Emigration of Greek Knowledge to the Arab World.

The period described in this chapter reflects activity prior to the establishment of surgical centers in Europe in the twelfth century. It is a kind of prologue to the reintroduction of high-quality surgical practice. Religious squabbles within Christianity led to European medicine and surgery, the principles of which were written in Greek, being transported eastwards into the region newly dominated by Islam. There the works were translated into Arabic and during three to four hundred years, the works were not only retained but were enriched by contributions from within Arab culture. This evolution naturally enough came to affect what happened next. However, one thing is clear and was even commented on as early as by Albucasis. The surgeon's respect and distinction within society had depreciated during the sojourn of medical science in the Islamic world, with physicians being regarded as distinctly superior beings. With regard to specific details related to opening the head there was broad consistency between the various authors all of whom seem to have been greatly influenced by Paul of Ægina. Thus, there is no mention of the crown trepan. Opening the skull was performed with the non-perforating trepans making small holes which were connected with chisels or lenticulars. The indication to do this was separation of the dura from the bone. Whether or not the sutures should be avoided when trepanning is not a topic mentioned in these writings. There was also no recommendation for prophylactic trepanation.

Arab world's impact on bladder cancer research and opportunities for growth: A bibliometric review study.

BACKGROUND: Bladder Cancer (BC) is a widespread form of cancer that affects over 1.6 million people globally. The majority of cases are diagnosed as urothelial carcinoma, with a higher likelihood of diagnosis in men and with increasing age. The Arab world (AW) is one of the regions with the highest incidence and mortality rates of BC, and the average age of diagnosis is between 40 and 49 years in North Africa and the Middle East. This study aims to assess the activity and distribution of BC publications in the AW. METHODS: A systematic search across MEDLINE and Embase databases spanning 2007 to 2021 identified 1208 English-language articles on bladder cancer with Arab affiliations. The dataset was normalized against the average population and GDP (2007-2020) for 22 Arab countries. Statistical analyses via SPSS and visualizations with VOSviewer unveiled collaboration patterns and thematic trends in Arab bladder cancer research. RESULTS: A total of 1208 BC publications were published in the AW, representing 0.24% of all biomedical publications. Egypt topped the list with the highest number of publications. The co-authorship analysis generated by VOSviewer revealed that out of 4766 authors, 161 met the minimum threshold of 5 publications. CONCLUSION: The findings reveal that Egypt and Jordan are at the forefront of BC research in the region, while other Arab countries are lagging behind despite being heavily impacted by the disease. To drive progress in the field, it's important to uncover the obstacles impeding BC research in these countries and implement effective solutions to overcome them.

EGFR Mutation in Non-squamous Non-small-cell Lung Carcinoma (NS-NSCLC) in the Arab World: A systematic Review.

BACKGROUND: Lung cancer is the most frequent cause of cancer-related deaths worldwide. The discovery of acquired genetic alterations in the epidermal growth factor receptor (EGFR) gene involved in growth factor receptor signaling, has changed the way these cancers are diagnosed and treated. EGFR is more frequent in Asian, females, and non-smokers. Data regarding its prevalence in the Arab World remains limited. This paper aims at reviewing the data available for the prevalence of this mutation in the Arab patient population and comparing it with other international series. METHODS: PubMed and ASCO databases were used to conduct a literature search and 18 relevant studies were included. RESULTS: Overall, 1775 patients with non-small cell lung cancer (NSCLC) were included in this analysis. 15.7% had an EGFR mutation and 56% of the mutated patients were females. 66% of EGFR mutated patients were nonsmokers. Exon 19 and exon 21 were, respectively the most and the second most prevalent mutation. CONCLUSIONS: The EGFR mutation frequency in Middle East and African patients lies between the frequency of Europe and North America. Like global data, it is more prevalent in females and non-smokers.

Willingness and Attitude of the Arab World Population Toward Solid-Organ Donation.

OBJECTIVES: Awareness regarding organ donation has been steadily growing in the Arab world yet is still far from the current demand. A thorough analysis of population behavior toward organ donation can improve organ transplant education. Therefore, we designed this study to assess the knowledge, attitude, donation desires, and views on organ donation among adults in Arab countries. MATERIALS AND METHODS: An observational cross- sectional study approach was used by assessing 1004 adult survey respondents from 22 Arab countries through the snowball sampling technique via social media platforms and emails. A fact sheet was used to collect demographic information, which was followed by a predesigned questionnaire to assess the attitude and willingness of participants toward solid-organ donation. RESULTS: Results showed that only 17.0% of respondents had willingness to donate in the future, and only 2.0% respondents were already organ donors or registered as organ donors. Respondents indicated that the most acceptable organs to be donated after death were kidneys (57.8%), followed by liver (45.1%) and heart (42.3%). Regarding the type of surgery for living donation, 48.1% of the respondents had no surgery type preference, whereas 12.9% would only agree to laparoscopic intervention. A significant difference (P < .001) was noted among respondents with transplant experience and without experience regarding organ donation willingness. In terms of paired exchange and list exchange donation, 18.0% indicated that they would refuse to donate, 23.0% would accept, and 19.0% would accept if no alternative was available. CONCLUSIONS: This study highlighted the psychology of the Arab world and factors influencing decisions toward solid-organ donation and transplant. The biggest factor for unwillingness to donate organs was posttransplant health-related risks; almost 50% of respondents were afraid of health complications. A need for awareness and education regarding the importance of organ donation and transplant emerged as common themes in this study.

Epidemiology of Bladder Cancer in the Arab World: 2019 Global Burden of Disease Data.

BACKGROUND: Urinary bladder cancer (UBC) has unique epidemiology. It is well known that some Arab countries have higher incidence of UBC due to certain risk factors, including schistosomiasis and smoking. METHODS: We systematically reviewed the Global Burden of Disease study (GBD) database for the year 2019. We queried GBD study database using results tool for UBC in the 22 Arab countries and compared the age-standardized incidence rate (ASIR), death rate (ASDR), mortality-to-incidence ratio (MIR) and Disability-Adjusted Life Years (ASDALYs) in Arab countries with global values. RESULTS: The Arab population represents 5.6% of the global population. There was an estimated number of 27,503 patients diagnosed with UBC in 2019 in the Arab world. The ASIR for developing UBC in the Arab countries was 9.9/100,000; which is higher than the average global ASIR (6.5/100,000). Specifically, the ASIR was higher than the global average in 11 out of the 22 Arab countries. Notably, the age-specific incidence in Egypt showed that younger individuals had higher incidence of UBC than other countries, reflecting unique epidemiology. It is estimated that 10,532 patients died of UBC in the Arab world in 2019. The average mortality-to-incidence ratio (MIR) was estimated to be 0.448. The burden of UBC as estimated by the number of DALYs in the Arab world was 272,976 years representing 4% of cancer burden in Arab countries and 6.2% of the global DALYs related to UBC. CONCLUSION: UBC has high incidence in many Arab countries, particularly in North Africa.  Risk factors are known and are modifiable, making prevention the most optimal way to reduce disease burden. High MIR in many Arab countries reflects suboptimal management and a window for improvement.

Gastric cancer in the Arab World: a systematic review.

Background: Gastric cancer (GC) is the fourth most common cancer worldwide, characterized by multifactorial pathogenesis and a heterogeneous geographic distribution. The complexity of this malignancy has evolved, with environmental and genetic factors and treatment strategies being more studied. Aims: We aimed to group and organize the clinicopathological and epidemiological features of GC in the Arab World and compare with data from Western countries. Methods: To obtain the highest number of topic-related articles, an extensive electronic search was conducted in the PubMed MEDLINE and Cochrane databases up to March 2022 using Boolean operators with a combination of keywords and MeSH terms. A total of 42 articles were retained after screening in accordance with the objectives of the study. The estimated age-standardized incidence rates in the Arab World were collected from the GLOBOCAN 2020 database. Results: A total of 46 articles were retrieved from 11 countries in the Arab World. Epidemiological elements were collected, especially tumour attributes, risk factors and population characteristics, in addition to some therapeutic strategies. Results were regrouped by theme and then organized in tables and charts, allowing a global and regional approach to the subject. Conclusion: This review shows that the Arab World is considered a low-rate GC incidence region, presenting almost the same tumour characteristics as the Western countries. The lack of GC data in the Arab World should trigger a rise in research on this type of malignancy to better understand the subject.

The spectrum of chromosomal translocations in the Arab world: ethnic-specific chromosomal translocations and their relevance to diseases.

Chromosomal translocations (CTs) are the most common type of structural chromosomal abnormalities in humans. CTs have been reported in several studies in the Arab world, but the frequency and spectrum of these translocations are not well characterized. The aim of this study is to conduct a systematic review to estimate the frequency and spectrum of CTs in the 22 Arab countries. Four literature databases were searched: PubMed, Science Direct, Scopus, and Web of Science, from the time of inception until July 2021. A combination of broad search terms was used to collect all possible CTs reported in the Arab world. In addition to the literature databases, all captured CTs were searched in three chromosomal rearrangement databases (Mitelman Database, CytoD 1.0 Database, and the Atlas of Genetics and Cytogenetics in Oncology and Hematology), along with PubMed and Google Scholar, to check whether the CTs are unique to the Arabs or shared between Arabs and non-Arabs. A total of 9,053 titles and abstracts were screened, of which 168 studies met our inclusion criteria, and 378 CTs were identified in 15 Arab countries, of which 57 CTs were unique to Arab patients. Approximately 89% of the identified CTs involved autosomal chromosomes. Three CTs, t(9;22), t(13;14), and t(14;18), showed the highest frequency, which were associated with hematological malignancies, recurrent pregnancy loss, and follicular lymphoma, respectively. Complex CTs were commonly reported among Arabs, with a total of 44 CTs, of which 12 were unique to Arabs. This is the first study to focus on the spectrum of CTs in the Arab world and compressively map the ethnic-specific CTs relevant to cancer. It seems that there is a distinctive genotype of Arabs with CTs, of which some manifested with unique clinical phenotypes. Although ethnic-specific CTs are highly relevant to disease mechanism, they are understudied and need to be thoroughly addressed.

Cancer Burden Among Arab World Males in 2020: The Need for a Better Approach to Improve Outcome.

PURPOSE: Cancer is a leading cause of increased morbidity and mortality worldwide. This work aims to study the Arab world males' cancers (AMCs) and the similarities and disparities with the world males' cancers (WMCs) from different burden points of view. MATERIALS AND METHODS: A descriptive review of the 2020 Global Cancer Observatory revealed AMCs compared with the 2020 WMCs and the 2018 AMCs. Data on the top 27 AMCs were compared among the region's countries and the world groups. RESULTS: In 2020, a total estimate of 217,203 new AMCs, 2.2% of WMCs, with an average age-standardized rate of 133.5/100,000 population, compared with 222/100,000 population of WMCs, was observed. Death estimates were 148,395, 2.7% of WMCs, with an average age-standardized rate of 95/100,000 population, compared with 120.8/100,000 population of WMCs. The five-year prevalence was observed in 442,014, 1.8% of WMCs. The average AMC mortality to incidence ratio (MIR) was 0.68, compared with 0.55 in WMCs and 0.54 in Arab females. Lung cancer was the top in incidence and mortality, whereas penile cancer was the lowest. The range of MIRs among the 27 cancer types was 0.19-0.96. CONCLUSION: The descriptive review of the 2020 males' cancers in the Arab world revealed a relatively high MIR, compared with males' cancers worldwide and the females' cancers in the Arab world. This requires further evaluation to discern the underlying causes and address them systematically. More cancer control actions are warranted.

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

PURPOSE: Cancer is the leading cause of morbidity and mortality worldwide. This work presents the Arab-world females' cancers (AFCs) statistics in 2020, compared with the 2018 AFCs statistics, the Arab-world male cancers statistics, and the world females' cancers (WFCs) statistics in 2020. This can help set the stage for a better policy for cancer control programs and improve outcomes. MATERIALS AND METHODS: A descriptive review of the 2020 Global Cancer Observatory concerning AFCs was performed. Data on various cancers were compiled and compared among the countries in the region and WFCs. RESULTS: A total estimate of 244,317 new cases and 132,249 deaths is reported in AFCs; representing 2.65% and 2.99% of WFCs, respectively, with an average crude incidence/mortality ratio of 116.2 (/100,000 population)/62.9 (/100,000 population) and an age-standardized incidence/mortality ratio of 137.7(/100,000 population)/77.2(/100,000 population) compared with 238.8(/100,000 population)/114.6(/100,000 population) and 186(/100,000 population)/84.2(/100,000 population) of WFCs, respectively. Five-year prevalent cases were 585,295; 2.28% of WFCs. In comparison to males, females accounted for 47.8% of the whole population, 52.9% in incidence, 46.9% in mortality, and 56.9% in the prevalence of patients with cancer. Mortality-to-incidence ratio (MIR) was 0.54 (range 0.39-0.62 in Arab countries, compared with 0.48 globally), and it ranged from 0.14 to 0.97 in the 30 AFC types. Breast cancer was the most common cancer in incidence and mortality, with an MIR of 0.39. CONCLUSION: The 2020 descriptive analysis of the females' cancers in the Arab world revealed a relatively high MIR compared with females' cancers worldwide; a lower MIR compared with the males; and comparable MIR to 2018 one. We call for more in-depth studies to determine the causes of these differences that might translate into actionable interventions and better outcomes.

Contribution of Arab Countries to Familial Mediterranean Fever Research: a PubMed-based bibliometric analysis.

Familial Mediterranean Fever (FMF) is an inherited autoinflammatory disease. One of the feared complications of FMF, amyloidosis is often correlated with an increased mortality rate. The severity of the disease is linked with different mutations in the MEFV gene that may favor different outcomes (amyloidosis, Bechet's disease…). Although several countries worldwide contribute remarkably to research related to FMF, Arab countries make up only a small part of this contribution. This study aims to estimate numerically the contribution of the Arab world to research conducted on FMF. PubMed is used to quantitate the number of FMF-related articles published by each Arab country from 2004 till 2019. The retrieved numbers are normalized with respect to each country's average population and average Gross Domestic Product (GDP) and are also compared to those of some non-Arab countries having high FMF prevalence. In comparison with some non-Arab countries, the Arab world has a minor contribution of 3.80% to the total FMF-related publications, faced by 24.93% solely by Turkey. Out of total research done by Arab countries, FMF-related articles constitute no more than 0.133%. When normalized against the average population, Tunisia ranks first, followed by Lebanon. Similarly, normalizing the retrieved numbers of articles against average GDP shows that Tunisia and Lebanon come first and second, respectively. Only 8 Arab countries published a total of 13 articles concerning amyloidosis which makes 4.7% of the total Arabic FMF published articles. This study reflects an undoubtable need for more research to be conducted on FMF by the Arab countries, which suffer greatly from immense shortage in research productivity, due to the many obstacles and limitations these countries face every day.

YouTube as a source of information on breast cancer in the Arab world.

BACKGROUND: The general population is increasingly using YouTube as a source of information on breast cancer, the most frequent cancer among women. Arabs are the most interested population in breast cancer on YouTube. The transmission of accurate information is important to reduce mortality rates. This cross-sectional study aims to evaluate breast cancer videos on YouTube in the Arab world. METHODS: A YouTube search for "breast cancer" in Arabic was performed. The most viewed 60 videos included were evaluated for global quality (GQS score), reliability (modified DISCERN score), content (content score), and misleading claims. Recorded and calculated data included views, duration, videos power index, and viewers' interaction. Sources from legal persons (governments, universities, TV channels, physicians' groups), and blogs (online health channels, individuals) were categorized. RESULTS: The median global quality (3/5), reliability (2/5), and content scores (4/11) were overall low. Misleading information was found in 42% of the videos. Although videos uploaded by legal persons were less popular (163,454 vs 327,488 views), they hosted more physicians (52% vs 15%), were less misleading (15% vs 64%), covered more content, and were of higher global quality and reliability than videos uploaded by blogs [p < 0.05]. While the topic of symptoms (55%) was discussed the most, genetic counseling (13%) and prevention (20%) were the least mentioned. CONCLUSIONS: YouTube is poorly informational and inaccurate on breast cancer in the Arab World where it is highly used. Although videos uploaded by legal persons tend to be more adequate, they are of lower popularity. Governments and physicians are encouraged to upload more intelligibly informational videos, guide the population to reliable sources, and support regulations.

A Bibliometric Analysis of Neurosurgery Research Productivity in Arab Countries Between 2005 and 2019.

BACKGROUND: The Arab world is lagging behind in the world of publications and research, especially in the biomedical-related field. This is a bibliometric analysis that aims to assess the neurosurgical research productivity across different Arab countries. METHODS: PubMed was used to quantify the number of neurosurgery-related articles published by each Arab country, by several journals, investigating specific topics between 2005 and 2019. Numbers were normalized with respect to each country's average population and average gross domestic product (GDP). RESULTS: Arab countries contributed 0.53% of total neurosurgery publications. Egypt had the highest number of neurosurgery-related publications (362), ahead of Saudi Arabia (238) and Lebanon (133). In terms of publications per million persons, Lebanon was first with 21.6 publications per million persons. In terms of GDP, Egypt ranked first with 18.85 publications per million $. There was an insignificant correlation between the number of publications on one hand and the average GDP (P = 0.09) on the other hand, whereas the average population explains around 50% of the neurosurgery-related publications (R squared = 0.49, P < 0.01). Neoplasms were the dominating area of research, and the WORLD NEUROSURGERY journal had the highest number of publications. CONCLUSIONS: The results reached by this study reflect an undoubtable need for more research on neurosurgery by Arab countries. This goes back to the different obstacles facing Arab countries every day, affecting the economic, educational, and health care systems.

Contribution of Arab world in transplant research: A PubMed-based bibliometric analysis.

BACKGROUND: The Arab world consists of 22 countries situated in the Middle East and North Africa, tied together by linguistic and cultural bonds. Over numerous past decades, this region tended to fall behind regarding biomedical research. Organ, tissue, and cell transplantation are life-saving and life-improving treatments for various diseases. Given the positive correlation between research activity and the improvement of the clinical frame of transplantation, this article intended to examine the regional activity of transplantation research between 2005 and 2019. METHODS: Using the PubMed database, the number of transplantation-related articles published by each country, and regarding 26 different procedures, was assessed. The results were normalized with respect to each country's average population & average Gross Domestic Product (GDP). In addition, the co-occurrence of keywords and the co-authorships were analyzed by VOS Viewer. RESULTS: Arab countries contributed to 1.25% of total transplantation publications. The number of transplantation publications had an inflection in 2013, with the last six years alone contributing to 65.27% of the overall regional transplantation-related publications. Kuwait and Lebanon ranked first in terms of publications per million persons, while Egypt ranked first in terms of publications per national GDP. Stem cell, bone & kidney transplantations had the highest number of Arab transplantation-related publications. Low levels of collaboration between authors and organizations were observed, besides a modest but increasing trend towards experimental work on animals and newer therapies. CONCLUSION: Despite the increase in transplant-related research activity in recent years, the Arab world still lags behind in this field compared to the worldwide contribution.

Similarities and disparities in cancer burden among Arab world females.

INTRODUCTION: Cancer is the leading cause of increased morbidity and mortality worldwide. This work aims to study the Arab-world females' cancers (AFCs), the similarities and disparities from epidemiological, economic and development-indices points of view. MATERIALS AND METHODS: Descriptive - Analytical review of the 2018 Global Cancer Observatory concerning AFCs. Data on various cancers were compiled and compared among the countries in the regions and the world females' cancers (WFCs). RESULTS: A total estimate of 227,494 new AFCs; 2.64% of WFCs, with an average crude incidence rate of 111.7* and an age-standardized rate of 134.5*, compared to 228* and 182.6* of WFCs, respectively. Death cases estimated to be 122,903; 2.95% of WFCs, with an average crude mortality rate of 60.3* and age-standardizedrate of 75.4*, compared to 110.2* and 83.1* of WFCs, respectively. Five-year prevalent cases were 530,735; 2.33% of WFCs, with an average proportion of 260.5*, compared to 603.5* of WFCs. Mortality to Incidence Ratio was 0.54 (range 0.36 - 0.80), compared to 0.58, 0.52, 0.49 in the medium human development index, upper-middle-income countries and world countries, respectively. */100,000 population. CONCLUSIONS: Despite the demographic and cultural similarities among the Arab communities, there are apparent disparities in AFCs. A systematic approach is required to address these remarkable differences in cancer ranking and rates among Arab countries themselves and when compared to other world groups and nations.

Perception of orofacial appearance among laypersons with diverse social and demographic status.

BACKGROUND: The perception of dentofacial esthetics differs considerably between patients and dentists. Patient's expectations regarding his/her esthetics are important and should be assessed ahead of any planning of esthetic treatment. The aim of this study was to explore the differences in perception of orofacial appearance by laypersons with different social and demographic status. MATERIALS AND METHODS: Self-administered questionnaires were distributed to 400 subjects. The questionnaire comprised three parts; the first part addressed the demographic variables. The second part queried about dental prosthesis, orthognathic or plastic surgery, and/or ongoing or previous orthodontic treatment. The third part included the Arabic version of the-8-item Orofacial Esthetic Scale (OES-Ar) whose responses were scored in the 5-point Likert scale. These scores were compared by different grouping factors (age, gender, marital status, and education) using non-parametric Mann-Whitney U and Kruskal Willis tests with 95% confidence interval (α > 0.05). RESULTS: A total of 268 questionnaires were eligible for analysis, representing 67% response rate. The satisfaction with facial profile appearance was the highest (4.0±1.1) followed by facial appearance (3.9±1.1), while the color of teeth was the least satisfying item (3.1±1.3). No significant differences were found between age groups for the mean summary score as well as for each item independently. No significant difference was found between both sexes except for the last item "overall impression". Married subjects rated one item (alignment of teeth) better than their counterparts. Positive perception of orofacial appearance increased significantly with the increase of education level, the perception of the oral health status, and the perception of the general health status. CONCLUSION: Good oral health and/or high education level are significant determinants of more positive perception of orofacial esthetic appearance. Patients with these characteristics might be more concerned about their orofacial appearance, and this should be taken into consideration before planning any esthetic restorative dental treatment.

Abu Al-Qasim Al-Zahrawi (936-1013 CE), Icon of Medieval Surgery.

Abu al-Qasim Al-Zahrawi (936-1013 common era [CE]), also known in the West as Albucasis, was a great Arab physician and surgeon of the late 10th and early 11th centuries CE. He is best known for his surgical knowledge and expertise. His greatest contribution to medicine is the Kitab al-Tasrif, which includes thirty treatises on medical sciences. His early and great contributions to the field of surgery were seminal. For his endeavors in this field, a number of surgeons and scholars have dubbed him the "Father of Operative Surgery".

Conversations and Misconceptions About Chemotherapy in Arabic Tweets: Content Analysis.

BACKGROUND: Although chemotherapy was first introduced for the treatment of cancer more than 60 years ago, the public understanding and acceptance of chemotherapy is still debatable. To the best of our knowledge, no study has assessed the conversations and misconceptions about chemotherapy as a treatment for cancer on social media platforms among the Arabic-speaking populations. OBJECTIVE: The aim of this study was to assess the types of conversations and misconceptions that were shared on Twitter regarding chemotherapy as a treatment for cancer among the Arabic-speaking populations. METHODS: All Arabic tweets containing any of the representative set of keywords related to chemotherapy and written between May 1, 2017 and October 31, 2017 were retrieved. A manual content analysis was performed to identify the categories of the users, general themes of the tweets, and the common misconceptions about chemotherapy. A chi-square test for independence with adjusted residuals was used to assess the significant associations between the categories of the users and the themes of the tweets. RESULTS: A total of 402,157 tweets were retrieved, of which, we excluded 309,602 retweets and 62,651 irrelevant tweets. Therefore, 29,904 tweets were included in the final analysis. The majority of the tweets were posted by general users (25,774/29,904, 86.2%), followed by the relatives and friends of patients with cancer (1913/29,904, 6.4%). The tweets were classified into 9 themes; prayers and wishes for the well-being of patients undergoing chemotherapy was the most common theme (20,288/29,904, 67.8%), followed by misconceptions about chemotherapy (2084/29,904, 7.0%). There was a highly significant association between the category of the users and the themes of the tweets (χ240= 16904.4, P<.001). CONCLUSIONS: Our findings support those of the previous infodemiology studies that Twitter is a valuable social media platform for assessing public conversations, discussions, and misconceptions about various health-related topics. The most prevalent theme of the tweets in our sample population was supportive messages for the patients undergoing chemotherapy, thereby suggesting that Twitter could play a role as a support mechanism for such patients. The second most prevalent theme of the tweets in our study was the various misconceptions about chemotherapy. The findings of our exploratory analysis can help physicians and health care organizations tailor educational efforts in the future to address different misconceptions about chemotherapy, thereby leading to increased public acceptance of chemotherapy as a suitable mode of treatment for cancer.

Human fertility in relation to education, economy, religion, contraception, and family planning programs.

BACKGROUND: The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. METHODS: We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. RESULTS: In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. CONCLUSIONS: These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.