United Arab Emirates: communities and community genetics.

The UAE society is cosmopolitan, but the indigenous inhabitants are traditional with puritanical values despite their exposure to other vastly different cultures and habits. Marriages between consanguineous couples are still the norm rather than the exception. As a result, there is a high frequency of genetic disorders, particularly autosomal recessive types. Despite the high frequency of genetic disorders like haemoglobinopathies and others characteristically found in this population, genetic services are inadequate. Screening for certain disorders like thalassaemia are not applied on a wide scale. Abortion is illegal, and therefore, prenatal diagnosis or preconception tests are not done. With the absence of a good national database, deficiency of genetic services and absence of preventative alternatives for carrier couples, genetic counsellors find it difficult to advice pragmatic solutions to issues relating to genetic diseases. This paper reviews common genetic problems in the UAE with special emphasis on available genetic services and support to families with children with inherited disorders. Existing barriers to the improvement of clinical services by prenatal counselling are also discussed.

Pattern of meningitis in Al-Ain medical district, United Arab Emirates--a decadal experience (1990-99).

OBJECTIVES: Haemophilus influenzae vaccine was introduced in the United Arab Emirates in 1999. Our objective was to describe the pattern of meningitis in a health district in the decade before the introduction of the vaccine and compare it with the data from elsewhere. METHODS: For this retrospective study we included 128 meningitis cases reported from 1990 to 1999. Information on the cases was abstracted from the case notification forms and clinical and laboratory data from the hospital case notes. RESULTS: H. influenzae was the most common cause of bacterial meningitis (n=59, 46.1%) followed by Streptococcus pneumoniae (n=20, 15.6%). Meningitis was a disease primarily of infants and children and the median age was 15 months. One fifth of the patients (n=27) had neurological sequelae of which 33.3% had seizures and 25.9% developed deafness. 18.9% (10 out of 53) of H. influenzae isolates were resistant to ampicillin compared with 5.9% (3 out of 51) to chloramphenicol. 78.9% (15 out of 19) of S. pneumoniae isolates were susceptible to penicillin. CONCLUSIONS: The epidemiology of meningitis in our health district is similar to the epidemiology of meningitis during the pre-vaccine era in other countries.

Prevalence of Helicobacter pylori infection among low socio-economic workers.

Epidemiological studies have shown that the prevalence of Helicobacter pylori infection in a community and occupational health are closely related to lifestyle and socio-economic status. There is little information on H. pylori profile in industrial workers in the literature. The aim of this study was to investigate the prevalence rate of H. pylori profiles among low socio-economic workers in the United Arab Emirates (UAE). This study was undertaken by determining IgG H. pylori antibody profiles among industrial exposed and referent workers, sera. Presence of anti-H. pylori antibodies in the frozen stored sera was determined by ELISA. Also, data on dietary and lifestyle were obtained. The result was considered positive if IgG anti-H. pylori antibody titers was > 300. People with seropositive levels of IgG antibodies to H. pylori were assumed to be infected with H. pylori. Most of the industrial workers lived in less modern accommodation, were less educated, ate their vegetable products unwashed and did not have drinking water facilities, when compared to referents. H. pylori serology by IgG was positive in 167 industrial workers (78.4%) and 137 in referent workers (64.3%) respectively, (p < 0.002). The sensitivity and specificity of the IgG serology assay were 94.5%, and 97.2% respectively. There was statistically significant difference between the exposed industrial and non-exposed control groups in respect of their H. pylori profiles.

A pilot survey of blood lead levels in various types of workers in the United Arab Emirates.

The aim of the present study is to determine the effect of blood lead on the health of industrial workers in United Arab Emirates (UAE). This is a cross-sectional pilot survey of blood lead levels (BLL) of 100 industrial workers (exposed) and 100 non-industrial workers (nonexposed), matched for age, sex and nationality selected from Al-Ain, Abu-Dhabi Emirate. Industrial workers had significantly higher mean of BLL (77.5+/-42.8 microg/dl and median 80.9 microg/dl) than non-industrial workers (19.8+/-12.3 microg/dl and median 11.0 microg/dl). In the present study, reported symptoms among industrial workers were strongly associated with BLL nausea/vomiting, muscular symptoms, dizziness, fatigue, irritability, memory disturbances, insomnia and allergic conjuctivitis, rhinitis and dermatitis. Furthermore, the present study revealed that industrial workers had higher prevalence of respiratory symptoms for phlegm, shortness of breath and diagnosed asthma. In conclusion, this study determined that occurrence of certain symptoms might be associated with lead exposure among industrial workers.

Occupational lead exposure and amino acid profiles and liver function tests in industrial workers.

The aim of the present study is to determine the effect of blood lead on the plasma levels of amino acids and serum liver enzymes in industrial workers in United Arab Emirates (UAE). This comparison study consisted of 100 industrial workers (exposed) and 100 non-industrial workers (non-exposed), matched for age, sex and nationality selected from Al-Ain, Abu-Dhabi Emirates. Industrial workers had higher proportion (19%) of smokers than non-industrial workers (11%) which was not considered to be statistically significantly different. Industrial workers had significantly higher mean of blood lead level (77.5 +/- 42.8 miccrog x dl(-1)) than non-industrial workers (19.8 +/- 12.3 microg x dl(-1)). The amino acid analysis showed higher values among industrial than non-industrial workers for histidine, isoleucine, leucine, threonine, lysine, valine, methionine and arginine (essential amino acids, (p<0.0001). Ornithine, taurine, glutamic acid, serine, glycine, proline and alanine (non-essential amino acids) showed significantly higher values in industrial when compared with the non-industrial workers (p<0.0001). Plasma liver function test, cardiac enzymes and renal function test were carried out on industrial and non-industrial workers. The results revealed alkaline phosphatase (p=0.012) and lactate dehydrogenase (p=0.029) were significantly higher in industrial than in non-industrial workers. On the basis of this study, it can be concluded that a substantial difference in amino acid profiles, blood lead and LFT between exposed and non-exposed was found. These results might be related to lead exposure and might have affects on the kidneys or liver.

Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women.

BACKGROUND: Incorporating breast cancer screening into day-to-day clinical care leads to early diagnosis and decreases mortality. Patients' participation in screening depends on their knowledge and attitudes, other barriers, and physician behavior. METHODS: A cross-sectional questionnaire survey was conducted to evaluate knowledge, attitudes, barriers, and practices related to breast cancer screening among Arabic women. A convenience sample was selected from 1,750 women aged 40-65 years who, for any reason, attended primary health care (PHC) clinics in Al-Ain, United Arab Emirates (UAE). RESULTS: Of the 1,750 invited women, 1,445 agreed to participate; 78 were excluded from analysis because of histories of breast cancer. Breast self-examination (BSE) was practiced by 12.7% of the study population, clinical breast examination (CBE) by 13.8%, and mammography by 10.3%. Knowledge about breast cancer screening was low in the study population. Women were infrequently instructed about or offered screening for breast cancer by health professionals. Being employed was an independent predictor for participation in the three screening examinations. CONCLUSIONS: Health workers infrequently offered screening examinations and women lacked adequate knowledge about breast cancer screening. Acquired information about barriers to screening may help in the design of effective screening programs for Arabic women.

Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan.

In Jordan, individuals with epilepsy commonly attend neuropsychiatric clinics. The objective of this study was to assess the psychosocial outcome of epilepsy among adolescents. The study included 101 epileptic adolescents who attended the neurology clinic at the Princess Basma Teaching Hospital in Northern Jordan and 101 non-epileptic controls. Sociodemographic characteristics and all relevant clinical data were collected through interviewing the cases and controls. Identification of the symptoms of anxiety and depression was made according to DSM-IV criteria. The patients were age and sex matched with the controls. The controls had achieved a significantly better education (> 12 years education) than the patients with epilepsy. The adolescents with epilepsy were also shown to be disadvantaged in their living circumstances. Some of them were dependent on their parents in some daily physical activities, such as bathing, which might be a sign of overprotection by their parents. Those with epilepsy had a significantly higher tendency to develop symptoms of anxiety and depression than the control group. Moreover these psychiatric symptoms, especially anxiety symptoms, were more likely to happen when seizures had not been properly medically controlled. Overprotective parental behaviour towards their ill children could also delay their psychosocial maturation. Therefore, counselling of patients and parents about epilepsy is an important factor in the control of seizures and their sequelae.

Psychiatric morbidity in Northern Jordan: a ten-year review.

OBJECTIVE: To study the psychiatric morbidity in the northern part of Jordan and to determine the frequency distribution of various psychiatric disorders, for planning services. METHOD: All records of 2,335 psychiatric patients attending the only psychiatric clinic in Northern part of Jordan during a ten-year period from 1984 to 1993 were extensively reviewed and subjected to computerized analysis. Diagnosis was made as per ICD-9. RESULTS: Out of the 2335 patients who attended the clinic, 55% were males and 45% were females. Those in the age group 25-44 recorded the maximum attendance. Among the male attendees of the clinic, schizophrenia was the commonest diagnosis(19.9%), while among females, affective disorders were the commonest(15.9%). CONCLUSION: Schizophrenia was found to be the commonest diagnosis in general among attendance of the clinic for the ten-year research period, while anxiety disorders were the commonest diagnosis among attendance of the clinic for the year 1993.

Contact dermatitis in auto repair workers.

Full text is available as a scanned copy of the original print version.

Prevalence of asthma and wheeze in primary school children in northern Jordan.

In order to determine the prevalence of asthma and wheeze in Northern Jordan, a questionnaire was distributed to 3540 school children aged 6-12 years in Irbid City. The completed questionnaires were returned by 3182 children, a response rate of 90%. The prevalence of physician-diagnosed asthma was 4.1%. Wheezing was reported by 8.3% of children. The male:female ratio was 2:1 for both conditions. In order of frequency, the triggering factors were respiratory tract infections, cold environment, exercise and dust. Statistically significant associations between wheezing (including asthma) and a family history of asthma, recurrent chest infections, eczema, allergic rhinicis and parental smoking were detected. Mode of delivery, breastfeeding and the presence of pets at home were not significantly associated. The prevalence of childhood asthma in Northern Jordan is similar to that in some countries of the developed world. Underdiagnosis may explain the relatively low prevalence of asthma found in this study population.

The effects of diclofenac on cryo-induced miosis.

The maintenance of pupil dilation is necessary for the success of scleral buckling procedures and in prophylactic transconjuctival cryopexy. To assess the miotic effect that is induced by cryotherapy and the ability of diclofenac sodium 0.1% (a potent prostaglandin synthetase inhibitor) to overcome such an effect, we conducted a randomized, masked and controlled experiment on 18 rabbits. These were divided into three groups; each group had their eyes treated by cryotherapy in a controlled fashion. Two groups were treated preoperatively with dilating drops: a solution without diclofenac in one group and one with diclofenac drops in the second. Pupil diameters were measured with Castroviejo's calipers by an independent observer at regular intervals. A third group had no drops and were treated as a control. A highly statistical difference was observed in the reduction of the miotic effect of cryotherapy in those eyes treated by diclofenac.

Lead exposure in indoor firing ranges: environmental impact and health risk to the range users.

Health risk from airborne lead exposure were evaluated in 54 trainees and 31 firearm instructors at two indoor firing ranges in Amman, Jordan. Airborne lead concentration was measured during shooting sessions of conventional lead ammunition. Venous blood was collected from the trainees, instructors and controls. The levels of blood lead (PbB) and the activity of amino levulinic acid dehydrogenase (ALAD) were measured. High concentrations of air lead that markedly exceeded the internationally adopted safe exposure levels were found on both ranges. Despite the absence of symptoms of lead poisoning, there was a significantly higher PbB in the instructors (19 +/- 7 micrograms/dl) and trainees (22.9 +/- 4.6 micrograms/dl) than in the controls (2.1 +/- 1.4 micrograms/dl). Furthermore, the activity of ALAD was significantly lower in both groups (29.2 +/- 1.3, 18.9 +/- 1.2 U/L, respectively) than in the controls (47.5 +/- 1.1 U/L) indicating a subcritical lead effect. In the trainees, levels of PbB rose from a pre-training mean of 2.2 to 22.9 micrograms/dl and the activity of ALAD decreased from 46.9 to 18.9 U/L. It is concluded that indoor firing range users are at risk of lead absorption and intoxication and, therefore, periodic biological monitoring of the frequent users of firing ranges is highly recommended. Environmental hygienic actions to control excessive emissions of lead on the ranges are also imperative.

Measuring severity of injuries to children from home accidents.

The severity of injuries from home accidents was assessed in 402 children under the age of 5 treated in the accident department of an inner London hospital. Our child injury severity scale comprises three grades of severity for six types of injury. There was moderate agreement between the observer and an assessor in categorising the cases. Burns and scalds and poisoning caused more severe injuries than other accidents. A strong correlation was found between the parent's social class and the severity of the accident, but there was no correlation with ethnic group as indicated by the parents' country of birth. The development of a reliable scale of severity is important if programmes of prevention of accidents to children in the home are to be evaluated successfully.

Accidents in the home among children under 5: ethnic differences or social disadvantage?

Accidents in the home to children under 5 in a multiracial population with a high level of social disadvantage were studied by interviewing at home the parents of 402 children attending the accident department of a west London hospital during one year. The parents' country of birth, whether they were employed, and their housing conditions were recorded using the definitions of the 1981 census. Four ethnic groups (British (183 children), Asian (127), Caribbean (61), and other (31)) were identified. Though attendance rates based on the populations of electoral wards at the census and standardised for distance from the hospital showed no significant differences among the ethnic groups, there was a strong gradient by social class and strong associations with unemployment of the mother (although not of the father), overcrowding, and tenure of housing. Social disadvantage seems to be more important than ethnicity as a determinant of accidents to children in the home.

How do child accidents happen?

This study describes how 402 child home accidents happened. It is based on home interviews of parents of children under five who attended a hospital accident and emergency department in a multi-racial area of west London. From the parents' account, the majority of these common domestic accidents--falls, poisoning, cuts, burns and scalds--happened when parental supervision was reduced, rather than because of household hazards. The implications for prevention are to give better emotional and financial support to parents rather than adopting traditional health education interventions to alter the environment.