) of the 438 outpatients who completed questionnaires downloaded mHealth apps. Common reasons for downloading mHealth apps included tracking physical activity, losing weight, learning exercises, as well as monitoring, and controlling diet. More than two thirds of the users (70%) stopped using the apps they downloaded due to loss of interest, lack of anticipated support, too time consuming, or better apps available. The most common personal reasons for never downloading mHealth apps were lack of interest, in good health, and the most common technical reasons included a limited data plan, lack of trust, cost, and complexity of the apps. We also found that gender, age, weight, and educational level influenced the decision whether to download mHealth apps or not. We have shown the potential in mHealth apps use among Jordanian patients is promising, and health care systems must adopt this technology as well as work through population needs and preferences to supply it.

Osteoporotic hip and vertebral fractures in the Arab region: a systematic review

Asia is projected to account for the largest proportion of the rising burden of osteoporotic fractures worldwide. Data from the Middle East is scarce. We performed a systematic review on the epidemiology of vertebral and hip osteoporotic fractures in 22 Arab League countries, using Scopus, PubMed, and Embase. We identified 67 relevant publications, 28 on hip and 39 on vertebral fractures. The mean age of patients was 70-74 years, female to male ratio 1.2:2.1. Age-standardized incidence rates, to the UN 2010 population, were 236 to 290/100,000 for women from Kuwait and Lebanon, lower in Morocco. Risk factors for hip fractures included lower BMD or BMI, taller stature, anxiolytics, and sleeping pills. Most patients were not tested nor treated. Mortality derived from retrospective studies ranged between 10 and 20% at 1 year, and between 25 and 30% at 2-3 years. Among 39 studies on vertebral fractures, 18 described prevalence of morphometric fractures. Excluding grade 1 fractures, 13.3-20.2% of women, mean age 58-74 years, had prevalent vertebral fractures, as did 10-14% of men, mean age 62-74 years. Risk factors included age, gender, smoking, multiparity, years since menopause, low BMD, bone markers, high sclerostin, low IgF1, hypovitaminosis D, abdominal aortic calcification score, and VDR polymorphisms. Vertebral fracture incidence in women from Saudi Arabia, mean age 61, was 6.2% at 5 years, including grade 1 fractures. Prospective population-based fracture registries, prevalence studies, predictive models, fracture outcomes, and fracture liaison services from Arab countries are still lacking today. They are the pillars to closing the care gap of this morbid disease.

Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to 'act locally and think globally'

BACKGROUND

Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations.

METHODS

Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness.

RESULTS

Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program.

CONCLUSIONS

Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings.

Prevalence and predictors of in-hospital mortality of patients hospitalized with COVID-19 infection

BACKGROUND

The severity and mortality from COVID-19 infection vary among populations. The aim of this study was to determine the prevalence and predictors of mortality among patients hospitalized with COVID-19 infection in a tertiary care hospital in Oman.

METHODS

We conducted a retrospective study using database that included: demographic, clinical characteristics, laboratory parameters, medications and clinical outcomes of all patients hospitalized in Royal Hospital, Muscat, Oman, between March 12, 2020 and December 1st 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 infected patients.

RESULTS

In total,1002 patients with COVID-19 infection with mean age of the cohort was 54±16 years (65% (n=650) male) were included, with an overall and intensive care unit (ICU) mortalities of 26% (n=257) and 42% (n=199/473), respectively. The prevalence of ICU admission was 47% (n=473) and the need for mechanical ventilation was 41% (n=413). The overall length of stay in the ICU was 13 (9-21) days. Adjusting for other factors in the model, the multivariable logistic regression demonstrated that in-hospital mortality in admitted COVID-19 patients was associated with old age (p<0.001), heart diseases (adjusted odds ratio (aOR), 1.84; 95% confidence interval (CI): 1.11-3.03; p=0.018), liver diseases (aOR, 4.48; 95% CI: 1.04-19.3; p=0.044), those with higher ferritin levels (aOR, 1.00; 95% CI: 1.00-1.00; p=0.006), acute respiratory distress syndrome (ARDS) (aOR, 3.20; 95% CI: 1.65-6.18; p=0.001), sepsis (aOR, 1.77; 95% CI: 1.12-2.80; p=0.022), and those that had ICU admission (aOR, 2.22; 95% CI: 1.12-4.38; p=0.022).

CONCLUSION

In this cohort, mortality in hospitalized COVID-19 patients was high and was associated with advanced age, heart diseases, liver disease, high ferritin, ARDS, sepsis and ICU admission. These high-risk groups should be prioritized for COVID-19 vaccinations.

Leveraging electronic health records to improve management of noncommunicable diseases at primary healthcare centres in Saudi Arabia: a qualitative study

Background

Electronic Health Records (EHRs) can contribute to the earlier detection and better treatment of chronic diseases by improving accuracy and accessibility of patient data. The Saudi Ministry of Health (MOH) implemented an EHR system in all primary health care clinics (PHCs) as part of measures to improve their performance in managing chronic disease. This study examined the perspective of physicians on the current scope and content of NCDs management at PHCs including the contribution of the EHR system.

Methods

Semi-structured interviews were conducted with 22 physicians working in chronic disease clinics at PHCs covering a range of locations and clinic sizes. The participants were selected based on their expertise using a combination of purposive and convenience sampling. The interviews were transcribed, analyzed and coded into the key themes.

Results

Physicians indicated that the availability of the EHR helped organise their work and positively influenced NCDs patient encounters in their PHCs. They emphasised the multiple benefits of EHR in terms of efficiency, including the accuracy of patient documentation and the availability of patient information. Shortcomings identified included the lack of a patient portal to allow patients to access information about their health and lack of capacity to facilitate multi-disciplinary care for example through referral to allied health services. Access to the EHR was limited to MOH primary healthcare centres and clinicians noted that patients also received care in private clinics and hospitals.

Conclusion

While well regarded by clinicians, the EHR system impact on patient care at chronic disease clinics is not being fully realised. Enabling patient access to their EHR would be help promote self-management, a core attribute of effective NCD management. Co-ordination of care is another core attribute and in the Saudi health system with multiple public and private providers, this may be substantially improved if the patients EHR was accessible wherever care was provided. There is also a need for enhanced capacity to support improving patient’s nutrition and physical activity.

Forecasting the SARS COVID-19 pandemic and critical care resources threshold in the Gulf Cooperation Council (GCC) countries: population analysis of aggregate data

OBJECTIVE

To generate cross-national forecasts of COVID-19 trajectories and quantify the associated impact on essential critical care resources for disease management in Gulf Cooperation Council (GCC) countries.

DESIGN

Population-level aggregate analysis.

SETTING

Bahrain, Kuwait, Oman, Qatar, United Arab Emirates (UAE) and Saudi Arabia.

METHODS

We applied an extended time-dependent SEICRD compartmental model to predict the flow of people between six states, susceptible-exposed-infected-critical-recovery-death, accounting for community mitigation strategies and the latent period between exposure and infected and contagious states. Then, we used the WHO Adaptt Surge Planning Tool to predict intensive care unit (ICU) and human resources capacity based on predicted daily active and cumulative infections from the SEICRD model.

MAIN OUTCOME MEASURES

Predicted COVID-19 infections, deaths, and ICU and human resources capacity for disease management.

RESULTS

COVID-19 infections vary daily from 498 per million in Bahrain to over 300 per million in UAE and Qatar, to 9 per million in Saudi Arabia. The cumulative number of deaths varies from 302 per million in Oman to 89 in Qatar. UAE attained its first peak as early as 21 April 2020, whereas Oman had its peak on 29 August 2020. In absolute terms, Saudi Arabia is predicted to have the highest COVID-19 mortality burden, followed by UAE and Oman. The predicted maximum number of COVID-19-infected patients in need of oxygen therapy during the peak of emergency admissions varies between 690 in Bahrain, 1440 in Oman and over 10 000 in Saudi Arabia.

CONCLUSION

Although most GCC countries have managed to flatten the epidemiological curve by August 2020, trends since November 2020 show potential increase in new infections. The pandemic is predicted to recede by August 2021, provided the existing infection control measures continue effectively and consistently across all countries. Current health infrastructure including the provision of ICUs and nursing staff seem adequate, but health systems should keep ICUs ready to manage critically ill patients.