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The conflict in Gaza presents distinct difficulties that significantly impact the psychological well-being of healthcare workers (HCWs) making it imperative to understand and address their mental health needs in this specific context. This article highlights the unique challenges of the ongoing Gaza conflict and its critical impact on the mental health of HCWs. Observations in the paper revealed that HCWs in Gaza face extraordinary challenges, including the targeting of medical facilities, severe shortages of medical supplies, and the ethical dilemmas of providing care in such constrained conditions. These factors contribute to heightened stress, anxiety, and a pervasive sense of helplessness among HCWs. The paper also notes the compounded emotional burden due to the loss of colleagues and the need to navigate complex interactions with patients' families under extreme conditions. Furthermore, the lack of basic needs like adequate nutrition and safe drinking water for HCWs themselves further compromises their ability to provide care effectively, contributing further to worsened mental health. The paper also notes the lack of sufficient media coverage and support for these workers, contributing to a sense of isolation and neglect. HCWs in Gaza find themselves in a uniquely challenging situation, one that is marked not only by the immediate stresses of the ongoing conflict but also by the deep-seated psychological scars from past wars. The circumstances in Gaza are clinically relevant as they directly affect the HCWs' ability to provide care and maintain their well-being. These findings highlight the need for targeted mental health interventions and support tailored to the specific challenges faced by HCWs in Gaza. Addressing these issues is crucial for their well-being and ability to provide effective healthcare under such demanding and traumatic circumstances. [ABSTRACT FROM AUTHOR]

Background: Patients with palliative needs experience high psychological and symptom distress that may lead to hopelessness and impaired sense of dignity. Maintaining patient dignity or the quality of being valued is a core aim in palliative care. The notion of dignity is often explained by functionality, symptom relief and autonomy in decision making. However, this understanding and its implications in Middle Eastern countries is not clear. The aim of this review is to 1) explore the understanding of dignity and how dignity is preserved in adult patients with palliative care needs in the Middle East 2) critically assess the findings against the Dignity Model dominant in western literature. Method: Using an integrative review we searched four databases EMBASE, Psych-Info, CINAHL, and PubMed. These databases retrieve a broad literature on palliative care and are often chosen in other palliative care reviews. To enhance the search strategy, three online journals were hand searched, reference lists of review papers scanned, and forward citations sought. No time limits were applied. The retrieved papers were assessed independently by two authors including quality assessment using the Hawker's appraisal tool. Results: Out of the 5113 studies retrieved, 294 full texts were assessed. Sixteen studies were included for synthesis of which fourteen were published in Iran. Seven themes were developed after data analysis: Maintaining Privacy and Secrecy; Gentle communication with a dialogue that preserves hope instead of blunt truth-telling; Abundance characterised by accessibility to medical supplies and financial stability; Family Support where relatives deliver major assistance in care; Physical Fitness; Reliable health care, and Social justice that endorses equal care to all. Conclusion: The results are compatible with the existing evidence from the Dignity Model ascertaining that dignity is socially mediated and influenced by interactions and physical fitness. Nevertheless, the findings highlight that patient dignity is also shaped by the socio-political, cultural, and economic conditions of the country, where family support, gentle communication and accessible health care are essential elements. [ABSTRACT FROM AUTHOR]

Background and Aim: Heart failure is still a leading cause of mortality and morbidity. Assist devices are reserved for advanced heart failure patients with no other therapeutic options. We aim in this paper to describe the characteristics and outcome of Lebanese left ventricular assist device (LVAD) patients.Results: From 2010 till December 2019, 78 patients were implanted with assist devices at the Beirut cardiac Institute, 82 pumps were used. To the most recent follow up after 10 years, 26 patients died (34%). 24 patients of 35 (68%) survived more than 5 years. Seven patients only (9%) died during one month of surgery. One year mortality was 19% (15 patients). The leading cause of early mortality was infection, whereas cerebrovascular accidents CVA were the leading cause of late mortality. Pump thrombosis occurred in 12% of the cases. The most serious long term complication was haemorrhagic CVA. Only seven patients (9%) received heart transplantation, with a mean time on support prior to transplantation of 1303 ± 213 days.Conclusion: In this manuscript we reported the characteristics and outcome of the largest population of LVAD patients in Lebanon. The survival rate was 81% at one year. These findings were comparable to the international registries except for rates of heart transplantation. More efforts should be made to encourage organ donation in Lebanon. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic necessitated an abrupt transition to online learning in nursing education, presenting unprecedented challenges. This research aims to comprehensively assess the challenges faced by nursing students during this transition, exploring key issues, recommending strategies, and analyzing their impact on student perceptions. Methods: Using a cross-sectional design, the study surveyed 941 nursing students across eight Arab countries—Jordan, Iraq, Lebanon, Palestine, Oman, KSA, UAE, and Egypt—to ensure a representative sample and enhance external validity. Data collection involved a thorough survey covering academic, technological, and administrative challenges. Reliability analysis, descriptive statistics, and variance analysis using Kruskal -Wallis and Mann–Whitney tests were conducted to examine differences between countries and sociodemographic variables. Results: Descriptive statistics revealed significant demographic disparities. Single individuals in Jordan and those with lower family income in Palestine and Lebanon reported notably higher challenges. Female students in Iraq and Lebanon perceived greater challenges compared to males. Students pursuing diplomas in Jordan and bridging programs in Lebanon faced elevated difficulties. Governmental university students in Lebanon and private university students in Jordan encountered distinct challenges. Lack of available internet was particularly challenging in Jordan and Lebanon, whereas students using tablets in Lebanon and laptops in Palestine reported heightened challenges. Economic disparities, notably in family income, further hindered engagement with online learning materials. Across countries, academic challenges included managing coursework and accessing resources, exacerbated by administrative inefficiencies, especially in Palestine and Lebanon. Students in the UAE reported fewer challenges, facilitated by robust internet infrastructure and comprehensive institutional support. Conclusion: This study provides critical insights into the challenges faced by nursing students during the Middle East's online learning transition. Key challenges encompass technological issues, academic workload, and administrative inefficiencies, with significant disparities across countries. The findings underscore the urgent need for targeted interventions, particularly in Palestine, to enhance online learning experiences. Policymakers and educational institutions can leverage these insights to advocate for student-centric approaches and policy development aimed at improving online learning across the region. [ABSTRACT FROM AUTHOR]

Background: An estimated 30% of women worldwide experience intimate partner violence (IPV) during their lifetime. Exposure to IPV is associated with poor health outcomes and the prevalence of violence may be higher amongst women seeking healthcare. Existing evidence from the Arab region is limited. We conducted a systematic review and meta-analysis of prevalence and health outcomes of domestic violence (IPV or violence from a family member) in clinical populations in Arab countries.Methods: Using terms related to domestic violence, Arab countries, and date limit > year 2000, we searched seven databases: Medline, EMBASE, PsycINFO, CINAHL, Web of Science: core collection, IBSS, Westlaw, IMEMR. We included observational studies reporting estimates of prevalence or health outcomes of domestic violence amongst women aged > 15 years, recruited while accessing healthcare in Arab countries. Studies that collected data on/after 1st January 2000 and were published in English, Arabic or French were included. Title/abstract screening, full text screening, quality assessment and data extraction were carried out. Extracted data were summarised and meta-analysis was performed where appropriate.Results: 6341 papers were screened and 41 papers (29 studies) met inclusion criteria. Total 19,101 participants from 10 countries were represented in the data. Meta-analysis produced pooled prevalence estimates of lifetime exposure to any type of IPV of 73·3% (95% CI 64·1-81·6), physical IPV 35·6% (95% CI 24·4-47·5), sexual IPV 22% (95% CI 13·3-32) and emotional/psychological IPV 49·8% (95% CI 37·3-62·3). Domestic violence (IPV or family violence) exposure was associated with increased odds of adverse health outcomes: depression OR 3·3 (95% CI 1·7-6·4), sleep problems OR 3·2 (95% CI 1·5-6·8), abortion OR 3·5 (95% CI 1·2-10·2), pain OR 2·6 (95% CI 1·6-4·1) and hypertension OR 1·6 (95% CI 1·2-2·0).Conclusions: Domestic violence is common amongst women seeking healthcare in Arab countries. Exposure to domestic violence is associated with several poor health outcomes. Further research into domestic violence in the Arab world is required.Trial Registration: Systematic review protocol was registered on PROSPERO: CRD42017071415 . [ABSTRACT FROM AUTHOR]

Background: Mobile apps facilitate patients' access to portals and interaction with their healthcare providers. The COVID-19 pandemic accelerated this trend globally, but little evidence exists on patient portal usage in the Middle East, where internet access and digital literacy are limited. Our study aimed to explore how users utilize a patient portal through its related mobile app (MyChart by EPIC). Methods: We conducted a cross-sectional survey of MyChart users, recruited from a tertiary care center in Lebanon. We collected MyChart usage patterns, perceived outcomes, and app quality, based on the Mobile Application Rating Scale (user version, uMARS), and sociodemographic factors. We examined associations between app usage, app quality, and sociodemographic factors using Pearson's correlations, Chi-square, ANOVA, and t-tests. Results: 428 users completed the survey; they were primarily female (63%), aged 41.3 ± 15.6 years, with a higher education level (87%) and a relatively high crowding index of 1.4 ± 0.6. Most of the sample was in good and very good health (78%) and had no chronic illnesses (67%), and accessed the portal through MyChart once a month or less (76%). The most frequently used features were accessing health records (98%), scheduling appointments (67%), and messaging physicians (56%). According to uMARS completers (n = 200), the objective quality score was 3.8 ± 0.5, and the subjective quality was 3.6 ± 0.7. No significant association was found between overall app usage and the mobile app quality measured via uMARS. Moreover, app use frequency was negatively associated with education, socioeconomic status, and perceived health status. On the other hand, app use was positively related to having chronic conditions, the number of physician visits and subjective app quality. Conclusion: The patient portal usage was not associated with app quality but with some of the participants' demographic factors. The app offers a user-friendly, good-quality interface to patient health records and physicians, appreciated chiefly by users with relatively low socioeconomic status and education. While this is encouraging, more research is needed to capture the usage patterns and perceptions of male patients and those with even lower education and socioeconomic status, to make patient portals more inclusive. [ABSTRACT FROM AUTHOR]

Background: Lead exposure (LE) and its attributable deaths and disability-adjusted life years (DALYs) have declined in the recent decade; however, it remains one of the leading public health concerns, particularly in regions with low socio-demographic index (SDI) such as the North Africa and Middle East (NAME) region. Hence, we aimed to describe the attributable burden of the LE in this region.Methods: Data on deaths, DALYs, years of life lost (YLLs), and years lived with disability (YLDs) attributable to LE in the NAME region and its 21 countries from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) 2019 study.Results: In 2019, the age-standardized death and DALY rates attributable to LE were 23.4 (95% uncertainty interval: 15.1 to 33.3) and 489.3 (320.5 to 669.6) per 100,000 in the region, respectively, both of which were higher among men than women. The overall age-standardized death and DALY rates showed 27.7% and 36.8% decreases, respectively, between 1990 and 2019. In this period, Bahrain, the United Arab Emirates, and Turkey had the highest decreases in the age-standardized death and DALY rates, while Afghanistan, Egypt, and Yemen had the lowest ones. Countries within high SDI quintile had lower attributable burden to LE compared with the low SDI quintile. Cardiovascular diseases and chronic kidney diseases accounted for the 414.2 (258.6 to 580.6) and 28.7 (17.7 to 41.7) LE attributable DALYs per 100,000 in 2019, respectively. The attributable YLDs was 46.4 (20.7 to 82.1) per 100,000 in 2019, which shows a 25.7% reduction (-30.8 to -22.5%) over 1990-2019.Conclusions: The overall LE and its attributed burden by cause have decreased in the region from 1990-2019. Nevertheless, the application of cost-effective and long-term programs for decreasing LE and its consequences in NAME is needed. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes is one of the leading causes of chronic kidney failure, which increases globally and represents a significant threat to public health. People from the Middle East represent one of the largest immigrant groups in Europe today. Despite poor glucose regulation and high risk for early-onset insulin-deficient type 2 diabetes, they have better kidney function and lower rates of all-cause and cardiovascular-specific mortality compared with people of European ancestry. Here, we assessed the genetic basis of estimated glomerular filtration rate (eGFR) and other metabolic traits in people of Iraqi ancestry living in southern Sweden.Methods: Genome-wide association study (GWAS) analyses were performed in 1201 Iraqi-born residents of the city of Malmö for eGFR and ten other metabolic traits using linear mixed-models to account for family structure.Results: The strongest association signal was detected for eGFR in CST9 (rs13037490; P value = 2.4 × 10-13), a locus previously associated with cystatin C-based eGFR; importantly, the effect (major) allele here contrasts the effect (minor) allele in other populations, suggesting favorable selection at this locus. Additional novel genome-wide significant loci for eGFR (ERBB4), fasting glucose (CAMTA1, NDUFA10, TRIO, WWC1, TRAPPC9, SH3GL2, ABCC11), quantitative insulin-sensitivity check index (METTL16), and HbA1C (CAMTA1, ME1, PAK1, RORA) were identified.Conclusions: The genetic effects discovered here may help explain why people from the Middle East have better kidney function than those of European descent. Genetic predisposition to preserved kidney function may also underlie the observed survival benefits in Middle Eastern immigrants with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: The provision of comprehensive, high quality palliative care (PC) is a global public health concern. In the United Arab Emirates (UAE), palliative medicine services are limited, and most patients in need of PC are treated in the acute hospital setting, where health professionals of all specialties provide treatment. Improving end-of-life care requires teaching medical students, residents, and other healthcare professionals about PC. The purpose of this study was to assess the current status of PC education in medical schools in the UAE, and to identify barriers to successful implementation of a PC and end-of-life curriculum. Methods: The authors conducted semi-structured interviews with deans from all medical schools in the UAE. Data were analyzed using qualitative content analysis. Results: All medical school deans in our study recognized the importance of inculcating palliative and end-of-life care into the undergraduate curriculum, but there was substantial variability in implementation, with opportunities for improvement. Barriers to the successful implementation of an undergraduate PC curriculum include (1) lack of student awareness and interest in PC, (2) inconsistent clinical exposure to PC, (3) lack of specialized PC faculty, (4) limited clinical facilities for PC training, (5) lack of a multidisciplinary approach to PC education, and (6) cultural barriers to PC education. Conclusions: Understanding challenges to teaching PC in the undergraduate medical curriculum can help inform educational interventions to improve PC knowledge and skills for UAE medical students. Curricular and policy reform are necessary to educate a future generation of health professionals, who can provide high quality palliative care services to UAE patients and their families. [ABSTRACT FROM AUTHOR]

Background: Population health (PH) research capacity and performance are essential pillars of evidence-based practice to help address health inequalities. Best evidence is provided by systematic reviews (SRs). None of the published bibliometric analysis specifically assess the production of SRs on PH in the Middle East and North Africa (MENA). The aim of our study is to investigate publication patterns and time trends of SRs reporting PH in the MENA region to evaluate the state of PH research performance in the region. Method: The study protocol was developed a priori (protocol registration number: CRD42017076736). PubMed was searched. Two independent reviewers screened 5747 identified articles. We investigated author affiliation and collaboration, yearly citations of the SRs and journal information. Joinpoint regression was used to explore these characteristics overtime. Results: Our meta-research included 387 SRs published between 2008 and 2016 which reported data on PH in 20 MENA countries. Publication of SRs increased over time in journals with impact factor < 4 and in the categories of yearly number of citations < 50 (p values ≤ 0.0024). Authors belonging to the region published increasingly (p value = 0.0001) over time. Thirty percent of the SRs were from authors solely from the region, while an additional 30% were from the region collaborating with Western country authors. Of these collaborative reviews, 79% were led by authors from the region. However, collaboration in the region (with the exclusion of collaboration with Western country authors) was rare (0.8%). These authors from the region published more in open-access journals while authors from Western countries collaborating or not with authors from the region published more in hybrid or non-open-access journals (p value < 0.0001). Collaboration between authors from MENA and Western countries led to published SRs in journals with impact factor ≥ 10. Systematic reviews with global coverage were published more by authors from Western countries, while SRs with country-level coverage were published by authors from the region (p value < 0.0001). Conclusion: The incremental trend of PH SR publications on MENA likely reflects the ongoing improvement in research performance in the region. Authors from the region appear to be taking a lead role in conducting and disseminating MENA PH research. Open-access journals are a major contributor in facilitating MENA research dissemination. Systematic review registration: PROSPERO registration number CRD42017076736 [ABSTRACT FROM AUTHOR]

Background: In spite of the evident general negative effects of armed conflict on countries' health systems and populations' health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe: 1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization; 2. Differences in proportions of AMR isolates between conflict and non-conflict countries.Methods: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for "antimicrobial resistances" and "Middle East", to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following: 1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%), and both carbapenem resistance (median 8.1 and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3 and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries.Conclusions: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp. [ABSTRACT FROM AUTHOR]

Background: Acceptance of Electronic patient portal (EPP) is instrumental for its success. Studies on users' acceptance in the Middle East region are scarce. This study aims to use the TAM as a framework to quantitatively describe potential users, diabetic and chronic high blood pressure patients and their providers, intention to use and factors influencing the intention to use EPP at AUBMC-FMC We concurrently test the internal construct validity and the reliability of the TAM.Methods: A cross-sectional survey design and the vignette approach were used. For validation, we needed a minimum of 180 patients; all 35 attending physicians and 11 registered nurses were targeted. We used descriptive statistics to calculate the intention to use EPP and its determinants based on the TAM constructs. Exploratory factor analysis (EFA) and structural equation modeling (SEM) were employed to estimate significant path coefficients for patients only as the sample size of providers was too small.Results: We had 199 patients, half intended to use EPP; 73% of providers (N = 17) intended to use EPP. Perceived ease of use and privacy concerns were significantly higher among providers than patients (Mean (M) = 0.77 vs M = 0.42 (CI: - 0.623; - 0.081)) and (M = 3.67 vs M = 2.13, CI: - 2.16; - 0.91) respectively; other constructs were not significantly different. Reliability of TAM revealed a Cronbach Alpha of α=.91. EFA showed that three components explained 73.48% of the variance: Behavioral Intention of Use (14.9%), Perceived Ease of Use (50.74%), Perceived Usefulness (7.84%). SEM found that perceived ease of use increased perceived usefulness (standardized regression weight = 0.49); perceived usefulness (0.51) had more predictive value than perceived ease of use (0.27) to explain the behavioral intention of use of the EPP.Conclusions: We found that providers valued the usefulness of EPP and were mostly intending to use it. This finding has yet to be tested in future studies testing actual use as intention and actual use may not be concordant. The intention to use among patients was lower than those reported in developed countries. We identified two factors that we need to address to increase use, namely perceived ease and usefulness, and proposed practical implications to address them; future research directions were also discussed. [ABSTRACT FROM AUTHOR]

Background: This study explores the relationship between armed conflict and breastfeeding practices of Iraqi mothers. To date, the relationship between violent conflict and breastfeeding is surprisingly understudied. Especially in the Middle East, which is conflict-prone and has a young population, research on war and household behavior is critical for promoting recovery and sustainable development. Methods: This study employs a unique pairing of the Iraq Body Count Database and the 2006 and 2011 Multiple Indicator Cluster Surveys for Iraq. We use probit models to explore the association between armed conflict and several breastfeeding outcomes – whether a child was ever breastfed, whether a child was breastfed within 1 h after birth, whether a child is currently breastfed, and whether an infant under 6 months of age is exclusively breastfed. Our proxies for conflict intensity are the average rate of conflict-related casualties across the 3 years prior to survey administration and the rate of casualties averaged across the 2 years prior to the birth of the child, in the governorate in which the family resides. We employ a number of other independent variables important for breastfeeding status, including health controls and characteristics of the household, child and mother. We also use a Cox proportional hazards model to study the association between conflict and breastfeeding duration. We complement this analysis with various robustness checks, including disaggregation by year, controls for household wealth and an analysis of breastmilk substitutes and their potential for an interaction with household wealth. Results: We find in our main results that increases in conflict-related casualties are associated with a significant decline in the probability that a child was ever breastfed and a decline in the probability that a child is currently breastfeeding. There is no significant association with exclusive breastfeeding or with initiation of breastfeeding within 1 h after birth. This result is robust to alternative measures of conflict, although some coefficients from estimation based on the 2006 subsample are positive and not significant, and reverse causation is a potential source of bias in interpreting cross-sectional feeding patterns. Results on breastfeeding duration are mixed. Our results also suggest an increase in the use of breastfeeding substitutes like formula concurrent to higher levels of conflict among wealthier households. Conclusion: The results are informative in the context of designing policy aimed at stabilizing the long-term health and productivity of populations in conflict areas. Infant formula provided with the objective of offering temporary relief creates risks, including reducing the probability and duration of breastfeeding. Attention to the supply of health care and to support systems for women, especially skilled breastfeeding support and targeted support to infants dependent on formula, are matters of the utmost urgency during and after conflict periods. [ABSTRACT FROM AUTHOR]

Background: Interprofessional education (IPE) is an emerging concept in the Middle East with a number of health professional degree programs continually striving to meet international accreditation requirements to enhance the quality of education and ensure high standards are maintained. Using the College of Pharmacy at Qatar University (CPH QU) as a model, this article describes the IPE initiatives coordinated through the College's IPE Committee, with representation from fourteen programs at four Healthcare institutions: Qatar University; Weill Cornell Medical College in Qatar; the University of Calgary in Qatar; and the College of North Atlantic in Qatar. These activities are based on the model proposed by the University of British Columbia across the different pharmacy professional years. Learning objectives for these initiatives were selected from the IPE shared competency domains and competency statements developed for Qatar context. Method: A meeting with six faculty members, who have been instrumental to designing and executing the IPE activities in the previous 2 years, was convened. Faculty members reflected on IPE activities and collaborations with other participating programs. A structured SWOC (Strengths, Weaknesses, Opportunities, Challenges) framework was used to guide discussion. The discussion was recorded and notes were taken during the meeting. Raised points were categorized into each SWOC category for the final analysis. Results: Implementation of IPE program is a major undertaking with a number of challenges that require invested time to overcome. This article highlights the importance of incorporating IPE into healthcare curricula to graduate students ready for collaborative practice in the workforce. Learning objectives for IPE initiatives need to be based on shared competency domains. When developing and implementing an IPE program it is necessary to align activities under a strong theoretical framework. This should be done under the leadership of an IPE steering group or committee to oversee the integration of IPE into the healthcare curriculum. Conclusion: The article presents many lessons learned through IPE implementation that are relevant to other academic institutions keen to incorporate IPE into their programs and also provides a successful model for integrating IPE into healthcare curricula. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation/cutting (FGM/C) is a common harmful traditional practice in many communities in Africa and to a lesser extent in Middle East and other regions in the world. In order to better understand publishing on this topic, we conducted a bibliometric study on FGM/C. Bibliometric analyses can be used as an indicator of the extent of interaction of researchers, health authorities, and communities with a particular health issue. Methods: Scopus database was used to retrieve data on FGM/C. Keywords used were "female genital mutilation", "female genital circumcision", "female genital cutting" and "female circumcision". Specifically, the number of publications, top productive countries and institutions, highly cited articles, citation analysis, co-authorships, international collaboration, role of African countries, top active authors, and journals involved in publishing articles on FGM/C were reviewed and analyzed. We indirectly assessed the impact of publications using total number of citations received, average number of citations per article, Hirsch-index, percentage of highly cited articles, and journal's impact factor. Results: One thousand and thirty-five publications on FGM/C were retrieved. The h-index of retrieved articles was 37. A steep rise in number of publications was noticed in mid-1990s and again in 2012. More than half of retrieved articles were published from 2006 - 2015. A total of 65 countries contributed. The top ten productive countries included ones from Northern America, Europe and Africa. Nigeria and Egypt were the most active African countries in FGM/C publications. At least nine African academic institutions were actively involved on FGM/C publications. Articles on FGM/C that received the highest number of citations were those that focused on negative physical and psychosexual consequences of FGM/C. Journal topic areas were obstetrics/gynecology, public health, and psychological sociology. Collaboration between African and European countries on FGM/C research was evident. Conclusion: Bibliometric analysis reveals that research publications on FGM/C have been increasing since the l970s, with collaboration between African and Western countries, and articles are being published in higher impact journals, not only obstetrics, but also public health and social sciences. FGM/C research can be helpful to international health agencies and governments not only to document negative outcomes, but also to identify best practices, and to note gaps in implementation and practice. [ABSTRACT FROM AUTHOR]

Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users' experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services.This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users' experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting.From this review, it is clear that the sociocultural context in the region is linked to service users' experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region. [ABSTRACT FROM AUTHOR]

Background Although informed consent is an integral part of clinical practice, its current doctrine remains mostly a matter of law and mainstream ethics rather than empirical research. There are scarce empirical data on patients' perceived purpose of informed consent, which may include administrative routine/courtesy gesture, simple honest permission, informed permission, patient-clinician shared decision-making, and enabling patient's self decision-making. Different purposes require different processes. Methods We surveyed 488 adults who were planning to undergo or had recently undergone written informed consent-requiring procedures. Perceptions of informed consent purpose (from norm and current practice perspectives) were explored by asking respondents to rank (1 = most reflective) 10 randomly-presented statements: "meaningless routine", "courtesy gesture" "litigation protection", "take away compensation rights", "inform patient', "make sure patient understand", "document patient's decision", "discover patient's preferences", "have shared decision", and "help patient decide". Results Respondents' mean (SD) age was 38.3 (12.5); 50.4% were males, 56.8% had ⩾ college education, and 37.3% had undergone a procedure. From the norm perspective, the least reflective statement was "meaningless routine" (ranked 1-3 by 2.6% of respondents) and the most reflective statements were "help patient decide", "make sure patient understand", and "inform patient" (ranked 1-3 by 65%, 60%, and 48% of respondents with median [25%,75%] ranking scores of 2 [1,5], 3 [2,4], and 4 [2,5], respectively). Compared to their counterparts, males and pre-procedure respondents ranked "help patient decide" better, whereas females and post-procedure respondents ranked "inform patient" better (p = 0.007 to p < 0.001). Age was associated with better ranking of "help patient decide" and "make sure patient understand" statements (p < 0.001 and p = 0.002, respectively), which were ranked 1-3 by only 46% and 42% of respondents from the current practice perspective (median ranking score 4 [2,6], p < 0.001 vs. norm perspective for both). Conclusions 1) the informed consent process is important to patients, however, patients vary in their views of its purpose with the dominant view being enabling patients' self decision-making, 2) males, pre-procedure, and older patients more favor a self decision-making purpose, whereas females and post-procedure patients more favor an information disclosure purpose, and 3) more self decision-making and more effective information disclosure than is currently practiced are desired. An informed consent process consistent with Mill's individual autonomy model may be suitable for most patients. [ABSTRACT FROM AUTHOR]

Background: Tunisia is a North African country of 10 million inhabitants. The native background population is Berber. However, throughout its history, Tunisia has been the site of invasions and migratory waves of allogenic populations and ethnic groups such as Phoenicians, Romans, Vandals, Arabs, Ottomans and French. Like neighbouring and Middle Eastern countries, the Tunisian population shows a relatively high rate of consanguinity and endogamy that favor expression of recessive genetic disorders at relatively high rates. Many factors could contribute to the recurrence of monogenic morbid trait expression. Among them, founder mutations that arise in one ancestral individual and diffuse through generations in isolated communities. Method: We report here on founder mutations in the Tunisian population by a systematic review of all available data from PubMed, other sources of the scientific literature as well as unpublished data from our research laboratory. Results: We identified two different classes of founder mutations. The first includes founder mutations so far reported only among Tunisians that are responsible for 30 genetic diseases. The second group represents founder haplotypes described in 51 inherited conditions that occur among Tunisians and are also shared with other North African and Middle Eastern countries. Several heavily disabilitating diseases are caused by recessive founde rmutations. They include, among others, neuromuscular diseases such as congenital muscular dystrophy and spastic paraglegia and also severe genodermatoses such as dystrophic epidermolysis bullosa and xeroderma pigmentosa. Conclusion: This report provides informations on founder mutations for 73 genetic diseases either specific to Tunisians or shared by other populations. Taking into account the relatively high number and frequency of genetic diseases in the region and the limited resources, screening for these founder mutations should provide a rapid and cost effective tool for molecular diagnosis. Indeed, our report should help designing appropriate measures for carrier screening, better evaluation of diseases burden and setting up of preventive measures at the regional level. [ABSTRACT FROM AUTHOR]

Background: Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom.Methods: A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs' perceptions of FPDR were generated using the 5-point Likert scale.Results: Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses.Conclusion: The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region. [ABSTRACT FROM AUTHOR]

Background: Little is known about the attitudes and practices of intensivists working in Lebanon regarding withholding and withdrawing life-sustaining treatments (LSTs). The objectives of the study were to assess the points of view and practices of intensivists in Lebanon along with the opinions of medical, legal and religious leaders regarding withholding withdrawal of life-sustaining treatments in Lebanese intensive care units (ICU).Methods: A web-based survey was conducted among intensivists working in Lebanese adult ICUs. Interviews were also done with Lebanese medical, legal and religious leaders.Results: Of the 229 survey recipients, 83 intensivists completed it, i.e. a response rate of (36.3%). Most respondents were between 30 and 49 years old (72%), Catholic Christians (60%), anesthesiologists (63%), working in Beirut (47%). Ninety-two percent of them were familiar with the withholding and withdrawal concepts and 80% applied them. Poor prognosis of the acute and chronic disease and futile therapy were the main reasons to consider withholding and withdrawal of treatments. Ninety-five percent of intensivists agreed with the "Principle of Double Effect" (i.e. adding analgesia and or sedation to patients after the withholding/withdrawal decisions in order to prevent their suffering and allow their comfort, even though it might hasten the dying process). The main withheld therapies were vasopressors, respiratory assistance and CPR. Most of the respondents reported the decision was often to always multidisciplinary (92%), involving the family (68%), and the patient (65%), or his advance directives (77%) or his surrogate (81%) and the nurses (78%). The interviewees agreed there was a law governing withholding and withdrawal decisions/practices in Lebanon. Christians and Muslim Sunni leaders declared accepting those practices (withholding or withdrawing LSTs from patients when appropriate).Conclusion: Withholding and withdrawal of LSTs in the ICU are known concepts among intensivists working in Lebanon and are being practiced. Our results could be used to inform and optimize therapeutic limitation in ICUs in the country. [ABSTRACT FROM AUTHOR]

Background: Burnout is a syndrome characterized by emotional exhaustion, increased depersonalization, and a diminished sense of personal accomplishment due to chronic emotional stress at work. Burnout impacts job satisfaction, job performance, vulnerability to illnesses, and interpersonal relationships. There is a gap in the systematic data on the burden of burnout among healthcare professionals from different sectors of healthcare in Middle Eastern countries. Our objective was to examine the burden of burnout among healthcare providers in the Middle East, how it was assessed, which sectors were included, and what interventions have been used.Methods: Articles were found through a systematic review of search results including PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO) using search terms reflecting burnout in Middle Eastern countries among populations of healthcare providers. Studies were included if they examined a quantitative measure of burnout among healthcare providers in the Middle East.Results: There were 138 articles that met our inclusion criteria for this systematic review. Studies focused on burnout in the Middle East among physicians (N = 54 articles), nurses (N = 55), combined populations of healthcare workers (N = 22), and medical students (N = 7). The Maslach Burnout Inventory was the most common tool to measure burnout. Burnout is common among physicians, nurses, and other healthcare professionals, with prevalence estimates predominantly ranging between 40 and 60%. Burnout among healthcare providers in the Middle East is associated with characteristics of their work environments, exposure to violence and terror, and emotional distress and low social support.Conclusions: Burnout is highly prevalent among healthcare providers across countries in the Middle East. Previous studies examining burnout in this region have limitations in their methodology. More thoroughly developed epidemiologic studies of burnout are necessary. Health system strengthening is needed in a region that has endured years of ongoing conflict, and there is an urgency to design and implement programs that tackle burnout among health professionals. [ABSTRACT FROM AUTHOR]

Background: Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are two coronaviruses with demonstrated potential to generate significant nosocomial outbreaks. In particular, MERS continues to pose a significant threat in the Middle East since 2012. Currently, no licensed vaccine or drug treatment is available to treat patients infected with either coronavirus. However, there are some MERS vaccines in the preclinical stage of development. We sought to evaluate the potential impact of targeted vaccination strategies for mitigating SARS and MERS outbreaks in healthcare settings using simple mathematical models and detailed historic transmission trees describing the progression of past nosocomial outbreaks of SARS and MERS. Results: Our findings suggest that vaccination strategies targeting patients and healthcare workers, which have been disproportionately affected during past outbreaks, and assuming two vaccination coverage levels at 50 and 75% have the potential to avert nearly 50% or more of MERS or SARS cases. Conclusion: Our modeling results informed by historic outbreak data for SARS and MERS suggest that vaccination strategies targeting patients could be an effective measure to mitigate and prevent outbreaks in the healthcare setting. [ABSTRACT FROM AUTHOR]

Background: Multiple studies have explored the use of active learning strategies among faculty members in different healthcare colleges worldwide, however, very few have described the use of these strategies in the Middle East. The aim of this study was to evaluate the extent of the implementation of active learning and its various techniques across different fields of healthcare education in various countries in the Middle East. Methods: A Web-based questionnaire was developed to obtain information on the use of active learning methods. This survey was disseminated among faculty members in healthcare colleges in 17 Middle Eastern countries. Results: Out of 22,734 online invitations that were sent to faculty members in different healthcare colleges, 2085 (9.17%) accepted the invitations, however, only 722 (34.63%) of those who agreed to participate filled out the questionnaire. Eighty-seven percent of the responders utilized at least one technique of active learning. Active learning was used more frequently by female responders. For example, 54.30% of the female responders reported using learning by teaching as one of their teaching methods compared to 41.30% of their male counterparts (p = 0.0005). The various forms of active learning were used at similar levels in both public and private healthcare colleges. Only minor differences were seen among different age groups or academic positions of the responders, but significant variabilities were noted among the several fields of healthcare education. For example, 61.54% of responders from the nursing faculty reported using reaction to videos as one of their teaching methods compared to 31.11% of their counterparts in the faculty of dentistry (p = 0.0021). The most frequently reported obstacles interfering with the effectuation of active learning include the lack of technical support and time constraints. Conclusions: Although some barriers to the implementation of active learning exist, it is extensively used by faculty members in healthcare colleges in the Middle East. [ABSTRACT FROM AUTHOR]