Underlying Factors Behind the Low Prevalence of Autism Spectrum Disorders in Oman: Sociocultural perspective

Epidemiological surveys from various countries indicate an increased prevalence of autism spectrum disorders (ASD), leading researchers to debate whether there are now 'more affected' or 'more detected'. The epidemiology of ASD in developing countries, such as Oman, has generally indicated a lower prevalence compared to developed countries in the West. In Oman, the prevalence is low; however, this article highlights some of the factors that could contribute to the appearance of a low ASD rate: cross-cultural variations in the presentation of distress; a lack of reliable biological markers for diagnosing ASD, and a lack of health services for children with ASD, thus limiting the number of participants in epidemiological surveys. While the defining features of ASD have yet to be established, pilot studies in Oman indicate a substantial number of children with these disorders. Therefore, it is important that these discrepancies be addressed and the need for appropriate services for this patient population in Oman be highlighted.

Quality of diabetes care at outpatient clinic, sultan qaboos university hospital

OBJECTIVE

To assess the clinical care of type 2 diabetes mellitus (T2D) patients at Sultan Qaboos University Hospital (SQUH), a countrywide tertiary referral center in Muscat, Oman. .

METHODS

We performed a retrospective, observational, cross-sectional study using a total of 673 Omani T2D patients from the Diabetes and Family Medicine Clinics at SQUH. We collected patient data from June 2010 to February 2012 from the Hospital Information System (HIS). Patients had to be Omani, aged more than 18 years old, and have T2D with active follow-up and at least three visits within one year to be included in the study. Ninety-three percent of the patients (n=622) were on oral hypoglycemic drugs and/or insulin, and 70% were on statins. Patients' anthropometric data, biochemical investigations, blood pressure, and duration of diabetes were recorded from the HIS. .

RESULTS

Using the recommended standards and guidelines of medical care in diabetes (American Diabetes Association and the American National Cholesterol Education Program III NCDP NIII standards), we observed that 22% of the patients achieved a HbA1C goal of <7%, 47% achieved blood pressure goal of <140/80mm Hg, 48% achieved serum low density lipoprotein cholesterol goal of <2.6mmol/L, 67% achieved serum triglycerides goal of <1.7 mmol/L, 59% of males and 43% of females achieved high density lipoprotein cholesterol goals (males>1.0; females >1.3mmol/L). Almost 60% of the patients had urinary microalbumin/creatinine ratio within the normal range. .

CONCLUSIONS

The clinical outcomes of the care that T2D patients get at SQUH were lower than those reported in Europe and North America. However, it is similar to those reported in other countries in the Arabian Gulf.

Association of gene variants with susceptibility to type 2 diabetes among Omanis

AIM: To investigate the association of 10 known common gene variants with susceptibility to type 2 diabetes mellitus (T2D) among Omanis.

METHODS: Using case-control design, a total of 992 diabetic patients and 294 normoglycemic Omani Arabs were genotyped, by an allelic discrimination assay-by-design TaqMan method on fast real time polymerase chain reaction system, for the following gene variants: KCNJ11 (rs5219), TCF7L2 (rs7903146), CDKAL1 (rs10946398), CDKN2A/B (rs10811661), FTO (rs9939609 and rs8050136), IGF2BP2 (rs4402960), SLC30A8 (rs13266634) CAPN10 (rs3792267) and HHEX (rs1111875). T2D patients were recruited from the Diabetes Clinic (n = 243) and inpatients (n = 749) at Sultan Qaboos Univesity Hospital (SQUH), Muscat, Oman. Adult control participants (n = 294) were volunteers from the community and from those visiting Family Medicine Clinic at SQU, for regular medical checkup. The difficulty in recruiting Omani participants with no family history of diabetes was the main reason behind the small number of control participants in this study. Almost all volunteers questioned had a relative with diabetes mellitus. Inspite of the small number of normoglycemic controls in this study, this sample was sufficient for detection of genes and loci for common alleles influencing T2D with an odds ratio of ≥ 1.3 reaching at least 80% power. Data was collected from June 2010 to February 2012.

RESULTS: Using binary logistic regression analysis, four gene variants showed significant association with T2D risk: KCNJ11 (rs5219, P = 5.8 × 10^-6, OR = 1.74), TCF7L2 (rs7903146, P = 0.001, OR = 1.46), CDKAL1 (rs10946398, P = 0.002, OR = 1.44) and CDKN2A/B (rs10811661, P = 0.020, OR = 1.40). The fixation index analysis of these four gene variants indicated significant genetic differentiation between diabetics and controls {[KCNJ11 (rs5219), P < 0.001], [TCF7L2 (rs7903146), P < 0.001], [CDKAL1 (rs10946398), P < 0.05], [CDKN2A/B (rs10811661), P < 0.05]}. The highest genotype variation % between diabetics and controls was found at KCNJ11 (2.07%) and TCF7L2 (1.62%). This study was not able to detect an association of T2D risk with gene variants of IGF2BP2 (rs4402960), SLC30A8 (rs13266634), CAPN10 (rs3792267) and HHEX (rs1111875). Moreover, no association was found between FTO gene variants (rs9939609 and rs8050136) and T2D risk. However, T2D risk was found to be significantly associated with obesity (P = 0.002, OR = 2.22); and with the Waist-to-Hip ratio (n = 532, P = 1.9 ×10^-7, OR = 2.4), [among males (n = 234, P = 1.2 × 10^-4, OR = 2.0) and females (n = 298, P = 0.001, OR = 6.3)].

CONCLUSION: Results confirmed the association of KCNJ11 (rs5219), TCF7L2 (rs7903146), CDKAL1 (rs10946398) and CDKN2A/B (rs10811661) gene variants with susceptibility to T2D among Omani Arabs.

Quality of diabetes care in primary health centres in north Al-batinah of oman

Objective:

To assess the quality of diabetic care provided in primary health care settings in Oman.

Methods:

This was a cross-sectional study of randomly selected 500 patients with diabetes mellitus (DM) attending 6 primary care diabetic clinics in the north Al-Batinah region of Oman from January to December 2010. Nine standards on the quality of diabetes care were audited.

Results:

The mean age of the sample was 51±13 years, ranging from 15 to 87 years; the majority (61%) were females. The mean duration of DM was 4±3 years, ranging from 1 to 18 years. Seventy-seven percent of the patients attended diabetic clinics at least 4 times per year. Of the 9 assessed diabetic standards, HbA1c was documented in 33% of the patients, body mass index in 12%, low-density lipoprotein cholesterol (LDL-C) in 40%, urinary albumin:creatinine ratio in 28%, creatinine in 63% and blood pressure (BP) in 96%. Optimal control among the documented indicators was noted in 32, 21, 25, 85, 95 and 19%, respectively. Twenty percent of the patients had their ECGs done while only 39% of the patients had foot examination. No patient had attained control in all of HbA1c., BP and LDL-C.

Conclusion:

There is a gap between the recommended DM care guidelines and current practice with consequent poor quality of care in these patients.

Impaired Fasting Glucose in Omani Adults with no Family History of Type 2 Diabetes

OBJECTIVES

The aim of this study was to estimate the prevalence of impaired fasting glucose (IFG) among Omani adults with no family history (FH) of diabetes and to investigate the factors behind the risk of developing type 2 diabetes (T2D), while excluding a FH of diabetes.

METHODS

A total of 1,182 Omani adults, aged ≥40 years, visited the Family Medicine & Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D.

RESULTS

Only 191 (16%) reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 (26%) had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A1C and blood pressure (BP), were significantly higher among individuals with IFG (P <0.01, P <0.05, P <0.01 and P <0.01, respectively). In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices (P <0.05). Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor.

CONCLUSION

Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman.

Familial Clustering of Type 2 Diabetes among Omanis

OBJECTIVE

The aim of this study was to screen Omani individuals for the familial aggregation of type 2 diabetes mellitus.

METHODS

A random cohort of 1182 Omani individuals visiting the Family Medicine Clinic at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, for regular medical checkup, aged ≥40 years, were sampled. Patients were categorized into three groups: (1) individuals who claim not to have diabetes and had no family history of diabetes; (2) individuals who claim not to have diabetes but had family history of diabetes; (3) individuals with diabetes. Only 16% of these Omani individuals had no diabetes and no family history of diabetes. Another separate random cohort of 234 Omani type 2 diabetes mellitus patients, from the Diabetes Clinic at SQUH, were interviewed and questioned about their family history of type 2 diabetes mellitus.

RESULTS

Ninety five percent of the patients had a family history of diabetes. Eighty percent had first degree relatives with diabetes and 46% had second degree relatives with diabetes. At least one parent with diabetes was reported among 55% of these diabetics, while maternal diabetes (55%) was found to be higher than paternal diabetes (47%). However, only 15% had both parents with diabetes. Furthermore, almost half of the 234 diabetics were having at least one of the following relatives with diabetes: brother, sister, aunt or an uncle.

CONCLUSION

The findings of this study confirm familial aggregation of diabetes among the Omani population. Compared to other populations, familial aggregation of type 2 diabetes mellitus among Omanis is relatively very high, and is perhaps due to the very high degree of consanguinity among Omanis. Since almost everyone seems to have a genetic predisposition to diabetes, the dramatic lifestyle changes over the past 25 years, could tip the population into an epidemic of type 2 diabetes mellitus.

Impact of nutrition on serum levels of docosahexaenoic acid among Omani children with autism

OBJECTIVES

Autism is a lifelong neurodevelopmental disorder of early childhood. Dietary supplementation of the ω-3 fatty acid (docosahexaenoic acid [DHA]) during prenatal and postnatal life is considered a protective dietary intervention strategy to minimize the risk for autism spectrum disorder (ASD). To our knowledge, no relevant studies have been conducted in the Middle East investigating the status of DHA among children with autism during early childhood. The aim of this study was to investigate the serum levels and dietary intake status of DHA among Omani children recently diagnosed with ASD.

METHODS

The present case-control study involved 80 Omani children (<5 y), 40 cases and 40 controls matched for age and sex. A semi-quantitative food frequency questionnaire was used to assess dietary intake of all the participants, while serum levels of DHA were measured using high-performance liquid chromatography.

RESULTS

Our results showed that children with ASD had lower dietary consumption of foodstuff containing DHA, as well as lower serum levels of DHA than controls.

CONCLUSION

The present finding from Oman supports the view of other studies that there are low serum levels of DHA among children with ASD.

Reasons for Consultation among Patients attending Primary Healthcare Centres in Oman

OBJECTIVES

Pathways to care or care-seeking, which translate into healthcare utilisation, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting.

METHODS

Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics.

RESULTS

About a third (n = 200; 29.6%) of the participants had a history of chronic illness; 231 (34%) were on regular medications; 211 (31%) were taking part in health education programmes; 130 (19%) were open to complementary medicine. The majority of the participants mentioned physician's advice (n = 570; 84%) as the strongest reason for seeking consultation. Conversely, physician's advice was strongly related to particular demographic factors.

CONCLUSION

This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed.

Pilot study on the prevalence of abuse and mistreatment during clinical internship: a cross-sectional study among first year residents in Oman

OBJECTIVE

To evaluate perceptions of being mistreated during internship among first year Oman Medical Specialty Board residents.

DESIGN

A cross-sectional study.

SETTING

Training centres for Oman Medical Specialty Board.

PARTICIPANTS

First year medical residents following completion of internship during the study period 2009-2010.

METHOD

A cross-sectional survey of first year medical residents.

RESULTS

Of 58 residents (response rate 84%), 96.6% perceived that mistreatment exists. Among different types of mistreatment reported, verbal and academic abuses were the most common (87.9%), followed by sexual harassment (24.1%), then physical abuse (22.4%). Forty-four (75.9%) residents had advised at least one of their relatives not to join medical school.

CONCLUSIONS

Mistreatment of medical interns is an ethical issue challenging the quality of clinical training. Further research is needed to understand factors influencing mistreatment and to draw guidelines to limit such problems.

Clinical characteristics of influenza A H1N1 versus other influenza-like illnesses amongst outpatients attending a university health center in Oman

OBJECTIVES

To identify the clinical characteristics of outpatients with flu-like illnesses stratified by influenza A H1N1 status.

METHODS

The study was conducted at the H1N1 staff clinic of Sultan Qaboos University Hospital in Muscat, Oman. The population consisted of university students and university/hospital staff and their family members. All adult patients who presented to the H1N1 clinic with an influenza-like illness over a 4-month period (from August until the end of November 2009) were included. Real-time reverse transcriptase (rRT) PCR was used for the diagnosis of H1N1 influenza. Demographic data, clinical signs and symptoms, history of exposure to H1N1, history of recent travel, and co-morbid conditions were documented. Analyses were conducted using univariate and multivariate statistical techniques.

RESULTS

Out of the 2318 patients identified, 27% (n=616) were positive for H1N1 influenza. The mean temperature in the H1N1-positive group was significantly higher than in the negative group (38.3 °C vs. 37.2 °C; p<0.001). Proportions of patients who reported cough, sore throat, headache, myalgia, gastrointestinal symptoms, exposure to a confirmed case of H1N1, and a history of travel were significantly higher in the H1N1-positive group as compared to the swab-negative group. However, the multivariable logistic model identified only the following significant predictor variables of H1N1 infection: younger age, fever (≥ 37.8 °C), sore throat, myalgia, diarrhea, and exposure to a confirmed H1N1 case within the last 7 days.

CONCLUSIONS

This study provides useful data on the clinical characteristics of H1N1 influenza in a large outpatient population from the Middle East. Patients who tested positive for H1N1 were more likely to have fever, sore throat, diarrhea, and myalgia compared to those with other influenza-like illnesses.

Emerging Burden of Frail Young and Elderly Persons in Oman: For whom the bell tolls?

Recent improvements in health and an increased standard of living in Oman have led to a reduction in environment-related and infectious diseases. Now the country is experiencing an epidemiological transition characterised by a baby boom, youth bulge and increasing longevity. Common wisdom would therefore suggest that Omanis will suffer less ill health. However, a survey of literature suggests that chronic non-communicable diseases are unexpectedly becoming common. This is possibly fuelled by some socio-cultural patterns specific to Oman, as well as the shortcomings of the 'miracle' of health and rapid modernisation. Unfortunately, such new diseases do not spare younger people; a proportion of them will need the type of care usually reserved for the elderly. In addition, due to their pervasive and refractory nature, these chronic non-communicable diseases seem impervious to the prevailing 'cure-oriented' health care system. This situation therefore calls for a paradigm shift: a health care system that goes beyond a traditional cure-orientation to provide care services for the chronically sick of all ages.

Relatives' advice and health care-seeking behaviour in oman

OBJECTIVES

It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking.

METHODOLOGY

During 2006-2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression.

RESULTS

The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation.

CONCLUSION

These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed.

Quality of Diabetes Care: A cross-sectional observational study in Oman

OBJECTIVES

The objective of this study was to evaluate the quality of diabetes care in Oman.

METHODS

This was a cross-sectional observational study. Fifty percent of all those attending six general health centres in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data.

RESULTS

A total of 430 diabetic subjects were included. Just over 61% percent of the subjects were female (n = 263). The overall mean age of the cohort was 52 ± 12 years ranging from 6 to 84 years. Only 40% (n = 171) and 39% (n = 169) of the diabetics had their random blood sugar (RBS) and fasting blood sugar (FBS) documented, respectively. However, 79% (n = 339) had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% (n = 317) for HbA1c and LDL (low density lipoproteins)-cholesterol to 95% (n = 409) for systolic and diastolic blood pressure (SBP/DBP) readings. A total of 58% (n = 249) of patients had non-missing values of HbA1c, SBP/DBP, total cholesterol, LDL-cholesterol, HDL (high density lipoproteins)-cholesterol, and triglycerides. Only 2.4% (6 out of 249 diabetics) were simultaneously within goal for HbA1c (<7%), SBP/DBP (<=130/80mmHg), total cholesterol (<5.2mmol/L), LDL-cholesterol (<3.3mmol/L), HDL-cholesterol (>1.1 - <1.68mmol/L), and triglycerides (<1.8mmol/L).

CONCLUSION

There was good documentation of values for the indicators used in the assessment of quality. However, the proportion (2.4%) of those meeting internationally recognised goals for the three diabetes-related factors was extremely low.

Impact of geographical proximity on health care seeking behaviour in northern oman

OBJECTIVES

Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This paper aims to evaluate the relationship between geographic proximity and health care usage behaviour among patients seeking medical consultation in the northern region of Oman.

METHODS

During 2006-2007, data was collected via face-to-face interviews among 428 randomized patients seeking medical consultation in various primary health care centres in the northern region of Oman. The association between geographical proximity as a reason to seek health care and other predictors was also analysed using multivariable logistic regression.

RESULTS

The data suggest that preference for geographical proximity as a reason for seeking health care is strongly associated with marital status, previous exposure to traditional medicine and health education, as well as history of immunisation.

CONCLUSION

This finding supports the view from elsewhere that geographical proximity remains a strong catalyst for care seeking in Oman. The psychosocial factors affecting care seeking are discussed.