Distribution of pathogenic variants in the CFTR gene in a representative cohort of people with cystic fibrosis in the Kingdom of Bahrain.

BACKGROUND: Cystic fibrosis (CF) is a rare multi-systemic recessive disorder. The spectrum and the frequencies of CFTR mutations causing CF vary amongst different populations in Europe and the Middle East. In this study, we characterised the distribution of CF-causing mutations (i.e. pathogenic variants in the  CFTR gene) in a representative CF cohort from the Kingdom of Bahrain based on a three-decade-long analysis at a single tertiary centre. We aim to improve CF genetic diagnostics, introduce of CF neonatal screening and provide CFTR modulator therapy (CFTRm). METHODS: CFTR genotyping  and associated clinical information were drawn from a longitudinal cohort. We sequenced 56 people with CF (pwCF) that had one or both CFTR mutations unidentified and carried out comprehensive bioinformatic- and family-based segregation analyses of detected variants, including genotype-phenotype correlations and disease incidence estimates. The study methodology could serve as a basis for other non-European CF populations with a high degree of consanguinity. RESULTS: Altogether 18 CF-causing mutations  were identified, 15 of which were not previously detected in Bahrain, accounting for close to 100% of all population-specific alleles. The most common alleles comprise c.1911delG [2043delG; 22.8%], c.2988+1G > A [3120+1G>A; 16.3%], c.2989-1G>A [3121-1G>A; 14.1%], c.3909C>G [N1303K; 13.0%], and c.1521_1523delCTT [p.PheF508del; 7.6%]. Although the proportion of 1st cousin marriages has decreased to 50%, the frequency of homozygosity in our pwCF is 67.4%, thereby indicating that CF still occurs in large, often related, families. pwCF in Bahrain present with faltering growth, pancreatic insufficiency and classical sino-pulmonary manifestations. Interestingly, two pwCF also suffer from sickle cell disease. The estimated incidence of CF in Bahrain based on data from the last three decades is 1 in 9,880 live births. CONCLUSION: The most commonCF-causing  mutations in Bahraini pwCF were identified, enabling more precise diagnosis, introduction of two-tier neonatal screening and fostering administration of CFTRm.

Public misconceptions and attitudes towards persons diagnosed with epilepsy in the Kingdom of Bahrain: A cross-sectional study.

BACKGROUND: Despite significant advancements in the understanding and treatment of epilepsy, the quality of life for persons diagnosed with Epilepsy (PdwE) can still be negatively impacted due to prevalent misconceptions and societal attitudes. This study aimed to investigate the knowledge, misconceptions, and attitudes towards epilepsy in Bahrain. METHODS: This cross-sectional study involved 1079 participants aged ≥ 18 years living in Bahrain. Data collection occurred between June and December 2023 through an online questionnaire. The questionnaire consisted of four sections: sociodemographic characteristics, sources of information, knowledge about epilepsy, and attitudes toward PdwE. RESULTS: Most participants (1063 out of 1179) were familiar with epilepsy, with social media being the main source of information (56.7%). While 75.6% correctly recognized epilepsy as a nervous system disorder. About 30% of participants believed that body shaking and falling to the ground were the only types of seizures. In terms of attitudes, 47.9% believed that PdwE could achieve high levels of education, but 40% thought they might face job loss due to their condition. Additionally, 27.5% disagreed with the idea of marrying someone with epilepsy or allowing a family member to do so. Being female, young, highly educated, and having a family member with epilepsy were associated with significantly more positive attitudes compared to other groups. CONCLUSION: The studied sample of the Bahraini public demonstrated a satisfactory level of knowledge about epilepsy. However, they still held certain misconceptions that could impact their attitudes towards PdwE. Community awareness campaigns can address this knowledge gap and reduce epilepsy stigma.

Analysis and prediction of nutritional outcome of patients with pediatric inflammatory bowel disease from Bahrain.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that causes anorexia, malabsorption, and increased energy requirements. Childhood IBD can significantly impact nutritional status and future health. OBJECTIVE: This study aimed to analyze the nutritional status of patients with pediatric IBD at presentation and during follow-up and to identify predictors of nutritional outcome. METHODS: This retrospective cohort study reviewed the medical records of children diagnosed with IBD in the Pediatric Department, Salmaniya Medical Complex, Bahrain, 1984 - 2023. Demographic data, clinical characteristics, and anthropometric data were collected. World Health Organization growth standards were used to interpret nutritional status. RESULTS: Of the 165 patients, 99 (60%) had anthropometric data at presentation, and 130 (78.8%) had follow-up data. Most patients were males (64.6%) and had Crohn's disease (CD) (56.2%), while 43.8% had ulcerative colitis (UC). The median age at presentation was 10.9 years and the mean follow-up duration was 12.6 years. At presentation, 53.5% of the patients were malnourished, that decreased to 46.9% on follow-up. Thinness was reduced from 27.3% at presentation to 12.1% at follow-up (p = 0.003). There was an increased tendency to normal weight on follow-up (59.6%) compared to time of presentation (46.5%), p = 0.035. Overweightness showed a non-significant increase from 26.3% at presentation to 28.3% at follow-up (p = 0.791). Children with IBD were more likely to become obese when they grow up to adulthood (2.3% versus 20.5%, respectively, p < 0.001). Weight-for-age, and height-for-age at presentation were higher among CD compared to UC, but body mass index (BMI) at follow-up was higher among UC patients (p < 0.05). Thinness at follow up was associated with very early-onset disease (p = 0.02), lower weight and BMI at presentation (p < 0.001 each), younger age at follow-up (p = 0.002), pediatric age group (p = 0.023), lower hematocrit (p = 0.017), and higher C-reactive protein (p = 0.007). Overweight at follow up was associated with increased weight and BMI at presentation (p < 0.001 each), longer disease duration (p = 0.005), older age (p = 0.002), and azathioprine intake (p = 0.026). Considering follow-up duration, univariate analysis exhibited that Bahraini nationality, post-diagnosis disease duration, age at follow-up, occurrence of diarrhea, height, and BMI at presentation were factors that decreased liability to abnormal nutritional status, while CD, history of weight loss, perianal disease, and skin rash, and intake of prednisolone expressed increased liability of abnormal nutritional status (p < 0.05). CONCLUSION: Pediatric IBD is associated with a high incidence of malnutrition. Thinness is more prominent at presentation, while overweight is higher on follow-up. Multiple risk factors aggravating abnormal nutritional status were highlighted. Accordingly, nutritional counseling should be prioritized in a multidisciplinary approach.

The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study.

OBJECTIVES: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Literature review of lupus nephritis From the Arabian Gulf region.

INTRODUCTION: The severity of lupus nephritis (LN) varies between different ethnicities. However, there are limited data regarding disease severity for LN in patients from the Arabian Gulf region; moreover, there are no treatment guidelines developed specifically for this population. The objective of this review was to characterise the incidence of LN, current treatment practices, the severity of LN, and the pathophysiology and biomarkers associated with LN in the Arabian Gulf region. METHODS: A literature search using EMBASE was conducted in October, 2021 to identify publications reporting on the incidence, treatment practices, severity, pathophysiology or biomarkers associated with LN, from countries in the Arabian Gulf region (including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). Additional relevant publications were provided by collaborators. A manual review of the publications was conducted to determine their relevance and data on the outcomes of interest were extracted. RESULTS: Of 3705 publications, 54 publications were identified as relevant. LN is one of the most commonly diagnosed renal diseases within the Arabian Gulf and approximately 10%-36% of all renal biopsies are for LN. Treatment patterns within the region appear to vary and generally follow treatment guidelines recommended by the Asia Pacific League of Associations for Rheumatology (APLAR), the European Alliance of Associations for Rheumatology (EULAR) and Kidney Disease Improving Global Outcomes (KDIGO). The majority of patients receive cyclophosphamide for induction therapy, whilst others receive mycophenolate mofetil. Most studies showed that the most frequently diagnosed class of LN within the Arabian Gulf region was Class IV (up to 63% of patients with LN). Sustained or increased levels of serum creatinine and proteinuria; and depressed levels of complement C3/C4 were commonly seen among patients with LN from the Arabian Gulf region. CONCLUSIONS: This review identified that LN may manifest more severely among patients from the Arabian Gulf region than in other populations, such as Caucasian populations. A greater understanding of LN and the treatment practices within the region, as well as the development of more specific treatment guidelines for this population may help improve outcomes for patients with LN in the Arabian Gulf region.

A theory-informed systematic review to understand physical activity among women in Gulf Cooperation Council countries.

BACKGROUND: This systematic review was conducted to identify health beliefs and modifying factors influencing physical (in) activity among adult women in Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). METHODS: A comprehensive search of the Medline (Ovid), EMBASE, Cochrane Central, Web of Science, and Google Scholar databases was conducted to identify relevant articles published between 2009 and 2019. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data collection and analysis based on the health belief model were performed to systematically examine the relationships of health beliefs and modifying factors to physical activity. RESULTS: The sample comprised 15 studies (Saudi Arabia, n = 6; Oman, n = 5; Qatar, n = 2; Kuwait, n = 2). Reported physical activity prevalences were low (nearly 0% to 50%) and depended on the location, subpopulation, and measurement instrument. Evidence for relationships of modifying factors and health beliefs to physical activity was scarce and sometimes inconclusive. Among modifying factors, middle age and employment were associated positively with physical activity; marital status, educational level, income, and body mass index were not associated. Regarding health beliefs, the only conclusive evidence reported was that a lack of time was not associated significantly with physical activity in a population of men and women. Women reported a lack of social support and lack of skills significantly more frequently than men; these factors may explain the gender difference in physical activity prevalence. Differences in the reporting of fear of injury and lack of willpower were not significant. CONCLUSIONS: Robust qualitative and quantitative research on the contributions of health beliefs and modifying factors to the low prevalence of physical activity among women in GCC countries is urgently needed. Current evidence indicates that unemployed women, women aged < 25 years, and elderly women are less likely to be physically active. Women in this population are more likely than men to believe that a lack social support and skills affects their physical activity. Many known factors and health beliefs appear to be unrelated to physical activity among adult women in GCC countries.

The reported prevalence of food allergy among school-aged children in Bahrain.

Allergic diseases have been continuously studied and monitored, while the topic of food allergy (FA) lags with only a few prevalence studies conducted in certain countries. The main aim of this study was to estimate the prevalence of FA in school-aged children in the Kingdom of Bahrain. A cross-sectional design was used on a randomized sample of school-aged children in Bahrain. An electronic questionnaire inquiring about demographic data and history of FA and its details was administered through school administrations between October and December 2020. Data was obtained from 1370 participants, comprising 822 males and 548 females. The prevalence of a reported history of FA in school-aged children in Bahrain was calculated as 15.5%. Furthermore, 9.9% of children reported a current FA. The most common experienced symptoms were skin symptoms followed by gastrointestinal symptoms. Moreover, 7% of children reported experiencing anaphylaxis, low blood pressure, or shock. This research concluded that the reported prevalence of FA history among school-aged children in Bahrain was higher than that observed in other studies estimating at 15.5%, with 9.9% persisting up to the time of the study. The most common single food allergen was found to be egg. The findings of this study provide a baseline for future larger studies to obtain more in-depth results.

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

INTRODUCTION: While feedback aims to support learning, students frequently struggle to use it. In studying feedback responses there is a gap in explaining them in relation to learning theory. This study explores how feedback experiences influence medical students' self-regulation of learning. METHODS: Final-year medical students across three campuses (Ireland, Bahrain and Malaysia) were invited to share experiences of feedback in individual semi-structured interviews. The data were thematically analysed and explored through the lens of self-regulatory learning theory (SRL). RESULTS: Feedback interacts with learners' knowledge and beliefs about themselves and about learning. They use feedback to change both their cognitive and behavioural learning strategies, but how they choose which feedback to implement is complex. They struggle to generate learning strategies and expect teachers to make sense of the "how" in addition to the "what"" in planning future learning. Even when not actioned, learners spend time with feedback and it influences future learning. CONCLUSION: By exploring our findings through the lens of self-regulation learning, we advance conceptual understanding of feedback responses. Learners' ability to generate "next steps" may be overestimated. When feedback causes negative emotions, energy is diverted from learning to processing distress. Perceived non-implementation of feedback should not be confused with ignoring it; feedback that is not actioned often impacts learning.

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

AIMS: The aims of this study were to assess the health-related quality of life (HRQoL) of adult Bahraini patients with diabetic foot ulcers (DFU) and to explore factors associated with poor HRQoL. METHODS: Cross-sectional HRQoL data were obtained from a sample of patients in active treatment for DFU at a large public hospital in Bahrain. Patient-reported HRQOL was measured using the following instruments: DFS-SF, CWIS and EQ-5D. RESULTS: The patient sample included 94 patients, with a mean age of 61.8 (SD: 9.9) years, 54 (57.5%) were males, and 68 (72.3%) were native Bahrainis. Poorer HRQoL was found among patients who were unemployed, divorced/widowed, and those with a shorter duration of formal education. Additionally, patients with severe DFUs, persisting ulcers, and a longer duration of diabetes reported statistically significantly poorer HRQoL. CONCLUSIONS: Findings from this study demonstrate a low level of HRQoL among Bahraini patients with DFUs. A longer duration of diabetes, in addition to ulcer severity and status statistically significantly influence HRQoL.

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

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

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

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

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

Background: The drinking of bottled water has remarkably increased at a global scale even in the regions possessing other adequate water sources. This study elaborates on the factors influencing the consumption of tap, filtered, and bottled water in the Kingdom of Bahrain and on the environmental consequences of bottled water consumption. Methods: A cross-sectional study was performed on 483 participants in the Kingdom of Bahrain between April and May 2019. A questionnaire-based survey was conducted to assess the preferred water type, to estimate the amount of bottled water consumption per year/capita, and other water consumption-related information. Results: The study revealed that filtered (35.90%) and bottled (34.50%) waters were predominantly consumed in the Kingdom, while the consumption of tap water was negligible (8.90%). The total consumption of bottled water was 0.51 liters/day, which is equivalent to 184.69 liters/year. Thus, 295.50 liters/capita/year of bottled water were consumed based on the approximate 1.6 million population in 2019. This consumption rate is extremely high in comparison to other countries. Conclusions: The study recommended improving population satisfaction of tap water, conducting tap water marketing campaigns, investments in recycling infrastructures, and introducing educational plans to properly dispose of water bottles.

Is laterality in breast Cancer still worth studying? Local experience in Bahrain.

BACKGROUND: Laterality in breast cancer means an increased frequency of left-sided breast cancers compared to right-sided breast cancers ranging between 1.05 and 1.26. It was first described in 1935 by Fellenberg, Sweden. The explanation of this phenomenon is not clear, but the association with other factors was found. This study aimed to explore the laterality of breast cancer in Bahrain as a model for Arabian countries. The association of laterality with the clinicopathological characteristics of the tumor was also analyzed to explore any applied clinical value. METHODS: This is a cross-sectional, retrospective review of a particular ethnic population to study laterality of breast cancer versus a number of clinicopathological factors, as well as prognosis. The study analyzed 228 breast cancer patients treated in Arabian Gulf University facilities in Bahrain between 1999 and 2020. Three bilateral breast cancer and two malignant phyllodes patients were excluded. The following variables were analyzed: laterality ratio (Lt/Rt) and the association between laterality and clinicopathological characteristics (age at diagnosis, family history of malignancy, size of the tumor, tumor grade, histological type, hormonal receptors and HER2, axillary lymph node status, tumor stage, five-year survival rate, nulliparity, and multifocality). RESULTS: The laterality ratio (Lt/Rt) was 1.06 and was 0.97 for patients below 50 years of age, and 1.19 for patients 50 years of age and above. Analysis of our data showed a statistically significant association between laterality and tumor stage (p. value =0.025) at presentation, and laterality and family history of malignancy (p. value =0.052). Right-sided breast cancer was associated with a higher positive family history of malignancy and an increased ratio of locally advanced and metastatic disease, and a reduced 5-year survival in relation to size and stage. Left-sided breast cancer was associated with higher early tumor stage. CONCLUSION: This is the first study exploring the issue of breast cancer laterality in a defined Arabian population. The laterality ratio in this study was 1.06, which is consistent with the globally published range (1.05 to 1.26) and is increasing with increasing age. The association between breast cancer laterality, and the hormonal and HER2 is still not widely addressed in the available literature, although other clinicopathological characteristics were extensively analyzed.

Glycemic control of adult patients with type 1 diabetes mellitus in Arabian Gulf Countries; PREDICT.

BACKGROUND: Optimum glycemic control is necessary to reduce and even prevent the risk of micro- and macrovascular complications of type 1 diabetes mellitus (T1DM). The main aim of this study was to assess the prevalence of T1DM patients with adequate glycemic control in 4 Arabian Gulf countries. METHODS: This study was a multicenter, observational, cross-sectional disease registry. Data were collected from adult T1DM patients who were treated with insulin within 6 months prior to the study visit. RESULTS: Out of 241 patients whose data were eligible for primary endpoint analysis, 27.4% had adequate glycemic control (HbA1c < 7%). The patients' age ranged from 18 to 64 years, and 53% were males. The mean (SD) duration of diabetes was 14.6 (9) years and the mean HbA1c was 8.11 (1.8) %. At the time of T1DM diagnosis, mean HbA1c was 10.7 (2.17) %. About 98% of the patients were normotensive and the lipid profile of patients was found to be optimal. The main variables associated with adequate glycemic control were low HbA1c at diagnosis (P < 0.001) and absence of a family history of diabetes (P = 0.002). CONCLUSIONS: We found that the glycemic control of T1DM adult patients in Kuwait, UAE, Oman and Bahrain is suboptimal. More efforts are necessary to pinpoint the causes of inadequate control in this population.

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

BACKGROUND: Women make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain's medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority. METHODS: Data were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004. RESULTS: The results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students' representation was higher than males over the years. CONCLUSIONS: This study highlights the increasing trend of women's participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.

Are oral health conditions associated with schoolchildren's performance and school attendance in the Kingdom of Bahrain? A life-course perspective.

BACKGROUND: The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children. AIM: To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life-course approach. DESIGN: A cross-sectional study was conducted with 466 schoolchildren aged 7-8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at-birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression. RESULTS: The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96-0.99). Children with caries-treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15-1.74). Disease Control and PreventionNone of the dental conditions were significantly associated with children's school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08-6.42). CONCLUSION: Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance.

The variables associated with dental anxiety and their management in primary care dental clinics in Bahrain: a cross-sectional study.

BACKGROUND: 20-80% of adults presenting to a dental clinic experience anxiety. Negative past dental experiences and environmental factors such as the waiting area of a dental clinic or sound of a drill are commonly considered triggering factors for anxiety. Anxiety management strategies are considered a part of routine dental procedure, due to increased prevalence and compromised patient care. Hence the aim of the present study is to identify the prevalence and variables associated with dental anxiety and their management in patients visiting the primary care dental clinics in Bahrain. METHOD: Four hundred and eighty participants were included. A 3-part questionnaire deciphered the demographic characteristics of the participants, the dental procedure undertaken, the level of anxiety, and the management strategy used by the dentist. The pre and post-treatment MDAS scores were recorded. Paired t test, ANOVA and Wilcoxon signed rank test was used to test the level of significance between the variables and the mean MDAS scores. The p ≤ 0.05 was considered statistically significant. RESULTS: The prevalence of dental anxiety was 23.7% with moderate anxiety, and 11.4% with high anxiety. Females presented with a higher mean MDAS both pre and post-treatment compared with males. A statistically significant difference between the pre and post-treatment MDAS scores were observed in educated patients less than 50 years of age. Those with unpleasant previous dental experience showed statistically significant difference. Analyses of anxiety management techniques showed that single techniques worked better than combination techniques. Rest and breaks combined with any other technique of choice showed significant reduction in the MDAS scores post treatment. CONCLUSION: To conclude, all patients attending the dental clinic present with some level of anxiety that necessitates the dentist to use anxiety management strategies. Non-pharmacological methods that are non-invasive must be the first choice. Rests and breaks, with any technique of choice provides the best possible anxiety management. It is possible to achieve the desired anxiety reduction in single visit to complete the planned dental intervention, other than in patients who are dental phobic.

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

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

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

Background: The severe, acute respiratory syndrome COVID-19 that was first reported in China in December 2019 quickly became a global pandemic that has resulted in over 100 million infections and more than 2 million deaths. Study Design: This study aimed to assess the awareness level of university students regarding the possibility of becoming infected with COVID-19. In order to achieve this objective, we assessed the students' knowledge, attitudes, and behaviors using an online survey questionnaire offered to a total of 300 students. Results: A positive response regarding awareness of COVID-19 symptoms was registered by more than 70% of the students, whereas 62% felt that wearing a mask did not give full protection against infection, approximately 30% agreed that antibiotics and antivirals did not treat COVID-19, and 62% agreed that vitamin C was helpful in treating common symptoms of COVID-19. Moreover, around 31% of the students believed that COVID-19 is a man-made virus. Students who had gotten infected with SARS-CoV-2 believed that wearing a mask gives full protection (p=0.018). In response to survey questions related to attitude, 80% of students cancelled and postponed meetings with friends, and 90% agreed that mask-wearing is the most precautionary measure used to prevent the infection. In addition, 82% avoided coughing in public, 82% avoided contact if they felt flu-like symptoms and 80% washed their hands far more often due to the pandemic. Interestingly, 76% carried hand sanitizer, 66.5% avoided shaking hands, and 42.7% were taking vitamin C supplements. Conclusions: This study showed that the participants had a positive awareness of COVID-19 transmission, symptoms, and treatments misconceptions and mistaken beliefs related to treatments and the origin of the virus were also common and should be addressed. This study thus provides a baseline for a population-based surveillance program that could help local authorities to improve pandemic preparation plans, particularly with regard to governmental education and media campaigns.