Mental health of ethnic minorities: the role of racism.

Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.

Comparison of machine learning classification techniques to predict implantation success in an IVF treatment cycle.

RESEARCH QUESTION: Which machine learning model predicts the implantation outcome better in an IVF cycle? What is the importance of each variable in predicting the implantation outcome in an IVF cycle? DESIGN: Retrospective cohort study comprising 939 transferred embryos between 2014 and 2018 in an IVF centre in Turkey with 17 selected features. The algorithms were Logistic Regression (LR), Decision Tree (DT), Naïve Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), Neural Network (Nnet), Gradient Boost Decision Tree (GBDT), eXtreme Gradient Boosting (XGBoost) and Super Learner (SL). The results were evaluated with performance metrics (F1 score, specificity, accuracy and area under the receiver operating characteristic curve [AUROC]) with 10-fold cross-validation repeated ten times. RESULTS: RF and SL models achieved the highest performance and showed F1 scores of 74% and 73%, specificity of 94%, an accuracy of 89%, and AUROC of 83%. In addition, the model identified the top features as maternal age, embryo transfer day, total gonadotrophin dose and oestradiol concentration. CONCLUSIONS: The present study revealed that machine learning algorithms successfully predicted implantation rates in an IVF attempt. In addition, maternal age is by far the most important predictor of IVF success when compared with other variables.

Co-Morbidity between Major Depression and Schizophrenia: Prevalence and Clinical Characteristics.

BACKGROUND: The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. SUBJECTS AND METHODS: A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. RESULTS: A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. CONCLUSION: This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.

Camel's milk allergy.

INTRODUCTION: Camel's milk is a safe and therapeutic nutrient. Camel's milk allergy is almost unknown. OBJECTIVE: To identify the clinical and laboratory features of camel's milk allergy. METHODS: In this retrospective study, the records of patients with camel's milk allergy were reviewed. Data collected included age, sex, clinical presentation, concomitant allergies, family history, laboratory tests (complete blood cell count [CBC], white blood cell [WBC] count, total immunoglobulin E [IgE], food specific IgE), and skin-prick tests (SPT) to camel's milk and other foods. RESULTS: Nine patients (four male patients, five female patients; mean age ± SD 4.3 ± 2.4 years) presented with cutaneous urticaria and/or angioedema (five patients [55.6%]) and anaphylaxis (four patients [44.4%]). Allergic reactions occurred within the first 15 minutes of ingesting camel's milk in all the patients (100%). Concurrent allergies were observed in 77.8% of the patients, of whom, five patients (71.4%) had atopic dermatitis (AD) and two patients (22%) had cow's milk allergy that exacerbated AD. All the patients (100%) had a family history of allergies. The family farm was the source of camel's milk in all the patients (100%). The WBC count was 9425 ± 1452.8 (mean ± SD) cells/µL, and eosinophils was 612 ± 455.4 (mean ± SD) cells/µL, and the median IgE was 301.5 kU/mL. A camel's milk SPT resulted in a wheal of 8.7 ± 4.9 (mean ± SD) mm. CONCLUSION: Camel's milk allergy is a distinct, yet very rare, disease entity. Cutaneous and systemic allergic reactions are the main clinical manifestations. Concomitant other allergies, viz., AD, and positive family history are risk factors. Early life exposure to camel's milk is a possible risk factor. High blood eosinophil counts and total IgE levels were observed in patients with camel's milk allergy. In the presence of a consistent and specific clear-cut history of camel's milk-related symptoms, a SPT was a dependable confirmatory test.

Safety and Efficacy of Autologous Intra-articular Platelet Lysates in Early and Intermediate Knee Osteoarthrosis in Humans: A Prospective Open-Label Study.

OBJECTIVE: To explore the safety and benefit from intra-articular autologous platelet lysate (PL) injection in early and intermediate knee osteoarthritis. DESIGN: Open-label prospective study. SETTING: Laboratory. PATIENTS: Adult patients, aged 35 to 70 years, with a history of chronic pain or swelling on one or both knees and imaging findings (radiograph or magnetic resonance imaging) of degenerative changes in the joint of grade I or II on the Kellgren scale were included. INTERVENTIONS: Autologous PL was given in the knee joint by percutaneous intra-articular route every 3 weeks for a total of 3 injections. MAIN OUTCOME MEASURES: Response was evaluated by nonnormalized Knee Osteoarthritis and Disability Outcome Score (KOOS). RESULTS: There was a significant improvement in the 5 aspects evaluated at weeks 32 and 52 compared with baseline. Symptoms score significantly improved at weeks 32 and 52 from a mean of 11.1 at baseline to 9.0 (P < 0.0001) and 8.7 (P < 0.0001). Stiffness score significantly improved at weeks 32 and 52 from 2.2 at baseline to 1.7 (P < 0.022) and 1.6 (P < 0.016). Pain score improved at 32 weeks and at 52 weeks from a baseline of 14.2 to 9.8 (P < 0.0001) and 9.2 (P < 0.0001). Daily Living score improved from 25.0 to 18.7 at 32 weeks (P < 0.0001) and to 15.6 at 52 weeks (P < 0.0001). Sport score improved from 10.7 to 8.4 at 32 weeks (P < 0.0001) and to 8.1 at 52 weeks (P < 0.0001). CONCLUSIONS: Intra-articular PL significantly improved score of all aspects evaluated by KOOS. Platelet lysate seems to be a safe product. CLINICAL RELEVANCE: To the best of our knowledge, this is the first clinical study addressing the use of autologous PL as a treatment measure for knee osteoarthrosis (KOA). There are no studies published regarding the treatment of KOA by intra-articular injections of PL. The previous studies were on the use of platelet-rich plasma (PRP) treatment for KOA. Platelet-rich plasma use has been in place for several years, however, a standardized protocol has not yet been established. Platelet lysate represents a safe, economical, easy to prepare, and easy to apply source of growth factors in the treatment of KOA. A head-to-head study is needed to compare PRP with PL in KOA.

Determinants of depression and somatisation symptoms in low back pain patients and its treatment: global burden of diseases.

OBJECTIVE: To determine the prevalence of Low Back Pain in primary care setting population and to examine its association with symptoms of depression and somatisation. METHODS: The cross-sectional study was conducted at 13 Primary Healthcare Centres (throughout Qatar from March to December, 2012. A General Health Questionnaire was used to identify the probable cases. A specially designed questionnaire with three parts was used for data collection: socio-demographic information of the studied subjects, modified version of the Roland-Morris scale for evaluating back-related functional disability, and Symptom Cheklist-90-Revised for depression and somatisation subscales. RESULTS: A representative sample of 2,600 patients was approached and 1,829(70.0%) of them participated in the study. The prevalence of low back pain in the study sample was 56.5%. There were statistically significant differences between subjects with and without low back pain in terms of body mass index (p< 0.025), gender (p< 0.003) and housing condition (p< 0.001). There was a significant difference between subjects with and without the pain in terms of all aspects of functional disability. Somatisation disorder in low back pain was 203 (19.6%) and depression disorder was 265 (25.4%). Most of the patients with LBP reported pain in the arms and legs (p< 0.001); shortness of breath (p< 0.028) palpitations (p=0.004); gastrointestinal complaints such as abdominal pain (p< 0.001), diarrhoea (p< 0.001) and vomiting (p< 0.001); feeling tired (p< 0.001); trouble with sleeping (p< 0.001); headache (p< 0.001) and fainting (p=0.043). The mode of treatment taken by the patients for relief were bed rest 695 (67.2%) followed by warm compression 480 (47.6%), physiotherapy 491 (47.5%), regular exercise 414 (40%), and back plasters 346 (33.5%). CONCLUSIONS: The present study showed that the symptoms of depression and somatisation were prevalent among low back pain patients. Functional disability was higher in the patients. Recognising this problem may lead to better patient-treatment matching and improved clinical outcomes.

Prevalence of thrombophilic genetic factors among patients with retinitis pigmentosa.

PURPOSE: To determine the prevalence of thrombophilic factors in patients with retinitis pigmentosa (RP). METHODS: Fifty consecutive patients with RP and 50 controls matched by age and gender were tested for the presence of the following mutations: factor II (GA20210), factor V Leiden (GA1691), methylenetetrahydrofolate reductase (CT677), factor XIIIa (Val→Leu), ß-fibrinogen (GA455), tumor necrosis factor receptor (TNFRII) (M196R), plasminogen activator inhibitor-1 (PAI-1) (4 G/5 G), and plasminogen activator inhibitor-1 (PAI-1) (GA844). RESULTS: The following heterozygous mutations were found in patients/controls: factor V Leiden (12/14), factor XIIIa (20/30), methylenetetrahydrofolate reductase 677 TT (48/52), ß-fibrinogen GA455 (36/36), TNFRII (M196R) (40/42), PAI-1 4 G/5 G (40/48), and PAI-1 GA844 (50/52). The difference between patients with RP and the control group was not statistically significant for the prevalence of any of the studied factors (P > 0.05). CONCLUSION: In this study, thrombophilic mutations were not increased in patients with RP. Thrombophilic mutations do not seem to be risk factors for RP. Routine investigation of hereditary thrombophilia in these patients is not justified.

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study.

OBJECTIVE: The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss. METHODS: A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis. RESULTS: Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers. CONCLUSION: The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.

The Impact of Serums Calcium 25-Hydroxy Vitamin D, Ferritin, Uric Acid, and Sleeping Disorders on Benign Paroxysmal Positional Vertigo Patients.

OBJECTIVE: This study's objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. METHODS: This is a case and control design study. The consecutive patients' visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix-Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. RESULTS: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette-water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. CONCLUSIONS: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients.

Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study.

BACKGROUND: The shortage of physicians in Turkey is a highly critical emergency. In fact, physicians' migration to developing or high-income countries, defined as brain drain, threatens the sustainability of the national healthcare system. AIMS: This study explored the driving factors associated with Turkish Physicians' brain drain, including high-economic inflation, social-politics, poor-living, equity, violence, and the desire to practice medical activity abroad. METHODS: A cross-sectional survey of 1,861 Turkish physicians aged 25 to 65 years old was conducted employing the Brain Drain questionnaire, the Depression Anxiety Stress Scale (DASS-21), the Patient Health Questionnaire 9 (PHQ-9), and the Fatigue Assessment Scale (FAS). RESULTS: Significant differences were observed among physicians staying in Turkey versus considering migration to Western countries, regarding their age, gender, marital status, educational level, occupational status, work years, hospital night shifts, income, and cigarette/nargileh smoking habits (all p ⩽ .018). The main reasons for brain drain included transport problems, harassment, low salary, malpractice, bad environment, job insecurity, workload, burnout, treating difficult patients, inadequate postgraduate systems, peer-pressure, health safety concerns, and favoritism in the workplace, as well as stress and depression caused by work overload. In fact, depression, anxiety, stress, fatigue, and burnout varied significantly among the different groups of physicians (all p ⩽ .013). Additionally, key predictors of brain drain were better job opportunities, poor hospital management (in Turkey), job-related stress, dealing with difficult patients, research deficiencies, workload, burnout, transportation issues, short consultation time, low salary, and fatigue. Among the general factors contributing to the brain drain in the Turkish Health System, we identified significant issues related to research deficiencies, compulsory working duties, poor quality of postgraduate, inadequate medical-schools, poor hospital management, and shortage of consultants. CONCLUSION: Physicians' migration is a major global public health concern, leading to substantial risks for healthcare services, especially in Turkey. Many physicians decide to migrate to work in Western countries.

Physical and Mental Health Characteristics of Hospitalized COVID-19 Patients with and without Type 2 Diabetes Mellitus in Turkey.

The aim of this study was to assess the rates of depression, anxiety, and stress and quality of sleeping among COVID-19 patients with and without type 2 diabetes mellitus (T2DM). A case and control design has been employed, involving patients affected by COVID-19 infection (884 with T2DM vs. 884 controls without T2DM) and hospitalized in Istanbul (Turkey) from January to December 2021. A multivariate stepwise regression approach was used to test the associations between sociodemographic, metabolic, serum markers, mental health scores, and T2DM/COVID-19 patients' clinical presentation. A statistically significant difference between T2DM and non-T2DM was found with respect to age, gender, BMI (body mass index), smoking, physical exercise, and physical comorbidities as well as levels of depression, anxiety, stress, and sleeping disorders (0.0003 ≤ all p = 0.025). With regard to serum biomarkers, vitamin D and ferritin were identified as useful parameters of reduction of glycated hemoglobin as well as COVID-19 infection among T2DM patients. This study detected that 25% of patients with COVID-19 and T2DM experienced mental distress, with sleeping disturbances and lifestyle changes markedly impacting their clinical outcome alongside metabolic and serum parameters.

Sleep quality, quality of life, fatigue, and mental health in COVID-19 post-pandemic Türkiye: a cross-sectional study.

Aim: This study explores the predictors and associated risk factors of sleep quality, quality of life, fatigue, and mental health among the Turkish population during the COVID-19 post-pandemic period. Materials and methods: A cross-sectional survey using multi-stage, stratified random sampling was employed. In total, 3,200 persons were approached. Of these, 2,624 (82%) completed the questionnaire package consisting of socio-demographic information, Pittsburgh Sleep Quality Index (PSQI), the WHO Quality of Life Brief Version (WHOQOL-BREF), Fatigue Assessment Scale (FAS), Patients Health Questionnaire (PHQ-15), GAD-7 anxiety scale, and the 21-item Depression, Anxiety, Stress Scale (DASS-21). Results: Significant differences between genders were found regarding socio-demographic characteristics (p < 0.01). Using PHQ-15 for depressive disorders, significant differences were found between normal and high severity scores (≥ 10), regarding age group (p < 0.001), gender (p = 0.049), educational level (p < 0.001), occupational status (p = 0.019), cigarette smoking (p = 0.002), waterpipe-narghile smoking (p = 0.039), and co-morbidity (p = 0.003). The WHOQOL-BREF indicated strong correlations between public health, physical health, psychological status, social relationships, environmental conditions, and sleep disorders (p < 0.01). Furthermore, comparisons of the prevalence of mental health symptoms and sleeping with PHQ-15 scores ≥ 10 (p = 0.039), fatigue (p = 0.012), depression (p = 0.009), anxiety (p = 0.032), stress (p = 0.045), and GAD-7 (p < 0.001), were significantly higher among the mental health condition according to sleeping disorder status. Multiple regression analysis revealed that DASS21 stress (p < 0.001), DASS21 depression (p < 0.001), DASS21 anxiety (p = 0.002), physical health (WHOQOL-BREF) (p = 0.007), patient health depression-PHQ-15 (p = 0.011), psychological health (WHOQOL-BREF) (p = 0.012), fatigue (p = 0.017), and environmental factors (WHOQOL-BREF) (p = 0.041) were the main predictor risk factors associated with sleep when adjusted for gender and age. Conclusion: The current study has shown that sleep quality was associated with the mental health symptoms of depression, anxiety, stress, and fatigue. In addition, insufficient sleep duration and unsatisfactory sleep quality seemed to affect physical and mental health functioning.

Breastfeeding Duration Reduces the Risk of Childhood Leukemia and Modifies the Risk of Developing Functional Gastrointestinal Disorders.

Objective: The aim of this study was to test the hypothesis that the duration of breastfeeding in infancy reduces the risk of childhood leukemia or lymphoma, and modifies the risk of developing functional gastrointestinal disorders (FGIDs). Subjects and Methods: This case-control study involved the recruitment of children with lymphoid malignancy and functional gastrointestinal symptoms with healthy children as controls. Focused questionnaires were used to collect data on breastfeeding history and other key risk factors. Univariate and multivariate analyses were undertaken. Results: Of the 334 children with lymphoid malignancy, 65% were male. The control group included 334 age- and sex-matched participants. Most (n = 189; 56.6%) of the children with leukemia were <10 years of age. Differences between cases and controls included the duration of breastfeeding (p < 0.0001), mean birthweight (p < 0.001), maternal age (p < 0.001), paternal age (p < 0.001), birth order (p < 0.001), mean number of children (p < 0.001), BMI percentile (p = 0.042), and maternal smoking (p = 0.012). Breastfeeding duration of up to 6 months' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for acute lymphoblastic leukemia (OR = 3.43, 95% confidence interval [CI] 2.37-4.98; p < 0.001), Hodgkin's lymphoma (OR = 1.58, 95% CI: 0.88-2.84, p = 0.120), Non-Hodgkin's lymphoma (OR = 2.14, 95% CI: 1.25-3.65, p = 0.005), and overall (OR = 1.95, 95% CI: 1.40-2.71, p < 0.001). Cases also differed from controls with regard to FGIDs, such as stomach ache (p < 0.001), dyspepsia (p < 0.001), early satiety (p = 0.017), bowel satisfaction (p < 0.001), bloating (p < 0.001), nausea (p = 0.005), vomiting (p = 0.039), constipation (p = 0.003), diarrhea (p = 0.010), gastrointestinal canal congestion (p =0.039), muscle aches pains (p = 0.008), fecal incontinence (p = 0.021), and indigestion (p = 0.003). A multivariate stepwise regression analysis revealed that maternal smoking (p < 0.001), formula feeding (p < 0.001), duration of breastfeeding (p < 0.001), birth order (p = 0.002), mother's age (p = 0.004) and the child's birthweight (p = 0.009) were predictors for leukemia. Further analysis showed that dyspepsia (p < 0.001), gastrointestinal tract canal congestion (p < 0.001), constipation (p = 0.009), diarrhea (p = 0.013), bowel satisfaction (p = 0.021), bloating (p = 0.022), duration of breastfeeding (p < 0.001), and stomach ache (p = 0.025) were significant predictors for developing FGID symptoms after adjusting for age, gender, and other confounding variables. Conclusion: This study confirmed that breastfeeding has some effect on reducing possible risk of childhood lymphoma and leukemia and FGID symptoms compared with healthy control children.

Colorectal cancer and associated genetic, lifestyle, cigarette, nargileh-hookah use and alcohol consumption risk factors: a comprehensive case-control study.

Aim: This study aimed to investigate the causes and risk factors of colorectal cancer (CRC) in a Turkish population, focusing on various modifiable and non-modifiable risk factors. Methods: A hospital-based case-control design was employed to compare individuals with CRC (cases) to individuals without CRC (controls). Male and female participants were recruited from the surgery, internal medicine, and out-patient departments. The study encompassed socio-demographic data, clinical information, radiological diagnoses, and biochemical measurements. Univariable and multivariable logistic regressions were used to determine associated risk factors of CRC. Results: The study included 704 individuals with CRC and 704 controls. Significant socio-demographic disparities were observed between the groups, with over 30% of the cases having lower levels of education and income compared to the controls. Lifestyle factors such as obesity, higher rates of smoking (cigarettes and hookah) and alcohol consumption were more prevalent among cases than controls. Further significant associations were identified with intestinal inflammation, obesity, processed food consumption, and symptoms such as abdominal pain, cramps, diarrhea, constipation, blood in stool, bloating, irritable bowel syndrome, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Diet analysis revealed that individuals with CRC consumed more red meat, processed and fast foods along with less pulses and vegetables. Genetic predispositions and exposure to chemicals also correlated strongly with increased CRC risk. Multivariable regression analysis identified, nausea/vomiting, constipation, intestinal disease, genetics factor, hookah-nargileh use, history of any cancer, family history of bowel cancer, constipation, cigarette smoking, stress, milk-yogurt consumption, obesity and red meat consumption as significant determinants for CRC. Conclusion: CRC risk is influenced by dietary, lifestyle, and genetic factors. Awareness of hereditary risk and participation in screening are crucial. Lifestyle changes, such as avoiding smoking, hookah, and alcohol use, and adopting a healthy diet, are essential for prevention.

Primary immunodeficiency diseases in children: 15 year experience in a tertiary care medical center in Qatar.

BACKGROUND: Primary immunodeficiency diseases (PID) are a group of heterogeneous, rare, genetic, mainly childhood disorders that affect specific components of immune system leading to serious complications. OBJECTIVES: This study is aimed at describing the prevalence and the categories of PID, the ages of onset and the diagnosis, the clinical presentations, the treatment modalities and the overall outcome of affected patients. MATERIALS AND METHODS: A retrospective study was conducted on 131 pediatric patients (aged 0-14 years) diagnosed with PID at Hamad General Hospital during a 15-year period (1998-2012). RESULTS: Data of 131 patients (75 males & 56 females) was analyzed with an estimated prevalence of 4.7 PID patients per 100,000 children younger than 14 years of age. The most common type of PID was predominantly antibody deficiency (23.7 %), followed by other well-defined immunodeficiency syndromes (22.9 %), 19.1 % combined T and B cell immunodeficiency, but rare CVID, and no cases of complement deficiency. The mean onset age was 24.01 months and diagnosis age was 42.2 months. Recurrent infections, particularly pneumonia (48.9 %), failure to thrive (34.4 %), otitis media (26 %), sepsis (23.7 %), and chronic diarrhoea (21.4 %) were commonest presenting conditions. P. aeruginosa (15.7 %), Salmonella species (13.2 %), and Non-TB mycobacteria (13.2 %) were the most common bacterial isolates. The overall mortality rate was 21.4 % with combined immunodeficiency's accounting for 53.4 % of deaths. CONCLUSIONS: This study reveals that PIDs are not rare in children in Qatar; and like other studies predominantly antibody deficiencies are the most common. Strategies that reinforce awareness and education of practicing physicians, bone marrow transplantation, and establishing PID national registry should be adopted to reduce mortality and morbidity of PID patients in Qatar.

Somatic symptoms in primary care and psychological comorbidities in Qatar: neglected burden of disease.

Although somatic complains are the predominant reasons for seeking general medical care, there has been limited research on the clinical presentation of somatic symptoms in primary care settings in developing countries. The frequency of somatic symptoms in primary care in Qatar and its relationship to comorbidities of mental disorders is presented here. A total of 2,320 Arab patients were approached, of whom 76% agreed to participate for the survey conducted among primary healthcare (PHC) centre patients. The study was conducted with the help of general practitioners (GPs), using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ)-8 for depression, the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety, PHQ-15 for somatic symptoms and the Psychological Stress Measure (PSM)-9 for stress. Of the subjects with somatic symptoms (229 cases), most were Qataris (57.2%). Poor hearing (52.1%), palpitation (47.1%) and stomach pain (43.8%) were the most common in men, whereas constipation (54.6%), feeling depressed (50.9%), and poor hearing (50.6%) were the most common in women; 48.5% had more than four somatic symptoms. Somatic symptoms were severe in 31.9%. Somatic symptoms were associated with depression (15.3%), anxiety (8.7%) and stress disorders (19.2%). The study findings revealed that somatic symptoms were significantly associated with socio-economic status. Somatic symptoms were significantly associated with depression, anxiety and stress disorders.

The national perinatal mortality rate in the State of Qatar during 2011; trends since 1990 and comparative analysis with selected high-income countries: the PEARL study project.

OBJECTIVE: To prospectively ascertain Qatar's national perinatal mortality rate (PMR) during 2011, compare it with recent data from selected high-income countries, and analyze trends in Qatar's PMR between 1990 and 2011 using historical data. STUDY DESIGN: A national prospective cohort study. METHODS: National data on live births, stillbirths, and early neonatal mortality (day 0­6) were collected from all public and private maternity units in Qatar (1st January­December 31st 2011) and compared with historical perinatal mortality data (1990­2010) ascertained from the database of maternity and neonatal units of Women's Hospital and annual reports of Hamad Medical Corporation (HMC). For inter-country comparison, country data were extracted from the World Health Statistics published by WHO in 2011 and from the European Perinatal Health Report published by the Europeristat project in 2008. RESULTS: A total of 20,725 births (20,583 live births plus 142 stillbirths) were recorded during the study period. Qatar's national PMR during 2011 was 9.55 [early neonatal mortality rate (ENMR) 2.7 and stillbirth rate (SBR) 6.85], which was a significant improvement from a PMR of 13.2 in 1990 [risk ratio (RR) 0.72, 95% confidence interval 0.58­0.89, P=0.002]. This improvement in PMR was more significant in ENMR (P<0.001) than in SBR (P=0.019). The stillbirths constituted 55% of PMR in 1990, which increased to 71.72% of PMR during 2011. The RR of PMR had a significant downwards trend between 1990 and 2011 (P=0.016). Qatar's 2011 PMR, SBR, and ENMR are comparable to those of selected high-income counties. CONCLUSIONS: Qatar's PMR, ENMR, and SBR have significantly improved between 1990 and 2011, and are currently comparable to those of selected high-income countries. An in-depth research to assess the correlates and determinants of stillbirth and perinatal mortality in Qatar is indicated.

A study of reasons of non-compliance of psychiatric treatment and patients' attitudes towards illness and treatment in Qatar.

The aim of this study was to examine the extent of psychiatric patients' compliance and non-compliance with treatment and examine the factors that affect compliance. Patients were recruited who were between 16 and 60 years of age and who were hospitalized with a psychiatric disorder and treated in the outpatient clinics of the psychiatry department. A total of 689 patients were approached and 564 patients agreed to participate in the study, a response rate of 81.8%. Participants were asked to complete a questionnaire that asked about socio-demographic characteristics (e.g., age, gender, nationality, level of education, occupation, marital status, and life style habits); medication(s) prescribed and the participant's response; the degree of social supervision (rated subjectively by the patient as "poor," "good," or "very good"); data also were obtained from clinical records. Data analyses explored significant associations between compliance and non-compliance and a group of relevant variables. Of the 564 patients studied, 328 (58.2%) were compliant with treatment and 236 (41.8%) were non-compliant. There was no significant difference between compliance and non-compliance in terms of gender (p = 0.471). Patients between 21-30 years of age were significantly more compliant with drug treatment than not. Non-compliance was more common among patients diagnosed with schizophrenia (28.4%), followed by depression (14.4%), and bipolar affective disorder (12.7%) (p = 0.001). Only 25% of compliant patients and 26.3% of non-compliant patients used non-psychotropic medication. Social supervision (40%) was very poor in non-compliant patients whereas 49.4% of compliant patients had very good family support. Notable reasons for non-compliance were irregular attendance to clinic (55.5%), ignorance about side effects of medication (61%), free medicine (45.8%), and a lack of education about medication (58.1%). This study revealed that non-compliance rates among psychiatry patients were comparable to the rates reported in other studies. The findings suggest that there is a need to provide community-level mental health education and proper counseling to psychiatry patients.

Socio-demographic and consanguinity risk factors associated with low birthweight.

OBJECTIVE: To examine socio-demographic and biological risk factors associated with mothers giving birth to a low birthweight newborn among Arab women in Qatar. METHODS: The case-control study was conducted at two main tertiary hospitals in Qatar in which participants were prospectively identified from January 2010 to April 2011. Data were collected by survey on maternal ethnicity, age, education, socioeconomic status, body mass index, consanguinity and gestational age. A total of 16,500 newborns were screened for low birthweight. A total of 863 mothers of low birthweight cases and an equal number of mothers of normal-weight babies were studied. RESULTS: Qatari mothers were found to be 1.2 times as likely to have a low birthweight (< 2500g) newborn compared to other Arab women (p < 0.057). Mothers with a primary school education were 1.6 times as likely as university educated mothers to have a low birthweight newborn (p < 0.006). Likewise, obese mothers were 1.5 times as likely as their normal-weight counterparts (p < 0.009). Consanguineous couples who were first-degree cousins were 1.9 times as likely as non-related couples to have a low birthweight newborn (p < 0.001). Newborns with a gestational age of < 37 weeks were 19.6 times as likely as those > or = 37 weeks to have a low birthweight (p < 0.001). CONCLUSION: The majority of the risk factors associated with low birthweight were modifiable. Health education campaigns need to target the most vulnerable groups to reduce the rates of low birthweight among Arabs in Qatar.

Gender difference on patients' satisfaction and expectation towards mental health care.

BACKGROUND: Recognizing patient satisfaction and expectation is considered as important components of assessing quality of care. AIM: The aim of this study was to determine the gender difference on the patient satisfaction with psychiatrists and explore their expectation from physicians to mental health care needs. DESIGN: This is a prospective cross sectional study conducted during the period from April 2009 to July 2009. SETTING: Psychiatry hospital of the Hamad Medical Corporation. SUBJECTS: A total of 1300 psychiatry patients aged 18 to 65 years were approached and 1054 (81.1%) patient's participated in this study. The study sample included only Qatari and other Arab nationals. MATERIALS AND METHODS: The study was based on a face to face interview with a designed Patient Doctor Relationship Questionnaire (PDRQ). A standard forward-backward procedure was applied to translate the English version of the PDRQ to Arabic. The main outcome measures of the study were 13-item patient doctor relationship questionnaire (PDRQ) score and other 11 items assessing what patients need from psychiatrists. Also, Socio-demographic data of the patients were collected. PDRQ was administered by qualified nurses among the psychiatry patients. RESULTS: Of the studied patients, 50.9% were males and 49.1% were females. Male patients (55.5%) were more satisfied with the treatment of psychiatrists than females (44.5%). A significant association was observed between male and female patients in terms of marital status (P = 0.02), number of children (P < 0.001), education level (P = 0.001) and monthly household income (P = 0.03). The satisfaction level significantly increased with higher education in both the groups (P = 0.001). The satisfaction level of male patients was significantly higher than female patients in most of the satisfaction areas (P ≤ 0.001). Male patients had significantly high expectations from psychiatrists than females (P < 0.001). Both the groups had different attitude in assessing mental health needs. CONCLUSION: The study findings revealed that in general, psychiatry patients were quite satisfied with the services provided by the psychiatrists and the study found a gender difference in their satisfaction level with the mental health care. Male patients had significantly greater expectations from psychiatrists than females. The individuals of lower socio-economic status and less education tend to be less satisfied with the mental health care.