May Measurement Month 2017: an analysis of blood pressure screening results from the United Arab Emirates-Northern Africa and Middle East.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. United Arab Emirates has a young population, but cardiovascular disease (CVD) is the commonest cause of death (40%). Myocardial infarction and stroke occurs at least a decade earlier than in western countries. Previous screening in our young population showed that 85% of the population had at least one CVD risk factor and about 62% of them were unaware of it. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screening was held in 23 sites such as mosques, sports, and men's/ladies' clubs, airports, parks, shopping malls, work places as well as their residences, and in the public areas of hospitals or outpatient clinics. A total of 6193 individuals were screened during MMM17. The mean age was 39.2 ± 13.1 years. After multiple imputation, 1867 (30.2%) had hypertension. Of individuals not receiving anti-hypertensive medication, 813 (15.8%) were hypertensive. Of 1054 individuals receiving anti-hypertensive medication, 427 (40.6%) had uncontrolled BP. MMM17 was a useful screening model as it makes BP measurement easily accessible. Eight hundred and thirteen (16%) possibly new hypertensives were uncovered and 427(40.6%) of those on treatment for hypertension were found to be uncontrolled. These results suggest that opportunistic screening can identify significant numbers with raised BP.

A Mixed-Methods Study to Explore the Impact of Hospital Accreditation.

There are several hospital accreditors globally but there is limited understanding of how accreditation impacts on hospital performance and the health system objectives. The objective of the study were to explore the impact of hospital accreditation and inform policy decision-making. We adopted a mixed-methods approach to include an online survey and 3 focus groups. We report 27 of 36 private hospitals who responded to the survey. Key reasons for accreditation were to improve quality (n = 23), implement evidence-based practice (n = 17), continuity of accreditation (n = 15), and popularity (n = 11). Reported improvements include quality of care (27), patient care (26), organizational processes (21), and patient satisfaction (19) among others. Average stakeholder satisfaction rate was 74%. Participants from the 3 focus group discussions felt that staff hours and stress levels were high during the accreditation process, and some standards were useful while others were deemed non-essential. There was support for a local accreditation body with an emphasis on best practice. The findings from the study suggest accreditation to have an impact on structure and process measures, but the gains in key areas were short-lived. There is a need to strengthen governance and develop performance measures to evidence outcome improvement, assure alignment with regulation and the health system objectives.

Biometric and metabolic changes in patients with diabetes prior, during and after the holy month of Ramadan (ABCD Study).

Physiological impact of the intermittent or prolonged fasting is known from various studies on healthy subjects. However, data on impact of fasting on biochemical and biometric parameters in people with diabetes is building up. Safety of Ramadan fasting has always been assessed after Ramadan. This study looked into the immediate effect of fasting during the fasting days compared to time before and after the fasting month. METHODS: This is an observational study. We looked into people with biometric and biochemical records before Ramadan, and we followed them up during and after Ramadan prospectively. We were aiming for assessing the biochemical and biometric changes for people with diabetes during Ramadan in comparison to pre-and post Ramadan. As well as the differences between these measures according to type and treatment of diabetes in those who fasted as well as in those who did not fast during Ramadan. RESULTS: Total of 342 patients were recruited to the study. All were patients with diabetes at a mild to moderate risk of complications if fasted. Majority were males 52.3% (n = 180), while females were 47.7% (n = 162). Most of the results showed a U shape between Pre-Ramadan, During Ramadan and Post-Ramadan periods. there was a modest but significant reduction in weight but regained after Ramadan. CONCLUSIONS: Our study suggests that for many people with diabetes fasting is not associated with an increased risk to their glycemic control, their weight and/or their blood pressure. Indeed, what is seen is marginal benefit or no change in all parameters. This stratifies the ongoing recommendation that allows patients with categorized as low risk to fast Ramadan or non-Ramadan days whenever desired.