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Hala Alasaad,1 Ela Beyyumi,1 Taoufik Zoubeidi,2 Nusrat Khan,1 Omar Abu-Sa’da,1 Mohammad Khassawneh,1 Abdul-Kader Souid3 1Department of Pediatrics, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates; 2Department of Statistics, College of Business and Economics, UAE University, Al Ain, Abu Dhabi, United Arab Emirates; 3Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi, United Arab EmiratesCorrespondence: Hala AlasaadDepartment of Pediatrics, Tawam Hospital, Al Ain, Abu Dhabi, United Arab EmiratesTel +971 52-6784481Email hasaad@seha.aeIntroduction: Hypoglycemia is frequent in level-1 postnatal units (PNU), which can result in many transfers to the level-3 neonatal unit (NNU).Objectives: This study reports on hypoglycemia (capillary blood glucose < 2.5 mmol/L in the first 24 h) in at-risk infants. Its main objective was to evaluate the impact of hypoglycemia in level-1 PNU on level-3 NNU admissions.Methods: The study was retrospective, conducted between January 01, 2018 and December 31, 2018. Inclusion criteria were infants in the PNU who were: 1) late-preterm (35≤ weeks’ gestation < 37), 2) infants-of-diabetic mothers (IDM), and/or 3) low (2.0– 2.5 kg) or high (> 4.0 kg) birthweight.Results: Of the 3192 deliveries, 983 (31%) were eligible for study enrollment; 77% were IDM and 19% late-preterm. A total of 192 (19.5%) newborns had hypoglycemia in the first 4 h and 42 (4.3%) within 4– 24 h. Twenty-two (2.2%) newborns were transferred to NNU, 17 in first 4 h and five within 4– 24 h. Overall, independent predictors of NNU transfer were late-preterm, cesarean delivery, and glucose measurement < 1.5 h (P ≤ 0.019). Independent predictors of hypoglycemia in the first 4 h were late-preterm, cesarean delivery, glucose measurement before feeding, and glucose measurement < 1.5 h (P ≤ 0.045). The independent predictor of hypoglycemia within 4– 24 h was cesarean delivery (P = 0.017). Ten neonates had blood glucose ≤ 1.0 mmol/L; they all required NNU transfer for intravenous glucose.Conclusion: This study shows frequent low glucose readings in these infants (overall prevalence, 23.8%) and confirms the need for clinical observation and regular monitoring. It is prudent to initiate and maintain proper feeding and to adhere to evidence-based guidelines.Keywords: late preterm, cesarean delivery, IDM, neonatal units, newborn feeding

Objectives To assess the prevalence of overweight, obesity and Insufficient Sleep Duration (ISD) and to investigate their relationship with related lifestyle factors among school-aged students. Obesity in childhood and adolescence is a serious health concern as it may have long term risk for overweight and obesity in adulthood. Methods This is a cross-sectional study of 1,611 students aged between 10 and 18 years from Al Ain city, United Arab Emirates. Data were collected using a multistage stratified random sampling method using a validated questionnaire and the level of significance was set at p Results The prevalence of overweight and obesity was 42.4%. ISD was 36.6% among students. Higher BMI was significantly related to being a male and inactive (95% CI=0.03–0.23), daily coffee consumption (95% CI=0.03–0.1), older age (95% CI=0.01–0.02), less average sleep duration (95% CI=−0.02 to −0.003) and spending more time on TV/videogames (95% CI=0.01–0.07). The likelihood of ISD was significantly lower among students who consumed breakfast daily (OR=0.58, 95% CI=0.41–0.83), spent less time on smart devices (OR=0.63, 95% CI=0.47–0.84), and never consumed energy drinks or soft drinks (OR=2.64, 95% CI=1.13–6.16, OR=2.02, 95% CI=1.24–3.29, respectively). Conclusions The prevalence of overweight and obesity among school-aged students is high. ISD and related lifestyle factors are significantly associated with overweight and obesity. Study findings emphasize the need to address and implement successful strategies for a healthy lifestyle starting from early childhood to combat the increasing rates of overweight and obesity in adulthood.

Learning outcomes assessment is an effective academic quality assurance tool that enables educators to review and enhance the alignment between planned, delivered, and experienced curricula. Accurately assessing what students know and are able to do after completing a learning module is the first step to decide on the strategies to implement and the proper actions to take in order to ensure the continuous improvement of the student learning experience. This paper introduces a simple process for effectively assessing the intended program learning outcomes using assessment data collected at the course level. The process takes advantages of the assessment instruments used regularly by course instructors to assess their students in the classroom. This would help the program collect effective assessment data, while reducing the assessment load and not overwhelming faculty with extra assessment tasks.

This article introduces a novel method, called Graphical Group Ridge (GG-Ridge), which classifies ridge regression predictors in disjoint groups of conditionally correlated variables and derives di...

Objective: The aim of the study was to describe and analyze the risk factors associated with patient safety events (PSEs), defined as adverse events (AEs), preventable AEs (PAEs), and near-miss events (NMEs), in the emergency department (ED). Methods: It was a retrospective cohort study using ED patients' data retrieved from January 2010 to December 2016. Quality assurance issues (QAIs) used as triggers included the following: issues during procedural sedation, death within 24 hours of admission, patients' and physicians' complaints, returns to the ED within 72 hours, and transfers to an intensive care unit within 24 hours. Results: Of 383,586 ED visits, 6519 (1.7%) QAIs were reported with a PSEs incidence of 6.1%. Among the 397 PSEs, 258 were AEs including 82 PAEs, and 139 NMEs. During the 7-year period, we observed a fourfold increase in NMEs, and despite a decrease in the rate of AEs with the highest (3.1%) and lowest (0.8%) incidence in 2011 and 2016, respectively, the incidence of PAEs events remained relatively constant. Unadjusted analysis showed that ED waiting time, boarding time, ED length of stay (LOS), ED disposition, as well as diagnostic and QAIs were significantly related to PSEs (P < 0.05). Multivariable analysis showed that the type of QAIs and diagnostic were associated with PSEs (P < 0.001). Type of QAIs was a risk factor for AEs and PAEs occurrence and factors involved in NMEs were type of QAIs (P = 0.02) and ED LOS (P < 0.001). “The odds of a PSE occurring increased by 0.2% for each additional minute increase in the ED waiting time, by 5.2% for each additional boarding hour, and by 4.5% for each ED LOS hour.” Conclusions: This study showed several potential risk factors for PSEs, especially ED LOS, type of QAIs, and diagnostic. Systematic interventions might have more impact on risk of PSE.

Learning outcomes assessment is an effective academic quality assurance tool that enables educators to review and enhance the alignment between planned, delivered, and experienced curricula. Accurately assessing what students know and are able to do after completing a learning module is the first step to decide on the strategies to implement and the proper actions to take in order to ensure the continuous improvement of the student learning experience. Nonetheless, learning outcomes assessment processes in higher education are still facing major challenges that affect their proper and effective implementation. Hence, faculty do not usually experience noticeable improvement in the students' performance over several assessment cycles, which causes their frustration and reluctance to continue participating in the assessment process. This paper discusses the main issues that affect the implementation of the assessment process and prevent the closure of the assessment loop. It also introduces a unified assessment process and an online management system that have been developed recently to address the discussed issues. The online management system streamlines the assessment process, while providing administrators and quality assurance officers with valuable infographics and reports to effectively oversee the implementation of the assessment process. The system has been deployed at the United Arab Emirates University since fall 2018, and has been successfully used by faculty to assess the learning outcomes for more than 1000 courses each semester. Moreover, collected statistics showed that the online features provided by the system allowed faculty to continue their assessment tasks seamlessly during the COVID-19 pandemic.

A claim made this decade that ‘Arabs don’t read’ raised concerns among civil society and authorities in the Arab countries which resulted in growing research to investigate this claim and major initiatives to promote reading among Arabs. This paper aims to contribute to our knowledge about reading in this region by studying the motivation and habits of recreational reading of university educated youth in the United Arab Emirates (UAE). It specifically aims to answer the questions: what are the recreational reading frequency, and the type and language of the reading material? Which personal characteristics correlate with recreational reading habits? And which factors impact the motivation to read? The findings are based on a survey of 775 undergraduate students at UAE University. The survey questionnaire included an adult reading motivation scale developed by Schutte and Malouff (2007) which was modified after assessing its goodness-of-fit to the UAE context using confirmatory factor analysis. Pearson’s chi-square test, Poisson regression and ANOVA were used to identify the correlates of reading habits and compare motivation scores across demographic groups. Seventy-one percent of the students read at least one book for pleasure in the last six months and they read, on average, for 2.3 hours per week. Reading frequency depends on gender, the student’s secondary education, and the parents’ education. Gender, parents’ education have significant effects on the motivation scores and the preferred language of reading (p-value < 0.01). Students read more during the academic year than in the vacation.

Background: Risks of diagnostic radiation have become more notable lately, particularly in young children with chronic medical conditions. This study reports on the cumulative radiation from chest radiographs in children with asthma. Its main purpose was to review our current practice and suggest minimizing the use of chest radiographs.Methods: The study was retrospective and conducted at a pediatric tertiary center. Eligibility criteria included children 2–15 y, admitted between January 2017 and December 2018 for asthma management.Results: Of the 643 children admitted as “asthma exacerbation,” 243 [40% females; age (mean ± SD) 5.4±3.3 y] met the study criteria for inclusion. Ninety-two (38%) children had a temperature of 38.8±0.7°C on the day of admission. Antibiotics were prescribed for 148 (61%) children, mainly for presumed pneumonia. Chest radiographs were requested for 214 (88%) children, mainly on the day of admission. Only 38 (18%) chest radiographs showed focal/multifocal pneumonia justifying antibiotic use. Significant predictors for requesting chest radiographs were antibiotic use for presumed pneumonia, lower oxygen saturation at presentation, and a requested blood culture. The rate of chest radiographs per year was negatively related to the child's age; the younger the child the higher the rate (model coefficient −0.259, P < 0.001). For children < 5 y, the rate of chest radiographs was 1.39 ± 1.21/y and radiation dose 0.028 ± 0.025 mSv/y. The corresponding rates for children ≥5 y were 0.78 ± 0.72/y and 0.008 ± 0.007 mSv/y, respectively (P < 0.001).Conclusion: Chest radiographs were commonly requested for children with asthma, especially younger children. Prospective studies are necessary to measure the impact of this practice on the children's health.

Background The United Arab Emirates (UAE) was the first country in the Middle East to report severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serosurveys are essential to understanding the extent of virus transmission. This cross-sectional study aims to assess the seroprevalence of SARS-CoV-2 infection in the Emirate of Abu Dhabi. Methods Between 19 July and 14 August 2020, 4487 households were selected using a random sample stratified by region and citizenship of the head of household (UAE citizen or non-citizen). A cluster sample of 40 labour camps was selected. Data on socio-demographic characteristics, risk factors and symptoms compatible with coronavirus disease 2019 (COVID-19) were collected. Each participant was first tested by Roche Elecsys® Anti-SARS-CoV-2 assay, followed, when reactive, by the LIAISON® SARS-CoV-2 S1/S2 IgG assay. Results Among 8831 individuals from households, seroprevalence was 10·4% [95% confidence intervals (CIs) 9·5–11·4], with higher seroprevalence in Abu Dhabi and Al Ain regions compared with those in Al Dhafra. In households, we found no sex difference and UAE citizens had lower seroprevalence compared with those of other nationalities. Among 4855 workers residing in labour camps, seroprevalence was 68·6% (95% CI 61·7–74·7), with higher seroprevalence among workers from Southeast Asia. In households, individuals with higher body mass indexes demonstrated higher seroprevalences than individuals with normal weight. Anosmia and ageusia were strongly associated with seropositivity. Conclusions The majority of household populations in the Emirate of Abu Dhabi remained unexposed to SARS-CoV-2. In labour camps, SARS-CoV-2 transmission was high. Effective public health measures should be maintained.

Objectives: The association of obesity and family history of type 2 diabetes mellitus (T2DM) provides an opportunity for risk stratification and prevention, as these two conditions are the most well-known risk factors for T2DM. We aimed to test the feasibility and effects of a diabetes mellitus prevention education program designed for overweight and obese Emirati people with at least one parent with T2DM. Methods: We conducted a pilot study using a pre-post design without a control arm at the Diabetes Center at Tawam Hospital in Al Ain, UAE. Overweight and obese subjects with at least one parent with T2DM were invited to participate. Three study assessments were conducted at baseline, three months, and six months including a questionnaire, anthropometry, and laboratory assessments. Interventions included three individualized or family-engaged counseling sessions based on the DiAlert protocol. The study outcomes included awareness of risks and prevention opportunities to T2DM, behavior changes in nutrition and exercise, decreased waist-circumference, and clinical/metabolic/inflammatory markers. Pre-post changes were analyzed using repeated-measures analysis of variance. Results: One hundred twenty-two overweight or obese individuals were approached. Forty-four individuals met the eligibility criteria, and 32 individuals (35.0±9.0 years; 75.0% female) completed the study. At six months, there were significant improvements in the glycated hemoglobin levels (p = 0.007), high-density lipoprotein (p < 0.049), serum creatinine (p < 0.025), estimated glomerular filtration rate (p = 0.009), and adiponectin levels (p < 0.024). Sixteen of 32 participants had ≥ 2 cm reduction in waist circumference. They demonstrated notable physical and laboratory improvements in moderate-vigorous activity, average activity counts per day, tumor necrosis factor-alpha, and interleukin-6 total cholesterol, triglyceride, and low-density lipoprotein. Conclusions: Offering family-oriented diabetes education to people at risk for T2DM is well received and has favorable effects on relevant risk factors. Better testing with large-scale randomized controlled studies is needed, and implementing similar educational programs for the Emirati population seems warranted.

Background Gestational diabetes mellitus (GDM) in singleton pregnancies represent a high-risk scenario. The incidence, associated factors and outcomes of GDM in twin pregnancies is not known in the UAE. Methods This was five years retrospective analysis of hospital records of twin pregnancies in the city of Al Ain, Abu Dhabi, UAE. Relevant data with regards to the pregnancy, maternal and birth outcomes and incidence of GDM was extracted from two major hospitals in the city. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and GDM, and the associations between GDM and maternal and fetal outcomes at birth. Results A total of 404 women and their neonates were part of this study. The study population had a mean age of 30.1 (SD: 5.3), overweight or obese (66.5%) and were majority multiparous (66.6%). High incidence of GDM in twin pregnancies (27.0%). While there were no statistical differences in outcomes of the neonates, GDM mothers were older (OR: 1.09, 95% CI: 1.06–1.4) and heavier (aOR: 1.02, 95% CI: 1.00 -1.04). They were also likely to have had GDM in their previous pregnancies (aOR: 7.37, 95% CI: 2.76–19.73). The prognosis of mothers with twin pregnancies and GDM lead to an independent and increased odds of cesarean section (aOR: 2.34, 95% CI: 1.03–5.30) and hospitalization during pregnancy (aOR: 1.60, 95% CI: 1.16–2.20). Conclusion More than a quarter of women with twin pregnancies were diagnosed with GDM. GDM was associated with some adverse pregnancy outcomes but not fetal outcomes in this population. More studies are needed to further investigate these associations and the management of GDM in twin pregnancies.

PurposeThe purpose of this study is to investigate the state of undergraduate business statistics education in the Middle East and North Africa (MENA) and assess its alignment with the best practices in equipping business graduates with the knowledge and skills demanded by the labor market.Design/methodology/approachA survey of 108 instructors from 80 business schools in 17 MENA countries was conducted to gauge information on the delivery of business statistics courses. The survey results were benchmarked to a proposed framework for best practices in business statistics education.FindingsThe gap analysis identified deficiencies in the delivery of business statistics education in the region as compared to international best practices. This study revealed a need to revise statistics education as part of a comprehensive reform of business education with the aim to meet international quality standards in business education.Research limitations/implicationsThe study relied on the self-reported responses of business statistics instructors in MENA. One hundred eight questionnaires were completed, corresponding to a response rate of 40 per cent. Moreover, the study did not measure the effectiveness of teaching and learning in business statistics courses.Practical implicationsRecommendations from the study are intended to guide business statistics instructors in improving the quality of business statistics education through adopting more effective ways to enhance student learning experience and graduate employability.Originality/valueThis study is the first of its kind to investigate and assess the business statistics education in the MENA region.

Background Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. However, the thoracic anatomical locations to be examined are debateable. We aimed to study the anatomical locations of blunt traumatic pneumothoraces as defined by chest CT scan to identify the areas that should be scanned while performing bedside diagnostic ultrasound. Methods This is a retrospective analysis of a data collected for a previous study in blunt trauma patients at our hospital during a 4-year-period with CT confirmed pneumothoraces. The anatomical distribution of the pneumothoraces and their volume were analyzed. Advanced statistical analysis was performed using repeated measures logistic regression models. Results Seven hundred three patients had a CT scan of the chest. Seventy-four patients (10.5%) were confirmed to have a pneumothorax. Only 64 were included in the study as they did not have a chest tube inserted before the CT scan. Twelve (18.8%) patients had bilateral pneumothorax. Seventy-six pneumothoraces were identified for which 41 patients had a right-sided pneumothorax and 35 patients had a left-sided pneumothorax. 95.1 % of the pneumothoraces detected on the right side were in the whole parasternal area with 75.6% seen in the lower parasternal region only. Similarly, 97.1 % of the pneumothoraces on the left side were seen in the whole parasternal area with 80% seen in the lower parasternal region only. Conclusions The current study showed that air pockets of blunt traumatic pneumothoraces are mainly located at the parasternal regions especially in pneumothorax with small volume. We recommend a quick ultrasound scanning of the parasternal regions on both sides of the chest from proximal to distal as the appropriate technique for the detection of pneumothoraces in blunt trauma setting.

Research assessing the nutrition knowledge of postbariatric surgery patients is limited, although this category of patients is predisposed to malnutrition. In this pilot study, we explored postbariatric nutrition knowledge, satisfaction levels with dietitian nutrition counseling, and decision to undergo bariatric surgery of 83 patients who attended a postbariatric outpatient nutrition clinic in Dubai, United Arab Emirates (UAE). A cross-sectional design involving gender-stratified random sampling method was used to recruit 83 postbariatric surgery participants. A self-administered questionnaire was employed to collect information about nutrition knowledge related to dietary recommendations after bariatric surgery as well as participant views on dietitian nutrition counseling, their decision to undergo bariatric surgery, and nutrition-related complications experienced after the surgery. The mean (SD) knowledge score of postbariatric diet was 9.7 (2.05) out of a maximum possible score of 14. The majority of the participants (78.3%) correctly identified which foods are recommended during the first stage of the postbariatric surgery diet, and more than 90% knew about the importance of high-protein supplements after bariatric surgery. Female participants had significantly higher mean knowledge score compared to males (p=0.02). Although nearly 80% of the participants reported regular follow-up with their dietitian, only 10.8% reported high adherence to the dietitian’s instructions. Moreover, more than two-thirds of the participants (71.1%) rated dietary advice provided by dietitians as vague. The most common complication experienced by the participants after bariatric surgery was nausea (61.4%). Furthermore, the majority of the participants (83.4%) found their daily and leisure activities to be more enjoyable after bariatric surgery. Ways of improving the quality of information delivery by dietitians should be explored to enhance patient comprehension and adherence to postbariatric surgery diet recommendations. Future research involving a larger and more representative sample to extend our findings are needed.

Objectives: Intense migrations from tuberculosis endemic areas to Gulf countries create special risks for people in the region. The purpose of this study was to provide data that could justify implementing universal, regular TB screening in UAE. Design: This prospective, cross-sectional study used interferon-γ release assay (IGRA) to screen for TB among Emirati citizens between August-2016 and May-2017; expatriates were not included in this study. Participants were recruited from Emiratis attending Tawam Hospital Polyclinics for problems unrelated to TB risk assessment. IGRA was requested for all enrolled participants. A risk-assessment questionnaire was completed by all participants. In addition, a retrospective review of IGRA results (January-2011 to April-2016) was conducted to compare prevalence of positive IGRA in the ‘prospective sample’ with that in ‘patients screened in the past’. Results: Four hundred fifty-five participants (69% females) were enrolled in this study. Participants’ age (mean ± SD) was 42 ± 16y. The majority of participants had traveled to or had helpers from TB-endemic areas. Two hundred forty (53%) participants had IGRA test. Forty-five (18.8%) participants had positive IGRA, similar to the retrospective results of 12.4% to 23.5%. Conclusions: The prevalence of positive-IGRA in this study is high. Keywords: TB screening, Latent TB infection, TB disease, United Arab Emirates, Gulf region, Interferon-γ release assay

Objective To study the prevalence of premenstrual dysphoric disorder (PMDD) symptom patterns among women in the United Arab Emirates and to measure the debilitating nature of PMDD symptoms and sociodemographic correlates. Methods This cross-sectional sample study used the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) and Premenstrual Symptoms Screening Tool (PSST) to screen for presence and severity of PMDD symptoms in Arab women attending ambulatory health services in Alain city, Emirate of Abu Dhabi, United Arab Emirates, for routine health care between May 2005 and September 2005. Results The study participants include 508 women (76% Emiratis, 15% Omanis, and 8% other Arabs) of childbearing age. In total, 94 women (18.6%) met MINI-Plus criteria for PMDD; of these, 21 (4.1%) met PSST criteria for severe symptoms, 29 (5.7%) for moderate symptoms, and 44 (8.7%) for mild or less symptoms. One woman (0.2%) with severe symptoms and 12 women (2.4%) with moderate symptoms had negative MINI-Plus scores. Presence of PMDD symptoms was significantly associated with higher education (P = .000), single marital status (P = .001), major life stressors (P = .001), and personal/family use of psychotropic medications (P = .000/P = .006), personal/family psychological problems (P = .000/P = .001), irregular/painful menses (P = .043/P = .001), and functional impairment on the Sheehan Disability Scale (P = .000). Multilogistic regression analysis showed higher education, major life stressor, personal use of psychotropic medications, personal/family psychological problem, and painful menses were independent predictors of PMDD symptoms. Conclusions PMDD symptoms were common among the Arab women in our study. The cyclically triggered mood disturbances were clustered in women with personal/familial psychological problems, perhaps linking biologic constitution to genetic predisposition for the development of PMDD symptomatology.

Background Obesity is currently a rapidly growing global problem of epidemic proportions and is especially prevalent in economically developed countries such as the United Arab Emirates. Obese individuals are increasingly considering bariatric surgery as their preferred means of choice for the reduction of excess body fat. This study explored the psychological characteristics that may potentially complicate the surgical management of obesity. Methods This was a cross-sectional study of Emirati patients attending a bariatric clinic at Tawam Hospital, Al Ain, United Arab Emirates, between December 2010 and February 2012. Participants were assessed using standard clinical psychiatric interviews. Also used were screening instruments such as the Hospital Anxiety and Depression Scale, Sheehan Disability Scale (SDS), Body Image Quality of Life Inventory (BIQLI), and Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS). Results A total of 105 patients, 70% of whom were female, participated in this study. Participants were found to have frequencies of anxiety and depressive symptoms at levels of 24% and 13%, respectively. Participants also reported perceived functional disabilities in the following: work/school (27%), social life (36%), family/home (35%), and religious duties (39%). A total of 13 participants (12%) had BIQLI scores showing slight-to-moderate effects on their quality of life. The mean MBSRQ-AS subscale on self-classified weight was higher than the reported norms. Anxiety and depressive symptoms positively correlated with functional impairment (SDS) and negatively correlated with quality of life (BIQLI) (P = .000). MBSRQ-AS subscales significantly correlated with depression, functional impairment, and quality of life (P ≤ .035). Conclusions Anxiety, depression, perceived functional disability, impairment in quality of life, and disturbance of self-image were found to be common among participants in the study pursuing bariatric surgery for obesity. Recognition, assessment, and treatment of these symptoms are expected to be conducive to positive outcomes of bariatric surgery.

Objective To explore in Arab communities the prevalence, dynamics, and resources available to address the physical and psychological consequences that may arise from psychiatric disorders. Methods An online survey of psychiatrists and primary care physicians from 17 Arab countries was conducted between September 2011 and June 2012. The survey serves as a needs assessment in a scientifically valid and culturally sensitive manner. Additionally, it focuses attention on the clinical strengths and weaknesses of Middle Eastern primary health care and mental health centers in identifying and treating trauma-related health and mental health issues. Results The 90 survey respondents comprised psychiatrists (n = 53) and primary care physicians (n = 37). They practiced in 3 clinical settings: primary mental health (27%), inpatient mental health (43%), and primary health care (29%). Traumas frequently reported by their patients were attributed to recent death of a close relative or friend (62.3%), domestic violence (41.4%), divorce/separation (72.1%), serious traffic accident (45.6%), sexual assault/rape (20.3%), child abuse (20.3%), psychological effects of war (30.9%), victims of crime (15.9%), refugees/internally displaced persons (20.6%), physical effects of war (19.1%), torture (13.2%), elderly abuse (11.6%), psychological effects of a natural disaster (7.4%), physical effect of a natural disaster (7.2%), and child soldiers (4.3%). Psychiatrists had significantly more patients with the following traumatic experiences: divorce/separation (81.4% vs 57.1%, P = .039), recent death of a close relative or friend (72.7% vs 47.6%, P = .048), and domestic violence (51.1% vs 19.0%, P = .014). Clinical teams comprised substantial numbers of students but small numbers of community volunteers and school counselors. Conclusions This study highlights the need to develop awareness and training programs in Arab communities to identify and properly treat traumatized individuals in psychiatric and primary care settings.

Background: The normal development of speech-language is especially challenging for Emirati toddlers, as they are frequently raised by live-in multilingual caretakers. Methods: In this community-based study, we screened preschool Emirati children for delayed expressive language and associated socio-emotional/behavioral problems. Arabic versions of the Language Development Survey and Child Behavior Checklist for ages 1.5-5 years were validated before being used in this study. The data collection instruments (questionnaires) were completed by primary caregivers in the presence of trained staff. Delayed language was defined as a vocabulary size fewer than 20 words at 18-23 months or fewer than 50 words at 24-35 months. Results: One hundred fifty two children (median-age, 26 months; 53% females) were enrolled in this study. Fifty-six percent of 18-23 month-old children had vocabulary size ≥ 20 words, 48% of the 24-29 month-old had vocabulary size ≥ 50 words and 46% of the 30-35 month-old had vocabulary size ≥ 50 words. Fifty four percent of 24-34 month-old children used combining words; with an average (SD) length-of-phrases of 3.9 (1.1), median=4.0; range=2.0-6.0. Household words (e.g. bed) were most common and exterior words (e.g. flowers) were least common. Vocabulary size was not significantly associated with gender, socioemotional variables or behavioral problems. Conclusion: Many toddlers with potential delayed speech-language were identified. They require further assessment and intervention, when indicated. Appropriate language screening strategies should be implemented in the childhood health supervision visits. Comprehensive studies of functional use of language for communication, discrimination and production of speech sounds and acquisition of reading and writing skills are greatly needed in our region.

Background: Behavioral symptoms in schoolchildren have been observed in preschoolers. As severe symptoms are more likely to persist and require treatment, proper assessment and early intervention are required in that age group. Aim: In this cross-sectional, community-based study we examined problem behaviors in Emirati children between the ages of 1.5 to 5 years. Method: The study was conducted between October 2015 and June 2016 at the Ambulatory Health Services in Abu Dhabi. Parents (84.9%) and other primary caregivers (15.1%) reported on internalizing and externalizing behavior problems using the Arabic version of Child Behavior Checklist/1.5-5 (CBCL/1.5-5) which was used to analyze the resulting behavior profiles. Results: Girls constituted 47.7% of the 815 participants. Problems occurred more commonly in boys than in girls. Boys had significantly more internalizing problem items than girls (p=0.04). Fifty-five (6.7%) children had only abnormal (T-scores ≥ 70) internalizing problem items, one (0.1%) child had only abnormal externalizing problem items, while 13 (1.6%) children had both. The prevalence of autism spectrum on the Motor and Social Development (MSD)-oriented scale was 13.6%, anxiety 9.6% and depression 8.0%. Conclusion: Frequent problem behaviors occur in preschool children who, therefore, require further evaluation and early intervention to prevent problems later in life.

Children are frequently exposed to toxic metals in the environment, and their developing central nervous system is particularly vulnerable to their effects. This study examined the blood level of heavy metals in children with learning disorder (LD) as compared to children without LD in the United Arab Emirates (UAE). Significantly high blood concentrations of seven heavy metals were found in children with LD. Further analysis using forward stepwise logistic regression showed that molybdenum levels and family history of developmental problems were the best predictors of LD. Our findings suggest the need for monitoring for toxic metals in the environment.

Background. Pneumonia is a common respiratory disease, which has a mortality rate of approximately 14% worldwide. The management of pneumonia is based on the patient and microbiological profile existing in the community. There is a paucity of data regarding patient demographics and the microbiological profile for pneumonia in the United Arab Emirates (UAE). Methods. We conducted a retrospective analysis of inpatients with pneumonia in the UAE. Epidemiological, clinical and microbiological data was collected from patients over the age of 16 years admitted to a single university hospital with a diagnosis of pneumonia between the years 1997 and 2002. Patients were categorised as having community acquired (CAP) or hospital acquired pneumonia (HAP). Results. Among the 361 patients, 186 were females and 175 males. The mean age (±SEM) of the males was 59±1.6 years and of the females, 56.9±1.5 years. The annual hospital admission rate for pneumonia increased from 410 per million population in 1997 to 760 in 2002. The pneumonia was community acquired in 289 (80%) and hospital acquired in 72 (20%). Hospitalisation for CAP showed a significant seasonal variation with peak admission rates in March and April and the nadir in August and September. The overall mortality rate was 13%, and was significantly higher for HAP (24%) than for CAP (10%, p

Background: Comprehensive global data on the health effects of indoor air pollutants are lacking. There are few large population-based multi–air pollutant health assessments. Further, little is known about indoor air health risks in the Middle East, especially in countries undergoing rapid economic development. Objectives: To provide multifactorial indoor air exposure and health data, we conducted a population-based study of indoor air pollution and health in the United Arab Emirates (UAE). Methods: We conducted a cross-sectional study in a population-based sample of 628 households in the UAE. Indoor air pollutants [sulfur dioxide (SO2), nitrogen dioxide (NO2), hydrogen sulfide (H2S), formaldehyde (HCHO), carbon monoxide (CO), and particulate matter] were measured using passive samplers over a 7-day period. Health information was collected from 1,590 household members via in-person interviews. Results: Participants in households with quantified SO2, NO2, and H2S (i.e., with measured concentrations above the limit of quantification) were twice as likely to report doctor-diagnosed asthma. Participants in homes with quantified SO2 were more likely to report wheezing symptoms {ever wheezing, prevalence odds ratio [POR] 1.79 [95% confidence interval (CI) 1.05, 3.05]; speech-limiting wheeze, POR 3.53 (95% CI: 1.06, 11.74)}. NO2 and H2S were similarly associated with wheezing symptoms. Quantified HCHO was associated with neurologic symptoms (difficulty concentrating POR 1.47; 95% CI: 1.02, 2.13). Burning incense daily was associated with increased headaches (POR 1.87; 95% CI: 1.09, 3.21), difficulty concentrating (POR 3.08; 95% CI: 1.70, 5.58), and forgetfulness (POR 2.68: 95% CI: 1.47, 4.89). Conclusions: This study provides new information regarding potential health risks from pollutants commonly found in indoor environments in the UAE and other countries. Multipollutant exposure and health assessments in cohort studies are needed to better characterize health effects of indoor air pollutants.

Using data from a sample of 1,099 workers, this paper investigates the determinants of employment and wages for workers in the United Arab Emirates. The paper further examines the wage distribution and the decomposition of the wage gap between the public and the private sectors. Results of the study are consistent with the dual labour market theory and indicate that the labour market in the United Arab Emirates is segmented based on sectors (public versus private) and types of workers (nationals versus non-nationals). The study concludes with a discussion of the implication of these findings for the effectiveness of labour and economic policy.

Consider a longitudinal experiment where subjects are allocated to one of two treatment arms and are subjected to repeated measurements over time. Two non-parametric group sequential procedures, based on the Wilcoxon rank sum test and fitted with asymptotically efficient allocation rules, are derived to test the equality of the rates of change over time of the two treatments, when the distribution of responses is unknown. The procedures are designed to allow for early stopping to reject the null hypothesis while allocating less subjects to the inferior treatment. Simulations – based on the normal, the logistic and the exponential distributions – showed that the proposed allocation rules substantially reduce allocations to the inferior treatment, but at the expense of a relatively small increase in the total sample size and a moderate decrease in power as compared to the pairwise allocation rule.

Background: While extensive research data is available on Attention Deficit Hyperactivity Disorder (ADHD) from industrialized countries, very few studies have been undertaken in the developing countries including the Arab world. Methods: A representative random sample of school children aged 5 to 16 years was evaluated for the prevalence of ADHD using the Conner Parent and Teacher Scale in Dubai, Al-Ain and Ras Al- Khaima to represent the urban, semi-urban and rural population of UAE. Results: The rate of ADHD was 4.1% as per the parent report and 3.4% as per the teacher report. Children with ADHD were noted to have a range of psychiatric co-morbidity. Conclusion: Our findings suggest the importance of comprehensive and early screening program for ADHD and we hope that this data on the prevalence and associated factors can provide the basis for setting priorities and designing interventions.

We provide an overview of the state of the higher education system in the UAE, and investigate its capacity to supply Dubai’s economy with skilled labor and achieve the emirate’s strategic social development objectives. We examine various characteristics of the higher education sector and discuss their inherent strengths and weaknesses in light of Dubai’s labor market needs. Our findings reveal that the UAE higher education sector has witnessed an impressive growth since 1997 mostly led by a vigorous expansion of the private higher education sector. This situation led to a substantial growth in higher education opportunities for the UAE population. However, the lack of development of graduate studies and the lower quality of graduates, as perceived by both employees and employers, represent the main challenges to the capacity of the sector in fulfilling the needs of Dubai’s economy.

Two-stage procedures are introduced to control the width and coverage (validity) of confidence intervals for the estimation of the mean, the between groups variance component and certain ratios of the variance components in one-way random effects models. The procedures use the pilot sample data to estimate an “optimal” group size and then proceed to determine the number of groups by a stopping rule. Such sampling plans give rise to unbalanced data, which are consequently analyzed by the harmonic mean method. Several asymptotic results concerning the proposed procedures are given along with simulation results to assess their performance in moderate sample size situations. The proposed procedures were found to effectively control the width and probability of coverage of the resulting confidence intervals in all cases and were also found to be robust in the presence of missing observations. From a practical point of view, the procedures are illustrated using a real data set and it is shown that the resulting unbalanced designs tend to require smaller sample sizes than is needed in a corresponding balanced design where the group size is arbitrarily pre-specified.

Child Behavior Checklist 2–3 is a parents' report questionnaire whose psychometric properties are known in the Western setting, but no studies have investigated this in an Arabic culture. In this study, the psychometric properties of the Arabic translation were studied using a sample of 694 children age 3 yr., ascertained as part of a community-based epidemiological study in the United Arab Emirates. The item-total correlations for items were satisfactory, ranging from .16 to .58. Cronbach alpha values for reliability ranged from .70 to .88 for the subscales and .93 for the Total score. The test-retest reliability coefficient for the Total score was .83. The validity was also high as 94.1% of those who scored above the cut-off point were classified correctly by a blind clinical interview. The results suggest that Child Behavior Checklist 2–3 is a reliable and valid checklist for use in the Arabic culture.

A sequential procedure is introduced to construct controlled width confidence intervals for the among groups variance component, as well as for certain ratios of variance components, in one-way random models. Width is controlled in the sense that it does not exceed a predetermined precision d. Several asymptotic results concerning the proposed procedure are given along with simulation results to assess its performance in moderate sample size situations. The proposed interval is also compared with the confidence interval based on the modified large sample method. In addition, some alternatives are suggested to accelerate the proposed procedure. An expression for the asymptotic expected sample size, which was obtained as a by-product of the sequential procedure, is used to discuss planning considerations in one-way random designs.

Objective Developmental disabilities are lifelong conditions with considerable public health impact, incurring substantial financial and societal costs. Data on prevalence and associated factors can provide the basis for setting priorities and designing interventions. Methods A representative random sample of 694 United Arab Emirates national children aged 3 years were evaluated in a two-stage epidemiological study. Results Stage 1 screening using the Denver Developmental Screening Test found that 8.4% [confidence interval (CI): 6.4–10.7] had global developmental delay (GDD). Using clinical diagnostic interview in Stage 2, the weighted prevalence for clinically significant developmental disability was estimated to be 2.44% (CI: 1.28–3.56). GDD was associated with pregnancy and birth complications, poor maternal education, family history of developmental problems, and major traumatic life events, as well as behavioral problems in children. Conclusion Our findings suggest the need for comprehensive and early screening programs for developmental problems, and the importance of training medical and child care professionals accordingly.

SUMMARY Objectives To investigate the prevalence, nature and sociodemographic correlates of mental disorders among the elderly United Arab Emirates (UAE) population. Study subjects and sample UAE nationals aged 60 years or more, were recruited from within a random sample of households representing the UAE national population, irrespective of the age of individuals in each household. Research Instruments (i) Geriatric Mental State Interview (GMS-A3): an Arabic version, using the AGECAT for analysis; (ii) A short questionnaire for relevant sociodemographic data. Procedure Purposely trained, Arabic speaking interviewers visited the targeted sample households to interview study subjects at their homes. Results The total number of screened subjects was 610: 166 (27.2%) in Al-Ain; 286 (46.9%) in Dubai and 158 (25.9%) in Ras Al-Khaimah. There were 347 (56.9%) male subjects and 263 (43.1%) female subjects. The mean age of the interviewed subjects was 68.6 (SD 8.3). The commonest diagnostic entities at the AGECAT syndrome case level were depression (20.2%), anxiety (5.6%), hypochondriasis (4.4%) and organic, mostly cognitive impairment with or without dementia (3.6%). Organic syndrome caseness, as an independent entity, showed significant correlation only to older age, while the rest of the mental disorders showed significant correlation with female gender, insufficient income and being single, separated, divorced or widowed. Conclusion The GMS-AGECAT package proved to be a useful tool for psychiatric assessment among the elderly in this Arabian culture. The prevalence rates of mental disorders among the elderly UAE population were, more or less, within the same range reported by other comparable worldwide studies. Copyright # 2004 John Wiley & Sons, Ltd.

Objectives: Peripheral Artery Disease (PAD) is common in patients with diabetes. Frequently, this complication is only recognized when the symptoms and signs are advanced. This study assessed its prevalence and associated risk factors in patients with type 2 diabetes mellitus who reside in the United Arab Emirates. The main purpose of the study was to identify potential disease modifiers that could be included in diabetic education programs. Methods: This prospective, cross-sectional study assessed PAD in 394 patients with type 2 diabetes mellitus. Each patient was investigated by history, physical examination and measurements of the ankle-brachial index (ABI) by bidirectional doppler. Results: Patients’ mean (±SD) age was 54 (±12) years and duration of diabetes 10 (±8) years. There were 264 females (67%). HbA1c was ≥7% in 247 (65%) patients, claudication present in 166 (42%) patients, reduced capillary refill time in 69 (17%) patients, retinopathy in 50 (13%) patients, and absent pulse in 20 (5%) patients. ABI was ≤1.0 in 149 (39%) patients (probable PAD) and

Television viewing and videogame use (TV/VG) appear to be associated with some childhood behavioral problems. There are no studies addressing this problem in the United Arab Emirates.One hundred ninety-seven school children (mean age, 8.7 ± 2.1 years) were assessed. Child Behavior Checklist (CBCL) subscale scores and socio-demographic characteristics were compared between children who were involved with TV/VG more than 2 hours/day and those involved less than 2 hours/day (the recommended upper limit by The American Academy of Pediatrics).Thirty-seven percent of children who were involved with TV/VG time of more than 2 hours/day scored significantly higher on CBCL syndrome scales of withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, internalizing problems, externalizing problems and the CBCL total scores compared with their counterparts. Moreover, these children were younger in birth order and had fewer siblings. After controlling for these confounders using logistic regression, we found that TV/VG time more than 2 hours/day was positively associated with withdrawn (p = 0.008), attention problem (p = 0.037), externalizing problems (p = 0.007), and CBCL total (p = 0.014).Involvement with TV/VG for more than 2 hours/day is associated with more childhood behavioral problems. Counteracting negative effects of the over-involvement with TV/VG in children requires increased parental awareness.

We consider the sequential procedures developed by Robbins and Siegmund (1974), Louis (1975) and Zoubeidi (1992) for comparing the means of two treatments. We let the procedures have equal power functions and compare their Bayes and minimax risks using the invariance property of their power functions. For each of several formulations of the problem we determine the most relatively efficient procedure and compute its expected total sample size.

Background: In adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children. Methods: Twelve patients with ASD were assessed one day before and 5-6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography. Results: Ten of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p

Background The impact of obesity and dyslipidemia on cardiovascular health in adolescents and young adults with diabetes is incompletely understood. This study evaluated the effects of these co-morbidities on markers of inflammation and endothelial dysfunction in young patients with the disease. Methods The study investigated sets of inflammatory, endothelial, and adipocyte biomarkers in 79 patients with type 1 diabetes, 55 patients with type 2 diabetes, and 47 controls. Results Mean (±SD) age was 20±6 y (median = 17, range = 12–31). Patients with diabetes had higher levels of cytoadhesive molecules (sICAM-1 and sVCAM-1, p8.0% (estimated average blood glucose >10 mmol/L) was associated with higher adiponectin (p