Ancient genomes illuminate Eastern Arabian population history and adaptation against malaria

The harsh climate of Arabia has posed challenges in generating ancient DNA from the region, hindering the direct examination of ancient genomes for understanding the demographic processes that shaped Arabian populations. In this study, we report whole-genome sequence data obtained from four Tylos-period individuals from Bahrain. Their genetic ancestry can be modeled as a mixture of sources from ancient Anatolia, Levant, and Iran/Caucasus, with variation between individuals suggesting population heterogeneity in Bahrain before the onset of Islam. We identify the G6PD Mediterranean mutation associated with malaria resistance in three out of four ancient Bahraini samples and estimate that it rose in frequency in Eastern Arabia from 5 to 6 kya onward, around the time agriculture appeared in the region. Our study characterizes the genetic composition of ancient Arabians, shedding light on the population history of Bahrain and demonstrating the feasibility of studies of ancient DNA in the region.

Determinants that attract and discourage foreign direct investment in GCC countries: Do macroeconomic and environmental factors matter?

In general, foreign direct investments (FDIs) play a crucial role in driving a country's economic development, promoting diversification, and enhancing competitiveness. The Gulf Cooperation Council (GCC) countries, which heavily rely on the oil and gas sectors, are particularly vulnerable to fluctuations in commodity prices. However, these countries have recognized the imperative of economic diversification and have increasingly turned to inward FDIs to achieve it. By attracting capital, advanced technology, and expertise from foreign investors, FDIs enable the GCC countries to expand their economic base beyond the oil and gas sectors. This diversification not only creates employment opportunities but also fosters resilient economic growth, ultimately leading to an improvement in the living standards of the local population. This study investigates the macroeconomic and environmental factors that potentially attract foreign direct investment (FDI) inflows into the Gulf Cooperation Council (GCC) countries in the long run. Additionally, the study explores the causal relationship between these factors and FDI inflows. The panel autoregressive distributed lag (ARDL) approach to co-integration is the primary analytical technique used, utilizing long time-series data from six GCC countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) during the period 1990-2019. The empirical results indicate that, in the long run, almost all independent variables significantly influence FDI in GCC countries. Variables such as GDP growth (GDPG), inflation (INFL), carbon dioxide emissions (CO2), and urbanization (URB) are found to be highly significant (p≤0.01) in their impact on FDI. Moreover, unemployment (UNEMP) also positively and significantly influences FDI in these countries in the long run. Based on the key findings, strategies aimed at reducing persistently high unemployment rates, maintaining population growth, viewing FDI as a driver for GDP growth, and continuing with infrastructure development and urbanization are expected to attract more FDI inflows into GCC countries in the long run. Additionally, fostering both long-term economic incentives and creating a conducive business infrastructure for investors are vital for attracting inward FDI into any nation, including those in the GCC. This research would benefit various stakeholders, including governments, local businesses, investors, academia, and the local society, by providing valuable knowledge and informing decision-making processes related to economic development, diversification, and investment promotion.

Outcome of premarital genetic counseling for couples at risk of hemoglobinopathies in Kingdom of Bahrain

OBJECTIVES

Hemoglobinopathies are the commonest inherited blood disorders and form a serious burden worldwide, affecting communities, patient quality of life and healthcare resources. The Kingdom of Bahrain has issued a law obligating couples to undergo premarital screening to detect those at risk of having children affected with these disorders. The aim of this study was to analyze the marital decisions of couples at risk for hemoglobinopathies and follow up the outcomes.

METHODS

A retrospective study was conducted on couples at risk for hemoglobinopathies identified during the premarital screening program at local health centers in the Kingdom of Bahrain and referred to the genetics department in the Salmaniya Medical Complex for genetic counselling in 2018-2020.

RESULTS

A total of 189 couples were found to be at risk for hemoglobinopathies, of whom 159 completed the survey. Of these, 107 (67%) decided to proceed with their marriage and 26 couples achieved pregnancy. Out of 24 at-risk pregnancies with known outcome, 83.3% were spontaneous whereas only 16.7% underwent in-vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD). Eight out of 20 infants born to couples after spontaneous conception were affected. A positive attitude toward IVF with PGD was held by 60% of at-risk couples.

CONCLUSIONS

Despite undergoing premarital screening and genetic counselling, a large percentage of at-risk couples proceeded with their marriage. Most of them justified their decision due to the availability of advanced methods that aid in the prevention of having an affected child. However, the cost of such intervention was a major barrier for the majority of couples.

"Tell me what is 'better'!" How medical students experience feedback, through the lens of self-regulatory learning

INTRODUCTION

While feedback aims to support learning, students frequently struggle to use it. In studying feedback responses there is a gap in explaining them in relation to learning theory. This study explores how feedback experiences influence medical students' self-regulation of learning.

METHODS

Final-year medical students across three campuses (Ireland, Bahrain and Malaysia) were invited to share experiences of feedback in individual semi-structured interviews. The data were thematically analysed and explored through the lens of self-regulatory learning theory (SRL).

RESULTS

Feedback interacts with learners' knowledge and beliefs about themselves and about learning. They use feedback to change both their cognitive and behavioural learning strategies, but how they choose which feedback to implement is complex. They struggle to generate learning strategies and expect teachers to make sense of the "how" in addition to the "what"" in planning future learning. Even when not actioned, learners spend time with feedback and it influences future learning.

CONCLUSION

By exploring our findings through the lens of self-regulation learning, we advance conceptual understanding of feedback responses. Learners' ability to generate "next steps" may be overestimated. When feedback causes negative emotions, energy is diverted from learning to processing distress. Perceived non-implementation of feedback should not be confused with ignoring it; feedback that is not actioned often impacts learning.

Impact of covid-19 outbreak on the behavior of children and adolescents in the Kingdom of Bahrain

With coronavirus disease-2019 (COVID-19) pandemic restrictions and lockdown, children and adolescents have experienced emotional and physical isolation from family and community members. This isolation has a negative impact on children's and adolescents' mental health, physical health, and behavior. An online cross-sectional study of children and adolescents aged 5 to 11 years was conducted to assess the effect of the COVID-19 pandemic on their behavior, emotions, and sleep routines. A total of 413 participants, with a mean age of seven (217 boys and 195 girls), were included in the study. Most of the children were in primary school and lived with both parents. Boys and older children were found to have been fatigued during the pandemic. A significant association was found between the participants' age and regression, opposition, and adaptation behaviors. A significant increase in screen usage and decrease in children's physical activity after the outbreak were noted. The COVID-19 pandemic has negatively affected children's and adolescents' psychosocial, behavioral, and physical habits. Government programs to support the mental and psychological well-being of children and adolescents should be encouraged. Social communication, physical activity, and collaborative games are also important factors.

Psychological morbidities among Nepalese migrant workers to Gulf and Malaysia

BACKGROUND

One of the important aftereffects of rapid global development is international mobility, which has placed the health of migrant workers as a key public health issue. A less-developed country, Nepal, with political instability and a significant lack of employment, could not remain untouched by this phenomenon of migration. Our goal was to identify and determine the predictors of anxiety, depression, and psychological wellbeing among Nepalese migrant workers in Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia.

METHODS

A descriptive cross-sectional study was used to collect information from 502 Nepalese migrant workers in the arrival section of Tribhuvan International Airport from May to June 2019 using purposive sampling. Workers with a minimum work experience of 6 months and above were included in the study. A structured questionnaire with socio-demographic items was used along with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and WHO (five) wellbeing scale for measuring the subjective psychological wellbeing and screening for depression.

RESULTS

The mean age of the respondents was 32.97 years. Majority (41.8%) of the respondents had work experience in Qatar and 63.7% had work experience of 1-5 years. The results suggested that 14.4% had mild to severe depression while 4.4% had a moderate level of anxiety. The WHO5 wellbeing index score suggested that 14.1% of the respondents had a score below 13, which is suggestive of poor psychological wellbeing. Further, the country of work (p = 0.043), sleeping hours (p = 0.001), occupation (p = 0.044), working hours (p = 0.000), water intake (p = 0.010) and anxiety level (p = 0.000) were found to be significantly associated with depression score. Similarly, sleeping hours (p = 0.022), occupation (p = 0.016), working hours (p = 0.000), water intake (p = 0.010), and anxiety level (0.000) were significantly associated with the WHO5 wellbeing score.

CONCLUSIONS

Nepalese migrant workers in the Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia bear an important burden of psychological morbidities. This highlights the need to prioritize the migrant worker's mental health by Nepal as well as Gulf countries and Malaysia.

Modeling spatial-temporal variability of PM2.5 concentrations in Belt and Road Initiative (BRI) region via functional adaptive density approach

The rapid development of the Belt and Road Initiative (BRI) has led to severe air pollution dominated by PM2.5 concentrations which can cause a profound negative impact on human health and economic activity. This problem poses a critical environmental challenge to efficiently handling large-scale spatial-temporal PM2.5 data in this extended region. Functional data analysis (FDA) technique offers powerful tools that have the potential to enhance the analysis of spatial distributions and temporal dynamic changes in high-dimensional pollution data. However, modeling the spatial-temporal variability of PM2.5 concentrations by FDA remains unrevealed in the BRI region. To address this research gap, our study aimed to achieve two main objectives: first, to model the spatial-temporal dynamic variability of PM2.5 in 125 BRI nations (1998-2021), and second, to identify the underlying clusters behind the variations. We employed the recently developed functional adaptive density peak (FADP) clustering approach to solve the current problem. The proposed method is based on the joint use of functional principal components (FPCs) and functional cluster analyses. The main results are as follows: (i) The first three FPCs almost captured 99% of the total variations involving all valuable information on PM2.5 concentrations. (ii) PM2.5 pollution was highly concentrated in the developing countries (Pakistan, Bangladesh, and Nigeria) and the developed countries (Arabian Gulf countries: Qatar, United Arab Emirates, Bahrain, Saudi Arabia, Oman), and the least developed countries (Yemen and Chad). (iii) Three optimal clusters were identified and thus classified the PM2.5 into three distinct degrees of pollution: severe, moderate, and light. (iv) Cluster 1 had a severe pollution effect degree with a high rate of change, and it covered the Arabian Peninsula countries, African countries (Cameroon, Egypt, Gambia, Mali, Mauritania, Nigeria, Sudan, Senegal, Chad), Bangladesh, and Pakistan. (v) About 62 BRI countries belonged to cluster 2 showing a light pollution degree with annul average of less than 20 [Formula: see text]; this pointed out that the PM2.5 concentration remains stable in the cluster 2-related countries. The findings of this research would benefit governments and policymakers in preventing and controlling PM2.5 pollution exposure in BRI. Furthermore, this research could pay attention to sustainable development goals and the vision of the Green BRI policy.

Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain

BACKGROUND

Teachers' awareness of epilepsy and attitudes toward students with epilepsy (SWE) largely affect their health, behavior, and academic performance. This study aimed to assess elementary schoolteachers' background knowledge and attitudes toward epilepsy in the Kingdom of Bahrain.

METHODS

A 23-item online questionnaire was distributed to elementary school teachers in all public schools in Bahrain between September 2022 and February 2023. The questionnaire included three sets of questions about teachers'1) demographics and teaching experience, 2) knowledge and experience with epilepsy, and 3) attitude towards SWE.

RESULTS

Three hundred and sixty-seven teachers responded to the questionnaire. Only 82 participants (22.3%) thought they had enough information about epilepsy. Approximately 25% had previously taught SWE. Even though 9.3% have witnessed a seizure before, only 2.2% received seizure first aid training courses. Most respondents (68.7%) knew that epilepsy is caused by abnormal brain electrical activity and is not contagious (95.1%). Regarding seizure types, 76.6% were aware of uncontrollable jerky movements, while staring spells were recognized by 45%. Most first-aid responses were inappropriate, as 59.7% would open the patient's mouth. Only 39.5% agreed on patient transfer to the hospital if the seizure lasted ≥5 min. Epilepsy was thought to cause mental retardation by 32.4%. Also, the belief that SWE were more prone to bullying was reported by 57.2%.

CONCLUSION

The knowledge and attitudes of schoolteachers in Bahrain towards epilepsy are relatively good but with remaining improvement potential. They do not fully grasp all seizure types nor adequate first-aid measures promoting future epilepsy educational programs.

The health-related quality of life in patients with diabetic foot ulcers in the Kingdom of Bahrain

AIMS

The aims of this study were to assess the health-related quality of life (HRQoL) of adult Bahraini patients with diabetic foot ulcers (DFU) and to explore factors associated with poor HRQoL.

METHODS

Cross-sectional HRQoL data were obtained from a sample of patients in active treatment for DFU at a large public hospital in Bahrain. Patient-reported HRQOL was measured using the following instruments: DFS-SF, CWIS and EQ-5D.

RESULTS

The patient sample included 94 patients, with a mean age of 61.8 (SD: 9.9) years, 54 (57.5%) were males, and 68 (72.3%) were native Bahrainis. Poorer HRQoL was found among patients who were unemployed, divorced/widowed, and those with a shorter duration of formal education. Additionally, patients with severe DFUs, persisting ulcers, and a longer duration of diabetes reported statistically significantly poorer HRQoL.

CONCLUSIONS

Findings from this study demonstrate a low level of HRQoL among Bahraini patients with DFUs. A longer duration of diabetes, in addition to ulcer severity and status statistically significantly influence HRQoL.

Development of standards for assessing water quality in marine coastal waters of Bahrain

Marine coastal waters of Bahrain are under pressure due to human activities and climate change. We used marine monitoring data (2005-2020) from 27 sites to establish baseline conditions and develop standards for assessments of water quality. Five hydrodynamic regions were identified: Oyster Beds, North, West, East, East (Coastal). Data from Oyster Beds sites, likely to be less impacted by human activities, were used to determine baseline conditions. For most parameters, candidate thresholds were based on 50 % and 100 % variation from baseline and 95th percentiles. Comparisons of data against different thresholds showed different outcomes. Overall, results indicate good water quality, with potential concerns in East (Coastal). Trend analyses showed some significant trends in all regions: downward (favourable) for some parameters (e.g. turbidity: North) and upward for others (e.g. nitrate: Oyster Beds, East and East (Coastal)). Future work requires greater understanding around optimum guidelines that protect and mitigate any adverse ecological impacts.

Spillover of volatility among financial instruments: ASEAN-5 and GCC market study

The research examines a comovement and spillover of volatility among foreign exchange, conventional and shariah stock markets in Association of South East Asian Nation-5 (ASEAN) countries and Gulf Cooperation Council (GCC) countries. Generalized Autoregressive Conditional Heteroskedasticity-Baba, Engle, Kraft and Kroner (GARCH-BEKK) and Dynamic Conditional Correlation (GARCH-DCC) models are used to capture the correlation and transmission volatility of the markets. The overall results show that both the Shariah and the conventional stock indices respond similarly to each country's currency. A bidirectional (two-way relationship) volatility spillover exists only in Malaysia and a unidirectional (one-way relationship) volatility is observed in Indonesia, Singapore, Thailand, and Bahrain. The rest of the markets-the Philippines, Saudi Arabia, and the United Arab Emirates (UAE)-do not have any volatility spillover evidence. Based on DCC outcomes, the conventional and Shariah stock in ASEAN-5 countries and GCC countries reveal the market efficiency, i.e., a positive high conditional correlation. Only Bahrain shows less efficiency than the other countries. It implies no portfolio diversification advantage in conventional and Shariah stock indices. Contrarily, currency and stock (conventional and Shariah) markets provide portfolio diversification benefits for all ASEAN-5 and GCC countries.

The burden of ischemic heart disease and the epidemiologic transition in the Eastern Mediterranean Region: 1990-2019

It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.

Investigation of germline variants in Bahraini women with breast cancer using next-generation sequencing based-multigene panel

Germline variants in BRCA1 and BRCA2 (BRCA1/2) genes are the most common cause of hereditary breast cancer. However, a significant number of cases are not linked to these two genes and additional high-, moderate- and low-penetrance genes have been identified in breast cancer. The advent of next-generation sequencing (NGS) allowed simultaneous sequencing of multiple cancer-susceptibility genes and prompted research in this field. So far, cancer-predisposition genes other than BRCA1/2 have not been studied in the population of Bahrain. We performed a targeted NGS using a multi-panel covering 180 genes associated with cancer predisposition to investigate the spectrum and frequency of germline variants in 54 women with a positive personal and/or family history of breast cancer. Sequencing analysis revealed germline variants in 29 (53.7%) patients. Five pathogenic/likely pathogenic variants in four DNA repair pathway-related genes were identified in five unrelated patients (9.3%). Two BRCA1 variants, namely the missense variant c.287A>G (p.Asp96Gly) and the truncating variant c.1066C>T (p.Gln356Ter), were detected in two patients (3.7%). Three variants in non-BRCA1/2 genes were detected in three patients (1.85% each) with a strong family history of breast cancer. These included a monoallelic missense variant c.1187G>A (p.Gly396Asp) in MUTYH gene, and two truncating variants namely c.3343C>T (p.Arg1115Ter) in MLH3 gene and c.1826G>A (p.Trp609Ter) in PMS1 gene. Other variants of uncertain significance (VUS) were also detected, and some of them were found together with the deleterious variants. In this first application of NGS-based multigene testing in Bahraini women with breast cancer, we show that multigene testing can yield additional genomic information on low-penetrance genes, although the clinical significance of these genes has not been fully appreciated yet. Our findings also provide valuable epidemiological information for future studies and highlight the importance of genetic testing, and an NGS-based multigene analysis may be applied supplementary to traditional genetic counseling.

Bioaccumulation of trace metal ions in the blue swimmer crab tissues Portunus pelagicus (Linnaeus, 1758) in Bahrain, Arabian Gulf

The blue swimmer crab, Portunus pelagicus, is an edible abundant crustacean found in many seas around the world, including the Arabian Gulf. In this study, the concentrations of six metal ions in the white and brown meats of P. pelagicus from four sites in Bahrain were determined. P. pelagicus was found to accumulate Zn2+ and Cu2+ higher than other metal ions in the order of Zn2+ > Cu2+ > Cd2+ > Ni2+ > Cr3+, while Pb2+ was not detected. The overall average concentrations of Zn2+, Cu2+, Cr3+, Ni2+, and Cd2+ in white meat were 236.2, 69.5, 0.109, 0.159, and 0.273 mg/kg, while in brown meat, they were 235.4, 199.2, 0.133, 1.25, and 4.87 mg/kg based on dry weight, respectively. Concentrations of Pb2+ and Cd2+ were safe according to Bahrain's and European Commission guidelines. The estimated weekly intake (EWI) values of Zn2+, Cu2+, Pb2+, and Cd2+ via consumption of crab's white meat (edible tissue) were 102.1, 30.1, 0.042, and 0.12 µg/kg/week, respectively, which are far lower than the maximum recommended values established by the FAO/WHO. The hazard quotient (HQ) values of individual trace metal ions and the synergistic effects of total trace metal ion (hazard index) were below 1, indicating that there is no potential health risk on the consumption of crab edible tissues (white meat). However, elevated levels of Cd2+ (0.05-1.73 mg/kg wet weight) in the brown meat (hepatopancreas) were detected. The female P. pelagicus accumulated high levels of Zn2+ and Cu2+ in the white meat, as well as Cu2+ in the brown meat compared to males. Additionally, it was found that Cu2+ and Cd2+ were significantly higher (p < 0.05) in brown meat compared to white meat. Higher concentrations (p < 0.05) of Zn2+, Cu2+, and Cd2+ were observed in crabs collected from sites that have harsher environmental conditions.

The Bahraini food based dietary guidelines: a holistic perspective to health and wellbeing

The impact of food consumption extends well beyond the physical aspect of health to affect the mind, the society, and the environment. The biopsycho-ecological (BSE) theory recognizes the interplay between these factors and emphasizes the need for a holistic perspective to dietary recommendations. This manuscript presents a situation analysis of food consumption and diet-related diseases in Bahrain and describes the themes of the Bahraini Food based dietary guidelines (FBDG) and their alignment with the BSE constructs. Available data revealed low fruit and vegetable intake and excessive consumption of processed meat and sugary drinks in the country. These dietary habits are accompanied by a high burden of non-communicable diseases and their risk factors, anemia, and vitamin D deficiency. The Bahraini FBDG consisted of 11 context-specific themes and key messages that addressed the four dimensions of health depicted by the BSE theory, as follows: diet, physical activity, and food safety (body), physical activity, mindful eating and mental health (mind); family relations and cultural heritage (society), and food waste and environmental footprints of dietary intake (environment). The Bahraini FBDG present a model of dietary guidelines that adopted a holistic perspective to address health as they promote the role of food and dietary habits in maintaining the health of the body and that of the mind, the society, and the environment.

Scalar properties of the transnational field of human rights: Field effects and human rights in Bahrain

Whilst a body of work exists that has engaged with and conceptualised transnational fields, and in particular for this paper, the transnational field of human rights, more work needs to be done to elaborate on the effects of transnational fields, at the national level. Using Bourdieu's field theory, and more recent scholarship that focuses on scalar aspects of fields, this research focuses on a human rights field at the national level in Bahrain. The paper addresses two levels/dimensions of the transnational field of human rights: the transnational level and the national level, focussing on the field's vertical autonomy. Based upon nineteen in-depth interviews, the research retrieves the biographical trajectories of Bahraini human rights activists and activists from iNGOs with a specific remit that includes Bahrain. The paper argues that the vertical autonomy of the transnational field of human rights has demonstrable field effects at the national level, and that this has a number of implications. First, where transnational fields have greater vertical autonomy, the national level can operate with varying hierarchies, with actors adopting practices that diverge from those acting transnationally. Second, as a result of these scalar differences and the vertical autonomy of the transnational field, actors at the national level may have to adapt their practices, others can be side-lined as a result of 'symbolic pollution.' Third, in order for local actors to engage with transnational advocacy networks, they must be the right type of actor.

An empirical study of innovation-led economic diversification in MENA oil exporters

This paper aims, on the one hand, to investigate the impact of innovation on economic diversification in 11 oil-abundant MENA countries (Algeria, Bahrain, Iran, Iraq, Kuwait, Libya, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen) over the period 1996-2019 using the Arellano-Bond difference GMM estimator and, on the other hand, to reveal how much the level of economic diversification will increase if MENA oil exporters will have innovation rates similar to that of a successful diversifier like Canada. The main findings emphasize the importance of innovation in promoting economic diversification in MENA oil-exporting countries; the level of innovation-led economic diversification increases at a greater pace in GCC countries than in their non-GCC counterparts. The results also show that governance, human development, domestic credit to private sector, and economic freedom positively and significantly affect economic diversification in MENA oil exporters, while oil rents negatively affect economic diversification in these countries. Moreover, the results confirm the effectiveness of the joint impact of governance index and oil rents in boosting economic diversification in oil-rich MENA countries. The results also reveal that the rate of improvement in economic diversification brought by replacing MENA oil exporters' innovation rates with those of Canada is 1.77% (for every 1% increase in innovation). Based on that, one can say that increasing the rate of innovation in MENA oil-exporting countries does accelerate the pace of economic diversification.

Factors Influencing Water Consumption in the Kingdom of Bahrain and Environmental Consequences of Bottled Water Consumption

BACKGROUND

The drinking of bottled water has remarkably increased at a global scale even in the regions possessing other adequate water sources. This study elaborates on the factors influencing the consumption of tap, filtered, and bottled water in the Kingdom of Bahrain and on the environmental consequences of bottled water consumption.

METHODS

A cross-sectional study was performed on 483 participants in the Kingdom of Bahrain between April and May 2019. A questionnaire-based survey was conducted to assess the preferred water type, to estimate the amount of bottled water consumption per year/capita, and other water consumption-related information.

RESULTS

The study revealed that filtered (35.90%) and bottled (34.50%) waters were predominantly consumed in the Kingdom, while the consumption of tap water was negligible (8.90%). The total consumption of bottled water was 0.51 liters/day, which is equivalent to 184.69 liters/year. Thus, 295.50 liters/capita/year of bottled water were consumed based on the approximate 1.6 million population in 2019. This consumption rate is extremely high in comparison to other countries.

CONCLUSIONS

The study recommended improving population satisfaction of tap water, conducting tap water marketing campaigns, investments in recycling infrastructures, and introducing educational plans to properly dispose of water bottles.

Clinical carbapenem-resistant Klebsiella pneumoniae isolates simultaneously harboring blaNDM-1, blaOXA types and qnrS genes from the Kingdom of Bahrain: Resistance profile and genetic environment

The prevalence of Carbapenem-resistant Klebsiella pneumoniae (CRKP) is currently increasing worldwide, prompting WHO to classify it as an urgent public health threat. CRKP is considered a difficult to treat organism owing to limited therapeutic options. In this study, a total of 24 CRKP clinical isolates were randomly collected from Salmaniya Medical Complex, Bahrain. Bacterial identification and antibiotic susceptibility testing were performed, on MALDI-TOF and VITEK-2 compact, respectively. The isolates were screened for carbapenem resistance markers (bla_NDM,bla_OXA-23,bla_OXA-48 and bla_OXA-51) and plasmid-mediated quinolone resistance genes (qnrA, qnrB, and qnrS) by monoplex PCR. On the other hand, only colistin-resistant isolates (n=12) were screened for MCR-1, MCR-2 and MCR-3 genes by monoplex PCR. Moreover, the Genetic environment of bla_NDM, integrons analysis, and molecular characterization of plasmids was also performed. Antibiotic susceptibility revealed that all the isolates (100%) were resistant to ceftolozane/tazobactam, piperacillin/tazobactam, 96% resistant to ceftazidime, trimethoprim/sulfamethoxazole, 92% resistant to meropenem, gentamicin and cefepime, 88% resistant to ciprofloxacin, imipenem, and 37% resistant to amikacin. Ceftazidime/avibactam showed the least resistance (12%). 75% (n=12/16) were resistant to colistin and 44% (n=7/16) showed intermediate susceptibility to tigecycline. The detection of resistant determinants showed that the majority (95.8%) of CRKP harbored bla_NDM-1, followed by bla_OXA-48 (91.6%) bla_OXA-51 (45.8%), and bla_OXA-23 (41.6%). Sequencing of the bla_NDM amplicons revealed the presence of bla_NDM-1. Alarmingly, 100% of isolates showed the presence of qnrS. These predominant genes were distributed in various combinations wherein the majority were bla_NDM-1 + bla_OXA-51+ qnrS + bla_OXA-48 (n =10, 41.7%), bla_NDM-1 + bla_OXA-23+ qnrS + bla_OXA-48 (n=8, 33.3%), among others. In conclusion, the resistance rate to most antibiotics is very high in our region, including colistin and tigecycline, and the genetic environment of CRKP is complex with the carriage of multiple resistance markers. Resistance to ceftazidime/avibactam is uncommon and hence can be used as a valuable option for empirical therapy. Molecular data on resistance markers and the genetic environment of CRKP is lacking from this geographical region; this would be the first report addressing the subject matter. Surveillance and strict infection control strategies should be reinforced in clinical settings to curb the emergence and spread of such isolates.

Women's contribution to medicine in Bahrain: leadership and workforce

BACKGROUND

Women make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain's medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority.

METHODS

Data were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004.

RESULTS

The results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students' representation was higher than males over the years.

CONCLUSIONS

This study highlights the increasing trend of women's participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.

COVID-19 Knowledge, Attitudes, and Preventive Measures of University Students in Bahrain

BACKGROUND

The severe, acute respiratory syndrome COVID-19 that was first reported in China in December 2019 quickly became a global pandemic that has resulted in over 100 million infections and more than 2 million deaths.

STUDY DESIGN

This study aimed to assess the awareness level of university students regarding the possibility of becoming infected with COVID-19. In order to achieve this objective, we assessed the students' knowledge, attitudes, and behaviors using an online survey questionnaire offered to a total of 300 students.

RESULTS

A positive response regarding awareness of COVID-19 symptoms was registered by more than 70% of the students, whereas 62% felt that wearing a mask did not give full protection against infection, approximately 30% agreed that antibiotics and antivirals did not treat COVID-19, and 62% agreed that vitamin C was helpful in treating common symptoms of COVID-19. Moreover, around 31% of the students believed that COVID-19 is a man-made virus. Students who had gotten infected with SARS-CoV-2 believed that wearing a mask gives full protection (p=0.018). In response to survey questions related to attitude, 80% of students cancelled and postponed meetings with friends, and 90% agreed that mask-wearing is the most precautionary measure used to prevent the infection. In addition, 82% avoided coughing in public, 82% avoided contact if they felt flu-like symptoms and 80% washed their hands far more often due to the pandemic. Interestingly, 76% carried hand sanitizer, 66.5% avoided shaking hands, and 42.7% were taking vitamin C supplements.

CONCLUSIONS

This study showed that the participants had a positive awareness of COVID-19 transmission, symptoms, and treatments misconceptions and mistaken beliefs related to treatments and the origin of the virus were also common and should be addressed. This study thus provides a baseline for a population-based surveillance program that could help local authorities to improve pandemic preparation plans, particularly with regard to governmental education and media campaigns.

Forecasting carbon emissions due to electricity power generation in Bahrain

Global warming and climate change have become one of the most embarrassing and explosive problems/challenges all over the world, especially in third-world countries. It is due to a rapid increase in industrialization and urbanization process that has given the boost to the volume of greenhouse gases (GHGs) emissions. In this regard, carbon dioxide (CO2) is considered a significant driver of GHGs and is the major contributing factor for global warming. Considering the goal of mitigating environmental pollution, this research has applied multiple methods such as neural network time series nonlinear autoregressive, Gaussian Process Regression, and Holt's methods for forecasting CO2 emission. It attempts to forecast the CO2 emission of Bahrain. These methods are evaluated for performance. The neural network model has the root mean square errors (RMSE) of merely 0.206, while the Gaussian Process Regression Rational Quadratic (GPR-RQ) Model has RMSE of 1.0171, and Holt's method has RMSE of 1.4096. Therefore, it can be concluded that the neural network time series nonlinear autoregressive model has performed better for forecasting the CO2 emission in the case of Bahrain.

Spatial and temporal analysis of the risks posed by metal contamination in coastal and marine sediments of Bahrain

Nine metals including Al, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn were analysed from sediment samples collected from 29 stations since 2007 from Bahraini waters. Within this study, it was investigated whether concentrations of these determinants are at concentrations above internationally established Assessment Criteria (AC). The majority of sites were considered not to pose a toxicological risk in terms of metal contamination. Where breaches occurred, they were mainly from historic samples related to Cr, Cu and Ni contamination. A trend assessment revealed that out of 59 significant trends, 36 were downwards and 23 upwards, indicating that some determinants like Al, Zn and Ni are improving strongly across some sites, whilst areas associated with industrial activity still see some increasing trends for Al, Cd, Pb and Zn.

Public survey of financial incentives for kidney donation in Bahrain

With the increasing prevalence of end-stage kidney disease in Bahrain, kidney donation is of vital importance. In this study, we want to assess how financial incentives will influence peoples' views and decisions regarding kidney donation. The aim is to establish strategies to increase the number of kidneys for transplantation in Bahrain. We adapted a previously established questionnaire on financial incentives for living kidney donations. The questionnaire assessed the public opinion in Bahrain on how kidney donation can be influenced by two different financial incentives, namely 10,000 Bahraini Dinars and life-long health insurance. We collected a convenient sample of 446 participants by distributing an electronic version of the questionnaire. IBM SPSS Statistics version 23 software was used for data entry and analysis. Of the total participants, 39% were male and 61% were female. Eighty percent of the participants believed that their chances for kidney donation will not increase in turn of receiving a financial compensation, while 20% of them believed that it will increase. Our study found that generally married participants (70%) find it a preferable development for health insurance companies to offer financial compensation for kidney donation, while nonmarried participants (30%) found it not a preferable but also not an adverse development (P = 0.038). Furthermore, there is a positive correlation between age and preferable views toward financial incentives to increase kidney donation (P <0.001). Although financial incentives for kidney donation might encourage a minority of the population, the majority will not be influenced by implanting a financial incentives' system for kidney donation.

Prevalence and reasons of increased type 2 diabetes in Gulf Cooperation Council Countries

Arab Gulf Cooperation Council countries are considered as one of the most regions exhibiting a high prevalence of diabetes including the kingdom of Saudi Arabia, Bahrain, Qatar, Oman, Kuwait, and United Arab of Emirates, which have similar population characteristics (for example, religion, language, lifestyle, diet, and income). The frequency rate of diabetes in these countries ranged from 8 to 22% according to the last International Diabetes Federation (IDF) report. Many factors impact the prevalence in this region including obesity, unhealthy lifestyle, increased life expectancy, increased healthcare expenditures, increased the incidence of type 2 diabetic mellitus (T2DM) among children and young persons, and genetic susceptibility. This study aims to review the published papers on the incidence of T2DM and explore the most reasons behind elevated incidence of T2DM in these countries.

Ramadan Fasting Improves Body Composition without Exacerbating Depression in Males with Diagnosed Major Depressive Disorders

Background: Ramadan fasting (RF) is a form of intermittent fasting that generally improves body composition and related metabolic profiles. Whether RF exacerbates depressive symptomatology in individuals diagnosed with major depressive disorder (MDD) is undetermined. Methods: 100 men, who lived in Bahrain and were between the ages of 18 and 64 years with an established diagnosis of MDD, participated in this 4-week study. Based on preference, participants were assigned to a fasting group (FG, n = 50) and a non-fasting group (NFG, n = 50). The FG engaged in fasting from 03:40 to 18:10 (dawn and dusk timings). Changes in depressive symptoms, body mass, body composition, and components of metabolic syndrome were measured. Results: There were no significant changes in depressive symptoms within the FG vs. NFG after controlling for baseline covariates: mean difference 0.49 (SE = 0.63), p = 0.43. No adverse effects were reported in either group. The FG experienced significant reductions in body mass, 1.87 kg, p = 0.001; body mass index, 0.69 kg/m², p = 0.001; body fat, 0.87%, p = 0.001; body surface area, 0.03 m², p = 0.001; and lean mass, 0.77 kg, p = 0.001. Conclusions: RF did not negatively affect depressive symptoms and improved body composition, suggesting short-term intermittent fasting may be a safe dietary practice for adult males with MDD.

Stock differentiation of the greater lizardfish Saurida tumbil (Teleostei: Synodontidae) collected along the western coast of the Arabian Gulf and Sea of Oman using meristic characters

Meristic variation among stocks of greater lizardfish Saurida tumbil through the western coasts of the Arabian Gulf and Sea of Oman was examined using meristic characters. Statistical analysis of meristic traits proposed that there is constrained migration of populations of greater lizardfish along the western coast of the Arabian Gulf and Sea of Oman. Overlapping of the two samples from the northern part of the Arabian Gulf (Iraq-Kuwait waters), three samples from the middle region of the Arabian Gulf (Bahrain-Qatar-Saudi Arabia) and two samples from the southern part of the Arabian Gulf/Sea of Oman (United Arab Emirates-Sultanate of Oman) suggested that there are three self-recruiting populations in the studied area. Inspection of the role of each meristic trait variable to Canonical discriminant analysis showed that changes among samples appeared to be linked with the pattern of distribution of water temperature and configuration of current in both the Arabian Gulf and Sea of Oman areas.

The relationship between attendance and academic performance of undergraduate medical students during surgical clerkship

BACKGROUND

The current study aimed to evaluate the previously unexplored correlation between undergraduate medical students' attendance during their surgical clerkship and their academic performance. It also aimed to explore any difference in the attendance rate between male and female students and whether this difference, if present, affects the academic performance.

METHODS

A retrospective descriptive cross-sectional study has been conducted on 331 undergraduate medical students during their surgical clerkships at the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU), Bahrain from September 2018 to June 2020.

RESULTS

There was a positive statistically significant correlation between students' attendance during surgical clerkship and academic performance (r = 0.360, P <  0.01). Mean attendance rate was greater in each increasing category of academic performance: 47.95% in the weak category (less than 65%, n = 42), 57.62% in the good performance category (65% to less than 75%, n = 108), 67.82% in the very good performance category (75% to less than 85%, n = 126), 83.16% in the excellent performance category (85% and above, n = 55). The mean attendance rate of male students was 59.76% (SD = 25.73), compared to 66.92% (SD = 24.30) in the female students. T-test indicated that the difference between the mean attendance of the two groups of the students (male, female) was statistically significant (t = 2.483, p <  0.05). On the other hand, the difference between the mean academic performance for the two groups of students, male & female, (t = 0.284, p = 0.777) was not statistically significant.

CONCLUSIONS

Our study showed a significant relationship between undergraduate medical students' attendance during their surgical clerkship and their academic performance. Further studies are needed to stratify this correlation according to clinical and theoretical teaching activities. No significant difference was observed in academic performance between female and male students.

Health Care Providers' Attitudes and Beliefs on Providing Palliative Care to Patients in Bahrain: Findings From a Qualitative Study

CONTEXT

Present studies suggested that cultural and religious factors, as well as law and policy, may have impeded the advancement of palliative care in the Middle East. Little is known about health care providers' perceptions of palliative care and the barriers to its development in the Gulf Cooperation Council.

OBJECTIVES

To understand health care professionals' attitudes and beliefs regarding palliative care and highlight current practice barriers in Bahrain.

METHODS

Semistructured interviews with 16 health care providers (physicians and nurses) were conducted. Thematic analysis was then performed after interviews were transcribed verbatim.

RESULTS

Health care professionals perceived palliative care as a service only delivered to patients at the end of life. Palliative care was only offered to patients who have been diagnosed with cancer and had exhausted all curative treatments. Do-not-resuscitate orders and code status discussions are not currently practiced. Palliative care decisions are usually decided by patients' families. Middle Eastern culture, health care law and policy, conservative interpretations of Islam, and a lack of professional expertise were identified as barriers.

CONCLUSION

This study unveiled the perceptions of palliative care among health care professionals in a Gulf Cooperation Council country. Six major barriers that hindered palliative care practice were identified. Future health care policy in the region needs to address these barriers within the current health care system while taking culture, religion, and social factors into consideration.

Population genetics of 30 insertion/deletion polymorphisms in the Bahraini population

This paper evaluates the forensic utility of 30 insertion-deletion polymorphism (indel) markers in a sample from the Bahraini population using the Qiagen Investigator DIPplex Kit. Allele frequencies and forensic stats of the 30 indels were investigated in 293 unrelated individuals from different governorates of the Kingdom of Bahrain. None of the markers showed significant deviation from Hardy Weinberg equilibrium except for HLD88 locus and no linkage disequilibrium were detected between all possible pair of the indel loci, assuming that these markers are independent and their allele frequencies can be used to calculate the match probabilities in the Bahraini population. The high power of discrimination (CPD = 0.9999999999998110) and the low combined match probability (CPM = 1.89 × 10-13) indicate that these markers are informative and can be successfully used for human identification in terms of forensics and paternity. Genetic distances and relatedness were displayed through multidimensional plotting and phylogenetic tree using various populations in the region. Our study showed that the Bahraini population was clustered with neighboring countries such as Kuwait and Emirates which indicates that these closely geographical regions share similar allele frequencies and are more genetically related than other reference population studied.

BNT162b2 mRNA COVID-19 Vaccine: First Approval

BNT162b2 (Comirnaty®; BioNTech and Pfizer) is a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine for the prevention of the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. BNT162b2 encodes the SARS-CoV-2 spike protein, the expression of which elicits immune responses against the antigen in recipients. In early December 2020, BNT162b2 received a temporary emergency use authorization (EUA) in the UK and, subsequently, a series of approvals or authorizations for emergency use in Bahrain, Canada, Mexico, Saudi Arabia and the USA. Soon after, BNT162b2 received conditional marketing authorizations in Switzerland (19 December 2020) and the EU (21 December 2020) for active immunization to prevent COVID-19 caused by SARS-CoV-2 in individuals 16 years of age and older. BNT162b2 is administered intramuscularly in a two-dose regimen. This article summarizes the milestones in the development of BNT162b2 leading to these first approvals for the prevention of COVID-19.

Source Apportionment of Ambient Black Carbon During the COVID-19 Lockdown

Black carbon (BC) particles being emitted from mobile and stationary emission sources as a result of combustion activities have significant impacts on human health and climate change. A lot of social activities have been halted during the COVID-19 lockdowns, which has evidently enhanced the ambient and indoor air quality. This paper investigates the possible emission sources and evaluates the meteorological conditions that may affect the dispersion and transport of BC locally and regionally. Ground-level equivalent BC (eBC) measurements were performed between January 2020 and July 2020 at a university campus located in Dammam city of the Kingdom of Saudi Arabia (KSA). The fossil fuel (eBCff) and biomass burning (eBCbb) fractions of total eBC (eBCt) concentrations were estimated as 84% and 16%, respectively, during the entire study period. The mean eBCbb, eBCff, and eBCt concentrations during the lockdown reduced by 14%, 24%, and 23%, respectively. The results of statistical analyses indicated that local fossil fuel burning emissions and atmospheric conditions apparently affected the observed eBC levels. Long-range potential source locations, including Iraq, Kuwait, Iran, distributed zones in the Arabian Gulf, and United Arab Emirates and regional source areas, such as the Arabian Gulf coastline of the KSA, Bahrain, and Qatar, were associated with moderate to high concentrations observed at the receptor site as a result of cluster analysis and concentration-weighted trajectory analysis methods.

Baseline survey of marine sediments collected from the Kingdom of Bahrain: PAHs, PCBs, organochlorine pesticides, perfluoroalkyl substances, dioxins, brominated flame retardants and metal contamination

A baseline survey of sediment contamination was undertaken at 14 locations around the coastline of Bahrain in May 2017, followed by a focused survey of 20 sites, in November 2019. Samples were assessed for industrial pollutants, including metals, PAHs and a suite of organohalogen compounds. The data generated indicated that levels of chemical contaminants were generally low and did not pose a toxicological risk when assessed against commonly applied sediment quality guidelines (SQG). The highest concentrations of PAHs and PCBs were identified in samples collected at coastal sites adjacent to a refinery area known to contain a diverse mix of industry. Tubli Bay, a heavily stressed small bay receiving high loads of sewage effluent, was also identified as an area warranting further investigation with elevated concentrations of BDE209, PFOS and metal contamination. Such data provides a useful baseline assessment of sediment contamination, against which management control measures can be assessed.

Pharmacists' background, interests, barriers, self-perceived competence and confidence to design and undertake pharmacy practice-based research in the GCC geographic area

BACKGROUND

The absence of ability and certainty to design and undertake pharmacy practice-based research (PPBR) was a major issue among pharmacists worldwide as reported in previous literature, despite them having an interest in conducting PPBR. Therefore, this study aimed at highlighting the research background of the Gulf Cooperation Council (GCC) pharmacists which are the six Arab states of the Arabian Gulf, and examining barriers to conducting PPBR. In addition, to determine the self-perceived level of competence and confidence when planning and conducting PPBR.

METHODS

This is a descriptive, cross-sectional questionnaire-based study, performed among pharmacists working in the GCC countries (i.e. Saudi Arabia, United Arab Emirates, Kuwait, Bahrain, Oman and Qatar). A pre-validated questionnaire was distributed to a convenience sample, via distribution of 500 research participation cards to conference attendees. These cards a quick response (QR) code, which should be scanned via mobile phone, to direct all readers to the online survey. All pharmacist delegates attending the conference (i.e. the Saudi International Pharmaceutical Sciences Annual National Conference (SIPHA) and Dubai International Pharmaceuticals and Technologies Conference and Exhibition (DUPHAT) in 2020 and who are working in one of the GCC co. untries as pharmacists were considered. The data were analysed using the Statistical Package for the Social Sciences (SPSS) and Excel software.

RESULTS

Two hundred and fourteen pharmacists were included. Seventy percent of the pharmacists had past PPBR background. Confidence and competence of pharmacists for research skills in regard to employing appropriate inferential statistical test, choosing software for statistical analysis, drafting a comprehensive plan for data analyses and determining appropriate sample size were weak. Highest competence and confidence were seen in preparing a presentation and searching the literature. Pharmacists with previous research experience (K-W: p = 0.001) and training (K-W: p = 0.003) had an overall ability to conduct PPBR. In addition, they had more interest in conducting PPBR (MWU = 3061.500, z = - 4.126, p = 0.000) and in learning about how to do so (MWU = 8698, z = - 1.898, p = 0.050).

CONCLUSIONS

Pharmacists practicing in the GCC geographic area realized the importance of planning and conducting PPBR and were more confident and competent to undertake and contribute to PPBR, except for skills related to statistical analysis. Therefore, training programmes especially for biostatistics and data analysis are mandatory to enhance pharmacists' research capabilities.

Quantification of landfill gas generation and renewable energy potential in arid countries: Case study of Bahrain

Sustainable solid waste management can provide pathways for renewable energy generation. The Kingdom of Bahrain has witnessed burgeoning municipal solid waste (MSW) generation rate due to socio-economic development. The authorities of this Small Island Developing State, which is located in arid environment, plan to produce 5% of the total electricity demand from renewable energy sources by 2025 and then double it to 10% by 2035. The US Environmental Protection Agency's Landfill Gas Emission Model software was used to estimate the generation of biogas from MSW at the Askar Landfill site. Results envisaged that maximum landfill gas (LFG) emission rates will be in 2020 following landfill closure by the end of 2019, as an intentional scenario, with a maximum electricity generation potential of 57.4 GWh that could provide power to 488 households. Revenues from carbon credits and electricity sales were US$97.8 million and US$64.8 million, respectively, for the period 2020-2035. The internal combustion engine exhibited the most viable option based on economic analysis of the cost of alternative LFG energy recovery technologies. Our work highlights the potential to use LFG-to-energy technologies to reduce the carbon footprint in arid climates for developing countries with substantial electricity subsidization.

Bibliometric analysis of road traffic injuries research in the Gulf Cooperation Council region

Background: Despite governmental interventions, the Gulf Cooperation Council (GCC) region continues to experience higher road traffic crash and fatality rates relative to Western nations. This trend suggests a potential disconnect between Road Traffic Injuries (RTI) research and the mitigation measures put in place. Method: Here, we present an in-depth bibliometric analysis to obtain a comprehensive understanding of RTI research in the GCC region. The Web of Science database was used to search and retrieve the relevant articles during the period of 1981-2019. Results: The volume of RTI research increased from 2015-2019, suggesting an increased focus on traffic safety in the GCC region. Saudi Arabia had the highest RTI research productivity level (126 publications); Bahrain had the lowest (7 publications). Inconsistent with its low publication volume, Hammad Medical Corps of Qatar had the highest citation impact score of 16.33. Global collaboration for RTI research was highest between Saudi Arabia and the United States. The most prevalent publication journal for the region was Accident Analysis and Prevention. The most common keywords were " road traffic accidents" and " road traffic injuries"; terms such as " mobile phones", " pedestrian safety", " pedestrians", and " distracted driving" were least common. In the five most productive GCC nations with respect to RTI research (Saudi Arabia, United Arab Emirates, Qatar, Kuwait, and Oman), researchers tended to publish works related to road traffic safety in traffic safety-oriented journals. Conclusions: The quantity and quality of RTI publications in GCC is insufficient to meet the increasing related public health and economic burden in the region. The trends among publication volumes, citations, and impact were inconsistent. There is a lack of research collaboration among the institutions. Most of the research related to RTI is being conducted by researchers with a medical background. Research focusing on pedestrians, cyclists and road user behavior is also inadequate.

Bibliometric analysis of road traffic injuries research in the Gulf Cooperation Council region

Background: Despite governmental interventions, the Gulf Cooperation Council (GCC) region continues to experience higher road traffic crash and fatality rates relative to Western nations. This trend suggests a potential disconnect between Road Traffic Injuries (RTI) research and the mitigation measures put in place. Method: Here, we present an in-depth bibliometric analysis to obtain a comprehensive understanding of RTI research in the GCC region. The Web of Science database was used to search and retrieve the relevant articles during the period of 1981-2019. Results: The volume of RTI research increased from 2015-2019, suggesting an increased focus on traffic safety in the GCC region. Saudi Arabia had the highest RTI research productivity level (126 publications); Bahrain had the lowest (7 publications). Inconsistent with its low publication volume, Hammad Medical Corps of Qatar had the highest citation impact score of 16.33. Global collaboration for RTI research was highest between Saudi Arabia and the United States. The most prevalent publication journal for the region was Accident Analysis and Prevention. The most common keywords were " road traffic accidents" and " road traffic injuries"; terms such as " mobile phones", " pedestrian safety", " pedestrians", and " distracted driving" were least common. In the five most productive GCC nations with respect to RTI research (Saudi Arabia, United Arab Emirates, Qatar, Kuwait, and Oman), researchers tended to publish works related to road traffic safety in traffic safety-oriented journals. Conclusions: The quantity and quality of RTI publications in GCC is insufficient to meet the increasing related public health and economic burden in the region. The trends among publication volumes, citations, and impact were inconsistent. There is a lack of research collaboration among the institutions. Most of the research related to RTI is being conducted by researchers with a medical background. Research focusing on pedestrians, cyclists and road user behavior is also inadequate.

Lung Cancer in Bahrain: Histological and Molecular Features

OBJECTIVES

To define the histological types of primary lung cancer in Bahrain and to determine prevalence of EGFR and ALK mutation in patients with non-small cell lung carcinoma.

METHODS

Data regarding Bahraini patients diagnosed with primary lung cancer between January 2013 and December 2018 were collected from the lab information system in Salmaniya medical complex, Manama, Bahrain.

RESULTS

One hundred and forty-three Bahraini patients were diagnosed with lung cancer in the study period. 67.1% of the patients were male. The mean age at diagnosis was 68 years. The most common histological type was adenocarcinoma (58%), followed by squamous cell carcinoma (19%). EGFR mutation was found in 21.5% of non-small cell lung cancer cases with predominance of exon 19 deletions (29%) and exon 21 nucleic acid changes (21%). ALK mutation was found in 10.5% of EGFR negative patients.

CONCLUSION

Adenocarcinoma is the most common primary lung cancer in Bahrain. Genetic mutations of EGFR and ALK genes were found in 21.5% and 10.5% of adenocarcinoma cases, respectively.

Healthcare providers' perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain

BACKGROUND

Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom.

METHODS

A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs' perceptions of FPDR were generated using the 5-point Likert scale.

RESULTS

Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses.

CONCLUSION

The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.

Interventions promoting physical activity among adults and children in the six Gulf Cooperation Council countries: protocol for a systematic review

INTRODUCTION

Prevalence of overweight, obesity and diabetes are high and rising across the Gulf Cooperation Council (GCC) countries (Oman, Bahrain, Kuwait, Qatar, Saudi Arabia and the United Arab Emirates). In parallel, physical activity (PA) levels are low relative to international standards. PA aids weight control and reduces risk of non-communicable diseases including diabetes and cardiovascular disease. It is likely interventions developed elsewhere will not translate to GCC countries due to unique environmental, social and cultural factors. This protocol is for a systematic review assessing the efficacy of interventions promoting PA within GCC countries among generally healthy adults and children. The primary outcome of interest is change in objectively measured or self-reported PA levels, the secondary outcomes of interest are changes in anthropometry or chronic disease risk factors (eg, blood pressure). Interventions will be compared with no intervention or those of differing PA intensity or duration. The relationships between PA change and the following will be assessed: intervention intensity or duration, season in which intervention occurs, sex, age, nationality and sustainability over time.

METHODS AND ANALYSIS

A systematic search strategy will identify indexed publications on the efficacy of interventions promoting PA. Randomised controlled trials and quasi-experimental studies recruiting predominantly healthy children and adults will be included. Studies of exercise rehabilitation will be excluded. Medline, Embase, Cinahl, Cochrane Library, SportDiscus, Web of Science, Index Medicus for the Eastern Mediterranean Region and Qscience will be searched. Clinical trial registries including the International Clinical Trials Registry Platform, the Iranian Registry of Clinical Trials and ClinicalTrials.gov will be searched for ongoing and unpublished studies. Searches will be ran from database inception until 1 May 2020 and be supplemented by checking references of key articles. Two reviewers will independently screen identified citations then full texts using prespecified inclusion and exclusion criteria. Piloted data extraction forms will be used in duplicate. Inconsistencies in screening or data extraction will be resolved by a third investigator or study author contact. Risk of bias will be independently assessed by two reviewers using validated tools. A narrative summary of findings will be produced supplemented with meta-analyses and exploration of heterogeneity as appropriate.

ETHICS AND DISSEMINATION

The review aims to strengthen the findings of the primary studies it incorporates and explore the impact of setting. It will synthesise existing published aggregate patient data. If publications or data with ethical concerns are identified, they will be excluded from the review. Results of the systematic review will be published in full and authors will engage directly with research audiences and key stakeholders to share findings.

PROSPERO REGISTRATION NUMBER

131817.

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.

The Association Between Clinicopathological Features and Molecular Markers in Bahraini Women With Breast Cancer

INTRODUCTION

Breast cancer (BC) is a heterogenous disease and a major public health burden in Bahrain. Based on hormone receptor status (ER, PR, and HER2), BC can be divided into four molecular subtypes: Luminal A, Luminal B, HER2+, and Triple negative, each of which display distinct clinical behaviour.

PATIENTS AND METHODS

This retrospective study included 216 patients diagnosed with BC between November 2017 and May 2019 at the Bahrain oncology centre. The clinicopathological characteristics (age, size of tumour, grade, lymph node involvement, metastasis) were examined, in addition to immunohistochemical markers (ER, PR, and HER2), and BRCA 1 and 2 status (when indicated). SPSS was used to evaluate the correlation between the molecular subtypes and different clinicopathological features.

RESULTS

BC in Bahraini women was relatively of large size (68.5% larger than 20mm), with frequent metastasis to the lymph nodes (57.4%). The mean age at diagnosis was 51.8 years ±11.5, with invasive ductal carcinoma (IDC) being the most common histological type (90.3%). The most common molecular subtype was Luminal A (60.2%), followed respectively by luminal B (19%), triple negative (13.4%) and HER-2 (7.4%).

DISCUSSION

Significant differences were found between the subtypes regarding grade (p=0.001) and BRCA mutation status (0.001). Triple negative subtype was associated with highly-aggressive behaviour compared to the other subtypes. It presented at younger age, with high grade, large tumor size, and predominance to distant metastasis. It was also linked with positive BRCA mutations.

CONCLUSION

A significant proportion of Bahraini females with BC present with aggressive features (i.e. younger age, poorly differentiated tumors, and lymph node involvement). Expectedly this was associated with underlying aggressive molecular subtypes (namely TNBC). The aggressive properties of such molecular subtype mandate further molecular testing to identify more accurate prognostic and predictive targets for effective treatment and risk reduction strategies.

Can Bahraini patients accept e-health systems?

PURPOSE

The purpose of this paper is to examine whether Bahraini individuals accept e-health system and the prominent factors affecting e-health system adoption in Bahrain.

DESIGN/METHODOLOGY/APPROACH

The authors adopted a quantitative and qualitative approach, i.e., a self-administered questionnaire, unstructured and a semi-structured interview, which were used to collect the data. A questionnaire was distributed to Bahraini residents selected randomly. The framework was based on the technology acceptance model (TAM) and theory of reasoned action (TRA). Important variables from both the TAM model and TRA theory were extracted and jointly used to build the research model.

FINDINGS

The findings indicated that the most factors affecting e-health adoption are trust, health literacy and attitude. Additionally, people in the private and government sectors understand e-health benefits.

PRACTICAL IMPLICATIONS

If healthcare professionals understand the factors affecting e-health system adoption from an individual and organisational perspective, then nurses, pharmacists and others will be more conscious about e-health and its adoption status.

ORIGINALITY/VALUE

E-health system adoption has become increasingly important to governments, individuals, and researchers in recent years. A novel research framework, based on TAM and TRA, was used to produce a new integrated model.

Knowledge towards human papilloma virus (HPV) infection and attitude towards its vaccine in the Kingdom of Bahrain: cross-sectional study

OBJECTIVES

To determine the level of awareness of human papilloma virus (HPV) infection and to assess attitudes towards receiving the vaccine among men and women in Bahrain.

DESIGN

A cross-sectional study. An interview-based questionnaire was used to measure HPV knowledge and attitude towards HPV vaccine.

SETTING

Ten randomly selected primary health centres (PHCs) in the Kingdom of Bahrain.

PARTICIPANTS

408 PHC attendees, including 268 women and 140 men aged 18-65 years. Only residents from Bahrain and English or Arabic speakers were invited to participate.

PRIMARY AND SECONDARY OUTCOME MEASURES

Extent of awareness of HPV infection, acceptance of HPV vaccine and describing the results in association to gender, educational level and other demographics.

RESULTS

A response rate of 91.4% was achieved, with a majority being female responders as opposed to male responders (65.7% vs 34.3%, respectively). Only 13.5% of the participants had heard of HPV, with female gender and employment in the health sector (p<0.001 for both) having a significant association with awareness of HPV. The majority of the participants (76%) were willing to take the vaccine if recommended, with 84.8% believing that both genders should be vaccinated. However, 48.5% were concerned about possible side effects from the vaccine and 83.6% wanted reassurance that the vaccine will protect against HPV. More than 90% of the participants agreed on the need for educating the community about the HPV infection.

CONCLUSION

Despite the limited knowledge about HPV infection among the study's participants, there is a favourable attitude towards the HPV vaccine. These data can support the initiation of a nationwide HPV immunisation programme.

Population genetic data of the 21 autosomal STRs included in GlobalFiler kit of a population sample from the Kingdom of Bahrain

Bahrain’s population consists mainly of Arabs, Baharna and Persians leading Bahrain to become ethnically diverse. The exploration of the ethnic origin and genetic structure within the Bahraini population is fundamental mainly in the field of population genetics and forensic science. The purpose of the study was to investigate and conduct genetic studies in the population of Bahrain to assist in the interpretation of DNA-based forensic evidence and in the construction of appropriate databases. 24 short-tandem repeats in the GlobalFiler PCR Amplification kit including 21 autosomal STR loci and three gender determination loci were amplified to characterize different genetic and forensic population parameters in a cohort of 543 Bahraini unrelated healthy men. Samples were collected during the year 2017. The genotyping of the 21 autosomal STRs showed all of the loci were in Hardy-Weinberg Equilibrium (HWE) after applying Bonferroni’s correction. We also found out no significant deviations from LD between pairwise STR loci in Bahraini population except when plotting for D3S1358-CSF1PO, CSF1PO-SE33, D19S433-D12S391, FGA-D2S1338, FGA-SE33, FGA-D7S820 and D7S820-SE33. The SE33 locus was the most polymorphic for the studied population and THO1 locus was the less polymorphic. The Allele 8 in TPOX scored the highest allele frequency of 0.496. The SE33 locus showed the highest power of discrimination (PD) in Bahraini population, whereas TPOX showed the lowest PD value. The 21 autosomal STRs showed a value of combined match probability (CMP) equal to 4.5633^E-27, and a combined power of discrimination (CPD) of 99.99999999%. Off-ladders and tri-allelic variants were observed in various samples at D12S391, SE33 and D22S1045 loci. Additionally, pairwise genetic distances based on FST were calculated between Bahraini population and other populations extracted from the literature. Genetic distances were represented in a non-metric MDS plot and clustering of populations according to their geographic locations was detected. Phylogenetic tree was constructed to investigate the genetic relatedness between Bahraini population and the neighboring populations. Our study indicated that the twenty-one autosomal STRs are highly polymorphic in the Bahraini population and can be used as a powerful tool in forensics and population genetic analyses including paternity testing and familial DNA searching.

Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain

BACKGROUND AND OBJECTIVES

In Bahrain, maintaining life support at all costs is a cultural value considered to be embedded in the Islamic religion. We explore end-of-life decision making for brain dead patients in an Arab country where medical cultures are dominated by Western ideas and the lay culture is Eastern.

METHODS

In-depth interviews were conducted from February to April 2018 with 12 Western-educated Bahraini doctors whose medical practice often included end-of-life decision making. Discussions were about who should make withdrawal of life support decisions, how decisions are made and the context for decision making. To develop results, we used the inductive method of thematic analysis.

RESULTS

Informants considered it difficult to engage non-medical people in end-of-life decisions because of people's reluctance to talk about death and no legal clarity about medical responsibilities. There was disagreement about doctors' roles with some saying that end-of-life decisions were purely medical or purely religious but most maintaining that such decisions need to be collectively owned by medicine, patients, families, religious advisors and society. Informants practised in a legal vacuum that made their ethics interpretations and clinical decision making idiosyncratic regarding end-of-life care for brain dead patients. Participants referred to contrasts between their current practice and previous work in other countries, recognising the influences of religious and cultural dimensions on their practice in Bahrain.

CONCLUSIONS

End-of-life decisions challenge Western-trained doctors in Bahrain as they grapple with aligning respect for local culture with their training in the ethical practice of Western medicine.

Quantifying exposure levels of coastal facilities to oil spills in Bahrain, Arabian Gulf

The Arabian Gulf is considered as a hub for global oil industry. Thus the Arabian Gulf marine environment is under permanent threat from oil spills due to oil exploitation, production, and transportation. Oil pollution poses adverse effects on marine environment, society, and economy. Oil spill incidents that occurred in Bahrain caused damage to marine environment and threatened the vital coastal facilities along the coastline of Bahrain. This study determined the exposure levels of coastal facilities in Bahrain to oil spills. The General NOAA Operational Modeling Environment (GNOME) model was validated and applied to hypothetical oil spill scenarios. The modeling results showed that the coastal facilities on the north-eastern coastline are more probable to be hit by oil spills, while those on the northern coastline are susceptible to receive more quantity of oil. The time required for oil to reach the western coastline is shorter compared to the other coastlines. The modeling outcomes can be utilized in contingency planning, setting the protection priorities and allocation and mobilization of response resources in both governmental and private sectors. The implications of the present study could be applied on a regional scale to ensure an integrated response to combat and or minimize oil pollution in the Arabian Gulf.

A qualitative exploration of clozapine prescribing and monitoring practices in the Arabian Gulf countries

Clozapine is considered as the first line antipsychotic for treatment resistant schizophrenia (TRS). Worldwide reports indicate an overall underutilization of clozapine in patients experiencing TRS. This study aims to understand the prescribing practices, monitoring strategies and barriers to the use of clozapine in the Arabian Gulf (AG) region. Qualitative methodology was employed to explore mental health professionals' experience with clozapine prescribing practices. Semi-structured, individual in-depth interviews were conducted. All interviews were analyzed using a thematic approach. A total of 13 interviews were conducted with participants from six AG countries. Four major themes emerged from the analysis in relation to clozapine prescribing and monitoring practices, clozapine use guidelines, and barriers to the use of clozapine. Thematic analysis revealed a tendency to under prescribe clozapine in the AG region, which appears to be predominantly influenced by prescriber-related barriers and less likely due to the lack of a nation-wide hematological monitoring program. Future studies should explore strategies for overcoming the barriers identified.

Public awareness of adverse drug reaction medical safety

Purpose The purpose of this paper is to contribute to the literature by assessing factors that typically engender adverse drug reactions (ADRs) jeopardizing medical safety. These factors are population knowledge, clarity in disclosure of the risks inhering ADRs and ADRs incidence. It seeks to minimize negative effect by early identification of drug reactions. Design/methodology/approach On the one hand, the study employs a model that shows relationships between various factors, and on the other hand, ADRs medical safety in the public healthcare sector. Findings Clarity of consultancy services in public healthcare significantly impact ADR medical safety. Population and healthcare provider education on ADRs medical safety are necessities. Implementation of an ADR reporting system in every healthcare institute is essential. This helps service providers to give a clear and accurate information to patients. It also makes patients more aware of consequences of ADRs. Research limitations/implications Time, place and sampling method are found to be the main study limitations. Researchers should take into their consideration the significant relationships between the factors and ADRs medical safety to improve level of awareness in the healthcare public sector. Practical implications Ways to improve ADR medical safety in healthcare sector are underscored. Healthcare service providers and professionals need to take into account the stipulated study factors in order to improve medical safety and reduce unnecessary medical costs. Originality/value Very few studies have been conducted on this topic; most of those that have been conducted were undertaken in western countries. This study assesses the level of healthcare safety in the country and suggests mechanisms to elevate that level.