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Khaleed Jemmieh,&ast; Mohamed Tawengi,&ast; Tamader Alyaarabi,&ast; Aseel Hassona,&ast; Ikhlas Ghoul,&ast; Sara Al Abdulla,&ast; Khaled E Elzawawi,&ast; Omar Karen,&ast; Suhail A Doi, Tawanda Chivese Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar&ast;These authors contributed equally to this workCorrespondence: Tawanda Chivese, Department of Population Medicine, College of Medicine, QU Health, Qatar University, PO Box 2713, Doha, Qatar, Email tchivese@qu.edu.qaBackground: The association between the cycle threshold (Ct) which reflects the SARS-CoV-2 viral load and the severity of COVID-19 is still not clear. We investigated the association between Ct values, symptoms and the risk of ICU admission and mortality from COVID-19 in Qatar.Methods: This case–control study used data of hospitalized individuals with confirmed COVID-19 during the period March to September 2020. Cases were defined as individuals with confirmed COVID-19 who were admitted to the intensive care unit (ICU) or died and controls as those who were not admitted to the ICU. The association between Ct value, symptoms, ICU admission and mortality was investigated using Ct value as a categorical variable (below and above 25) in multivariable regression models and adjusted for relevant confounders.Results: A total of 622 participants with median age 53 (IQR: 53– 63), of which 69% were males, were included. There were 236 ICU admissions and 111 deaths. When categorized, Ct value (< 25 vs ≥ 25) had no association with the odds of ICU admission (OR 0.85, 95% CI 0.56 to 1.29) or odds of mortality (OR 1.21, 95% CI 0.71 to 2.08). Respiratory (OR 2.95, 95% CI 1.57 to 5.56) and gastrointestinal symptoms (OR 1.99, 95% CI 1.18 to 3.35) were associated with higher odds of ICU admission. Similarly, respiratory (OR 4.96, 95% CI 1.10 to 22.43) and gastrointestinal symptoms (OR 3.17, 95% CI 1.29 to 7.84) were associated with higher odds of mortality.Conclusion: Although RT-PCR Ct has good diagnostic value, its prognostic value appears to be unreliable. Respiratory and gastrointestinal symptoms are associated with COVID-19 criticality and mortality in this setting.Keywords: COVID-19, Ct-value, RT-PCR, symptoms, Qatar Biobank, QBB

Mohamed Ghaith Al-Kuwari,1 Samya Al Abdulla,2 Maha Abdulla,1 Azza Mustafa Mohammed,1 Ahmad Haj Bakri,1 Fahad Shaikhan,3 Hanan Buhaddoud1 1Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar; 2Operations, Primary Health Care Corporation, Doha, Qatar; 3Preventative Health – Health Protection, Primary Health Care Corporation, Doha, QatarCorrespondence: Azza Mustafa Mohammed Tel +974 40270065Email ammohammed@phcc.gov.qaObjective: This study is a part of the Primary Health Care Corporation’s (PHCC) Health Needs Assessment (HNA) Initiative. It focuses on identifying perceptions of Arabic speaking primary care clients regarding community’s major health issues, their experiences in utilizing health services, and the barriers that limit their access to health care in the State of Qatar.Study Setting and Design: A total of 10 focus groups sessions were conducted at different PHCC’s health centers between October of 2019 and March of 2020. Sessions were distributed to cover all PHCC’s three geographical regions. Data were analyzed using thematic analysis.Participants: A total of 89 adult Arabic speaking individuals were recruited. Participants included were in the age groups (18– 69), native Arabic speaker, and registered at one of the PHCC’s health centers with a valid health card at time of recruitment.Results: Areas investigated included perceptions of the community’s health issues, needed health services, and perceived barriers to health care. Priority health issues identified were chronic non-communicable diseases, mental health, timely access to care, cultural competency of delivered services, and integration and coordination across health care settings and sectors. Participants were able to identify socioeconomic and environmental factors such as the need for health and wellness interventions at schools that affects the health of the individual and the community. The importance of raising the community’s awareness about health-related issues and availability of health services was highlighted by study participants.Conclusion: Collecting qualitative data provides an opportunity to examine people’s perceptions, and motivations and engage the whole community. This process is very important for strategic planning of health services. The study attempts to fill the knowledge gap and should be linked to health policy and the development of socially and culturally appropriate health programs.Keywords: primary care, qualitative research, PHCC, health needs assessment, Qatar

Manal Al-Zaidan,1 Mohamed Izham Mohamed Ibrahim,2 Mohamed Ghaith Al-Kuwari,3 Azza Mustafa Mohammed,3 Mansoor Nawaz Mohammed,4 Samya Al Abdulla5 1Pharmacy Department, Primary Health Care Corporation, Doha, Qatar; 2College of Pharmacy, QU Health, Qatar University, Doha, Qatar; 3Directorate of Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar; 4Clinical Information Systems Department, Primary Health Care Corporation, Doha, Qatar; 5Directorate of Operations, Primary Health Care Corporation, Doha, QatarCorrespondence: Manal Al-ZaidanDirector of Pharmacy, P.O. Box 26555, Doha, QatarTel + 974 40271103Email malzaidan@phcc.gov.qaAbstract: The COVID-19 pandemic has strained health care systems around the world. Pharmacists have made substantial contributions to the health care operations during the COVID-19 response. The Pharmacy Department at Qatar Primary Health Care Corporation (PHCC) acted proactively to ensure that all patients received their medications and their refilled prescriptions in time and without any disruption. The Medication Home Delivery Service was introduced and implemented for all Qatar residents to prevent unnecessary visits to health centers, minimize the spread of COVID-19 to vulnerable populations, especially those with multiple comorbidities, and protect health care workers from exposure to the virus. Moreover, several other precautionary measures were taken by the PHCC to ensure uninterrupted access to health care, including moving to a virtual health care delivery model. As of September 2020, the service had served around 64,213 patients since its launch in March 2020. In total, 70,357 medications were delivered and 69,092 (98.2%) medication packages were delivered successfully to patients, with an average of 450.8 medication packages delivered per month. Despite various challenges, the PHCC is considering continuing the Medication Home Delivery Service in the long term to continue with a more effective and efficient service for patients during the coming months and years.Keywords: COVID-19, pandemic, pharmacy service, medication home delivery, PHCC, Qatar

Field experiment was conducted to evaluate the performance of four sunflower hybrids (As508, Euroflor, Velta and Flamme) in two locations (Al-Qurna an Al-Medina) in Basrah Governorate during the fall seasons of years 2007 and 2008. A Complete Randomized Block design with three Replications for each location was used. Euroflor hybrid showed the highest grain yield (2.58 and 2.72 t/h) for both seasons respectively while the hybrid Flamme gave the lowest grain yield (1.87 and 1.97t/h) for both seasons, Al-Qurna location gave the highest, Leaf area index (LAI),number of seeds per head and grain yield for the both seasons. Euroflor planted in Al-Qurna location recorded the highest grain yield (2.90t/h) in growing season of 2007. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by impaired social interaction and communication and the occurrence of stereotyped and repetitive behaviors. Several studies have reported altered cytokine profiles in ASD and hence may serve as potential diagnostic biomarkers of the disorder. This study aims to identify diagnostic biomarkers for ASD in a well-defined study cohort in Qatar., Methods: We measured the protein levels of 45 cytokines in the plasma samples of age- and gender-matched children (2-4 years) with ASD (n = 100) and controls (n = 60) using a Luminex multiplex assay. We compared the differences in the levels of these cytokines between the two study groups and then fitted the significantly altered cytokines into a logistic regression model to examine their diagnostic potential for ASD., Results: We found elevated levels of IFN-γ, FGF-2, IL-1RA, and IL-13 and reduced levels of eotaxin, HGF, IL-1 alpha, IL-22, IL-9, MCP-1, SCF, SDF-1 alpha, VEGFA, and IP-10 in the plasma of children with ASD compared to controls. Furthermore, we observed that elevated levels of IFN-γ (odds ratio (OR) = 1.823; 95% (confidence interval) CI = 1.206, 2.755; p = 0.004) and FGF-2 (OR = 2.528; 95% CI = 1.457, 4.385; p < 0.001) were significantly associated with increased odds of ASD, whereas reduced levels of eotaxin (OR = 0.350; 95% CI = 0.160, 0.765; p = 0.008) and HGF (OR = 0.220; 95% CI = 0.070, 0.696; p = 0.010) were significantly associated with lower odds of ASD relative to controls. The combination of these four cytokines revealed an area under the curve (ROC-AUC) of 0.829 (95% CI = 0.767, 0.891; p < 0.001), which demonstrates the diagnostic accuracy of the four-cytokine signature., Conclusions: Our results identified a panel of cytokines that could discriminate between children with ASD and controls in Qatar. In addition, our findings support the predominance of a Th1 immune phenotype in ASD children and emphasize the need to validate these results in larger populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nour-Eldine, Manaph, Ltaief, Abdel Aati, Mansoori, Al Abdulla and Al-Shammari.)

Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization., Objective: This study aims to comprehensively examine the community call center's operations and their significant role during the COVID-19 pandemic., Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations., Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19-related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls., Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises., (©Muhammad Atif Waheed, Lolwa Al Mannai, Hanan Khudadad, Jamil Alenbawi, Mariama Aminata Mansaray, Samya Al Abdulla. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.01.2024.)

In this paper, we investigate the potential use of Zeolitic Imidazolate Frameworks (ZIF-8) as a sensing material for CO 2 detection. Three synthesis techniques are considered for the preparation of ZIF-8, namely room temperature, microwave-assisted, and ball milling. The latter is a green and facile alternative for synthesis with its solvent-free, room-temperature operation. In addition, ball milling produces ZIF-8 samples with superior CO2 adsorption and detection characteristics, as concluded from fluorescence measurements. Characterization tests including X-ray diffraction (XRD), Fourier transform infrared (FTIR), Thermogravimetric analysis (TGA), Field emission scanning electron microscopy (FE-SEM) and Energy-dispersive X-ray spectroscopy (EDS) are conducted to inspect the structural morphology, the thermal stability, and elements content of the ZIF-8 samples obtained from the different aforementioned synthesis techniques. The characterization tests revealed the appearance of a new phase of ZIF-8 which is ZIF-L when deploying the ball milling technique with different structure, morphology, response to CO 2 exposure and thermal stability when compared to its counterparts. Fluorescence measurements are carried out to evaluate the limit of detection (LOD), selectivity, and recyclability of the different ZIF-8 samples. The LOD of the ZIF-8 sample synthesized based on ball milling synthesis technique is 815.2 ppm, while LODs of the samples obtained from microwave and room temperature-based synthesis techniques are 1780.6 ppm and 723.8 ppm, respectively. This indicates that the room temperature and ball milling produced MOFs have comparable LODs. However, the room temperature procedure requires the use of a harmful solvent. The range of LOD demonstrates the suitable use of ZIF-8 for indoor air quality monitoring and other industrial applications., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

There are numerous reports and publications in reputable scientific and engineering journals that attribute substantial enhancement in heat transfer capabilities for heat exchangers once they employ nanofluids as working fluids. By definition, a nanofluid is a working fluid that has a small volume fraction (5% or less) of a solid particle with dimensions in the nanoscale. The addition of this solid material has a reported significant impact on convective heat transfer in heat exchangers. This work investigates the significance of the reported enhancements in many recent related publications. Observations on these publications' geographical origins, fundamental heat transfer calculations, experimental setups and lack of potential applications are critically made. Heat transfer calculations based on methodologies outlined in random selection of available papers were conducted along with a statistical analysis show paradoxically inconsistent conclusion as well as an apparent lack of complete comprehension of convective heat transfer mechanism. In some of the surveyed literature for example, heat transfer coefficient enhancements were reported to be up to 27% and 48%, whereas the recalculations presented in this work restrain proclaimed enactments to ~ 3.5% and - 4% (no enhancement), respectively. This work aims at allowing a healthy scientific debate on whether nanofluids are the sole answer to enhancing convective heat transfer in heat exchangers. The quantity of literature that confirms the latter statement have an undeniable critical mass, but this volition could be stemming from and heading to the wrong direction. Finally, the challenges imposed by the physical nature of nanoparticles, as well as economic limitations caused by the high price of conventional nanoparticles such as gold (80$/g), diamond (35$/g), and silver (6$/g) that hinder their commercialization, are presented., (© 2023. Springer Nature Limited.)

Background: In March 2020, Qatar started reporting increased numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). National preventive measures were implemented, and a testing plan was developed to respond to the pandemic with the Primary Health Care Corporation (PHCC) as the central element. PHCC is the main public primary healthcare provider in Qatar and it operates in 27 health centers with around 1.4 million registered individuals as of January 1, 2020. The latter population was distributed across four main nationality groups; Middle Eastern and North African (51.5%), Asian (41.2%), African (2.4%), and others (5.1%). At the primary healthcare level in Qatar, this study describes the epidemiological characteristics of individuals registered at PHCC who had contracted COVID-19 in 2020 during the first wave before the vaccination phase and examines the factors associated with the positivity rate., Methods: Retrospective data analysis was conducted for persons screened for SARS-CoV-2 in primary healthcare health centers in Qatar between March 11 and December 31, 2020. The study analyzed the demographic characteristics of the tested persons and noncommunicable disease burden, positivity rate by month, nationality, and age-group, and the factors associated with the positivity rate., Results:  Between March 11 and December 31, 2020, PHCC tested 379,247 persons for SARS-CoV-2, with a median age (IQR) of 32 (21-42) years. Of these, 57.0% were from the Middle East and North Africa, and 32.5% were originally from Asia. Overall, 10.9% had diabetes mellitus and 11.3% had hypertension. The epidemiological curve showed a steep increase in the positivity rate from March till May 2020, at the highest rate of 37.5% in May 2020. The highest positivity rate was observed among Asian males at 15.7%. The positivity rate was the lowest among the age-group aged 60 years and above. It was almost the same among the tested persons for SARS-CoV-2 in the three main age groups (0-18, 19-39, 40-59) at 10.1%, 12.3%, and 12.2%, respectively. In a multi regression model, being a male was associated with a higher risk (OR 1.15; 95% CI 1.13-1.17). Asians were at higher risk than those originally from the Middle East and North Africa (OR 1.29; 95% CI 1.27-1.32). COVID-19 infection was higher among those presenting clinical symptoms than asymptomatic individuals (OR. 4.52; 95% CI 4.42-4.64)., Conclusion: The epidemic among the PHCC-registered population predominantly affected younger ages and males, namely, coming from Asia. At the primary healthcare level, the COVID-19 infection rate was higher among those who presented with clinical symptoms. The lowest positivity rate among individuals >60 years may reflect the effectiveness of public health measures related to the high-risk group. Scaled-up testing at the primary healthcare level helped to detect more cases during the peak of the first wave and was reflected in a steady increase in the positivity rate flattened later due to the established public health measures., (© 2022 Ali Abdulmalik, Al-Kuwari, Bakri, Al Abdulla, Kandy, Abdulla, Gibb, licensee HBKU Press.)

Aims: To assess the prevalence of depression and its associated factors among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar., Methods: A cross-sectional study was conducted from January to April 2021 where 683 adult patients with Type 2 diabetes mellitus were selected by cluster sampling technique using probability-proportionate to size sampling. Diabetes mellitus was defined as having HA1c of greater than or equal to 6.5%, and patients were assessed for depression using the Patient Health Questionnaire-9. The relationship between depression, glycemic control, and background characteristics was analyzed using Chi-square, and binary logistic regression analyses. Adjusted logistic regression models estimated the significant factors that were independently associated with depression., Results: 20.1% of the study participants had depression with the vast majority of them having mild depression (70.8%). More than three-quarters had uncontrolled diabetes mellitus (81.5%). Male patients were at higher risk for developing depression (AOR =1.98, 1.25-3.14) when compared to female patients. On the other hand, being Qatari was associated with a lower risk for depression compared to non-Qatari patients (AOR =0.56, 0.34-0.90), and treatment with insulin-containing regimens was associated with a lower risk for depression as compared to treatment with non-insulin- containing regimens (AOR =0.49, 0.30-0.78)., Conclusions: Prevalence of depression among patients with Type 2 diabetes attending family medicine clinics in Qatar is high. Therefore, utilizing a multidisciplinary health care plan for screening and management of depression in patients with diabetes in a primary health care setting is highly recommended., Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Patient's health care experiences and satisfaction are frequently used as a healthcare quality indicator., Aim: The study aims to evaluate the level of patient satisfaction with the pharmacy services provided at the Primary Health Care Corporation's (PHCC) pharmacies in Qatar., Methods: This study is a cross-sectional survey conducted in December of 2019. The study's setting is the Primary Health Care centers' pharmacies. All adult patients (≥18 years old) with mobile phone numbers documented on file who had their prescription orders filled at the PHCC's pharmacy units in 2019 were included in the study. Descriptive and inferential statistical methods were used to present the findings. The significance level was set at the alpha level of 0.05., Results: The usable responses were 9,564 from the total participants. Around 55.2% ( N  = 5,283) were males, 56.5% ( N  = 5,405) were in the age group (25-40), 19.2% ( N  = 1,837) were Qatari nationals, 39.7% ( N  = 3,801) had their medication dispensed in the Central Region of the State of Qatar, and 72.8% ( N  = 6,964) had at least undergraduate or higher degrees. The overall mean (SD) satisfaction score was (3.24 ± 0.629). Participants were less satisfied with their pharmacist's communication, especially offering information about medication's side effects (2.61 ± 1.2) and general health counselling (2.39 ± 1.2). Respondents were also less satisfied with waiting time (3.02 ± 1.3). Waiting time, gender, age, nationality, geographical region of the pharmacy, educational level, and familiarity with the PHCC were significantly associated with satisfaction level., Conclusion: The patients were reasonably satisfied, and the satisfaction level differed among different sociodemographic groups. Based on the public's needs and expectations, pharmacists need to continuously improve their effort to enhance the healthcare quality in the organization., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Manal Al Zaidan et al.)

Background and Purpose: A growing field of interest is exploration of the functional outcomes of post-coronavirus disease 2019 (COVID-19) patients with stroke after rehabilitation. The association between stroke and COVID-19 infection is still being studied. We had explored the functional gain in post-COVID-19 patients with stroke following active rehabilitation services in Qatar to understand the possible predictors of functional gain., Methods: We had included twenty patients diagnosed with post-COVID-19 with stroke in this retrospective pilot study conducted at a Qatar rehabilitation setting. We had used preexisting data from electronic medical records. We had included the Functional Independence Measure (FIM), post-COVID-19 functional status (PCFS), Action Research Arm Test (ARAT), Functional Ambulation Category (FAC), and Borg Rating of Perceived Exertion (RPE) as outcome measures. We had used descriptive statistics to summarize the baseline characteristics. A paired t-test had been used to compare the pre and posttests of the study group at admission and discharge. Multiple regression analyses had been performed to assess the predictors of functional gain, including age, employment status, impaired side, family history, and length of stay (LOS). All the results had been presented with associated 95% confidence intervals., Results: This study had revealed an increase in functional gain (mean FIM gain, 32.9 ± 8.9) and improvements in functional performance throughout active rehabilitation (LOS, 62.45 ± 37.61). Significant differences had been noted in all outcome measures from admission until discharge ( p  < 0.05). Age (β = - 0.769, p  = 0.022) and impaired side (β = 0.573, p  = 0.007) had significantly predicted National Institutes of Health Stroke Scale (NIHSS) scores. Age (β = - 0.764, p  = 0.047) had been a major factor that significantly predicted FIM gain. LOS (β = - 0.990, p  = 0.002) had predicted FAC. The mean age was 56 ± 8 years., Conclusion: Various factors are independently associated with functional gain after rehabilitation. Our findings suggest that active rehabilitation services and immediate intervention will be required to rehabilitate post-COVID-19 patients with stroke, a vulnerable population, to achieve adequate functional improvement., (© 2022 Asirvatham, Abubacker, Chandran, Boppana, Al Abdulla, Saad, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.)

Objectives: To describe clinical characteristics and laboratory investigations of patients with COVID-19 diagnosed in primary care in Qatar and to assess predictors of hospitalisation., Design: A retrospective cross-sectional study., Setting and Participants: 3515 confirmed patients with COVID-19 diagnosed in any of the 27 primary healthcare centres in Qatar between 9 April 2020 and 30 June 2020., Main Outcome Measures: Demographic characteristics, comorbidities, contact tracing, clinical and laboratory data, in addition to patient disposition at the time of diagnosis RESULTS: Mean age of patients was 35.5 years (±14.7). 2285 patients (65.0%) were males, 961 patients (27.3%) had a history of concomitant comorbidity and 640 patients (18.2%) were asymptomatic. Adult patients (19-64 years old) were more likely to report symptoms than children or elderly. Fever and cough were the most frequently documented symptoms affecting 1874 patients (46.7%) and 1318 patients (37.5%), respectively. Most patients had normal vital signs at presentation; however, patients who were subsequently hospitalised had higher median temperature than non-hospitalised patients (37.7°C, IQR: 37.0°C-38.4°C, and 37.2°C, IQR: 36.8°C-37.8°C, respectively). Hospitalised patients had significantly higher C reactive protein (CRP) (median CRP: 20 mg/L, IQR: 5.0-61.2 mg/L) than non-hospitalised patients (median CRP: 4.6 mg/L, IQR: 1.7-11.50 mg/L), and lower median absolute lymphocyte count (1.5×10 3 /µL, IQR: 1.1×10 3 /µL-2.1×10 3 /µL, and 1.8×10 3 /µL, IQR: 1.3×10 3 /µL-2.4×10 3 /µL, respectively). Predictors of hospitalisation were increasing age (adjusted OR (AOR): 2.614, 95% CI 1.281 to 5.332 for age between 50 years and 64 years, and AOR: 3.892, 95% CI 1.646 to 9.204 for age ≥65 years), presence of two or more comorbidities (AOR: 2.628; 95% CI 1.802 to 3.832) and presence of symptoms (AOR: 1.982: 95% CI 1.342 to 2.928)., Conclusion: The majority of COVID-19 cases diagnosed in primary healthcare in Qatar were symptomatic. Most cases had normal vital signs and laboratory results at presentation. Predictors of hospitalisation were increasing age, the presence of symptoms and having two or more comorbidities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To assess primary care physicians' satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction., Design: A cross-sectional web-based survey conducted from 1 June to 30 July 2020., Setting: All the 27 public primary healthcare centres in Qatar., Participants: 294 primary care physicians working in the publicly run primary healthcare corporation in Qatar., Primary Outcome Measures: Overall satisfaction towards COVID-19 management in Qatar and satisfaction towards each aspect of this management including COVID-19 clinical practice guidelines, psychological support, team dynamics, work safety as well as institutional and governmental regulations., Results: 294 primary care physicians participated in the survey with a response rate of 65%. Overall satisfaction of physicians towards COVID-19 19 management at Primary Health Care Corporation was 77%. The highest satisfaction was towards institutional and governmental support while it was the lowest towards the corporation case definition and management of COVID-19 guidelines. Female physicians were less satisfied with psychological support in comparison to males (64.1% and 51% respectively, p=0.049). Overall satisfaction towards case definition and management of COVID-19 guidelines were strongly correlated with their clarity, updating these guidelines in due time and applicability of the guidelines (r=0.759 P<0.001; r=0.701 P<0.001; r=0.698 P<0.001) respectively, while satisfaction towards work safety was strongly correlated with availability and quality of Personal Protective Equipment provided (r=0.83 P<0.001 and r=0.811 P<0.001 respectively)., Conclusion: Most primary care physicians in Qatar who responded to the survey were satisfied with the COVID-19 guidelines developed rapidly in response to this pandemic. Availability and quality of PPE were a particular concern. The clinicians who were less satisfied were younger and female., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Setting: The State of Qatar has had one of the highest COVID-19 infection rates globally and has used state-managed quarantine and isolation centres to limit the spread of infection. Quarantine and isolation have been shown to negatively affect the mental health of individuals. Qatar has a unique population, with around 90% of the population being economic migrants and a majority being blue-collar workers and labourers., Objectives: This study was carried out to evaluate the psychological impact of institutional isolation and quarantine during the COVID-19 pandemic outbreak in Qatar. The study also explored the sociodemographic correlates of this psychological impact., Design, Participants and Intervention: A cross-sectional study involving 748 consenting individuals in institutional quarantine and isolation in Qatar during the months of June and July 2020 was carried out. Relevant sociodemographic data along with depressive and anxiety symptomatology scores were collected from consenting adults at these facilities., Results: 37.4% (n=270) of respondents reported depressive symptoms and 25.9% (n=189) reported anxiety symptoms. The scores were higher for individuals in isolation facilities and higher for migrants from poor socioeconomic group (p<0.001 for both). Within this group, although worries about infection were widely reported, lack of contact with the family was cited as one of the most important sources of distress. Respondents reported that contact with the family and reliable information were important factors that helped during the duration of isolation and quarantine., Conclusions: Our study reported significantly elevated scores for depression and anxiety during institutional quarantine, which is in keeping with emerging evidence. However, in contrast to other studies reporting mostly from native populations, this study of a population with an overwhelming majority of immigrants highlights the special mental health needs of this specific group and can inform future healthcare policies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, primary and secondary healthcare workers (HCWs) have faced unprecedented stress, jeopardizing their mental well-being., Aims: To compare risk perception and psychological distress between primary and secondary HCWs., Method: A cross-sectional web-based survey was conducted with HCWs in Qatar from April 5 to July 5, 2020. Psychological distress and risk perception were assessed using the Kessler Psychological Distress Scale, a perceived COVID-19 risk questionnaire, and a sociodemographic questionnaire., Results: Of the 4417 participating HCWs, 3421 (90.3%) felt that their job increased their risk of COVID-19 exposure, 3759 (90.9%) accepted this as part of their job, and 3440 worried that this also increased the risk of exposure to their families. Moreover, 2911 (84.8%) believed that their employer would look after their needs if they contracted COVID-19. Moderate to severe psychological distress was present in 1346 (30.5%) HCWs. Primary HCWs were less likely to experience moderate to severe psychological distress than secondary HCWs (adjusted OR, 0.48; 95% CI 0.29-0.77, P  = .003). Secondary HCWs who worked in COVID-19 designated areas had greater psychological distress., Conclusions: HCWs' exposure to outbreaks has various psychological effects, which may have long-term consequences and affect their decision-making capacity. Strategies to enhance the mental well-being of HCWs exposed to COVID-19 should be introduced immediately.

Objectives: Diabetes Intervention Accentuating Diet and Enhancing Metabolism-I (DIADEM-I) is the first randomised controlled trial (RCT) in the Middle East and North Africa (MENA) region testing the effectiveness of an intensive lifestyle intervention (ILI) for weight loss and diabetes remission. We report on the recruitment process and baseline characteristics of the DIADEM-I cohort based on origin (Middle East vs North Africa), and waist circumference., Design: DIADEM-I is an open-label randomised, controlled, parallel group RCT recruiting young individuals (18-50 years) with early type 2 diabetes (≤3 years since diagnosis) originating from MENA. Individuals from primary care were randomised to usual medical care or ILI (total dietary replacement phase using meal replacement products, followed by staged food reintroduction and physical activity support). The primary outcome is weight loss at 12 months. Other outcomes are glycaemic control and diabetes remission., Setting: Primary care, Qatar., Participants: 147 (73% men) randomised within DIADEM-I who were included in the final trial data analysis., Outcome Measures: Recruitment metrics, and baseline clinical and metabolic characteristics., Results: Of 1498 people prescreened, 267 (18%) were invited for screening and 209 (78%) consented. 173 (83%) were eligible. 15 (7%) withdrew before randomisation and the remaining 158 were randomised. Mean age was 42.1 (SD 5.6) years and mean body mass index was: 36.3 (5.5) kg/m 2 (women) and 34.4 (5.4) kg/m 2 (men). Mean diabetes duration was 1.8 (1.0) years and mean glycosylated haemoglobin (HbA1c) was 7.0% (1.30) (52.5 mmol/mol (SD 14.3)). Participants originated from 13 countries. Those from North Africa reported greater physical activity and had lower family history of diabetes. 90% of subjects were taking diabetes medications and 31% antihypertensives. Those with greater waist circumference had significantly higher insulin resistance and lower quality of life., Conclusion: Recruitment of participants originating from the MENA region into the RCT was successful, and study participation was readily accepted. While DIADEM-I participants originated from 13 countries, there were few baseline differences amongst participants from Middle East versus North Africa, supporting generalisability of RCT results., Trial Registration Number: ISRCTN20754766; NCT03225339., Competing Interests: Competing interests: ST has participated as an advisory board member of Novo Nordisk and reports a previous educational grant from Cambridge Weight Plan UK for an investigator initiated randomised clinical trial (ISRCTN21335883). All other authors declare no competing interests., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in north Africa. We aimed to assess whether an intensive lifestyle intervention would lead to significant weight loss and improved glycaemia in young individuals with early diabetes., Methods: This open-label, parallel-group, randomised controlled trial (DIADEM-I), done in primary care and community settings in Qatar, compared the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, aged 18-50 years, with a short diabetes duration (≤3 years), had a BMI of 27·0 kg/m 2 or more, and who were from the Middle East and north Africa region. Participants were randomly allocated (1:1) either to the intensive lifestyle intervention group or the usual medical care control group by a computer-generated sequence and an online randomisation service. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. Participants in the control group received usual diabetes care, which was based on clinical guidelines. The primary outcome was weight loss at 12 months after receiving the assigned intervention. Our analysis was based on the intention-to-treat principle. Key secondary outcomes included diabetes control and remission. The trial was registered with the ISRCTN registry, ISRCTN20754766, and ClinicalTrials.gov, NCT03225339., Findings: Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg (95% CI 9·72 to 14·23) compared with 3·98 kg (2·78 to 5·18) in the control group (adjusted mean difference -6·08 kg [95% CI -8·37 to -3·79], p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (odds ratio [OR] 12·03 [95% CI 5·17 to 28·03], p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001). Five serious adverse events were reported in four participants in the control group; four admissions to hospital because of unanticipated events (supraventricular tachycardia, abdominal pain, pneumonia, and epididymo-orchitis), and one admission to hospital for an anticipanted event (hyperglycaemia)., Interpretation: Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing., Funding: Qatar National Research Fund., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Qatar is one of the fastest growing countries in the Arabic region. Primary Health Care Corporation (PHCC) is the main provider of primary health services in Qatar and employs 1600 nurses. In 2014, PHCC started to migrate from paper to electronic documentation of patient records using a clinical information system (CIS). Since implementation, the use of CIS and perception of users have not been assessed., Objective: This study measured nurses' perceptions regarding the utilisation, quality and user satisfaction with the CIS in PHCC., Methods: Using a pre-existing survey, a cross-section of nurses from six health centres in Qatar were systematically selected and invited to participate in the study. Eighty-nine surveys were completed (response rate: 98.8%) and descriptive analyses were performed., Results: Nurses' perceptions regarding the utilisation, quality and user satisfaction with the CIS were positive. Nurses indicated that the CIS is a resource for clear, accurate and up-to-date data and that their performance improved due to the CIS. Yet responses to an open-ended question in the survey revealed some concerns related to the CIS, such as patient confidentiality, system downtime and time constraints., Conclusion: Ensuring that the CIS is facilitating nurses' work is crucial to guarantee high-quality care to the community. The findings provide foundational data to help PHCC to understand nurses' perceptions and to take steps to overcome challenges that nurses face related to the CIS in their daily practice. This work could also provide direction for future research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Premenstrual dysphoric disorder (PMDD) is not well-studied in Arab populations. The goal of this study was to validate the Arabic version of the Premenstrual Symptoms Screening Tool (PSST) using the DSM diagnosis of PMDD as the gold standard. The PSST was translated and culturally adapted using back translation and the approval of the original author. We recruited 194 adult women (between October 2013 and March 2014) from two primary care centers in Doha, Qatar. A psychiatrist determined the diagnosis using the semi-structured Mini International Neuropsychiatric Interview, and another rater blinded to the diagnosis finalized the Arabic PSST and administered other clinical questionnaires. The data showed that premenstrual symptoms and PMDD were observed in about 37 percent and 15 percent, respectively, of the women enrolled. The mean age of the women with PMDD according to the PSST was about 30 years, and the majority had children. The Arabic PSST showed high specificity of 95.6 percent but low sensitivity of 26.7 percent. A factor analysis of the different items in Arabic PSST showed that the Arabic PSST could detect the cases with definite PMDD and thus can be a useful tool in primary care settings as this treatable disorder is underdiagnosed in the Arab populations.

Background: Type 2 diabetes mellitus (T2DM) and obesity are syndemic and will have a significant impact on affected individuals and healthcare services worldwide. Evidence shows that T2DM remission can be achieved with significant weight loss in those who are younger with early diabetes and requiring fewer medications for glycaemic control. DIADEM-I aims to examine the impact of an intensive lifestyle intervention (ILI) using a low-energy diet (LED) meal replacement approach combined with physical activity in younger individuals with early T2DM., Methods: The planned study is an ongoing, non-blinded, pragmatic, randomised controlled, parallel-group trial examining the impact of an LED-based ILI on body weight and diabetes remission in younger (18-50 years) T2DM individuals with early diabetes (≤ 3-year duration). The ILI will be compared to usual medical care (UMC). The primary outcome will be weight loss at 12 months. Other key outcomes of interest include diabetes remission, glycaemic control, diabetes complications, cardiovascular health, physical activity, mental health, and quality of life. It is planned for the study to include 138 subjects for assessment of the primary outcome. Safety will be assessed throughout., Discussion: If DIADEM-I demonstrates a clinically significant effect for younger individuals with early T2DM, it will inform clinical guidelines and services of the future for management of T2DM., Trial Registration: ISRCTN: ISRCTN20754766 (date assigned: 7 June 2017); ClinicalTrials.gov, ID: NCT03225339 Registered on 26 June 2017.

For men age > or =75 years, the USPSTF recommends against screening for prostate cancer. This is a USPSTF grade D recommendation. The task force found at least fair evidence that screening is ineffective or that harms outweigh benefits. For men age > or =75 years, the USPSTF has found insufficient evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes, compared with treatment after clinical detection. This is a USPSTF "I" statement. The evidence is insufficient to recommend for or against routinely providing screening. Evidence on effectiveness is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.