Predictors and health outcomes of tobacco smoking among the population of Gaza: A large-scale study.

Tobacco smoking, a significant public health concern globally, is associated with a rise in noncommunicable diseases and preventable deaths, with pronounced impacts in conflict zones like Gaza. A study in Gaza focused on individuals over 40 years of age, aiming to identify predictors of tobacco use and its links to diseases like coronary artery disease, chronic lung disease, and stroke. The research, based on the Gaza NCD study data with 4576 participants and a 96.6% response rate, found an overall tobacco smoking prevalence of 19.4%, with higher rates among men. Adjusting for various factors, the study revealed significant associations between cigarette smoking in men and adverse health outcomes, such as coronary artery disease and chronic lung disease. However, after adjusting for independent variables, shisha smoking in men showed no association with these health outcomes. In conflict-affected regions like Gaza, this large-scale study sheds light on predictors of cigarette and shisha smoking and their impact on health outcomes, offering valuable insights for researchers, public health officials, healthcare professionals, and policymakers. The findings aid in predicting smoking prevalence, addressing current health challenges, and mitigating potential health and financial burdens associated with tobacco use in conflict zones.

Neurocysticercosis in non-endemic regions: The experience of Qatar.

Objective: To describe the occurrence and features of Neurocystircercosis (NCC) in Qatar. Background: Qatar has a mixed population of natives and expats. NCC is not endemic to the region, but clinical practice suggests its occurrence in large numbers. Design/ methods: A database was created to summarize information retrospectively collected on patients with NCC seen through the national health system (HMC) between 2013 and 2018. We identified demographic and disease related variables (clinical manifestations, investigative findings, treatment and outcome) for all patients. Results: Out of 420 identified NCC patients, 393 (93.6%) were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% included pathology at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non enhancing lesions. Albendazole was received by 55% of patients, and phenytoin was the most prescribed anti-seizure drug (57%). When long term follow up was available, 70% of the patients presenting with seizures were completely seizure free. Conclusion: NCC is prevalent in Qatar, mainly within the large Southeast Asian immigrant population. NCC is currently a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with intraparenchymal single lesion shares a large proportion of our cohort.

Corneal nerve loss predicts dementia in patients with mild cognitive impairment.

OBJECTIVES: This study compared the utility of corneal nerve measures with brain volumetry for predicting progression to dementia in individuals with mild cognitive impairment (MCI). METHODS: Participants with no cognitive impairment (NCI) and MCI underwent assessment of cognitive function, brain volumetry of thirteen brain structures, including the hippocampus and corneal confocal microscopy (CCM). Participants with MCI were followed up in the clinic to identify progression to dementia. RESULTS: Of 107 participants with MCI aged 68.4 ± 7.7 years, 33 (30.8%) progressed to dementia over 2.6-years of follow-up. Compared to participants with NCI (n = 12), participants who remained with MCI (n = 74) or progressed to dementia had lower corneal nerve measures (p < 0.0001). Progressors had lower corneal nerve measures, hippocampal, and whole brain volume (all p < 0.0001). However, CCM had a higher prognostic accuracy (72%-75% vs 68%-69%) for identifying individuals who progressed to dementia compared to hippocampus and whole brain volume. The adjusted odds ratio for progression to dementia was 6.1 (95% CI: 1.6-23.8) and 4.1 (95% CI: 1.2-14.2) higher with abnormal CCM measures, but was not significant for abnormal brain volume. INTERPRETATION: Abnormal CCM measures have a higher prognostic accuracy than brain volumetry for predicting progression from MCI to dementia. Further work is required to validate the predictive ability of CCM compared to other established biomarkers of dementia.

Factors associated with suicidality among school attending adolescents in morocco.

Suicide amongst adolescents is a growing epidemic accounting for 6% of all adolescent deaths. Even though 79% of adolescent suicides occur in low- and middle-income countries, where suicide is the second leading cause of death, research is relatively lacking. As such, we aim to gain a greater understanding of suicide in said countries by assessing ideation and planning and associated factors in Morocco. Global Schools Health Survey data was analyzed. Approximately 14.4 and 12.9% reported ideation and planning respectively during the prior year in 2016, indicating a decrease from the reported rates of ideation of 16.0 and 17.0% and planning of 14.6 and 15.0% in 2006 and 2010 surveys respectively. Increased ideation was found to be positively associated with identifying as female and increasing age, whereas planning was positively associated with a lower educational level and living in a rural area. Both were positively associated with increased hunger frequency. Several factors increased the likelihood of ideation: bullying, feeling lonely, current cigarettes smoking, and current marijuana use. Studying factors associated with suicide is challenging, alternatively, factors affecting ideation and planning can be assessed. Sociocultural differences may impact trends in a specific region, though countries in said region may have comparable trends. The study adds to the limited data available in the region. Reverse causality and under-reporting could be the main limitations of this study. Interventions taking into account those results should be tested to decrease such a prevalence.

The Impact of the COVID-19 Lockdown "Home Quarantine" on the Physical Activity and Lifestyle of Children in Qatar.

Background: Several studies have investigated how the coronavirus disease 2019 (COVID-19) pandemic impacted children's lifestyle. To our knowledge, this is the first study that assesses the impact of quarantine on physical activity, screen time, sleep, and diet in children aged 5 to 12 in Qatar. Methods: Cross-sectional data from an online survey distributed in Qatar was analyzed. The survey measured the parents' or caregivers' assessment on the change in the child's physical activity, sleep, screen time, and diet between the two periods (before quarantine and during quarantine). The data was analyzed using frequency distributions, paired t-test and McNemar's test. Results: Data from 144 respondents were analyzed. Due to the quarantine, the total weekly average hours of physical activity significantly decreased with a greatest reduction for the school and after school durations. Only 4.5% of the children were engaging in at least 60 minutes of physical activity per day (in contrast to 25.6% prior to quarantine). The reported barriers for physical activity were screen time for school (52.8%) and leisure (51.4%). There was a significant increase in the total number of main meals per day, with a higher consumption of unhealthy food. The majority of the children had their bedtime and waketime shifted to later because of the quarantine. The parents' or caregivers' satisfaction with the child's lifestyle during quarantine showed that 49.1% were disappointed or very disappointed. Also, 53.8% described their child's mental health as "better before quarantine." Conclusions: Quarantine had a negative impact on the lifestyle of children in Qatar. When implementing restrictions, authorities should consider some interventions to counterpart such impact.

Assessment of an intensive education program for pharmacists on treatment of tobacco use disorder using an objective structured clinical examination: a randomized controlled trial.

BACKGROUND: Tobacco use is one of the major public health threats globally. Community pharmacists are uniquely positioned to offer tobacco cessation services owing to their easy accessibility by the public. To prepare Qatar community pharmacists to develop the competencies and skills required to offer smoking cessation services, an intensive tobacco control education program was designed and implemented. The study aimed to assess the impact of the tobacco education program on the pharmacists' skills and competence. METHODS: A random sample of community pharmacists in Qatar was chosen for participation in the program. Consenting participants were randomly assigned to either intervention or control groups. The intervention group received an intensive education program on treatment of tobacco-use disorder, while a short didactic session on a non-tobacco-related topic was delivered to the control group. The pharmacists' tobacco cessation skills and competencies were assessed using an Objective Structured Clinical Examination (OSCE). RESULTS: A total of 54 and 32 community pharmacists in the intervention group and the control group, respectively, completed the OSCE. The intensive tobacco education group achieved significantly higher total scores than the control group in all the OSCE cases. Specifically, the mean total scores for the intervention group were 15.2, 15.3, 14.2, 14.6, 16.3, and 15.2 compared to 8.8, 6.2, 7.7, 9.2, 8.3, and 11.3 for the control group (p < 0.001) for cases one to six respectively. CONCLUSION: The study demonstrated that an intensive tobacco cessation education program can improve pharmacists' tobacco cessation skills and increase their tobacco cessation counseling abilities. TRIAL REGISTRATION: Clinical Trials NCT03518476 ( https://clinicaltrials.gov/ct2/show/NCT03518476 ) Registration date: May 8, 2018.

Loss of corneal nerves and brain volume in mild cognitive impairment and dementia.

Introduction: This study compared the capability of corneal confocal microscopy (CCM) with magnetic resonance imaging (MRI) brain volumetry for the diagnosis of mild cognitive impairment (MCI) and dementia. Methods: In this cross-sectional study, participants with no cognitive impairment (NCI), MCI, and dementia underwent assessment of Montreal Cognitive Assessment (MoCA), MRI brain volumetry, and CCM. Results: Two hundred eight participants with NCI (n = 42), MCI (n = 98), and dementia (n = 68) of comparable age and gender were studied. For MCI, the area under the curve (AUC) of CCM (76% to 81%), was higher than brain volumetry (52% to 70%). For dementia, the AUC of CCM (77% to 85%), was comparable to brain volumetry (69% to 93%). Corneal nerve fiber density, length, branch density, whole brain, hippocampus, cortical gray matter, thalamus, amygdala, and ventricle volumes were associated with cognitive impairment after adjustment for confounders (All P's < .01). Discussion: The diagnostic capability of CCM compared to brain volumetry is higher for identifying MCI and comparable for dementia, and abnormalities in both modalities are associated with cognitive impairment.

Primary care physicians' knowledge of travel vaccine and malaria chemoprophylaxis and associated predictors in Qatar.

BACKGROUND: In an era of globalization, travel-related illnesses have become a focus of public health concern, especially in the Arab region where travel health services are insufficient and not well-established. This study was conducted to assess travel vaccine and malaria chemoprophylaxis knowledge and associated predictors among primary care physicians (PCPs) in Qatar. METHODS: This was a cross-sectional study. A structured questionnaire was used to collect data from all physicians working at all 27 primary healthcare centers from March 1st to May 31st 2020. Knowledge scores were computed and a multivariable linear regression model was built to identify predictors of higher knowledge. RESULTS: A total of 364 PCPs participated (response rate of 89.2%). Participants' mean age was 44.5 (±7.8) with 59.1% being males. Their overall mean knowledge score was 9.54/16 (±3.24). Significant predictors of higher knowledge included: aged 40-49 years (1.072; 95% CI: 0.230, 1.915) , had medical degree from non-Arab countries (0.748; 95% CI: 0.065, 1.432) , had training in TM (1.405; 95% CI: 0.407, 2.403), and provided ≥10 consultations/ month (2.585; 95% CI:1.294, 3.876) . Online information was the main reported resource of travel medicine consultation. CONCLUSIONS: The overall PCPs' mean percentage knowledge score of travel medicine was 59.6% (±20.3). A high volume of pretravel consultation, prior training, middle age group, and medical degree from non-Arab countries were significant predictors of higher knowledge. Continuing education and training provided by recognised international institutions for all PCPs is highly recommended to narrow the gap in travel medicine knowledge.

The association of parental involvement with adolescents' well-being in Oman: evidence from the 2015 Global School Health Survey.

BACKGROUND: The parent-adolescent relationship plays a key role in adolescent development, including behaviour, physical health, and mental health outcomes. Studies on the parental factors that contribute to an adolescent's dietary habits, exercise, mental health, physical harm and substance use are limited in the Middle East and North Africa region, with none in Oman. This study aims to investigate the association between parental involvement and adolescent well-being in Oman. METHODS: Cross-sectional data from the 2015 Global School Health Survey for Oman was analysed. The dataset consisted of 3468 adolescents. Adolescents reported on their parental involvement (checking to see if they did their homework, understanding their problems, knowing what they are doing in their free time and not going through their things without permission). Parental involvement was scored on a 20-point scale. Associations with the following dependent variables: nutrition, exercise, hygiene, physical harm, bullying, substance use, tobacco use and mental health well-being were done using Spearman's correlations, linear and logistic regressions. RESULTS: The surveyed population was 48% male, 65% aged 15 to 17 years old and 5% reported that they "most of the time or always" went hungry. Parental involvement was positively correlated with each of the dependent variables. Adolescents with higher parental involvement had significantly higher odds of good nutrition (1.391), hygiene (1.823) and exercise (1.531) and lower odds of physical harm (0.648), being bullied (0.628), poor mental health (0.415), tobacco use (0.496) and substance use (0.229). CONCLUSIONS: Parental involvement plays a positive role in all aspects of adolescents' well-being in Oman. Awareness campaigns and interventions aimed to help improve the well-being of adolescents should incorporate such positive role in their designs.

Comparison of Surgical Site Infection Risk Between Warfarin, LMWH, and Aspirin for Venous Thromboprophylaxis in TKA or THA: A Systematic Review and Meta-Analysis.

BACKGROUND: Infection following arthroplasty can have devastating effects for the patient and necessitate further surgery. Venous thromboembolism (VTE) prophylaxis is required to minimize the risk of deep venous thrombosis and pulmonary embolism. Anticoagulation has been demonstrated to interfere with wound-healing and increase the risk of infection. We hypothesized that different anticoagulation regimes will have differing effects on rates of periprosthetic joint infection. The aim of this study was to compare the surgical site infection risk between the use of warfarin, low-molecular-weight heparin (LMWH), and aspirin for VTE prophylaxis following total knee or hip arthroplasty. METHODS: A systematic literature search was conducted in November 2018 using the PubMed, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies that compared warfarin, LMWH, and/or aspirin with regard to surgical site infection rates following hip or knee arthroplasty. Meta-analyses were performed to compare the infection and VTE risks between groups. RESULTS: Nine articles involving 184,037 patients met the inclusion criteria. Meta-analysis showed that warfarin prophylaxis was associated with a higher risk of deep infection (or infection requiring reoperation) (odds ratio [OR] = 1.929, 95% confidence interval [CI] = 1.197 to 3.109, p = 0.007) and surgical site infection overall (OR = 1.610, 95% CI = 1.028 to 2.522, p = 0.038) compared with aspirin in primary total joint arthroplasty, with similar findings also seen when primary and revision procedures were combined. There was no significant difference in infection risk between warfarin and LMWH and between LMWH and aspirin. There was a nonsignificant trend for VTE risk to be higher with warfarin compared with aspirin therapy for primary procedures (OR = 1.600, 95% CI = 0.875 to 2.926, p = 0.127), and this was significant when both primary and revision cases were included (OR = 2.674, 95% CI = 1.143 to 6.255, p = 0.023). CONCLUSIONS: These findings caution against the use of warfarin for VTE prophylaxis for hip and knee arthroplasty. Further randomized head-to-head trials and mechanistic studies are warranted to determine how specific anticoagulants impact infection risk. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Corneal Nerve and Brain Imaging in Mild Cognitive Impairment and Dementia.

BACKGROUND: Visual rating of medial temporal lobe atrophy (MTA) is an accepted structural neuroimaging marker of Alzheimer's disease. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic technique that detects neuronal loss in peripheral and central neurodegenerative disorders. OBJECTIVE: To determine the diagnostic accuracy of CCM for mild cognitive impairment (MCI) and dementia compared to medial temporal lobe atrophy (MTA) rating on MRI. METHODS: Subjects aged 60-85 with no cognitive impairment (NCI), MCI, and dementia based on the ICD-10 criteria were recruited. Subjects underwent cognitive screening, CCM, and MTA rating on MRI. RESULTS: 182 subjects with NCI (n = 36), MCI (n = 80), and dementia (n = 66), including AD (n = 19, 28.8%), VaD (n = 13, 19.7%), and mixed AD (n = 34, 51.5%) were studied. CCM showed a progressive reduction in corneal nerve fiber density (CNFD, fibers/mm2) (32.0±7.5 versus 24.5±9.6 and 20.8±9.3, p < 0.0001), branch density (CNBD, branches/mm2) (90.9±46.5 versus 59.3±35.7 and 53.9±38.7, p < 0.0001), and fiber length (CNFL, mm/mm2) (22.9±6.1 versus 17.2±6.5 and 15.8±7.4, p < 0.0001) in subjects with MCI and dementia compared to NCI. The area under the ROC curve (95% CI) for the diagnostic accuracy of CNFD, CNBD, CNFL compared to MTA-right and MTA-left for MCI was 78% (67-90%), 82% (72-92%), 86% (77-95%) versus 53% (36-69%) and 40% (25-55%), respectively, and for dementia it was 85% (76-94%), 84% (75-93%), 85% (76-94%) versus 86% (76-96%) and 82% (72-92%), respectively. CONCLUSION: The diagnostic accuracy of CCM, a non-invasive ophthalmic biomarker of neurodegeneration, was high and comparable with MTA rating for dementia but was superior to MTA rating for MCI.

Effect of treatment with exenatide and pioglitazone or basal-bolus insulin on diabetic neuropathy: a substudy of the Qatar Study.

INTRODUCTION: To assess the effect of exenatide and pioglitazone or basal-bolus insulin on diabetic peripheral neuropathy (DPN) in patients with poorly controlled type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This is a substudy of the Qatar Study, an open-label, randomized controlled trial. 38 subjects with poorly controlled T2D were studied at baseline and 1-year follow-up and 18 control subjects were assessed at baseline only. A combination of exenatide (2 mg/week) and pioglitazone (30 mg/day) or glargine with aspart insulin were randomly assigned to patients to achieve an HbA1c <53 mmol/mol (<7%). DPN was assessed with corneal confocal microscopy (CCM), DN4, vibration perception and sudomotor function. RESULTS: Subjects with T2D had reduced corneal nerves, but other DPN measures were comparable with the control group. In the combination treatment arm (n=21), HbA1c decreased by 35.2 mmol/mol (3.8 %) (p<0.0001), body weight increased by 5.6 kg (p<0.0001), corneal nerve branch density increased (p<0.05), vibration perception worsened (p<0.05), and DN4 and sudomotor function showed no change. In the insulin treatment arm, HbA1c decreased by 28.7 mmol/mol (2.7 %) (p<0.0001), body weight increased by 4.6 kg (p<0.01), corneal nerve branch density and fiber length increased (p≤0.01), vibration perception improved (p<0.01), and DN4 and sudomotor function showed no change. There was no association between the change in CCM measures with change in HbA1c, weight or lipids. CONCLUSIONS: Treatment with exenatide and pioglitazone or basal-bolus insulin results in corneal nerve regeneration, but no change in neuropathic symptoms or sudomotor function over 1 year.

Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40.

The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.

Effect of gender on childhood maltreatment in the state of Qatar: Retrospective study.

BACKGROUND: International maltreatment studies show a range of results for overall rates of child maltreatment and gender differences. The ISPCAN Child Abuse Screening Tools (ICAST) were designed to reduce variability in data collection. OBJECTIVE: To investigate the influence of gender on the experiences of discipline and maltreatment in childhood among young people in Qatar, informingpractice and policy development. PARTICIPANTS AND SETTING: A representative sample of Qatari youth aged between 18 and 24 years were identified using a cross sectional random household survey. The total number of subjects was 697 of whom 46.8% were male. METHODS: Participants self-administered the ICAST-R (retrospective), which includes questions about exposure below the age of 18 to potentially abusive physical, psychological and sexual behaviors. Verbal consent was obtained following an introductory explanation and assurance ofconfidentiality. RESULTS: At least one form of physical abuse was reported by 22.1% of participants and was significantly higher among males (28.2%) than females (16.7%) p<0.001). A trend for greater abuse was identified among boys aged over five which become statistically significant between 10 -13 years (p=0.001). For psychological abuse the overall rates were very similar, 16.2% for girls and 15.0% for boys. Only 17 (2.5%) of participants reported sexual abuse, with no statistically significant gender difference. CONCLUSIONS: Physical, psychological and sexual abuse all occur in Qatar. This study demonstrates the importance of identifying the role of gender and age when exploring the extent and nature of maltreatment in a population. It allows for better targeting of preventative action.

Change in cardiac troponin T level after intravitreal anti-vascular endothelial growth factor treatment: Prospective pilot study.

BACKGROUND: Evaluate subclinical myocardial injury associated with intravitreal anti-vascular endothelial growth factor therapy by measuring serum high-sensitivity cardiac troponin T. METHODS: This is a prospective pilot comparative study conducted at American University of Beirut Medical Center, Beirut, Lebanon. In total, 40 consecutive patients were randomized to receive either intravitreal bevacizumab or ranibizumab. Patients received three consecutive monthly injections of the assigned drug, then continued treatment as needed. Systemic concentrations of high-sensitivity cardiac troponin T and vascular endothelial growth factor were obtained at baseline, week 9, and week 24. Primary endpoint measure was change in high-sensitivity cardiac troponin T levels compared to baseline. Secondary endpoint measure was change in systemic vascular endothelial growth factor levels. RESULTS: There was no significant difference in high-sensitivity cardiac troponin T levels over time (p = 0.227) within each treatment group and no significant difference between treatments at any time point (p = 0.276). There was a significant decrease in plasma vascular endothelial growth factor levels at week 9 (p = 0.001) and week 24 (p < 0.001) compared to baseline. In the ranibizumab group, vascular endothelial growth factor levels were not significantly different at weeks 9 and 24 compared to baseline (p = 0.708 and p = 0.117, respectively). There was a significant association between the number of bevacizumab injections from weeks 8 to 24 and the decrease in vascular endothelial growth factor levels at week 24 (R = -0.67, p = 0.032). This correlation was not observed in the ranibizumab group (R = -0.341, p = 0.141). CONCLUSION: Repeated intravitreal bevacizumab or ranibizumab did not influence serum high-sensitivity cardiac troponin levels. Intravitreal bevacizumab but not ranibizumab lowered free-systemic vascular endothelial growth factor levels, which was observed in this study to be inversely related to the number of bevacizumab injections.

Self-Reported Sleep and Exercise Patterns in Patients with Schizophrenia: a Cross-Sectional Comparative Study.

BACKGROUND: Adequate sleep and physical activity have been linked to the overall well-being of both medical and psychiatric patients. Patients with schizophrenia have shown abnormal sleep patterns and decreased physical activity that were linked to their psychopathology and physical health. These phenomena are not studied yet in Arab patients with schizophrenia. The purpose of this study is to study the sleep and exercise patterns in Arab patients with schizophrenia compared with those of healthy controls. METHOD: A total of 99 patients with schizophrenia and 101 controls were recruited. Arabic versions of sleep, exercise, socio-demographic, and clinical questionnaires were administered as well as the validated scales to measure psychopathology, depression, and suicidality in these participants. RESULTS: The majority of patients with schizophrenia slept more than 8 h per day and exercised less when compared with controls. Sleep quality was worse in those with higher depression score and higher suicidality scores were seen in patients with lower sleep duration. Multinomial regression showed that patients with schizophrenia have higher odds of sleeping more than 8 h even after controlling for the intake of antipsychotics, age, gender, smoking status, and other confounding factors. CONCLUSION: Our results showed that Arab patients with schizophrenia are at increased risk of having longer sleep duration with inadequate physical activity, which are correlating with worsening of depressive symptoms and suicidality. Thus, more attention should be paid to the changes in sleep patterns and level of exercise when treating Arab patients with schizophrenia.

Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar.

AIMS/INTRODUCTION: Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar. MATERIALS AND METHODS: This was a cross-sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut-off ≥4 and the neurothesiometer with a cut-off ≥15 V, respectively. RESULTS: The prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7-37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians (P < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92-6.70), smoking AOR 2.43 (95% CI 1.43-4.15), obesity AOR 1.74 (95% CI 1.13-2.66), being female AOR 1.65 (95% CI: 1.03-2.64) and duration of diabetes AOR 1.08 (95% CI 1.05-1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. CONCLUSIONS: PDPN occurs in one-third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.

Evaluation of an intensive education program on the treatment of tobacco-use disorder for pharmacists: a study protocol for a randomized controlled trial.

BACKGROUND: Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar. METHODS/DESIGN: The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach. DISCUSSION: If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03518476 . Registered on 8 May 2018. Version 1/22 June 2018.

Premenstrual dysphoric disorder in Arab women: Validation and cultural adaptation of the Arabic version of the premenstrual screening tool.

Premenstrual dysphoric disorder (PMDD) is not well-studied in Arab populations. The goal of this study was to validate the Arabic version of the Premenstrual Symptoms Screening Tool (PSST) using the DSM diagnosis of PMDD as the gold standard. The PSST was translated and culturally adapted using back translation and the approval of the original author. We recruited 194 adult women (between October 2013 and March 2014) from two primary care centers in Doha, Qatar. A psychiatrist determined the diagnosis using the semi-structured Mini International Neuropsychiatric Interview, and another rater blinded to the diagnosis finalized the Arabic PSST and administered other clinical questionnaires. The data showed that premenstrual symptoms and PMDD were observed in about 37 percent and 15 percent, respectively, of the women enrolled. The mean age of the women with PMDD according to the PSST was about 30 years, and the majority had children. The Arabic PSST showed high specificity of 95.6 percent but low sensitivity of 26.7 percent. A factor analysis of the different items in Arabic PSST showed that the Arabic PSST could detect the cases with definite PMDD and thus can be a useful tool in primary care settings as this treatable disorder is underdiagnosed in the Arab populations.

A Randomized Controlled Trial of a Theory-Informed School-Based Intervention to Prevent Waterpipe Tobacco Smoking: Changes in Knowledge, Attitude, and Behaviors in 6th and 7th Graders in Lebanon.

Waterpipe tobacco smoking (WTS) is spreading worldwide. Research has indicated health consequences of WTS similar to cigarettes. Prevalence of WTS is high among young people. In Lebanon, current use rates of 35% have been documented among 13⁻15 year olds. We evaluated a school-based intervention. Method: We conducted a randomized-controlled-trial of a theory-informed WTS intervention. The intervention consisted of ten sessions based on social cognitive theory and the social influences approach. Thirty-one schools participated: 14 intervention and 17 control; a total of 1279 students completed pre and post assessments. We measured knowledge, attitudes and self-reported behaviors related to WTS using Chi-square tests and regression analyses to compare results between the two study arms. Results: The intervention increased knowledge of intervention group compared to control group participants-about WTS constituents and health consequences; and shifted attitudes of intervention group participants to be even more unfavorable towards WTS. We found no impact of the intervention on WTS behaviors. Discussion: The effectiveness of the intervention on knowledge and attitudes supports previous research. The lack of intervention effect on behavior is not surprising given the timing of the post assessment immediately after the intervention, and the social context that was supportive of waterpipe use.