A review of pharmacogenomics studies assessing the knowledge and attitudes of physicians and pharmacists across the Arab and Middle Eastern Region

The principal goal of pharmacogenomics (PGx) is to achieve the highest drug efficacy while maintaining a low toxicity profile. Historically, health care systems used to target treatment for all individuals with the same diagnosis using a standardized medication or dose that fits all. However, a recent pattern in medicine has emerged focusing on personalized and precision medicine. For effective implementation of PGx, there is a need for more collaborations between all the stakeholders in the healthcare system to integrate the pharmacogenetics concept into practice. When it comes to the knowledge and attitudes towards pharmacogenomics, the majority of medical professionals, including pharmacists and physicians, appear to lack appropriate knowledge and training. Across the Middle East and Arab Region, only few studies have addressed this topic. The current review objective is to shed light on pharmacists’ and physicians’ knowledge and attitudes towards PGx practice in the UAE, Arab and the Middle East region as compared to the rest of the world. Moreover, highlighting the role of the pharmacists in the application of PGx services and the educational challenges that are faced. Proposed solutions to improve the knowledge gaps will also be discussed. We also aim to provide the international readers as well as the local researchers with a summary of the trends and distribution of the results across these countries. (AU)

Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review

Background: The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology. Objective: The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region. Methods: A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Results: Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies. (AU)

Perspectives of the community in the developing countries toward telemedicine and pharmaceutical care during the COVID-19 pandemic

Background: Pharmaceutical care (PC) services have expanded in recent years, resulting in improved patient outcomes. However, such PC services are currently available for free in the majority of Arabic countries. During the coronavirus disease (COVID-19) pandemic, telemedicine is especially beneficial since it allows for continuity of care while allowing for social distancing and minimizing the risk of infection. Objective: To assess the community’s attitude, opinion, and willingness to pay for telemedicine and PC services during COVID-19 pandemic, as well as to create a website provision for telemedicine and PC services. Methods: This cross-sectional study was conducted, over five months (December 2020– April 2021), among the general population in Arabic countries, excluding pharmacists, physicians, and pharmacy students. Results: A total of 1717 participants were involved, most of them were from Jordan (52.2%) and Iraq (24.8%). Sixty two percent of participants seek pharmacists’ advice whenever they have any medication changes and 45.1% of the participants agreed with the idea of paying pharmacists to decrease medication errors. Interestingly, 89.5% of participants encouraged the idea of creating a website that provides a PC, and 35.5% of them would pay for it. The failure to document the medical information of the patients had most applicants’ agreement as a reason of medical errors (M=4.17/5, SD=0.787). More than three-quarters of participants agreed that creating a database containing the patients’ medical information will reduce medical errors. Conclusion: From a patients’ perspective, this study suggests a large patient need for expanding PC services in Arabic countries and introduces a direct estimate of the monetary value for the PC services to contribute to higher savings. The majority of participants supported the idea of creating a website provision of telemedicine and PC services, and a considerable proportion of them agreed to pay for it. (AU)

Evaluating the knowledge, attitudes, and uptake of the influenza vaccine in healthcare professionals: A cross-sectional study from the United E

Background: Influenza, a yearly epidemic, can present with a wide array of symptoms ranging from mild rhinorrhoea and cough to life-threatening superadded bacterial infections. It affects the lives of around 12.5% of the world’s population every year and accounts for almost half a billion deaths. With growing populations, these numbers will follow a similar growth resulting in increased morbidity and mortality. Currently, the recommended method to prevent influenza is through the administration of a yearly vaccine that entails the suspected strains of the virus for the year and region. Objective: This study aims to explore the knowledge, attitudes, and practices of the health care professionals in the United Arab Emirates (UAE) regarding Influenza vaccination. Methods: A cross-sectional study, utilizing a self-administered questionnaire, was distributed amongst health care professionals in the four largest emirates in the UAE, via convenience sampling. 417 responses were completed and analysed using SPSS-24. Results: 54.1% (n=225) of participants continue going to work while being sick despite 67.6% (n=282) reporting they are aware of the recommendations published by the Centers for Disease Control and Prevention (CDC). Multiple linear regression showed that age and profession were the only significant predictor of influenza vaccine knowledge. 54.2% (n=226) of the participants reported receiving the vaccine; of those, only 38.9% (n=88) receive it annually. One of the most commonly reported barriers to taking the vaccine was the uncertainty of its effectiveness. Those using a reminder system were 2.044 times more likely to take the vaccine regularly. Conclusion: This study demonstrates that the attitudes and practices towards taking the influenza vaccine as recommended are suboptimal. Campaigns targeting health care professionals regarding the influenza vaccine and the CDC recommendations would perhaps positively skew the results in the future (AU)

Public knowledge, beliefs, psychological responses, and behavioural changes during the outbreak of COVID-19 in the Middle East

Objective: To evaluate the knowledge, believes, psychological and behavioural impact of COVID-19 on the general population in the Middle East, exploring how it impacted public lives. Methods: A descriptive cross-sectional online survey was sent to a convenience sample in the Middle East through social media (Facebook and WhatsApp) between 16th of June and 30th of June 2020. The questionnaire was designed to collect the demographic, participant’s source of information regarding COVID-19, knowledge and believes about COVID-19, the psychological consequences of COVID-19, impact of COVID-19 on participant’s behaviour. The final version of the questionnaire was further tested for content validity by experts in the field. Results: A total of 2,061 participants completed the survey, with the majority being females (n=1394, 67.6%), from urban areas (n=1896, 92%) and the majority were from countries of The Levant (n=1199, 58.1%), followed by the Arabian Peninsula (n=392, 19.1%), Iraq (n=300, 14.6%) and Egypt (n=138, 6.7%). Few participants (3.0%) reported to have been infected and many (n=1847, 89.6%) were committed to quarantine at home. Social media platforms were the most common sources of information (41.2%). Many (63%) believed that COVID-19 is a biological weapon and were afraid of visiting crowded places (85%). The majority avoided public facilities (86.9%) such as prayer places and believed that the news about COVID-19 made them anxious (49.5%) (AU)

The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

Background/Objective: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders

Introducción/Objetivo: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. Método: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. Resultados: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. Conclusiones: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos

Obesity among adolescents in five Arab countries; relative to gender and age / La obesidad entre los adolescentes en cinco países árabes; en relación con el género y la edad

Objective: To determine the prevalence of overweight and obesity among adolescents in five Arab countries, relative to age and sex. Methods: A multistage stratified random sampling technique was used to select the secondary school students from five Arab countries (Kuwait, Libya, Palestine, Syria and United Arab Emirates). The total sample was 3302 (1584 males, 1718 females). Weight and height were measured, and body mass index was used to calculate the proportion of overweight and obesity based on the International Obesity Task Force standard (IOTF). Results: Kuwaiti adolescents showed the highest prevalence of overweight and obesity among both males and females, compared to their counterparts in other countries. There was no trend in the proportion of overweight and obesity by age in any of the countries included in the study. Conclusion: Adolescent obesity has reached a critical level in the Arab countries. Therefore there is an urgent need to establish programs to prevent and control obesity among schoolchildren in these countries (AU)

Objetivo: determinar la prevalencia de sobrepeso y obesidad en adolescentes de cinco países árabes, en relación con la edad el sexo. Métodos: se empleó una técnica de muestreo aleatorio, estratificado y por etapas para seleccionar a estudiantes de secundaria de cinco países árabes (Kuwait, Libia, Palestina, Siria y los Emiratos Árabes Unidos). La muestra total fue de 3.302 (1.584 chicos, 1.718 chicas). Se midieron el peso y la talla y se utilizó el índice de masa corporal para calcular la proporción de sobrepeso y obesidad basándonos en el estándar de la International Obesity Task Force (IOTF). Resultados: los adolescentes kuwaitíes mostraron la mayor prevalencia de sobrepeso y obesidad tanto en chicas como en chicos, en comparación con otros países. No hubo una tendencia en la proporción de sobrepeso y obesidad por sexo en ningún país de los incluidos en el estudio. Conclusión: la obesidad en adolescentes ha alcanzado un nivel crítico en los países árabes. Por lo tanto, existe la necesidad urgente de establecer programas para prevenir y controlar la obesidad en los escolares de estos países (AU)

Societal perspectives on community pharmacy services in West Bank - Palestine / Perspectivas sociales de los servicios de farmacia comunitaria en West Bank-Palestina

Understanding the public's view of professional competency is extremely important; however little has been reported on the public’s perception of community pharmacists in Palestine Objectives: To determine the perception of Palestinian consumers of the community pharmacist and the services they offer Method: This project used the survey methodology administered by structured interviews to consumers who attended the 39 randomly selected pharmacies, in six main cities in Palestine. The questionnaire had range of structured questions covering: Consumers’ patronage patterns, consumers’ interaction with community pharmacists, consumers’ views on how the pharmacist dealt with personal health issues, procedure with regard to handling private consultations. Results: Of 1,017 consumers approached, 790 consumers completed the questionnaire (77.7 %). Proximity to home and presence of knowledgeable pharmacist were the main reasons for patients to visit the same pharmacy. Physicians were identified as the preferred source of advice by 57.2% and pharmacists by 23.8%. Only 17% of respondents considered pharmacists as health professionals who know a lot about drugs and are concerned about and committed to caring for the public. In addition, 49% indicated that pharmacists spoke more quietly cross the counter during counseling and almost one third reported that the pharmacist used a private area within the pharmacy. The majority of respondents would be happy to receive different extended services in the community pharmacy like blood pressure monitoring. Conclusions: Palestinian consumers have a positive overall perception of community pharmacists and the services they offer. Awareness should be created amongst the public about the role of pharmacist and the added value they can provide as health care professional. There is a need to consider privacy when giving patient counseling to increase user satisfaction (AU)

Entender la visión del público de la competencia profesional es extremamente importante; sin embargo, se ha comunicado poco sobre la percepción del público sobre la farmacia comunitaria en Palestina. Objetivos: Determinar la percepción de los consumidores palestinos de farmacias comunitarias y los servicios que éstas ofrecen. Métodos: Este proyecto utilizó la metodología de encuesta administrada a través de entrevistas estructuradas a consumidores que visitaron 39 farmacias aleatoriamente seleccionadas en las seis principales ciudades de Palestina. El cuestionario tenía una serie de preguntas estructuradas que cubrían: patrones de clientela de los consumidores, interacción de los consumidores con los farmacéuticos comunitarios, visión de los consumidores de como los farmacéuticos tratan sus problemas personales, procedimientos relativos al manejo de las consultas privadas. Resultados: De los 1017 consumidores que se aproximaron, 790 completaron el cuestionario (77,7%). La proximidad a casa y la presencia de un farmacéutico reconocido fueron las dos razones principales de que los pacientes visitasen la misma farmacia. Los médicos fueron identificados como la fuente preferida de consejo por el 52,2% y los farmacéuticos por el 23,8%. Sólo el 17% de los respondentes consideró a los farmacéuticos con profesionales de la salud que sabían mucho sobre medicamentos y que se preocupaban y se comprometían en cuidar del público. Además, el 49% hablaba más bajo sobre el mostrador durante el consejo y casi un tercio comunicó que el farmacéutico usó un área privada en la farmacia. La mayoría de los entrevistados estarían contentos por recibir varios servicios ampliados de las farmacias comunitarias con la monitorización de presión arterial. Conclusiones: Los consumidores palestinos tienen una percepción general positiva de los farmacéuticos comunitarios y los servicios que ofrecen. Se debería aumentar el conocimiento del público sobre el papel del farmacéutico y el valor añadido que pueden proporcionar como profesionales de la salud. Para aumentar la satisfacción del usuario, es necesario considerar la privacidad cuando se proporciona consejo (AU)

The Food Dome; dietary guidelines for Arab countries / La Cúpula alimentaria: guías dietéticas para los países árabes

Dietary guidelines are important tool for selection a healthy diet. There is no special dietary guidelines for Arab people. Health Institutes are mainly using the Western dietary guidelines, such as American Food Pyramid. The objective of this paper therefore, was to summarize the steps taken by Arab Centers for Nutrition to establish ‘Food Dome’, the dietary guidelines for the Arab countries. The development of Food Dome was done in eight steps as: 1) Identification of the current nutritionproblems,2) Identification of current food consumption patterns, 3) Identification of food groups used in the region, 4) Identification of specific foods within each group, 5) Estimation of nutritional profile for each group,6) Identification the serving sizes for each group, 7) Incorporating physical activity into the food guidelines, 8)Identification of the pictorial illustration for the food guidelines. This Food Dome provides dietary guidelines for the Arab people to prevent the risk of diet-related diseases. It is also a useful tool for nutrition education. However, more testing in the target population is needed to evaluate the understanding of messages delivered by this Food Dome (AU)

Las guías dietéticas son una herramienta importante para las elección de una dieta saludable. No existen guías dietéticas específicas para las personas de origen árabe. Los Institutos de Salud utilizan principalmente las guías dietéticas occidentales, como la Pirámide americana de la alimentación. Por lo tanto, el objetivo de este artículo es el de resumir los pasos dados por los Centros Árabes para la Nutrición para establecer la "Cúpula alimentaria", las guías dietéticas para los países árabes. El desarrollo de la Cúpula alimentaria se realizó en ocho pasos: 1) Identificación de los problemas nutricionales actuales; 2) Identificación de los patrones actuales de consumo de alimentos; 3) Identificación de los grupos de alimentos usados en la región; 4) Identificación de alimentos concretos dentro de cada grupo; 5) Estimación del perfil nutricional para cada grupo; 6) Identificación las raciones servidas para cada grupo; 7) Incorporación de la actividad física dentro de las guías alimentarias; 8) Identificación de la ilustración pictórica para las guías alimentarias. Esta Cúpula alimentaria proporciona unas guías dieté-ticas para la gente árabe para prevenir el riesgo de las enfermedades relacionadas con la dieta. También es una herramienta útil para la educación nutricional. Sin embargo, se necesitan pruebas adicionales en la población diana para evaluar la comprensión de los mensajes suministrados por esta Cúpula alimentaria (AU)

La dermatología en los servicios de atenciónprimaria: situación en Oriente Medio / Dematology practice in primary health care services: where do we stand in the Middle East

Antecedentes: Durante las dos últimas décadas se ha producido una expansión clara de los servicios de atención primaria en Oriente Medio. Como consecuencia, ha aumentado el número de consultas por trastornos de la piel realizadas por los médicos de atención primaria (MAP). Sin embargo, carecemos de información respecto al nivel de conocimientos de los MAP en este campo. Objetivo: El objetivo de nuestro estudio es valorar la capacidad de los médicos de atención primaria con o sin formación en dermatología para identificar, diagnosticar y tratar los trastornos de la piel. Materiales y métodos: Se pidió a los médicos de las clínicas de atención primaria del hospital de la universidad que contestaran a un cuestionario con múltiples respuestas sobre varias dermatosis. Éstas se agruparon en: comunes, infrecuentes y raras. Las cuestiones incluían la identificación de la descripción correcta de la lesión de la piel, diagnóstico, tratamiento y deseo de remisión. También se valoraron las características demográficas de los médicos. Resultados: Participaron 19 MAP. Los 8 MAP que habían tenido formación específica sobre dermatología tuvieron mejor rendimiento que los MAP que no habían recibido esta formación (p=0,04). Los MAP fueron capaces de hacer un diagnóstico correcto más frecuentemente para las dermatosis comunes que para las dermatosis no frecuentes o raras (p=0,001). Por otra parte, cuando se les pidió que reconocieran una descripción correcta de la lesión de la piel, los MAP hicieron una descripción más correcta de las dermatosis raras y menos de las comunes (p=0,04).Conclusión: Los MAP con un corto período de formación clínica específica de dermatología son mejores en la identificación, diagnóstico y tratamiento de los trastornos de la piel que aquellos que no tienen esta formación. Debería considerarse la posibilidad de dar dicha formación a los MAP para proporcionar una atención sanitaria más eficaz (AU)