Search

Over the last decade, research into the negative effects of problematic internet use has greatly increased. The current study adopted a mediation-moderation model in exploring the relationship between problematic internet use and substance abuse (drinking, drug use, and smoking tobacco cigarettes) among 1,613 adolescents (aged 10–16) in the UK. The findings of the study revealed a significant positive correlation between problematic internet use and substance abuse, which is mediated by traditional and cyber bullying and victimisation. Furthermore, the parent–child relationship was found to be a protective factor that moderated the correlation between problematic internet use and substance abuse and the correlation between problematic internet use and traditional bullying. The study emphasises the critical need to reduce problematic internet use among adolescents as a risk factor for involvement in bullying as perpetrators and victims, in addition to substance abuse. Furthermore, the findings of the study highlight the importance of a good parent–child relationship as a protective factor among adolescents. In light of the findings of the study, interventions for reducing problematic internet use taking into account bullying and the parent–child relationship are needed among adolescents.

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar &lt, 7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

The current study aims to investigate the effect of cumulative exposure to violence on mental health amongst children and adolescents living in the Gaza Strip. The sample consists of 1029 children and adolescents aged 11-17 years. Of them, 533 (51.8%) were female and 496 (48.2%) were male. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh). Violence was derived from the Multicultural Events Schedule for Adolescents (M.E.S.A.) containing three domains: violence at home, violence in the neighbourhood, and violence at school. Emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Posttraumatic Stress Disorder was measured using the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Finally, depression symptoms were measured by the Depression scale. Around two thirds of the children (64.5%, N = 665) reported that they were exposed to violence at home, 48.2% (N = 497) to violence in the neighbourhood, 78.2% (N = 806) to violence at school. In addition, boys significantly showed more exposure to violence compared to girls. Moreover, the prevalence of PTSD according to DSM-5 is 53.5% (N = 549). The results also showed that cumulative effect of exposure to violence in more contexts (political war trauma, violence at home, neighbourhood and/or school) predicted higher levels of PTSD, social and emotional problems, depression, and overall mental health problems amongst children. Cumulative exposure to violence may increase the propensity of developing mental health problems such as PTSD, emotional and behavioural problems, and depression symptoms and thus interventions should be targeted to these populations.

The prevalence rate of Autism Spectrum Disorder (ASD) has reached over 1% world-wide prompting governments, health providers and schools to develop programs and policies to address this challenging disorder. Here, we review the cause(s), as well as environmental factors, genetic mutations, and neural pathways that are implicated in ASD. We also discuss the criteria that are commonly used for the diagnosis of ASD and future clinical genetic testing that can aid in the diagnosis of this disorder. Finally, we provide practical steps that can be used to reduce the incidence and severity of ASD, as well as prognosis and treatment of autism.

Background After the war, which was conducted against Palestinian civilians in the Gaza Strip, the prevalence of posttraumatic stress disorder (PTSD) among children and adolescents has increased. The counselling department at the Ministry of Education in the Gaza Strip applied a counselling program in schools in order to alleviate the effect of exposure to war. The aim of the study is to investigate the effectiveness of the counselling program after exposure to war-traumatic events among Palestinian children and adolescents in the Gaza Strip. Methods The sample consists of 572 students aged 12–18 years old. Of them, 331 (57.9%) were female and 241 (42.1%) were male. Traumatic events were measured by War-Traumatic Events Checklist (W-TECh). PTSD was measured by the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Anxiety symptoms were adapted from The Anxiety Symptoms Scale, and depression symptoms were measured by Child Depression Inventory. Repeated measures design was employed as the counselling program was applied in all the schools at the same time. Specifically, the data were collected from the participants before the application of the counselling program and 2 months later. Results After applying the school-based counselling program, the prevalence of PTSD (according to DSM-V) decreased from 57.5% to 45.6% among the children and adolescents who were exposed to war-traumatic events. In addition, PTSD symptoms, and emotional, somatic and cognitive functional impairment symptoms has decreased after the implementation of the counselling program especially amongst girls. Conclusions The school-based counselling program was effective in decreasing the PTSD symptoms among children and adolescents after the exposure to war-traumatic events.

Conflict leads to toxic stress and health problems in childhood and beyond. Long term investment in evidence-informed mitigation strategies is needed to end the devastating cycles of violence. يؤدي الصراع إلى إجهاد سام ومشاكل صحية في مرحلة الطفولة وما بعدها. هناك حاجة إلى استثمار طويل الأجل في استراتيجيات التخفيف المدعومة بالأدلة لإنهاء دورات العنف المدمرة.

Background Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. Objective In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. Methods We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. Results SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45–3.57) but male infants (aRR, 0.57; 95% CI, 0.4–0.81), those born to parous (aRR 0.66; 95% CI, 0.45–0.93), or overweight (aRR, 0.64; 95% CI, 0.42–0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49–2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63–2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11–1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8–3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47–318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36–3.22). Conclusion Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.

Background Consanguineous marriages are common in the Middle East including the Gulf countries. The rate of consanguinity in Qatar is approximately 54%, which are mainly first cousins’ marriages. Previous studies showed that consanguinity increases the prevalence of birth defects and other genetic disorders. Thus, we studied the effects of consanguinity in a cohort of subjects with certain genetic disorders in Qatar. Methods This cross‐sectional study was conducted at two centers in Qatar (Hamad Medical Corporation “HMC” and Shafallah “SC”) including 599 Qatari families with certain types of genetic and nongenetic anomalies. Results Consanguineous marriages were seen in 397 of 599 (66.2%) Qatari families and first cousin group counts for 65% in Qatari population. In the total cohort and at HMC, all consanguineous marriages had a significantly higher risk of Autosomal Recessive disorders than nonconsanguineous marriages (total cohort: odds ratio (OR) = 1.72; 95% CI: 1.10, 2.71; p = .02; HMC: OR = 2.98; 95% CI: 1.37, 6.09; p = .005). On the other hand, at HMC, nonconsanguinity was significantly related to chromosomal abnormality (OR = 6.36; 95% CI: 1.13, 35.85; p = .036). Conclusion Our data suggest a significant role of parental consanguinity in increasing the prevalence of genetic disorders; mainly Autosomal Recessive disorders. Chromosomal abnormality disorders were significantly higher among nonconsanguineous marriages. These results help better inform policy makers on social, educational, and public health initiatives that might mitigate the impact of genetic disease in the Qatari society., The study highlights the significant role of parental consanguinity and specific relatedness (first cousin) in increasing the risk of developing genetic disorders, in particular Autosomal Recessive.

Despite concerns about the effects of internet use, little is known about how problematic internet use impacts on British children and adolescents. By adapting the Problematic Internet Use Questionnaire (PIUQ, Demetrovics, Szeredi, & Rozsa, 2008), this study seeks its validation while studying its association with psychopathological and health problems. A sample of 1,814 children and adolescents (aged 10–16 years old) from UK schools completed questionnaires about PIU, behavioural problems, depression, anxiety and health problems. Confirmatory Factor Analysis identified three independent factors: Neglect, Obsession and Control Disorder. Using path analysis, PIU was significantly predicted by conduct problems, hyperactivity, impact on daily life activities, depression and poorer physical health. Males were more likely than females to score higher on PIU. The study shows for the first time that the adapted PIU questionnaire constitutes a valid tool for the assessment of problematic internet use among children/adolescents. The results also suggest an urgent need for the development of intervention strategies.

The clinical implementation of assessment and evidence based interventions is lagging behind research, with huge cost to individuals and society, write Andrea Danese and colleagues. To provide the best possible care to some of the most vulnerable children, specialist training, clinical capacity, and access to care must be increased

The prevalence of “toxic stress” and huge downstream consequences in disease, suffering, and financial costs make prevention and early intervention crucial, say Charles A Nelson and colleagues

Classical homocystinuria (HCU) is the most common inborn error of metabolism in Qatar, with an incidence of 1:1800, and is caused by the Qatari founder p.R336C mutation in the CBS gene. This study describes the natural history and clinical manifestations of HCU in the Qatari population. A single center study was performed between 2016 and 2017 in 126 Qatari patients, from 82 families. Detailed clinical and biochemical data were collected, and Stanford-Binet intelligence, quality of life and adherence to treatment assessments were conducted prospectively. Patients were assigned to one of three groups, according to the mode of diagnosis: (a) late diagnosis group (LDG), (b) family screening group (FSG), and (c) newborn screening group (NSG). Of the 126 patients, 69 (55%) were in the LDG, 44 (35%) in the NSG, and 13 (10%) in the FSG. The leading factors for diagnosis in the LDG were ocular manifestations (49%), neurological manifestations (45%), thromboembolic events (4%), and hyperactivity and behavioral changes (1%). Both FSG and NSG groups were asymptomatic at time of diagnosis. NSG had significantly higher intelligence quotient, quality of life, and adherence values compared with the LDG. The LDG and FSG had significantly higher methionine levels than the NSG. The LDG also had significantly higher total homocysteine levels than the NSG and FSG. Regression analysis confirmed these results even when adjusting for age at diagnosis, current age, or adherence. These findings increase the understanding of the natural history of HCU and highlight the importance of early diagnosis and treatment. SYNOPSIS: A study in 126 Qatari patients with HCU, including biochemical, clinical, and other key assessments, reveals that patients with a late clinical diagnosis have a poorer outcome, hereby highlighting the importance of early diagnosis and treatment.

Background The aim of this study was to investigate the effect of exposure to war-traumatic events on mental health in children and adolescents in the presence of other stressors such as stressful life events, exposure to traumatic events (not related to war trauma; eg, being in a car accident or having a serious illness), and poverty. Methods Participants were chosen from the Gaza Strip using a stratified random sampling method. The data were collected in October, 2013, 1 year after the Gaza War on Nov 14–26, 2012. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh), which includes three categories: personal trauma; witnessing trauma to others; and seeing demolition of property. Stressful life events were measured using the Stressful Life Events Scale. Exposure to traumatic events (not related to war-trauma) was measured using the University of California at Los Angeles post-traumatic stress disorder (PTSD) reaction index for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV (child version). PTSD was measured using the PTSD Symptoms Scale. Finally, depression was measured using the Child Depression Inventory. Findings The sample consisted of 1029 students aged 11–17 years. 496 (48%) participants were boys, and 533 (52%) participants were girls. 909 (88%) students had experienced personal trauma, 861 (84%) had witnessed trauma to others, and 908 (88%) had seen demolition of property during the war. Boys reported more exposure to personal trauma, witnessing trauma to others, seeing demolition of property, and overall traumatic events compared to girls. Girls reported more exposure to stressful life events, exposure to trauma (not related to war-trauma), PTSD, and depression. 549 (54%) students had a diagnosis of PTSD diagnosis. We found a positive correlation between the age and exposure to war-traumatic events and stressful life events and between family size and exposure to war-traumatic events and PTSD. By contrast, we found a negative correlation between family income and stressful life events, exposure to traumatic events not related to war trauma, PTSD, and depression. Finally, exposure to war-traumatic events, experience of stressful life events, and exposure to traumatic events not related to war-trauma were positively correlated with PTSD and depression. Interpretation Socioeconomic status such as big family size and low family income increased the severity of effects of stressful life events, exposure to war-traumatic events, and exposure to traumatic events not related to war-trauma. Consequently, the possibility of PTSD and depression was high. The findings also show that stressful life events, exposure to war-trauma, and exposure to traumatic events not related to war-trauma could be considered as risk factors for PTSD and depression. Funding Qatar National Research Fund (QNRF), a member of Qatar Foundation Doha, Qatar, National Priority Research Programs under grant NPRP 7-154-3-034 to MS.

Objective\ud To determine the mean duration of fussing and crying and prevalence of colic using modified Wessel criteria in infants in the first 3 months of life.\ud \ud Study design\ud A systematic literature search was performed using the databases Medline, PsycINFO, and Embase. The major outcome measure was mean total fuss/cry duration during 24 hours at ages 1-2 weeks (11 samples), 3-4 weeks (6 samples), 5-6 weeks (28 samples), 8-9 weeks (9 samples), and 10-12 weeks (12 samples).\ud \ud Results\ud Of 5687 articles reviewed, 28 diary studies (33 samples) were suitable for inclusion in meta-analysis; these studies included 8690 infants. No statistical evidence for a universal crying peak at 6 weeks of age across studies was found. Rather, the mean fuss/cry duration across studies was stable at 117-133 minutes (SDs: 66-70) in the first 6 weeks and dropped to a mean of 68 minutes (SD: 46.2) by 10-12 weeks of age. Colic was much more frequent in the first 6 weeks (17%-25%) compared with 11% by 8-9 weeks of age and 0.6% by 10-12 weeks of age, according to modified Wessel criteria and lowest in Denmark and Japan.\ud \ud Conclusions\ud The duration of fussing/crying drops significantly after 8-9 weeks of age, with colic as defined by modified Wessel criteria being rare in infants older than 9 weeks. Colic or excessive fuss/cry may be more accurately identified by defining fuss/cry above the 90th percentile in the chart provided based on the review.

Aim: To determine whether maternal and child intake of dietary omega-3 (n-3) fatty acids (FA), together with the presence or absence of breast-feeding, predicted psychiatric diagnosis of externalizing disorders in childhood.\ud \ud Methods: Data concerning childhood externalizing disorders were collected from 8242 children aged 7.9 years in a large British cohort. Intake of n-3 FA was measured for the study mother during pregnancy and for the child at 3 years. Duration of breast-feeding was examined to account for moderating effects. Adjustment was made for a variety of potential confounders.\ud \ud Results: Maternal intake of n-3 and breast-feeding predicted oppositional/conduct disorder and comorbid externalizing disorder before adjustment for confounding factors. However, there was no association between intake of n-3 by mother or child and any type of externalizing disorder once socio-demographic factors were taken into account.\ud \ud Conclusions: Any association between intake of n-3 and childhood externalizing disorders appears to be strongly confounded with socio-demographic factors. This is important to note given the current popularity of n-3 as a possible treatment for behaviour problems related to inattention and impulsivity. Care must be taken that studies investigating this relationship account fully for factors associated with both behaviour and diet.

AIM The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm(EPC) at age 6 years. METHOD A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%]) aged 6 years who were born at 25 weeks’ gestation or earlier (mean 24.5wks, SD 0.7wks; mean birthweight 749.1g, SD 116.8g), and parents of 148 classmates born at term (66 males [44.6%], 82 females [55.4%]). All children underwent neurological, cognitive, and anthropometric assessment, and parents and teachers completed a behaviour scale. RESULTS Eating problems weremore common among the EPC than the comparison group (odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1–6.3), including oralmotor (OR 5.2, 95% CI 2.8–9.9), hypersensitivity (OR 3.0, 95% CI 1.6–5.6), and behavioural (OR 3.8, 95% CI 1.9–7.6) problems. Group differences were reduced after adjustment for cognitive impairment, neuromotor disability, and other behaviour problems. EPC with eating problems were shorter, lighter, and had lower mid-arm circumference and lower body mass index (BMI) even after adjusting for disabilities, gestational age, birthweight, and feeding problems at 30 months. INTERPRETATION Eating problems are still frequent in EPC at school age. They are only partly related to other disabilities but make an additional contribution to continued growth failure and may require early recognition and intervention.

BackgroundParticipant drop-out occurs in all longitudinal studies, and if systematic, may lead to selection biases and erroneous conclusions being drawn from a study.AimsWe investigated whether drop out in the Avon Longitudinal Study of Parents And Children (ALSPAC) was systematic or random, and if systematic, whether it had an impact on the prediction of disruptive behaviour disorders.MethodTeacher reports of disruptive behaviour among currently participating, previously participating and never participating children aged 8 years in the ALSPAC longitudinal study were collected. Data on family factors were obtained in pregnancy. Simulations were conducted to explain the impact of selective drop-out on the strength of prediction.ResultsDrop out from the ALSPAC cohort was systematic and children who dropped out were more likely to suffer from disruptive behaviour disorder. Systematic participant drop-out according to the family variables, however, did not alter the association between family factors obtained in pregnancy and disruptive behaviour disorder at 8 years of age.ConclusionsCohort studies are prone to selective drop-out and are likely to underestimate the prevalence of psychiatric disorder. This empirical study and the simulations confirm that the validity of regression models is only marginally affected despite range restrictions after selective drop-out.

Investigations of cyberbullying are beginning to emerge in the scientific literature because of their implications for child and adolescent development. In particular, cyberbullying victimisation has been associated with similar negative consequences to traditional or face-to-face bullying such as lower academic achievement, anxiety, and sometimes even suicide. Research has also started to emerge investigating the impact of such incidences on the life of adults. The literature in this area has been steadily growing over the last decade and this review highlights the current situation in terms of relevant features and the psychological impact on victims. The selection process consisted of a comprehensive search that was conducted in January 2015 in the following databases: PsychInfo, ERIC, Web of Science and Medline. A total of 19 papers were included. We conclude with suggestions for online psychological treatment for victims and bullies as a means of coping with the distress caused from cyberbullying experiences.

Cyberbullying is a worldwide problem affecting mental health, education, safety and general well-being for individuals across the globe. Despite the widespread availability of the Internet, research into prevalence rates of cyberbullying in Qatar is lacking and legislating for cyberbullying in Qatar has been slow to develop. However, recently there have been some positive initiatives in the country such as the development of a National ICT Strategy and a website detailing safe practice guidelines for Internet usage. A Cybercrime Law has been proposed but has yet to be officially implemented in Qatar and as a result, the provisions for cyberbullying among school-aged children are still unknown. The current paper presents an evaluation of the legislative and public policy solutions to cyberbullying available in Qatar and outlines the critical challenges that could potentially face educators in shaping best practice guidelines for the future. Acknowledgements: The authors would like to thank Qatar National Research Fund (QNRF) a member of Qatar Foundation Doha, Qatar, National Priority Research Programs grant (NPRP 5- 1134-3-240) funded to Dr. Muthanna Samara. We also would like to thank the teachers and head teachers in Qatar who were kind enough to provide us with information and advice.

This study aims to investigate the perception of bullying amongst Qataris and Arabic speakers in Qatar by covering several areas (1) to what extent is the term "tanamour" used amongst Arabic speakers to refer to bullying and how far is it promoted; (2) attempts to identify which other words might be used to explain bullying in the country; (3) To what extent are people aware of distinguishing bullying from incidents according to the criteria of imbalance of power, intention, and repetition. Three scenarios were presented orally which contained incidents of bullying or aggression. The first scenario described intentional and repeated direct bullying (a boy continuously having his chocolate stolen at school). The second related a case of intentional and repeated cyberbullying (two boys continuously spread rumours about their classmate). The final scenario was not a case of bullying but rather, a one-off incident where a boy hits their classmate. Participants were asked to describe how they saw these incidents so that the terms used could be recorded (part A). This phase allowed people to describe events in their own words freely without prompting. In the second phase, participants were asked to select from a previously determined list, the most appropriate word they felt described the three scenarios already given and were presented via a laptop. The list contained commonly used terms for bullying behaviours in Arabic. However, if participants felt none of the words adequately described the behaviours, they were encouraged to use their own. Participants were not informed directly that the meetings would be about bullying but rather 'behaviours they may encounter in daily life'. They were also told that there were no 'correct answers' and to just state their opinion as they wished (including saying nothing or ending participation if they wanted). Two researchers were present at every meeting except one where it was appropriate for a female only. All sessions were recorded except one where participants found it inappropriate. Focus groups included 36 participants and took place either in participant's homes or places of work, and took 20-60 minutes long depending on group number and length of discussion. The study took place amongst families, friends and social workers in Qatar where 36% of the sample were Qataris and the rest were from other different Arabic speaking countries such as Egypt, Syria, Yemen, Palestine, Bahrain, Jordan, Somalia and Iraq. Even though this is a preliminary study, the findings indicate that there is some diversity due to the differences in cultures as there is considerable confusion with regards to the terminology used to describe bullying in Arabic. With respect to the aims of the study it has been unequivocally demonstrated that 'tanamor' is not widely used in Qatar and that when it is, it is often misused. There isn't a clear word emerged that has any equivalence to bullying in English. It is clear that there is a tremendous amount of work to be done to qualify both a term and concept behind this damaging behaviour in the Middle-East. Acknowledgements: The authors would like to thank Qatar National Research Fund (QNRF) a member of Qatar Foundation Doha, Qatar, National Priority Research Programs grant (NPRP 5- 1134-3-240) funded to Dr. Muthanna Samara. We also would like to thank the teachers and head teachers in Qatar who were kind enough to provide us with information and advice.

BackgroundDespite the revolutionary success of introducing tyrosine kinase inhibitors (TKIs), such as imatinib mesylate (IM), for treating chronic myeloid leukemia (CML), a substantial proportion of patients’ treatments fail.AimThis study investigates the correlation between patient adherence and failure of TKIs’ treatment in a follow-up study.MethodsThis is a follow-up study of a new cohort of CML patients. Adherence to IM is assessed using the Medication Event Monitoring System (MEMS 6 TrackCap, AARDEX Ltd). The 9-item Morisky Medication Adherence Scale, medication possession ratio (MPR) calculation, and the electronic medical records are used for identifying potential factors that influence adherence. Clinical outcomes are assessed according to the European LeukemiaNet 2013 guidelines via reverse transcriptase quantitative polymerase chain reaction measurement of the level of BCR-ABL1 transcripts in peripheral blood. Response is classified at the hematological, cytogenetic, and molecular levels into optimal, suboptimal, or failure.ResultsA total of 36 CML patients (5 citizens and 31 noncitizen residents) consented to participate in the study. The overall mean MEMS score was 89. Of the 36 patients, 22 (61%) were classified as adherent (mean: 95) and 14 (39%) were classified as nonadherent (mean: 80.2). Adherent patients were significantly more likely to obtain optimal response (95%) compared to the nonadherent group (14.3%; P < 0.0001). The rate of poor adherence was as high as 39% using MEMS, which correlates with 37% treatment failure rate. The survey results show that 97% of patients increased the IM dose by themselves when they felt unwell and 31% of them took the missing IM dose when they remembered. Other factors known to influence adherence show that half of patients developed one or more side effects, 65% of patients experienced lack of funds, 13% of patients declared unavailability of the drug in the NCCCR pharmacy, and 72% of patients believed that IM would cure the disease. The MPR results reveal that 16% of patients had poor access to treatment through the hospital pharmacy.Discussion and ConclusionThis is the first prospective study to evaluate CML patients’ adherence and response to IM in Qatar. The high rate of treatment failure observed in Qatar is explained by poor adherence. An economic factor (unaffordable drug prices) is one of the main causes of nonadherence and efforts should be made locally to improve access to medication for cancer diseases. Other risk factors associated with poor adherence could be improved by close monitoring and dose adjustment. Monitoring risk factors for poor adherence and patient education that include direct communication between the health-care teams, doctors, nurses, pharmacists, and patients are essential components for maximizing the benefits of TKI therapy and could rectify this problem. The preliminary results show that patients’ response to treatment may be directly linked to patients’ adherence to treatment. However, further in-depth and specific analysis may be necessary in a larger cohort.

BACKGROUND Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the first two years of life. Full Text of Background... METHODS We studied at the time of early school age children who had been born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. The children underwent standardized cognitive and neurologic assessments at six years of age. Disability was defined as severe (indicating dependence on caregivers), moderate, or mild according to predetermined criteria. Full Text of Methods... RESULTS Of 308 surviving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defined as results more than 2 SD below the mean) was present in 21 percent of the children born extremely preterm (as compared with 1 percent in the standardized data), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 percent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was present in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate-to-severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly predictive of developmental problems at 6 years of age. Full Text of Results... CONCLUSIONS Among extremely preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.

Objectives To test whether health-related quality of life (HRQL) based on societal standards differs between very low birth weight/very preterm (VLBW/VP) and full-term (FT) adolescents using self and parent proxy reports. Also, to examine whether self and parent reported HRQL is explained by indicators of objective functioning in childhood. Study design This prospective cohort study followed 260 VLBW/VP adolescents, 12 VLBW/VP adolescents with disability, and 282 FT adolescents. Objective functioning was assessed at 8.5 years; HRQL was assessed at 13 years with the Health Utilities Index Mark 3 (HUI3). Results Adolescents reported more functional impairment than their parents especially in the psychological aspects of health. The mean difference in HUI3 multi-attribute utility scores between FT and VLBW/VP adolescents was small (parents: 0.91 [95% CI, 0.90, 0.92] vs 0.88 [95% CI, 0.86, 0.90]; adolescents: 0.87 [95% CI, 0.85, 0.89] vs 0.84 [95% CI, 0.82, 0.86]), but high for VLBW/VP adolescents with disabilities (0.18, 95% CI, −0.04, 0.40). Objective function did not predict HRQL in FT adolescents but contributed to prediction of HRQL in VLBW/VP adolescents without disabilities. Different indicators of objective functioning were important for adolescent vs parent reports. More variation in HUI3 scores was explained by objective function in VLBW/VP parent reports compared with adolescent reports (25% vs 18%). Conclusions VLBW/VP adolescents reported poorer HRQL than their FT peers in early adolescence. Improvement in HRQL as VLBW/VP children grow up is, at least partly, explained by exclusion of the most disabled in self reports by VLBW/VP adolescents and the use of different reference points by adolescents compared with parents.

OBJECTIVE: To determine whether language and educational problems are specific or due to general cognitive deficits in children born at 25 weeks' gestation or less. STUDY DESIGN: A national cohort study assessed 241 of 308 (78%) surviving children at a median age of 6 years, 4 months along with 160 of these children's classmates. Formal tests included standard cognitive, language, phonetic, and speech assessments. The children's school achievement was rated by classroom teachers. RESULTS: Mean cognitive scores for index children were 82 (standard deviation [SD] +/- 19) compared with 106 (SD +/- 12) for the peer group. Extremely preterm children had an increased risk of language problems (odds ratio [OR] = 10; 95% confidence interval [CI] = 3 to 32), speech problems (OR = 4.4; 95% CI = 3 to 7), and overall school difficulties (OR = 25; 95% CI = 12 to 54). Extremely preterm boys were twice as likely to show deficits as extremely preterm girls, but no such sex-based differences were apparent in the comparison group. Differences in general cognitive scores explained specific language or phonetic awareness deficits, but not speech ratings or educational difficulties, in the extremely preterm children. CONCLUSIONS: Language or phonetic difficulties are not specific and indicate general cognitive functional difficulties. The findings have implications for models of global deviation of brain development in extremely preterm children.