Profile of contact lens prescribing in GCC countries

PURPOSE

This study aimed to report the pattern of contact lens prescribing from the Gulf Cooperation Council (GCC) countries.

METHODS

Optometrists in the GCC region were contacted to participate in a web-based survey hosted on Qualtrics XM (Provo, Utah, USA). The survey methodology was adapted from the International Contact Lens Prescribing Consortium, and participants were asked to report their last five lens fits. It collected information on practitioner demographics (age, gender, nationality, qualification, country of practice, and number of years of experience), CL user demographics (age and gender) and on lens specific details such as lens type, lens design, lens material, replacement plan, and modality of lens wear. Descriptive statistics were used to analyse and report the data.

RESULTS

This study reports 739 contact lens fits by 174 practitioners from six GCC countries. The average age of the patients was 29.72 ± 9.07 (Mean ± SD) years and 64 % of them were females. The majority (80.2 %) were fitted with soft contact lenses, with 59 % preferring silicone hydrogels, 20 % wearing them for cosmetic purposes and nearly half of them disposed of their lenses daily (55 %). Among the RGP lenses, 41 % were scleral lenses. This survey demonstrated a greater proportion of new lens fits (55 % vs. 37 %), disposable hydrogel lens use (21 % vs. 13 %), and a preference for cosmetic contact lenses (20 % vs. 4 %) compared to the international data.

CONCLUSION

The pattern of CL prescriptions in the GCC region closely resembled the global trend. The survey observed a higher preference towards frequent replacement soft lenses, a greater proportion of silicone hydrogel lenses, a higher percentage of rigid lens fits, a greater affinity for cosmetic contact lenses, and a higher percentage of new fits. These trends suggest that contact lens prescription habits in the region are likely to continue evolving in the future.

Government responses to the COVID-19 pandemic of the Gulf Cooperation Council countries: good practices and lessons for future preparedness

The COVID-19 pandemic has dramatically threatened the Gulf Cooperation Council (GCC) countries which have a large proportion of foreign workers. The governments of GCC countries have proactively implemented a comprehensive set of policy measures, and up to our knowledge, a systematic analysis of qualitative and quantitative evidence on the government response is still lacking. We summarized the GCC countries' government response and quantitatively measured that response using four indexes-the Government Response Index, the Stringency Index, the Vaccine Index, and the Initial Response Index, to analyse their response for future pandemic preparedness. Overall, the government response of all the GCC countries to the COVID-19 pandemic has been comprehensive, stringent, and timely. Notably, the GCC countries have implemented comprehensive vaccine policies. In addition, they have worked actively to protect foreign workers to improve their access to health services and secure their essential living conditions, regardless of their immigrant status. All the GCC countries dynamically adjusted their response to the evolving COVID-19 epidemiological burden and started to relax the stringency of the control policies after the Omicron wave, though the governments had different response magnitudes as measured by the four indexes. These findings have provided several important lessons for future pandemic response and preparedness for countries with similar economic, demographic, and health contexts in (1) prompt actions of containment and closure policies with dynamic adjusting, (2) strengthening health system policies, (3) comprehensive vaccination policies with universal access, (4) equitable and free access to testing, diagnosis, and treatment for all, and (5) strengthening the resilience of health systems.

Identifying the Barriers to Acceptance of Blockchain-Based Patient-Centric Data Management Systems in Healthcare

A number of recent studies have shown that wastage and inefficiency are a significant problem in all global healthcare systems. One initiative that could radically improve the operational efficiency of health systems is to make a paradigm shift in data ownership-that is, to transition such systems to a patient-centric model of data management by deploying blockchain technology. Such a development would not only make an economic impact, by radically cutting wastage, but would deliver significant social benefits by improving patient outcomes and satisfaction. However, a blockchain-based solution presents considerable challenges. This research seeks to understand the principal factors, which act as barriers to the acceptance of a blockchain-based patient-centric data management infrastructure, in the healthcare systems of the GCC (Gulf Cooperation Council) countries. The study represents an addition to the current literature by examining the perspectives and views of healthcare professionals and users. This approach is rare within this subject area, and is identified in existing systematic reviews as a research gap: a qualitative investigation of motivations and attitudes among these groups is a critical need. The results of the study identified 12 key barriers to the acceptance of blockchain infrastructures, thereby adding to our understanding of the challenges that need to be overcome in order to benefit from this relatively recent technology. The research is expected to be of use to healthcare authorities in planning a way forward for system improvement, particularly in terms of successfully introducing patient-centric systems.

Migrant workers with COVID-19: a major challenge for Gulf Cooperation Council (GCC) countries to curb the spread of infection

The six Gulf Cooperation Council (GCC) countries (Saudi Arabia, the United Arab Emirates, Bahrain, Kuwait, Oman and Qatar) host the majority of the estimated 23 million international migrants working in the Arab states. As the COVID-19 pandemic continues to evolve across the GCC states, the health authorities have reported a considerable number of non-national confirmed COVID-19 cases in the region. In Gulf countries, where more than half of the population are foreigners, migrant workers are more likely to contract and spread the disease due to numerous contributing factors. In this regard, unhygienic and overcrowded living conditions, barriers in accessing national or private health services, challenges in accessing accurate health information related to COVID-19, and lack of facemasks and hand hygiene facilities in their housing camps are the major factors that we identified and discuss in this paper. Moreover, we formulated specific recommendations for relevant authorities to overcome the challenges related to migrant workers during this pandemic situation. Because the migrant workers with COVID-19 infection could subsequently lead to more widespread community transmission, protecting this vulnerable group means reducing the risk of transmission for the entire population. It is essential to include migrant workers in all aspects of the response to COVID-19, such as prevention, detection, access to treatment, and containment measures.

Awareness and practice of dentists in gulf cooperation council countries regarding medication-related osteonecrosis of the jaw - A web-based survey

Background/purpose

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication among dental patients undergoing treatment with antiresorptive medications such as bisphosphonate and denosumab. The present survey investigated the awareness and practice of dentists in the Gulf Cooperation Council (GCC) countries regarding MRONJ.

Materials and methods

This questionnaire-based study was conducted among dental practitioners in all six GCC countries. A questionnaire was designed and distributed among all potential participants via different social media platforms. SPSS version 22 was used for data analysis, and P-value <0.05 was considered statistically significant.

Results

Overall, 1685 dentists from the six GCC countries participated in the present study. The surveyed dentists revealed relatively fair practices and awareness regarding MRONJ and its prevention, with the majority reported asking their patients about history of anti-osteoporotic medications (67.8%), recording name of the medication (73.1%) and duration of treatment (75.5%). However, the majority of the participants were unconfident about the duration of drug holiday prior to dental surgical interventions (70.6%) and the overall good level of knowledge/practice related to MRONJ was just 50.6%. The regression analysis revealed that previous exposure to MRONJ cases and attending a seminar, course, meeting, or conference about osteonecrosis of the jaw were independent predictors for positive awareness/good practice regarding MRONJ (P < 0.05).

Conclusion

The results show inadequate awareness and practices of dentists practicing in GCC countries regarding MRONJ, with significant variations among the countries. Therefore, appropriate interventions such as periodic continuous education courses are required to improve dentists' knowledge and practices regarding MRONJ.

Water resources availability, sustainability and challenges in the GCC countries: An overview

The Gulf Cooperation Council (GCC) countries include Bahrain, Kuwait, Saudi Arabia, Sultanate of Oman, Qatar, and United Arab Emirates. The GCC countries are located in an arid region. They have limited renewable water resources due to scarcity of rainfall. This paper provides the most recent and accurate quantitative and qualitative assessment of available water resources and demands in the GCC countries. The annual renewable surface water, desalinated capacity, wastewater treatment capacity, and per capita water consumption in the GCC countries are assessed. The possible impacts of climate change are discussed. The annual renewable surface water, desalinated capacity, and wastewater treatment capacity in the GCC countries are estimated as 4.14, 26.4, and 10.07 billion m3, respectively. The average per capita water consumption is around 550 l/d. The GCC countries have high water footprints. Although tertiary treated, the reuse of treated wastewater is limited and constrained to the development of forests and green areas. Water demand trends reveal the need for the implementation of sustainable water management programs. Emerging solutions include imposing a new tariff system, improving irrigation efficiency, controlling agricultural water consumption, developing innovative desalination and treatment technologies, maximizing treated wastewater utilization and rainwater harvesting, eliminating leakage in networks, and considering virtual water concepts in the water budget and planning.

Prevalence of orthodontic treatment needs in permanent dentition in the population of Gulf Cooperation Council countries: A systematic review and meta-analysis of observational studies

The aim of this systematic review and meta-analysis was to comprehensively analyze the existing information on the prevalence of the need for orthodontic treatment in the permanent dentition stage among populations in Gulf Cooperation Council (GCC) countries. For observational studies in GCC countries, the key terms were electronically searched in Science Direct, PubMed, Embase, Cochrane Reviews, Google Scholar, and Sage databases (1990-2021). The bias risk for the selected studies was evaluated using the modified Strengthening the Reporting of Observational Studies in Epidemiology statement. Thirteen studies reported on the prevalence of orthodontic treatment needs among 33,134 children in GCC countries in permanent dentition with an age range of 11-19 years satisfied the inclusion criteria. Out of the 13 studies, 9 reported on the prevalence of malocclusion, 11 reported on the prevalence of occlusal traits, and 12 reported on the prevalence of orthodontic treatment needs as per the Dental Health Component (DHC) of Index of Orthodontic Treatment Need (IOTN), 4 reported as per both DHC and Aesthetic Component (AC) of IOTN, and 1 reported as per only AC of IOTN. Meta-analysis of the included studies indicated that the pooled malocclusion prevalence rate was 10.60% (confidence interval [CI] 95%: 0.093-0.076) with 8.58% Class I (CI 95%: 0.074-0.188), 2.09% Class II (CI 95%: 0.014-0.058), and 0.93% Class III (CI 95%: 0.005-0.018) malocclusions. The most prevalent type of occlusal trait was spacing (13.10%, CI 95%: 0.018-0.169), followed by crowding (4.96%, CI 95%: 0.017-0.091). The pooled prevalence of borderline and definite needs for orthodontic treatment based on DHC and AC of IOTN was 0.82% (CI 95%: 0.014-0.035), 1.13% (CI 95%: 0.011-0.091), 4.08% (CI 95%: 0.009-0.114), and 2.06% (CI 95%: 0.002-0.048), respectively. The findings were heterogeneous (P < 0.05). These findings indicated that the prevalence of malocclusion and orthodontic treatment needs was not high in the GCC population.

Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review

BACKGROUND

In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners launched the 90-90-90 targets. These were further updated to correspond to 95-95-95 by the year 2025. We present an overview of the progress made by Gulf Cooperated Council (GCC) countries towards meeting the global targets.

METHODS

We extracted data from Global AIDS Monitoring (GAM), UNAIDS AIDS Info, HIV case reporting database, and the WHO global policy uptake for six countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab of Emirates (UAE) to assess the HIV/AIDS burden in the six GCC countries, and the progress towards achieving the 95-95-95 goal.

RESULTS

By the end of 2021, an estimated 42,015 people living with HIV (PLHIV) were residing in the GCC countries with prevalence levels below 0.01%. Data from four GCC countries, Bahrain, Oman, Qatar and UAE, indicated that by 2021, 94%, 80%, 66%, and 85% of HIV-positive population knew their status, respectively. 68%, 93% (2020 data), 65%, 58% and 85% of PLHIV in Bahrain, Kuwait, Oman, Qatar and UAE who knew their status were on anti-retroviral therapy (ART), respectively, and 55%, 92%, 58% and 90% (2020 data) among those who were on ART had viral suppression in Bahrain, Kuwait, Oman and KSA, respectively.

CONCLUSION

The GCC countries have made great strides toward fulfilling the 95-95-95 targets, but the interim 2025 overall UNAIDS targets remain unmet. The GCC countries must strive diligently to accomplish the targets by emphasising early identification of the cases by enhanced screening and testing, as well as prompt commencement of ART therapy with viral load suppression.

Bullying in Elementary Schools: Differences across Countries in the Persian Gulf

The current research aimed to examine the similarities and differences in bullying prevalence across the six member states of the Gulf Cooperation Council (GCC): Saudi Arabia, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates. Level tests require measurement invariance to be met before they can be performed. In 2019, 45k people participated and provided data for the Trends in International Mathematics and Science Study (TIMMS). When the exact measurement invariance (MI) protocols failed, the alignment methodology was used to analyze the data. After ensuring measurement invariance via the free alignment method, findings revealed statistically significant differences in bullying prevalence; specifically, bullying levels were significantly lower in Saudi Arabia compared to all other countries. The United Arab Emirates ranked second, with the second-lowest bullying rates, which were also significantly lower compared to the rates in all the other countries. As a whole, Saudi Arabia had the lowest levels, followed by the UAE, Kuwait, Oman, Bahrain, and Qatar. Although the absolute difference between Saudi Arabia and the other countries was only modest, further research into the causes, consequences, and preventative measures of bullying is warranted.

GCC Countries Strategic Options in a Global Transition to Zero-Net Emissions

Using a multi-level perspective approach combined with top-down macroeconomic models, we analyze the situation of the GCC countries in the perspective of a global transition to zero-net emissions before the end of the century. Based on these analyses, we propose strategic and political options for these oil and gas exporting countries. We show that it would be unwise for GCC member states to adopt an obstructionist strategy in international climate negotiations. On the contrary, these countries could be proactive in developing international emissions trading market and exploiting negative emissions obtained from CO2 direct reduction technologies, in particular direct air capture with CO2 sequestration, and thus contribute to a global net-zero-emissions regime in which clean fossil fuels are still used.

The asymmetric effect of ICT on CO2 emissions in the context of an EKC framework in GCC countries: the role of energy consumption, energy intensity, trade, and financial development

This study examines how "information and communication technology (ICT)" affects carbon dioxide (CO₂) emissions in Gulf Cooperation Council (GCC) nations asymmetrically, controlling energy consumption, its intensity, trade, and financial development following an environmental Kuznets curve (EKC) approach. It employs panel data covering 1995-2019, 2^nd generation unit root, Westerlund cointegration tests, nonlinear pooled mean group (PMG) estimate, and Dumitrescu-Hurlin causality check. The Westerlund test validates a long-run association among variables. The study confirms the EKC proposition for the GCC countries. It reveals that a decrease in CO₂ emissions is associated with both positive and negative parts of ICT and the expansion of financial development. While per capita GDP increases pollution, squared GDP per capita reduces it; energy consumption, intensity, and trade amplify carbon emissions. D-H causality check yields several bidirectional and one-way causalities and verifies the robustness of PMG outcomes. Our findings suggest that promoting ICT becomes one of the critical techniques to decrease CO₂ emissions in GCC nations due to its significant negative influence on CO₂ emissions.

Unlocking the eHealth professionals' career pathways: A case of Gulf Cooperation Council countries

BACKGROUND

During the past two decades, various sectors and industries have undergone digital transformation. Healthcare is poised to make a full transformation in the near future. Although steps have been taken toward creating an infrastructure for digital health in the Middle East, as it stands, digital health is still an emerging field here. The current global health care crisis has underscoredthe need for digitization of the healthcare sector to provide high-value, high-quality care and knowledge generation. With the advent of digital transformation in countries around the globe, there is a rising demand for investment and innovation in health information technology. With the demand for health informatics (HI) graduates in different disciplines (e.g., healthcare professions, information technology, etc.), there is an urgent need to determine and regulate clear career pathways and the core competencies necessary for digital health professional to practice effectively and to allow technology to add value to the healthcare systems. Given the changing landscape of the profession, the Kingdom of Saudi Arabia (KSA) and the Gulf Cooperation Council (GCC) countries are experiencing a rising demand to produce digital health professionals who can meet the needs of all the stakeholders involved, including patients, healthcare professionals, managers, and policymakers. However, despite the number of region-wide initiatives in the form of training programs, there remains a knowledge-practice gap and unclear job roles within the HI community. In recent years, regional digital health workforce initiatives have been put forward, such as the GCC Taskforce on Workforce Development in Digital Healthcare. The taskforce initiated a survey and several workshops to identify and classify HI disciplines according to the needs of the job market and through comparisons with similar efforts developed across the globe, such as the TIGER project and the EU*US eHealth Work project. Digital health implementation has been flourishing in the Middle East for the past 15 years. During this period, while digital health professions have been thriving in the industry to deliver tools and technologies, academic institutions have offered some amount of training and education in digital health; however, the career pathway for digital health professionals is not clear due to mismatch about the qualifications, skills, competencies and experience needed by the healthcare industry.

OBJECTIVES

Due to this discrepancy between the academic curriculum and the skills needed in the healthcare industry, the objectives of this study are to define the career pathway for eHealth professions and identify the challenges experienced by academic institutions and the industry in describing digital health professionals.

METHODS

We elicited qualitative data by conducting six focus groups with individuals from different professional backgrounds, including healthcare workers, information managers, computer sciences professionals, and workers in the revenue cycle who participated in a workshop on November 2-3, 2019, in Dubai. All focus group sessions were audio-recorded and transcribed, and participants were de-identified before analysis. An exploratory method was used to identify themes and subthemes. Saturation was reached when similar responses were found during the analysis. In this study, we found that respondents clearly defined eHealth career pathways based on criteria that included qualifications, experience, job scope, and competency. We also explored the challenges that the respondents encountered, including differences in the required skill sets and training and the need to standardize the academic curriculum across the GCC region, to recognize the various career pathways, and to develop local training programs. Additionally, country-specific projects have been initiated, such as the competency-based Digital Health framework, which was developed by the Saudi Commission of Healthcare Specialties (SCFHS) in 2018. Competency-based digital health frameworks generally include relevant job definitions, roles, and recommended competencies. Both the GCC taskforce and the Saudi studies capitalized on previous efforts by professional organizations, including Canada's Digital Health formerly known as (COACH), the U.S. Office of the National Coordinator for Health Information Technology (ONC), the American Medical Informatics Association (AMIA), and the Health Information and Management Systems Society (HIMSS).

RESULTS

In this study, we found that respondents defined eHealth career pathways based on different criteria such as: qualifications; various background of health and IT in the HI field; work experiences; job scope and competency. We also further explore the challenges that the respondents encountered which delineates four key aspects such as need of hybrid skills to manage the digital transformation, need of standardization of academic curriculum across GCC, recognition of the career pathways by the industry in order to open up career opportunity and career advancement, and availability of local training programs for up-skilling the current health workforce.

CONCLUSION

We believe that successful health digital transformation is not limited to technology advancement but requires an adaptive change in: the related competency-based frameworks, the organisation of work and career paths for eHealth professionals, and the development of educational programmes and joint degrees to equip clinicians with understanding of technology, and informaticians with understanding of healthcare. We anticipate that this work will be expanded and adopted by relevant professional and scientific bodies in the GCC region.

Epidemiology of Varicella Zoster Virus and Herpes Zoster Virus in Gulf Cooperation Council Countries: A Review of the Literature

INTRODUCTION

The reactivation of varicella zoster virus (VZV) in previously infected individuals can cause herpes zoster (HZ), which is characterized by a localized, painful dermatomal rash. While there is a global trend of increasing HZ cases, there is a lack of research examining the epidemiology of HZ within the Gulf Cooperation Council (GCC) countries. Therefore, we aimed to critically appraise evidence on VZV and HZ epidemiology in the GCC countries and identify gaps in the current literature.

METHODS

A literature review was conducted via a comprehensive appraisal of the literature. PubMed and local-language journals were searched to identify articles related to HZ and VZV published up until 31 January 2022, with a sole focus on the GCC countries. Included studies reported on surveillance data, seroepidemiology, and patient outcomes for HZ and VZV, and comprised primary data reports, case series, case reports, narrative and systematic literature reviews, studies reporting HZ incidence or prevalence, and Ministry of Health reports.

RESULTS

Thirteen studies were found that reported on VZV seroprevalence in Saudi Arabia, the United Arab Emirates (UAE), and Qatar, ranging from 15.0% to 92.2%, while no data were identified for Bahrain, Kuwait, or Oman. There was very limited country-wide information on the incidence of HZ in GCC countries, and three identified studies reported HZ prevalence as seen in a single clinic, ranging from 0.62% to 2.3%. A single study from Saudi Arabia and government surveillance data reported on the impact of VZV vaccination on VZV infection, though there was no evidence on the impact of VZV vaccination on HZ.

CONCLUSION

There is a clear gap in the literature regarding the incidence of HZ infection, and the impacts of HZ and VZV vaccinations in the GCC countries. Further research into the epidemiology of HZ is necessary to inform the implementation of vaccination programs in the GCC countries.

Corporate governance mechanisms, royal family ownership and corporate performance: evidence in gulf cooperation council (GCC) market

This research is motivated by the increasing importance of the Gulf Cooperation Council (GCC) economies within the world economy and the lack of research on corporate governance mechanisms in these countries. This study examines the relationship between corporate governance mechanisms and firm performance in GCC countries, focusing on the uniqueness of royal family ownership. We further investigate whether corporate governance mechanisms affect the royal family ownership-firm performance relationship. The data sample of the study includes 266 company-year observations over the period of 2009-2017. Results demonstrate that board size with less than nine members on board and audit quality (AUQ) are effective corporate governance mechanisms because their monitoring functions can enhance firm performance. However, our result demonstrates that firm performance significantly deteriorates with institutional ownership, chief executive officer duality (CEODU) and local auditors (AUQL). The result also shows that royal ownership has a significant positive effect on firm performance. In line with the resource dependency theory, this finding indicates that royal members who have a link with the external environment are more likely to have easy access to vital resources to aid in business performance improvement. Further analysis found that the big four international audit firms (AUQ) and AUQL positively moderate the relationship between royal ownership and firm performance. The finding suggests that AUQL and the big four international auditors play a complementary role in the governance system by strategising with royal members who own shares in the firm to further enhance firm performance. With the existence of royal family ownership, which is common amongst corporations in monarchy countries, the results of our study should help corporations in the GCC region to establish the best governance mechanisms to enhance firm performance.

The labor market in the digital era: What matters for the Gulf Cooperation Council countries?

Digital transformation affects all organizations, large and small. Waves of technological change are frequent and accelerating, requiring constant adaptation by companies and their employees. Artificial intelligence, automation, and digital tools are changing the traditional organizational structure and ways of working. After the COVID-19 pandemic, the labor market has to move toward an inclusive digital transformation that braces the business systems. This paper is an attempt to explore the effect of digitalization on employment in Gulf Cooperation Council (GCC) countries and compare them to some selected advanced countries. The methodology focuses on the second-generation unit root tests and the Auto Regressive Distributed Lagged model for the period 2000-2020. The findings show a negative and significant impact of ICT on employment in the industrial and services sectors for GCC countries with a moderate adjustment speed toward the long-run equilibrium. This result is explained by the shortage of skilled workers in GCC countries compared to advanced countries, where the findings show a positive and significant effect of ICT technologies on total employment, especially in the industrial sector. The adjustment speed toward the long run is significantly higher in advanced countries than in GCC countries.

Sickle cell disease in Gulf Cooperation Council countries: a systematic review

INTRODUCTION

Evidence related to the national burden of Sickle Cell Disease (SCD) in Gulf Cooperation Council (GCC) largely fragmented. Thus, the aim of this study is to systemically review studies from GCC countries to assess the epidemiological profile of SCD.

AREAS COVERED

We searched combinations of key terms in MEDLINE/PubMed, CINAHL, and EMBASE. We selected relevant observational studies reporting the frequency, incidence, prevalence, risk factors, mortality rate, and complications of SCD among the GCC population. Studies restricted to laboratory diagnostic tests, experimental and animal studies, review articles, case reports and series, and conference proceedings and editorials were excluded. A total of 1,347 articles were retrieved, out of which 98 articles were found to be eligible and included in the study. The total number of participants from all the included studies was 3496447. The prevalence of SCD ranged from 0.24%-5.8% across the GCC and from 1.02%-45.8% for the sickle cell trait. Consanguineous marriage was a risk factor for likely giving children affected with hemoglobinopathies.

EXPERT OPINION

The prevalence of SCD and its complications vary among GCC. Because of the high prevalence of SCD and its complications, health authorities should focus on more rigorous prevention and treatment strategies.

The introduction of tobacco excise taxation in the Gulf Cooperation Council Countries: a step in the right direction of advancing public health

BACKGROUND

The Gulf Cooperation Council (GCC) countries relied, until recently, solely on import duties for tobacco products. The agreement for the introduction of an excise and value added tax (VAT) in 2016 and 2017, respectively, in most GCC countries, was a major breakthrough for public health. There is, however, ample room for improvement.

METHODS

The study examines the outcomes of tax reforms, for both public health and public finances, based on the World Health Organization (WHO) recommendations and best practices worldwide. Tax simulations were performed using the WHO TaXSiM model. The study is based on data from Saudi Arabia, the only GCC country for which sufficient data existed.

RESULTS

We recommend a stepwise tax reform, which involves increasing the current ad valorem excise tax rate, phasing out import duties keeping total tax share constant and introducing a minimum excise, and finally switching to a revenue-neutral specific excise. Specific excises must be adjusted for inflation and income increases. If implemented, cigarette tax reform simulations show that the recommended reforms would lead to a higher than 50% increase in cigarette prices, 16% reduction in cigarette sales and almost 50% increase in total cigarette tax revenue. A significant number of cigarette-related deaths would be averted.

CONCLUSIONS

The recommended tax reforms are expected to lead to significant improvements in both public health and tobacco tax revenues. Our results provide useful insights that are of relevance to the whole GGC region. The effectiveness of the reforms, however, requires a strong tax and customs administration, including the establishment of a good database to monitor and advance public health.

Investigating the role of export product diversification for renewable, and non-renewable energy consumption in GCC (gulf cooperation council) countries: does the Kuznets hypothesis exist?

This study explores the effects of renewable and nonrenewable energy demand on export product diversification, economic growth, natural resources, human capital, and trade in GCC (Gulf Cooperation Council) countries using data of six countries from 1990 to 2019. The empirical analysis integrates the panel unit root tests (IPS and CIPS), panel quantile regression, and fully modified OLS models. The empirical results confirm that there exists a significant negative relationship between renewable energy and export diversification; signifying that diversification of products will reduce renewable energy. Similarly, when compared to the square of export product diversification, it shows a positive and significant correlation. The empirical findings highlighted the presence of Kuznets's hypothesis between export product diversification, renewable, and non-renewable energy consumption. Furthermore, the findings suggest that natural resources and economic growth may increase overall energy consumption in GCC countries. It implies an important policy suggestion that encouraging export diversification will reduce GCC countries' reliance on oil to meet energy demand.

Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries

Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.

The dynamic linkage between globalization, financial development, energy utilization, and environmental sustainability in GCC countries

This study investigates the impact of globalization, financial development, and energy utilization on environmental sustainability in the Gulf Cooperation Council (GCC) countries. GCC countries are currently experiencing higher demand and utilization of energy resources, high global integration, and improvements in the financial sector that poses serious environmental sustainability challenges. We have employed a relatively comprehensive proxy, i.e., ecological footprint for environmental sustainability and more advanced and robust econometric strategies (second-generation) to examine the impact of globalization, financial development, and energy utilization on environmental sustainability in the GCC countries, which have a significant departure from the extant literature. The results of this study show that globalization, financial development, and energy utilization are significantly deteriorating the environmental quality in the GCC countries. Additionally, in order to account for the national heterogeneity, we have performed country-specific analysis and interestingly, results reveal that globalization, financial development, and energy utilization negatively influence the environmental sustainability in each sample country that is consistent with the findings of overall panel. Furthermore, the findings are robust to various robustness checks that we have performed for checking the reliability of our main findings. This study also offers some useful policy implications to the stakeholder in general and specifically concerning the GCC countries for promoting their environmental sustainability.

Impact of COVID-19 Pandemic and Lockdown Measures on the Mental Health of the General Population in the Gulf Cooperation Council States: A Cross-Sectional Study

Background: In the Gulf Cooperation Council (GCC) countries (Kuwait, Qatar, Saudi Arabia, Bahrain, United Arab Emirates, and Oman), as in the rest of the world, the COVID-19 has been spreading since 2019, and it had a significant impact on various aspects of life. The outbreak and the restrictive measures imposed by countries to stop the spread of the virus could harm the mental health condition of the general population. This cross-sectional study aims to assess the impact of the pandemic on mental health and investigate the potential risk factors. Methods: An online survey was collected from individuals in GCC countries from May to October 2020. The final sample included 14,171 participants, 67.3% females and 60.4% younger than 35 years old. The survey consisted of depression, Anxiety, Insomnia, and post-traumatic stress questionnaires. Crude and adjusted Odds ratios are calculated using simple and multivariable logistic regressions to investigate the association between risk factors and mental health issues. Results: Endorsement rates for depression were 11,352 (80.1%), 9,544 (67.3%) for anxiety, 8,845 (63.9%) for insomnia and 9,046 (65.2%) for post-traumatic stress. Being female and younger age were associated with a higher likelihood of developing depression, anxiety, insomnia, and post-traumatic stress. In addition, participants with underlying psychological problems were three times more likely to develop depressive and post-traumatic stress symptoms. Conclusion: According to the findings, women, youth, singles, divorced individuals, and individuals with pre-existing psychological and medical conditions are subject to a higher risk of mental health problems during the pandemic, which policy-makers should consider when imposing restrictive measures.

Oral and Oropharyngeal Cancers and Possible Risk Factors Across Gulf Cooperation Council Countries: A Systematic Review

Background

In recent years, there is an emerging increase in the prevalence of oral and oropharyngeal cancers (O-OPCs) across the Arabian Gulf Cooperation Council (GCC) countries. Consequently, this review aimed to explore the epidemiology and possible risk factors of O-OPCs in GCC countries.

Methods

Data published after 2008 related to O-OPCs in GCC countries were obtained through electronic searches in Medline/PubMed, Scopus, Web of Science, EMBASE and Google Scholar. Keywords related to the association between O-OPCs metrics (epidemiology and risk factors) and GCC countries were used for electronic searches.

Results

The overall prevalence of OPCs increased significantly over time (40-51%) in some countries (Saudi Arabia and Arab Emigrated) of the Gulf regions. The pooled risk factor was 3.4 (2.5 - 4.7). Among the risk factors, human papillomavirus and the use of smoke and smokeless tobacco revealed odds ratio (OR) 3.31 (3.13 - 4.5) and 0.60 (0.45 - 0.80) at 95% confidence interval (CI).

Conclusion

A positive correlation between factors like age, diet, hygiene, genetics, viral and bacterial infection, consumption of alcohol and tobacco products with OPC-MFC is suggested.

Association between human health and indoor air pollution in the Gulf Cooperation Council (GCC) countries: a review

Studies on the assessment of indoor air pollutants in terms of concentration and characterization in the Gulf Cooperation Council (GCC) countries have been recently carried out. This review assesses the health effects associated with indoor air pollution exposures in GCC, including other air pollutants (siloxanes, flame retardants, synthetic phenolic antioxidants) which were not explored in a previous study. In addition, the influence of ventilation conditions due to different indoor environments was also investigated. It was revealed that there is a lack of human health assessment studies on most indoor air pollutants in almost all GCC countries, except the United Arab Emirates, Kingdom of Saudi Arabia and Kuwait, where few attempts were made for some specific pollutants. Commonly reported plausible health effects potentially associated with indoor air pollution were related to respiratory symptoms and sick building syndrome (SBS). Many of the current health assessment studies in GCC countries were based on predictions and/or estimates of exposures rather than clinically based observational studies. Measured ventilation levels and indoor air velocities in most buildings failed to meet the American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE) threshold limits of 8 L/s/p and 0.18-0.25 m/s, respectively. Additionally, limited studies have investigated respiratory symptoms and SBS potentially attributable to poor ventilation in the region. It is highly recommended that future indoor air quality (IAQ) studies in GCC should focus more on epidemiologic and intervention studies.

Relationship between oil price volatility and military expenditures in GCC countries

Natural resource-rich countries transfer more sources to military expenditures due to extreme security concerns. As public revenues have declined due to the decline in oil prices, military expenditures have been cut in many countries. Nevertheless, this is not valid for all countries. Even in some countries, despite the decrease in oil prices and volatility, military expenditures increase. The aim of this study is to investigate the relationship between volatility in oil prices and military expenditures in GCC countries (United Arab Emirates, Bahrain, Qatar, Kuwait, Saudi Arabia, and Oman). The analysis period was determined differently for each country depending on the availability of data. UAE and Qatar were excluded from the analysis as the defense expenditures data of these countries could not be provided regularly. ARDL model was preferred for the research. According to the bound test results, there is a cointegration relationship between the variables in all countries. Besides, the long-term results showed that the volatility in oil prices in all countries, except for Bahrain, positively affects military expenditures. The error correction model indicated that there is a reverse relationship between oil price volatility and military expenditures. These findings indicated that despite the volatility in oil prices, military expenditures in GCC countries are not reduced.

Mycotoxin contamination of food and feed in the Gulf Cooperation Council countries and its detection

Mycotoxins are secondary metabolites produced by different fungal spices and are found in diverse agricultural crops worldwide; they pose a severe threat to public health. Mycotoxins can cause either acute or chronic symptoms, depending on the type and dose of mycotoxin one has been exposed to. Thus, a continuous monitoring of mycotoxins is needed. Since the discovery of mycotoxins, numerous countries, including the Gulf Cooperation Council (GCC) countries, have established mycotoxin-specific regulations for feed and food. Although a number of studies in GCC countries have investigated the presence of mycotoxins, till date, there are no reviews focusing on the mycotoxin contamination of the food and feed from this region. This review is the first study to present an up-to-date overview of the occurrence of mycotoxins in feed and food in the GCC countries and to discuss the techniques used for mycotoxin analysis.

Renewable energy utilization to promote sustainability in GCC countries: policies, drivers, and barriers

There is a growing focus on the role of renewable energy (RE) policies such as feed-in tariffs (FITs), renewable portfolio standards (RPSs), subsidies, incentives, and research and development in the global energy policy mix and in promoting environmental sustainability. Although most developed countries have well-formulated RE policies, in developing countries, such policies face many barriers. This study analyzes the policies, drivers, and barriers to RE deployment for fostering environmental sustainability in the Gulf Cooperation Council (GCC) countries. In the GCC region, the need for economic diversification to reduce dependency on single resource, diminishing hydrocarbon reserve, loss of oil export revenue, climate change mitigation pledges, and abundant solar energy resource are the key drivers for diversifying energy sources to include RE. However, the apparent lack of consolidated policy framework for wide-scale RE utilization calls for a well-articulated policy to advance RE development in each member state. Although FIT and RPS approaches could be effective for initial deployment of small-scale RE projects, a competitive tendering and auctioning mechanisms are more suitable for large-scale projects. Whereas, developing effective energy codes could successfully promote RE deployment, the increased share of RE in energy supply would have synergistic impacts on the region. The GHG emissions avoidance expected to be achieved by the GCC countries will vary between 5 and 247 million tons of CO₂ equivalent by 2030. The fulfillment of inspirational RE targets for 2030 would contribute in fulfilling climate change mitigation pledges, environmental sustainability, economic growth, and generating new jobs.

Capacity building in health care professions within the Gulf cooperation council countries: paving the way forward

BACKGROUND

There is a worldwide shortage of health care workers. This problem is particularly severe in the Gulf Cooperation Council (GCC) countries because of shortages in certain medical disciplines, due to a lack of nationally-trained professionals and a less developed educational system compared to other high income countries. Consequently, GCC countries are heavily dependent on an expatriate health care workforce; a problem exacerbated by high turnover. We discuss challenges and potential strategies for improving and strengthening capacity building efforts in health care professions in the GCC.

MAIN TEXT

In the GCC, there are 139 schools providing professional health education in medicine, dentistry, pharmacy, nursing, midwifery, and other specialties. Health education school density reported for the GCC countries ranges between 2.2 and 2.8 schools per one million inhabitants, except in Oman where it is 4.0 per one million inhabitants. The GCC countries rely heavily on expatriate health professionals. The number of physicians and nurses in the GCC countries are 2.1 and 4.5 per 1000 respectively, compared to 2.8 and 7.9 among member countries of the Organisation for Economic Cooperation and Development (OECD). Interestingly, the number of dentists and pharmacists is higher in the GCC countries compared to OECD countries. A nationally trained health care workforce is essential for the GCC countries. Physiotherapy and occupational therapy are two identified areas where growth and development are recommended. Custom-tailored continuing medical education and continuing professional development (CPD) programs can augment the skills of health practitioners, and allow for the expansion of their scope of practice when warranted.

CONCLUSION

Capacity building can play an essential role in addressing the major health challenges and improving the overall quality of health care in the region. Efforts aimed at increasing the number of locally-trained graduates and developing and implementing need-based CPD programs are vital for capacity building and lifelong learning in health care professions.

Indoor air pollution and exposure assessment of the gulf cooperation council countries: A critical review

Indoor air pollution is one of the human health threat problems in the Gulf Cooperation Council (GCC) countries. In these countries, due to unfavorable meteorological conditions, such as elevated ambient temperature, high relative humidity, and natural events such as dust storms, people spend a substantial amount of their time in indoor environments. In addition, production of physical and biological aerosols from air conditioners, cooking activities, burning of Arabian incense, and overcrowding due to pilgrimage programs are common causes of low quality indoor air in this region. Thus, due to infiltration of outdoor sources as well as various indoor sources, people living in the GCC countries are highly exposed to indoor air pollutants. Inhalation of indoor air pollutants causes mortalities and morbidities attributed to cardiorespiratory, pulmonary, and lung cancer diseases. Hence, the aim of this review study is to provide a summary of the major findings of indoor air pollution studies in different microenvironments in six GCC countries. These include characterization of detected indoor air pollutants, exposure concentration levels, source identifications, sustainable building designs and ventilation systems, and the mitigation strategies. To do so, >130 relevant indoor air pollution studies across the GCC countries were critically reviewed. Particulate matters (PM₁₀ and PM_2.5), total volatile organic compounds (TVOCs), carbon dioxide (CO₂), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and heavy metals were identified as the reported indoor air pollutants. Apart from them, indoor Radon and bioaerosols were studied only in specific GCC countries. Thus, future studies should also focus on the investigation of emerging indoor air pollutants, such as ultrafine and nanoparticles and their associated health effects. Furthermore, studies on the mitigation of indoor air pollution through the development of advanced air purification and ventilation systems could improve the indoor air quality (IAQ) in the GCC region.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States

OBJECTIVES

The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area.

METHODS

A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms.

RESULTS

Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358).

CONCLUSION

Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Maternal and birth cohort studies in the Gulf Cooperation Council countries: protocol for a systematic review and narrative evaluation

INTRODUCTION

Cohort studies have revealed that genetic, socioeconomic, communicable and non-communicable diseases, and environmental exposures during pregnancy may influence the mother and her pregnancy, birth delivery and her offspring. Numerous studies have been conducted in the Gulf Cooperation Council (GCC) countries to examine maternal and birth health. The objectives of this protocol for a systematic review are to systematically review and characterise the exposures and outcomes that have been examined in the mother and birth cohort studies in the GCC region, and to summarise the strength of association between key maternal exposures during pregnancy (ie, body mass index) and different health-related outcomes (ie, mode of birth delivery). The review will then synthesise and characterise the consequent health implications and will serve as a platform to help identify areas that are overlooked, point out limitations of studies and provide recommendations for future cohort studies.

METHODS AND ANALYSIS

Medline, Embase, Cochrane Library and Web of Science electronic databases will be comprehensively searched. Two reviewers will independently screen each study for eligibility, and where discrepancies arise they will be discussed and resolved; otherwise a third reviewer will be consulted. The two reviewers will also independently extract data into a predefined Excel spreadsheet. The included studies will be categorised on the basis of whether the participant is a mother, infant or mother-infant dyad. Outcome variables will be divided along two distinctions: mother or infant. Exposure variables will be divided into six domains: psychosocial, biological, environmental, medical/medical services, maternal/reproductive and perinatal/child. Studies are expected to be of heterogeneous nature; therefore, quantitative syntheses might be limited.

ETHICS AND DISSEMINATION

There is no primary data collection; therefore, ethical review is not necessary. The findings of this review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42017068910.

Wastewater reuse in the countries of the Gulf Cooperation Council (GCC): the lost opportunity

Reuse of treated wastewater is not only environmentally and financially sound, it is becoming indispensable for meeting the staggering water demand in certain regions, especially under conditions of alarming water scarcity. Reusing treated wastewater will help in reducing the pressure on expensive desalinated water production and depleting groundwater withdrawal, thereby reducing associated harmful environmental impacts. Reuse of wastewater in general and in the countries of the Gulf Cooperation Council (GCC) in particular has been a priority research area and has been in the media spotlight for some time, especially the use of tertiary quality water resources for agricultural purposes. However, reuse of treated wastewater is still in its primitive stage in terms of implementation in GCC. In addition, the overall volume of tertiary treated water that outflows unutilized to the sea is much greater than the volume reused. This paper provides a general review of and statistics on current practices of treatment of domestic wastewater in the GCC. The review highlights water resources, sanitation service coverage, wastewater treatment, effluent types, treated and reuse quantities, costs, and tariffs. The paper provides recommendations to improve wastewater treatment in the GCC to alleviate the stress on the scarce groundwater resources, provide a relatively inexpensive alternative to desalination, reduce the environmentally adverse impacts and externalities of desalination plants, and eliminate the discharge of untreated wastewater in coastal areas or terrestrial landfills.