Nurses' comfort and well-being: A descriptive study to find out the relationship between nurses' awareness of self-comfort and well-being at long-term care settings in the state of Kuwait

The study aims to examine out nurses' awareness of self-comfort and well-being in long-term care settings in the state of Kuwait to avoid profession burnout. Nurses are vital resource to health care institutions, the attention on nurses' comfort and well-being should be given valued concerns by top management, as poor staff well-being can pose risks among them and may result in poor performance such as less quality care that is result from less productivity and if the staff well-being ignored the institution performance might be underachieved. A descriptive cross-sectional study design was utilized. The questionnaire assessed participants' socio-demographic data, comfort, and well-being. Data were collected from 260 (86.7% response rate) nurses over the course of 3 months from long-term care facilities in 2 different organizations in Kuwait. The overall nurses' comfort level was moderate with a mean percent score of 67.55 ± 12.50. However, the overall nurses' well-being level was low with a mean percent score of 49.58 ± 6.93. As well as, a strong, positive, and significant correlation was noticed between overall nurses' comfort and its domains with the overall nurses' well-being and its domain. The regression analysis revealed that nurses' perception of their comfort may predict their well-being (P < .001) and explained 34% of the variation in nurses' well-being (R2 = 0.470, β = 0.428, F = 34.762, P < .001). This study emphasized on the importance of creating a healthy, comfortable work environment that promotes nurses' well-being, as well as eliminating discomfort and job dissatisfaction from the organizational culture among nurses as it effects on the organizational performance, productivity, and quality of care.

Identifying urban emission sources and their contribution to the oxidative potential of fine particulate matter (PM2.5) in Kuwait

In this study, we investigated the seasonal variations, chemical composition, sources, and oxidative potential of ambient PM2.5 (particles with a diameter of less than 2.5 μm) in Kuwait City. The sampling campaign was conducted within the premises of Kuwait Institute for Scientific Research from June 2022 to May 2023, covering different seasons throughout the year. The personal cascade impactor sampler (PCIS) operated at flow rate of 9 L/min was employed to collect weekly PM2.5 samples on PTFE and quarts filters. These collected samples were analyzed for carbonaceous species (i.e., elemental and organic carbon), metals and transition elements, inorganic ions, and DTT (dithiothreitol) redox activity. Furthermore, principal component analysis (PCA) and multi-linear regression (MLR) were used to identify the predominant emission sources and their percentage contribution to the redox activity of PM2.5 in Kuwait. The results of this study highlighted that the annual-averaged ambient PM2.5 mass concentrations in Kuwait (59.9 μg/m3) substantially exceeded the World Health Organization (WHO) guideline of 10 μg/m3. Additionally, the summer season displayed the highest PM2.5 mass concentration (75.2 μg/m3) compared to other seasons, primarily due to frequent dust events exacerbated by high-speed winds. The PCA identified four primary PM2.5 sources: mineral dust, fossil fuel combustion, road traffic, and secondary aerosols. The mineral dust was found to be the predominant source, contributing 36.1% to the PM2.5 mass, followed by fossil fuel combustion and traffic emissions with contributions of 23.7% and 20.3%, respectively. The findings of MLR revealed that road traffic was the most significant contributor to PM2.5 oxidative potential, accounting for 47% of the total DTT activity. In conclusion, this comprehensive investigation provides essential insights into the sources and health implications of PM2.5 in Kuwait, underscoring the critical need for effective air quality management strategies to mitigate the impacts of particulate pollution in the region.

Transcriptome analysis of Sparidentex hasta larvae exposed to water-accommodated fraction of Kuwait crude oil

Anthropogenic activities have been shown to significantly affect marine life. Water pollution and oil spills are particularly deleterious to the fish population, especially during their larval stage. In this study, Sobaity-sea bream Sparidentex hasta (Valenciennes, 1830) larvae were exposed to serial dilutions of water-accommodated fraction of Kuwait crude oil (KCO-WAF) for varying durations (3, 6, 24, 48, 72 or 96 h) in acute exposure regime. Gene expression was assessed using RNA sequencing and validated through RT-qPCR. The RNA sequencing data were aligned to the sequenced genome, and differentially expressed genes were identified in response to treatment with or without KCO-WAF at various exposure times. The highest number of differentially expressed genes was observed at the early time point of 6 h of post-exposure to KCO-WAF. The lowest number of differentially expressed genes were noticed at 96 h of treatment indicating early response of the larvae to KCO-WAF contaminant. The acquired information on the differentially expressed genes was then used for functional and pathway analysis. More than 90% of the differentially expressed genes had a significant BLAST match, with the two most common matching species being Acanthopagrus latus and Sparus aurata. Approximately 65% of the differentially expressed genes had Gene Ontology annotations, whereas > 35% of the genes had KEGG pathway annotations. The differentially expressed genes were found to be enriched for various signaling pathways (e.g., MAPK, cAMP, PI3K-Akt) and nervous system-related pathways (e.g., neurodegeneration, axon guidance, glutamatergic synapse, GABAergic synapse). Early exposure modulated the signaling pathways, while KCO-WAF exposure of larvae for a longer duration affected the neurodegenerative/nervous system-related pathways. RT-qPCR analysis confirmed the differential expression of genes at each time point. These findings provide insights into the underlying molecular mechanisms of the deleterious effects of acute exposure to oil pollution-on marine fish populations, particularly at the early larval stage of Sparidentex hasta.

Cost-effectiveness analysis of sodium zirconium cyclosilicate for hyperkalemia among patients with chronic kidney disease or heart failure in Kuwait

INTRODUCTION

Our model was conducted from Kuwaiti payer's perspective to provide evidence on the cost-effectiveness of Sodium zirconium cyclosilicate (SZC) versus patiromer to correct and maintain serum potassium (K+) in combination with renin-angiotensin-aldosterone system inhibitors (RAASis) with different dose titration in patients with chronic kidney disease/heart failure (CKD/HF) with/without renal replacement therapy (RRT).

METHODOLOGY

The model was developed as a patient-level, fixed-time increment stochastic simulation to simulate the complexity of disease, including multiple coexisting and competing conditional risks. This model was established to compare SZC versus patiromer as a treatment for hyperkalemia (HK) among adult populations with underlying conditions of advanced CKD stages 3a-5 or HF to correct and maintain serum K + over a lifetime horizon. The clinical outcomes of SZC and patiromer were demonstrated through arm-specific K + trajectories extracted from the HARMONIZE trial and OPAL-HK trial, respectively. The utility data was captured from different studies. Direct medical cost was captured from local data from Kuwaiti hospitals. Sensitivity analyses were conducted to assess the uncertainty in the model.

RESULTS

Within different scenarios of CKD/HF, SZC was a cost-saving option, with/without RRT, whether one-off administration or repeated administration, except for one-off treatment administration among the HF cohort, which generated an incremental cost effectiveness ratio of KWD 331/quality adjusted life year (QALY). The incremental QALY of SZC ranged from 0.007 to 0.202. In addition, the savings observed with SZC fall within a range of KWD -60 to KWD -1,235 at serum K+ ≥ 5.1 mmol/L.

CONCLUSION

The evidence generated by our model recommends the inclusion of SZC as a treatment option to correct HK and maintain normal serum K + level for CKD/HF patients within the Kuwaiti healthcare system. The costs saved from reducing frequent HK episodes, RAASis discontinuation/down titration, major cardiovascular events, and hospitalization offset the drug acquisition cost of SZC.

Three new species of temporary fish parasite, Gnathiid Isopods (Crustacea: Isopoda: Cymothoida) from Kuwait

Gnathiid isopods (Crustacea) were collected between 2014 and 2022 from various sites in shallow waters of the Kuwait coasts. Three new species of gnathiids are described: Caecognathia alsalmiyah sp. nov. is characterised by the well-extended, distally pointed with three cusps supraocular lobe and the presence of pylopod with four articles; Elaphognathia alshumaimah sp. nov. is distinguished from its congeners by having an elongated, distally curved mandible, with a single pronounced conical internal lobe; Gnathia kuwaitensis sp. nov. is easily distinguished from the other species of the genus Gnathia by the conical mediofrontal process, which is slightly sunken and having pronounced superior frontolateral process, with median notch distally.

Early autoantibody screening for type 1 diabetes: a Kuwaiti perspective on the advantages of multiplexing chemiluminescent assays

Type 1 diabetes (T1D) incidence has increased globally over the last decades, alongside other autoimmune diseases. Early screening of individuals at risk of developing T1D is vital to facilitate appropriate interventions and improve patient outcomes. This is particularly important to avoid life-threatening diabetic ketoacidosis and hospitalization associated with T1D diagnosis. Additionally, considering that new therapies have been developed for T1D, screening the population and individuals at high risk would be of great benefit. However, adopting such screening approaches may not be feasible due to limitations, such as cost, adaptation of such programs, and sample processing. In this perspective, we explore and highlight the use of multiplexing chemiluminescent assays for T1D screening and emphasize on their advantages in detecting multiple autoantibodies simultaneously, maximizing efficiency, and minimizing sample volume requirements. These assays could be extremely valuable for pediatric populations and large-scale screening initiatives, providing a cost-efficient solution with increased diagnostic accuracy and deeper insights into T1D pathogenesis. Eventually, the adoption of such screening methods can help transform T1D diagnosis, especially in countries with high T1D prevalence, such as Kuwait, which will contribute to the development of novel therapeutic interventions, positively impacting the lives of those affected by T1D and other autoimmune diseases.

Diversity and spatiotemporal variations in bacterial and archaeal communities within Kuwaiti territorial waters of the Northwest Arabian Gulf

Kuwaiti territorial waters of the northwest Arabian Gulf represent a unique aquatic ecosystem prone to various environmental and anthropogenic stressors that pose significant constraints on the resident biota which must withstand extreme temperatures, salinity levels, and reducing conditions, among other factors to survive. Such conditions create the ideal environment for investigations into novel functional genetic adaptations of resident organisms. Firstly, however, it is essential to identify said organisms and understand the dynamic nature of their existence. Thus, this study provides the first comprehensive analysis of bacterial and archaeal community structures in the unique waters of Kuwait located in the Northwest Arabian Gulf and analyzes their variations with respect to depth, season, and location, as well as their susceptibility to changes in abundance with respect to various physicochemical parameters. Importantly, this study is the first of its kind to utilize a shotgun metagenomics approach with sequencing performed at an average depth of 15 million paired end reads per sample, which allows for species-level community profiling and sets the framework for future functional genomic investigations. Results showed an approximately even abundance of both archaeal (42.9%) and bacterial (57.1%) communities, but significantly greater diversity among the bacterial population, which predominantly consisted of members of the Proteobacteria, Cyanobacteria, and Bacteroidetes phyla in decreasing order of abundance. Little to no significant variations as assessed by various metrics including alpha and beta diversity analyses were observed in the abundance of archaeal and bacterial populations with respect to depth down the water column. Furthermore, although variations in differential abundance of key genera were detected at each of the three sampling locations, measurements of species richness and evenness revealed negligible variation (ANOVA p<0.05) and only a moderately defined community structure (ANOSIM r2 = 0.243; p>0.001) between the various locations. Interestingly, abundance of archaeal community members showed a significant increase (log2 median ratio of RA = 2.6) while the bacterial population showed a significant decrease (log2 median ratio = -1.29) in the winter season. These findings were supported by alpha and beta diversity analyses as well (ANOSIM r2 = 0.253; p>0.01). Overall, this study provides the first in-depth analysis of both bacterial and archaeal community structures developed using a shotgun metagenomic approach in the waters of the Northwest Arabian Gulf thus providing a framework for future investigations of functional genetic adaptations developed by resident biota attempting to survive in the uniquely extreme conditions to which they are exposed.

Psychological morbidities among Nepalese migrant workers to Gulf and Malaysia

BACKGROUND

One of the important aftereffects of rapid global development is international mobility, which has placed the health of migrant workers as a key public health issue. A less-developed country, Nepal, with political instability and a significant lack of employment, could not remain untouched by this phenomenon of migration. Our goal was to identify and determine the predictors of anxiety, depression, and psychological wellbeing among Nepalese migrant workers in Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia.

METHODS

A descriptive cross-sectional study was used to collect information from 502 Nepalese migrant workers in the arrival section of Tribhuvan International Airport from May to June 2019 using purposive sampling. Workers with a minimum work experience of 6 months and above were included in the study. A structured questionnaire with socio-demographic items was used along with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and WHO (five) wellbeing scale for measuring the subjective psychological wellbeing and screening for depression.

RESULTS

The mean age of the respondents was 32.97 years. Majority (41.8%) of the respondents had work experience in Qatar and 63.7% had work experience of 1-5 years. The results suggested that 14.4% had mild to severe depression while 4.4% had a moderate level of anxiety. The WHO5 wellbeing index score suggested that 14.1% of the respondents had a score below 13, which is suggestive of poor psychological wellbeing. Further, the country of work (p = 0.043), sleeping hours (p = 0.001), occupation (p = 0.044), working hours (p = 0.000), water intake (p = 0.010) and anxiety level (p = 0.000) were found to be significantly associated with depression score. Similarly, sleeping hours (p = 0.022), occupation (p = 0.016), working hours (p = 0.000), water intake (p = 0.010), and anxiety level (0.000) were significantly associated with the WHO5 wellbeing score.

CONCLUSIONS

Nepalese migrant workers in the Gulf countries (United Arab Emirates, Saudi Arabia, Qatar, Oman, Kuwait, Bahrain) and Malaysia bear an important burden of psychological morbidities. This highlights the need to prioritize the migrant worker's mental health by Nepal as well as Gulf countries and Malaysia.

Real world study of ocrelizumab in multiple sclerosis: Kuwait experience

BACKGROUND

Ocrelizumab is a humanized anti-CD20 antibody that has been approved for the treatment of patients with multiple sclerosis (MS). Real-world data in the Middle East is very limited.

OBJECTIVES

To describe the effectiveness and safety of ocrelizumab treatment in MS patients in a real clinical setting.

METHODS

This is an observational, registry-based study. MS patients who were treated with ocrelizumab and completed at least one-year follow-up post-treatment were included. Baseline clinical and radiological characteristics were collected before ocrelizumab initiation. The relapse rate, disability measures, magnetic resonance image (MRI) activity (new T2 lesions and/or GD+ enhancing T1 lesions), and adverse events (AE) at the last follow-up visits were assessed.

RESULTS

Data from 447 patients were analyzed, of which 260 (58.2%) were females. The mean age and mean disease duration were 37.39 ± 11.61 and 9.38 ± 7.57 years respectively. Most of the cohort was of a relapsing form (74.3%; n = 332), whereas active secondary and primary progressive forms represented 15.4% (n = 69) and 10.3% (n = 46) respectively. In the relapsing cohort, Ocrelizumab was prescribed in 162 (48.8%) patients due to highly active disease, and in 99 (29.8%) patients due to disease breakthrough while on prior therapies. In the last follow-up visits, most of the relapsing cohort was relapse-free (95.8% vs. 27.4%; p <0.001), had no evidence of MRI activity (3.6% vs. 67.5%; p <0.001) while EDSS score was stable (1.80+1.22 vs. 1.87+1.16; p < 0.104) when compared to baseline. NEDA-3 was achieved in 302 (91%) of RRMS patients. Confirmed disability progression was 27.5% and 23.9% in SPMS and PPMS respectively. Adverse events were observed in 139 (31.1%); infusion reactions and infections represented the most.

CONCLUSION

This study showed that ocrelizumab is an effective and safe treatment for MS patients in a real clinical setting similar to what was observed in clinical trials.

Human biomonitoring of environmental contaminants in Gulf Countries - current status and future directions

BACKGROUND

This systematic review aimed to evaluate the status of Human Biomonitoring (HBM) in the Gulf Cooperation Council (GCC) region and provide recommendations for future research, considering the increased environmental contaminants that pose a threat to human health in this rapidly industrializing area.

METHODS

A thorough search was performed in PubMed and Web of Science databases up to February 2023 to identify biomonitoring studies on human exposure and levels in the GCC region. Two independent reviewers assessed study eligibility, conducted data extraction and risk of bias assessment. The NIH Quality Assessment Tools and PRISMA guidelines were utilized for quality evaluation and reporting of results.

RESULTS

A total of 38 eligible articles were included in this systematic review out of 662 articles screened. The majority of the publications were from Saudi Arabia (n = 24) and Kuwait (n = 10), while limited representation was found from Qatar (n = 3) and the UAE (n = 1). No articles were identified from Oman and Bahrain. The studies focused on metals, organohalogen compounds, pesticides, polycyclic aromatic hydrocarbons, and phthalates. The findings revealed elevated levels of metals and established correlations between metal exposure and adverse health effects, including infant neurodevelopmental issues, vitamin D deficiency, and oxidative stress. The presence of organohalogen compounds and pesticides was prevalent in the GCC region, with significant associations between exposure to these compounds and negative health outcomes. Notably, high levels of perchlorate were observed in the Kuwaiti population, and a study from Saudi Arabia found an association between per- and polyfluorinated substances and increased odds of osteoporosis.

CONCLUSIONS

This review emphasizes the need to address environmental health challenges in the GCC region through improved HBM research methods and strategies. Implementing biomonitoring programs, conducting cohort studies, investing in tools and expertise, promoting collaboration, and engaging the community are crucial for reliable HBM data in the GCC.

Autochthonous case of Trichophyton indotineae in Kuwait

Trichophyton indotineae is an emerging dermatophyte that has remarkable impact on public health worldwide. In addition to producing severe extensive skin lesions, this species is frequently resistant to terbinafine, used as a first line agent. As a result, the infection is often refractory, making treatment very challenging. The current report describes the first case of Trichophyton indotineae infection in Kuwait. The infected woman had no recent travel history. She failed to respond to several courses of antifungals, but finally responded to voriconazole. The report suggests that T. indotineae is under recognised, hence, active surveillance of dermatophytes is warranted.

A Survey Study on Knowledge and Attitude Toward the Ethics Committee and Research Ethical Practices Among Researchers From Kuwait

The integrity of research findings and the safety of participants who voluntarily consent to participate in research studies must be assured through ethical approaches. Additionally, ethical guidelines and the ethics committee protect participants from unfair practices by the research team. Therefore, this study aims to assess the knowledge and attitudes toward the ethics committee and research ethical practices among the researchers of a diabetes institute in Kuwait. An anonymous survey was conducted through an online questionnaire using Microsoft Forms. The study had a response rate of 86%. Among the 55 participants in this study, 43 (78%) had ethics training. Researchers involved in more than four research projects were shown to have a much higher awareness of the ethics committee and its role than researchers involved in no projects. Approximately 90% of researchers had training in research ethics and were knowledgeable about informed consent forms and assent, as well as additional protections for vulnerable populations. Ninety-eight percent of respondents were of the view that an ethics committee was necessary. Our study concluded that most of the researchers at the institute were aware of the role of the ethics committee, and ethical principles. However, we recommend that continuous and customized training on research ethics should be provided.

Strategies for cost-effective remediation of widespread oil-contaminated soils in Kuwait, an environmental legacy of the first Gulf War

The Kuwaiti oil fire during the first Gulf War resulted in the formation of approximately 300 "oil lakes" of varying sizes that covered over 110 km2 of the desert land. This threatens the fragile desert ecosystems and human health. Following the award of over US$2 billion to the State of Kuwait by the United Nations, large-scale remediation of the oil-contaminated soils has now been on the agenda. However, how to implement the remediation program in a cost-effective way represents a major challenge. In this study, cost-effective remediation strategies were developed based on field and laboratory investigations in a typical oil lake area. Overall, most of the lighter petroleum hydrocarbons (PHCs) were lost due to evaporation. Long-chain aliphatic PHCs dominated the PHCs in the investigated oil lake area. This has implications for developing remediation strategies. Toxicity assessment results showed that the majority of soils pose a low environmental risk with a hazard index <1. Therefore, intensive treatment of these PHCs may not be necessary for these soils. Although active treatment methods are needed to remove the contaminants as soon as practical for the relatively small areas of high contamination, more cost-effective passive methods should be considered to minimize the remedial costs for the larger area of the non-hotspot areas. Given the extremely low risk in terms of groundwater contamination by the contaminated soils, it may not be necessary to remove the soils from the contaminated sites. A low-cost capping method should be sufficient to minimize human exposure to the PHC-contaminated soils.

An annotated checklist of the Amphipoda (Crustacea) of Kuwait, north-western Arabian Gulf

Kuwaits intertidal and subtidal habitats were surveyed from 2013 to 2016 for amphipods, and earlier records from Kuwait and the rest of the Gulf were compared to provide the first annotated checklist of Amphipoda in Kuwait. A total of 82 sites in mainland and islands were surveyed including intertidal and subtidal zones. The resulting data identified 86 amphipod taxa belonging to 54 genera, 32 families and 3 suborders, including 20 new records to science that are currently being described. A total of 46 amphipod species, 34 genera and 19 families constituted new regional records either for Kuwait or the entire Gulf area. Information on local distribution, occurrence, and habitat are provided for each species. Within the tidal zonation, 50 species inhabited both the intertidal and subtidal areas, 19 were intertidal, 12 subtidal, and 3 species were found in the supratidal zone. Sandy and rocky shores supported the most diverse amphipod assemblages. A gradient of increasing amphipod species richness from north to south along Kuwaits mainland coastline was revealed. The high level of regional endemism supported notable taxonomic distinction of the amphipod fauna of Kuwait from the other Gulf areas. Compositional dissimilarity among amphipod faunas increased with distance within a wide longitudinal gradient across the Gulf, Sea of Oman, and north-western Arabian Sea.

Biotin-thiamine responsive basal ganglia disease: a retrospective review of the clinical, radiological and molecular findings of cases in Kuwait with novel variants

BACKGROUND

Biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare autosomal recessive neurometabolic disorder that is caused by biallelic pathogenic SLC19A3 variants and is characterized by subacute encephalopathy associated with confusion, convulsions, dysphagia, dysarthria, or other neurological manifestations.

METHODS

A retrospective review of the data registry in Kuwait Medical Genetics Center for all cases diagnosed clinically and radiographically and confirmed genetically with BTBGD.

RESULTS

Twenty one cases from 13 different families were diagnosed with BTBGD in Kuwait. Most cases (86%) presented with confusion, dystonia, convulsions, or dysarthria, while three individuals were diagnosed pre-symptomatically during familial targeted genetic screening. Symptoms resolved completely within 2-week of treatment in two-thirds of the symptomatic cases but progressed in six of them to a variety of severe symptoms including severe cogwheel rigidity, dystonia and quadriparesis due to delayed presentation and management. Neuroradiological findings of the symptomatic cases revealed bilateral central changes in the basal ganglia. Two novel homozygous missense SLC19A3 variants were detected in a Kuwaiti and a Jordanian individuals, in addition to the previously reported Saudi founder homozygous variant, c.1264A > G; p.(Thr422Ala) in the remaining cases. Age of diagnosis ranged from newborn to 32 years, with a median age of 2-3 years. All cases are still alive receiving high doses of biotin and thiamine.

CONCLUSION

This is the first study reporting the phenotypic and genotypic spectrum of 21 individuals with BTBGD in Kuwait and describing two novel SLC19A3 variants. BTBGD is a treatable neurometabolic disease that requires early recognition and treatment initiation. This study highlights the importance of performing targeted molecular testing of the founder variant in patients presenting with acute encephalopathy in the region.

Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review

BACKGROUND

In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners launched the 90-90-90 targets. These were further updated to correspond to 95-95-95 by the year 2025. We present an overview of the progress made by Gulf Cooperated Council (GCC) countries towards meeting the global targets.

METHODS

We extracted data from Global AIDS Monitoring (GAM), UNAIDS AIDS Info, HIV case reporting database, and the WHO global policy uptake for six countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab of Emirates (UAE) to assess the HIV/AIDS burden in the six GCC countries, and the progress towards achieving the 95-95-95 goal.

RESULTS

By the end of 2021, an estimated 42,015 people living with HIV (PLHIV) were residing in the GCC countries with prevalence levels below 0.01%. Data from four GCC countries, Bahrain, Oman, Qatar and UAE, indicated that by 2021, 94%, 80%, 66%, and 85% of HIV-positive population knew their status, respectively. 68%, 93% (2020 data), 65%, 58% and 85% of PLHIV in Bahrain, Kuwait, Oman, Qatar and UAE who knew their status were on anti-retroviral therapy (ART), respectively, and 55%, 92%, 58% and 90% (2020 data) among those who were on ART had viral suppression in Bahrain, Kuwait, Oman and KSA, respectively.

CONCLUSION

The GCC countries have made great strides toward fulfilling the 95-95-95 targets, but the interim 2025 overall UNAIDS targets remain unmet. The GCC countries must strive diligently to accomplish the targets by emphasising early identification of the cases by enhanced screening and testing, as well as prompt commencement of ART therapy with viral load suppression.

KIR genotype and haplotype repertoire in Kuwaiti healthy donors, hematopoietic cell transplant recipients and healthy family members

The gene complex located on chromosome 19q13.4 encodes the Killer-cell Immunoglobulin-like Receptors (KIRs), which exhibit remarkable polymorphism in both gene content and sequences. Further, the repertoire of KIR genes varies within and between populations, creating a diverse pool of KIR genotypes. This study was carried out to characterize KIR genotypes and haplotypes among 379 Arab Kuwaiti individuals including 60 subjects from 20 trio families, 49 hematopoietic cell transplantation (HCT) recipients and 270 healthy Kuwaiti volunteer HCT donors. KIR Genotyping was performed by a combination of reverse sequence specific oligonucleotide probes (rSSO) and/or Real Time PCR. The frequencies of KIR genes in 270 healthy Kuwaiti volunteer donors were compared to previously reported frequencies in other populations. In addition, we compared the differences in KIR repertoire of patients and healthy donors to investigate the reproducibility of previously reported significant differences between patients with hematological malignancies and healthy donors. The observed frequencies in our cohort volunteer HCT donors was comparable to those reported in neighboring Arab populations. The activating genes KIR2DS1, KIR2DS5 and KIR3DS1 and the inhibitory gene KIR2DL5 were significantly more frequent in patients compared to healthy donors, however, none of the previously reported differences were reproducible in our Kuwaiti cohort. This report is the first description of KIR gene carrier frequency and haplotype characterization in a fairly large cohort of the Kuwaiti population, which may have implications in KIR based HCT donor selection strategies.

Perennial Existence of Organochlorine Pesticides in the Soils of Amghara, Kuwait

A comprehensive study from the surface soil samples of 14 locations from Amghara, Kuwait were assessed for the investigation of organochlorine pesticides (OCPs). There is limited information regarding the distribution pattern of OCPs in the soil samples of Kuwait. The total concentration of OCPs was in the range of 209.39 pg/g -7449.18 pg/g with an average value of 1313.04 pg/g. DDT had higher concentrations in soil samples (969.52 pg/g) than the other pesticides, according to the findings. The distribution pattern of OCPs in the Amghara soils revealed their origin as both historical and recent applications of pesticides. The study extended, how residual quantities could be used to determine health risks of both children and adults. Children and adults in all the locations were subject to negligible cancer risk, according to the health risk evaluation.

Perceptions of Oral Health and Quality of Life among Parents in Kuwait

PURPOSE

To determine the self-perceived oral health and general health as well as the oral health-related quality of life (OHRQoL) among parents in Kuwait.

MATERIALS AND METHODS

This cross-sectional study was conducted among parents visiting the School Oral Health Programme (SOHP) clinics in all the governorates in Kuwait. Being a parent and able to read and understand the Arabic language was the inclusion criterion. A convenience sample of parents (n = 2357) were enrolled in this study, which was conducted using a self-administered questionnaire in Arabic. The questionnaire included previously validated questions and also questions designed for this study. The parents completed and returned the questionnaire while waiting for their children in the waiting area of the SOHP clinic.

RESULTS

The mean age of the parents was 38.3 ± 7.3 years. The majority (75.2%) of the participants perceived their oral health 'excellent', 'very good' or 'good' and 76.4% also rated their general health as 'excellent', 'very good' or 'good'. Overall, higher levels of perceived oral health were reported more frequently by younger participants, females, Kuwaitis, and those who had higher levels of education (p < 0.001). Most of the participants (72.3%) were satisfied with their oral health, (91.0%) enjoyed eating their food and (79.0%) liked their smile. Perceived difficulty in chewing food was stated by only 21.0%, and very few (5.0%) had speech difficulties. Almost half (45.0%) mentioned that they had never had any dental and/or gum problems that affected their daily activities during the past 6 months, nor did such problems influence their social activities. Nearly two-thirds (61.0%) stated that they never had any difficulty in conversation, and half (49.0%) did not report any disturbance in their sleep. Cronbach's alpha (0.89) showed a high degree of internal consistency between different OHRQoL responses.

CONCLUSION

Most of the parents were satisfied with their oral health, which had an impact on their quality of life.

Sustainable and resilient e-commerce under COVID-19 pandemic: a hybrid grey decision-making approach

E-commerce saw a paradigm shift during COVID. Consumers turned to online shopping when pandemic lockdowns caused brick-and-mortar stores to shut for extended periods. Although the pandemic drove more buyers online, it had negative impacts that affected e-commerce performance. This study assesses both positive and negative impacts and their relative significance. The findings are then used to prioritize different strategies for e-commerce development in four vibrant Middle Eastern economies: United Arab Emirates, Saudi Arabia, Qatar, and Kuwait. The study employs a hybrid approach incorporating grey analytical hierarchy process (GAHP) and grey relational analysis (GRA). The GAHP evaluates the relative significance of impacts, whereas the GRA ranks the strategies. The study is based on the responses from 36 local e-commerce specialists. The findings revealed that the supply chain disruption was a rather significant factor, and that "expanding supplier base" was a top-ranked strategy. The study suggests that increasing market share of e-commerce will necessitate the improvement of the supply chains, including the expansion of the supply base, as well as the establishment of sustainable supply chains. In addition to that, the moment has come to implement meaningful changes, such as digital transformation of supply chains, in order to fulfil customer expectations.

An empirical study of innovation-led economic diversification in MENA oil exporters

This paper aims, on the one hand, to investigate the impact of innovation on economic diversification in 11 oil-abundant MENA countries (Algeria, Bahrain, Iran, Iraq, Kuwait, Libya, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen) over the period 1996-2019 using the Arellano-Bond difference GMM estimator and, on the other hand, to reveal how much the level of economic diversification will increase if MENA oil exporters will have innovation rates similar to that of a successful diversifier like Canada. The main findings emphasize the importance of innovation in promoting economic diversification in MENA oil-exporting countries; the level of innovation-led economic diversification increases at a greater pace in GCC countries than in their non-GCC counterparts. The results also show that governance, human development, domestic credit to private sector, and economic freedom positively and significantly affect economic diversification in MENA oil exporters, while oil rents negatively affect economic diversification in these countries. Moreover, the results confirm the effectiveness of the joint impact of governance index and oil rents in boosting economic diversification in oil-rich MENA countries. The results also reveal that the rate of improvement in economic diversification brought by replacing MENA oil exporters' innovation rates with those of Canada is 1.77% (for every 1% increase in innovation). Based on that, one can say that increasing the rate of innovation in MENA oil-exporting countries does accelerate the pace of economic diversification.

Projecting the potential cost-effectiveness of dapagliflozin for chronic kidney disease in Kuwait

INTRODUCTION

In 2019, the prevalence of dialysis in Kuwait were 465 patient/million population, while the annual mortality rate among dialysis patients reached 12%. To improve resource allocation within the health care system, a cost-effectiveness model was conducted from a societal perspective to assess the cost-effectiveness of the use of dapagliflozin as an add-on-therapy against SoC (ramipril) among CKD patients with or without type-2 diabetes over their lifetime.

METHODOLOGY

A Markov process model was utilized to assess the cost-effectiveness of dapagliflozin + ramipril versus ramipril alone on a cohort of patients with an eGFR of 25 to 75 mL/min/1.73, with or without type-2 diabetes and a urinary ACR of 200 to 5,000 over their lifetime. The model included nine health states: (i) the six stages of CKD representing stages 1, 2, 3a, 3b, 4 and 5; (ii)ESRD, which represents RRT as dialysis or kidney transplant and (iii) death. Most of the clinical data were captured from the DAPA-CKD study. We assumed that the mortality risk of our study was similar to DAPA-CKD. The utility data were captured from different studies. Direct medical and indirect costs were captured from local data sources. Sensitivity analyses were conducted.

RESULTS

The difference in QALY between dapagliflozin + ramipril versus ramipril was 0.2. The difference in cost between the two arms was KWD -4,120 (-USD25750). Dapagliflozin + ramipril generate better QALYs and lower costs than ramipril in CKD patients. Dapagliflozin improved the outcomes and generated cost savings in CKD patients.

CONCLUSION

Adoption of dapagliflozin + ramipril is considered to be a cost saving option in addition to the improvement in QALYs in CKD patients with or without type-2 diabetes due to its nephroprotective effect, regardless of the aetiology of CKD, which eventually leads to reduction of dialysis and the transplantation cost burden on the Kuwaiti health care system. This study was focussed only on DAPA-CKD cohort.

Effective bioremediation of soil from the Burgan oil field (Kuwait) using compost: A comprehensive hydrocarbon and DNA fingerprinting study

An innovative combination of metagenomic profiling of microbial communities and GC-MS & Pyrolysis-GC-MS fingerprinting methods were used to assess the biodegradation of contaminated soil from the Burgan oil field in Kuwait. The soil was treated with (sludge) compost in microcosms to evaluate the feasibility of this material for bioremediation purposes. The most favourable trial showed a > 80% decrease in TPH, thereby indicating strong potential for full-scale application using a cost-effective technology and thus in line with the principles of the circular economy. The microbial study showed that compost addition enhanced the organic matter and nutrient content of the soil. However, the microorganisms in the compost did not seem to play a relevant role in bioremediation, meaning that compost amendments serve as a biostimulation rather than a bioaugmentation approach. The chemical study of the distinct oil fractions revealed rapidly biodegraded compounds (alkanes, alkyl-aromatics, etc.) and others that were much more refractory (hopanes, benzohopanes, etc.). Of note, although heavy fractions are usually considered recalcitrant to biodegradation, we observed incipient degradation of the asphaltene fraction by means of double-shot thermodesorption and pyrolysis. Finally, chemical fingerprinting also revealed that the treated soil contained some of the compounds found in the compost, such as coprostanol, cholesterol, and plant sterols. This observation would support the use of these compounds as proxies to monitor the effects of compost and to adjust dosages in real-scale bioremediation treatments.

On the implementation of the circular economy route for E-waste management: A critical review and an analysis for the case of the state of Kuwait

Electronic waste (e-waste) has become one of the major causes of environmental concerns due to its large volume, high generation rate and toxic environmental burdens. Recent estimates put e-waste generation at about 54 million tonnes per annum with figures reaching approximately 75 million tonnes per annum by 2030. In this manuscript, the state-of-the-art technologies and techniques for segregation, recovery and recycling of e-waste with a special focus on the valorisation aspects of e-plastics and e-metals which are critically reviewed. A history and insight into environmental aspects and regulation/legislations are presented including those that could be adopted in the near future for e-waste management. The prospects of implementing such technologies in the State of Kuwait for the recovery of materials and energy from e-waste where infrastructure is lacking still for waste management are presented through Material Flow Analysis. The information showed that Kuwait has a major problem in waste accumulation. It is estimated that e-waste in Kuwait (with no accumulation or backlog) is generated at a rate of 67,000 tpa, and the imports of broadcasting electronics generate some 19,428 tonnes. After reviewing economic factors of potential recovered plastics, iron and glass from broadcasting devices in Kuwait as e-waste, a total revenue of $399,729 per annum is estimated from their valorisation. This revenue will open the prospect of ventures for other e-waste and fuel recovery options as well as environmental benefits and the move to a circular economy.

Identification of high nitrate concentration in shallow groundwater of an arid region: a case study of South Kuwait's Bay

Coastal aquifer is a fragile environment due to the interaction of groundwater with seawater, especially in arid environments. Groundwater along Kuwait's Bay is polluted due to discharge of waste from desalination plants, power plants, and other anthropogenic activities. Earlier studies on submarine groundwater discharge in Kuwait's Bay region have reported the transfer of nutrient flux from the groundwater to Kuwait's Bay. The current study focused on nitrate sources and processes governing their distribution in groundwater samples collected from the southern part of Kuwait's Bay. The concentration of nitrate in the samples ranged from 22.7 to 803.9 mg/L. Higher values were noted in the samples collected inland and a few samples adjacent to the Bay. Spearman's correlation analysis of the data indicated that NO₃- has a strong positive correlation with SO₄^2- and moderate positive correlation with Na ⁺ , TDS/EC. The PCA analysis and factor scores revealed the different sources for groundwater nitrate contamination as follows: leakage of sewer lines in the urban region has led to the infiltration of contaminated sewage, high saline environment due to seawater intrusion, chemical weathering, and influence of denitrifying bacteria. The health risk has resulted due to the NO_3- concentration being above the standard limit for adults. Furthermore, the nitrate concentration was higher in the region adjoining the landfills. In addition, the discharge of groundwater with higher nitrate to the adjacent open water in the Bay may lead to eutrophication. Hence, proper management strategies are to be adopted to control the nitrate pollution in groundwater.

Evolution of hydrogeochemistry in groundwater production fields of Kuwait - Inferences from long-term data

Kuwait Group aquifers and Dammam Formation are the two prominent aquifers, the wells tapping Dammam Formation and Dual completion wells are used for groundwater production. The current study investigates the spatiotemporal evolution of hydrochemical characteristics of the Shagaya water field utilizing long-term (1975-2019) hydrochemical data from 116 water wells. The Shagaya water well field has been differentiated into A to F sub-Fields. Mann-Kendall and Sen's Slope method along with spatial interpolation of change in TDS with time identified a significant decrease in TDS with time in the major portions of the Shagaya B, C, D, and E Fields. The study infers that 82% of wells extracting water from the Dammam Formation and 42% of Dual completion wells show a decrease in TDS concentration. The most plausible explanation for this phenomenon was the inflow of better-quality water from the up gradient parts of the Kuwait Group and the Dammam Formation aquifers due to the fall in the potentiometric head with high volume production in the well field. The results of ionic ratios (Na/Cl, Ca/Mg, Ca/SO₄, Ca + Mg/SO₄+HCO₃), isotopes (³⁴S, ⁸⁷Sr/⁸⁶Sr), relationships between ²H and ¹⁸O, and Ne/He and ³He/⁴He ratios identified that salinization was due to the result of rock-water interaction, ion exchange, mixing between groundwater of Kuwait Group and Dammam Formation and with groundwater from deeper parts of the aquifer. The long-term analysis of the data shows a notable variation of chemistry in a few locations and thus the study helps to manage, sustain groundwater resources, and protection of host aquifers.

Estimation of fine particulate matter in an arid area from visibility based on machine learning

BACKGROUND

The absence of air pollution monitoring networks makes it difficult to assess historical fine particulate matter (PM_2.5) exposures for countries in the areas, such as Kuwait, which are severe impacted by desert dust and anthropogenic pollution.

OBJECTIVE

We constructed an ensemble machine learning model to predict daily PM_2.5 concentrations for regions lack of PM_2.5 observations.

METHODS

The model was constructed based on daily PM_2.5, visibility, and other meteorological data collected at two sites in Kuwait. Then, our model was applied to predict the daily level of PM_2.5 concentrations for eight airports located in Kuwait and Iraq from 2013 to 2020.

RESULTS

As compared to traditional statistic models, the proposed machine learning methods improved the accuracy in using visibility to predict daily PM_2.5 concentrations with a cross-validation R² of 0.68. The predicted level of daily PM_2.5 concentrations were consistent with previous measurements. The predicted average yearly PM_2.5 concentration for the eight stations is 50.65 µg/m³. For all stations, the monthly average PM_2.5 concentrations reached their maximum in July and their minimum in November.

SIGNIFICANCE

These findings make it possible to retrospectively estimate daily PM_2.5 exposures using the large-scale databases of historical visibility in regions with few particulate matter monitoring stations.

IMPACT STATEMENT

The scarcity of air pollution ground monitoring networks makes it difficult to assess historical fine particulate matter exposures for countries in arid areas such as Kuwait. Visibility is closely related to atmospheric particulate matter concentrations and historical airport visibility records are commonly available in most countries. Our model make it possible to retrospectively estimate daily PM_2.5 exposures using the large-scale databases of historical visibility in arid regions with few particulate matter ground monitoring stations. The product of such models can be critical for environmental risk assessments and population health studies.

Remission of type 2 diabetes: Perspectives of dietitians in Kuwait

Although many dietary and lifestyle interventions have been proposed, the concept of total dietary replacement (TDR) to achieve remission of type 2 diabetes in the Gulf region is new. With the high levels of obesity and type 2 diabetes in the region, offering TDR to patients for weight loss and remission of type 2 diabetes would assist in achieving health outcomes. The aim of the current study was to explore and understand remission of type 2 diabetes and TDR from the perspectives of dietitians to identify challenges and recommend solutions for implementation in Kuwait. A qualitative approach utilizing focus groups was chosen to explore the topic. Purposive sampling was used to gain experiences from a diverse sample across primary, secondary, and tertiary specialized diabetes centers. Discussions were audio-recorded and transcribed verbatim. Grounded theory using an iterative approach was applied to analyze the data. Three focus groups with a total of 17 participants achieved data saturation. The sample was varied in terms of workplace and years of experience. The three emerging themes were motivation to use the TDR approach, perceived challenges of TDR, and suggestions to improve and adapt approaches for Kuwait. Dietitians reported that remission of type 2 diabetes is a great motivator for patients to undergo TDR, although various factors were identified that may affect uptake including age, level of education, and social and cultural environment. By understanding dietitians' perspectives, it has provided insight on views regarding the implementation of TDR to achieve remission in Kuwait and how best to tailor approaches by focusing on patient support needs and adopting a flexible approach.

Variation of centennial precipitation patterns in Kuwait and their relation to climate change

The impact of climate change could be inferred by observing long-term climate variables like temperature, precipitation, and evapotranspiration. A local study on the climatic factors such as temperature, precipitation, CO₂ emissions, and population was carried out. The temperature records of the study period reflected an increase of 1.3 °C, higher than the global average. The relationship between the climatic factors from statistical analysis inferred that local factors did not influence the precipitation in Kuwait but showed an interrelationship among temperature, CO₂ emissions, and, population. Therefore, Kuwait's precipitation concerning regional atmospheric processes like sea surface temperature, volcanic eruption, wind direction, and El Nino and La Nina events were studied. The pragmatic change in wind direction in Kuwait from northwest to north after 2005 has enforced to study the effect of the volcanic eruption of Mount Etna on the precipitation in Kuwait. A marked correlation between the precipitation trends and post-eruptive periods of Mount Etna was observed. Similarly, El Nino and La Nina events were correlated, especially with the monthly temperature and total rainfall. Thus, the increase in sea surface temperature and volcanic events influenced the Hadley cell circulation and the shift of the Intertropical Convergence Zone, affecting the rain events in Kuwait.

Past, present and future trends of selected pesticidal and industrial POPs in Kuwait

Given the background of current global initiatives for controlling persistent organic pollutants (POPs), an overview of the scientific knowledge about the POPs issues in Kuwait is presented in this study. Both acute and chronic exposure to POPs can be associated with a wide range of deleterious health effects, including illness and death. POPs have drawn significant political and scientific interest in their fate and actions, particularly where local releases have resulted in dispersed contamination far from the source regions. These concerns inevitably led to the establishment of the Stockholm Convention (SC) on POPs. In recent years, Kuwait has carried out a wide variety of environmental research, in particular, on the monitoring of POPs in different matrices. The technological development facilitated to achieve the opposite monitoring of pesticidal and industrial POPs. The majority of these POPs are from a point source. Kuwait does not have pesticide manufacturing facilities and has not produced pesticides for POPs in the past. In the agriculture sector, Kuwait primarily imports pesticides for pest and disease control. This review encompasses the historical presence and current status of (pesticidal) organochlorine pesticides (OCPs) and (industrial POPs) PCBs and PBDEs in Kuwait based on the export, import, consumption and usage. This research also contrasts pesticide and industrial POP data from various Kuwaiti environmental matrices with data from other parts of Asia, the EU, the USA and Africa.

Planning for a Multi-Well Artificial Recharge Field in Kuwait with the Help of Numerical Modeling

Kuwait, an arid country, wants to have a reserve of water for emergency use and has planned to create an underground reserve of water through multi-well artificial recharge at Kabd area. Numerical modeling of different recharge-recovery scenarios was carried out to chalk out an optimum strategy for implementation of the project. These scenario runs suggested that apart from the aquifer parameters and the quality of the groundwater and the recharge water, the well spacing and well construction, orientation of the field with respect to the prevailing hydraulic gradient, and the injection and the pumping schedule would determine the overall recovery efficiency of the setup. For the selected site, following strategies were found to have positive impact on meeting the goals of the creation of a reserve of water for use in an emergency: (1) during the reserve creation stage, simultaneous recharge and pumping through alternate wells; (2) the compensation of the water lost from the reserve created due to the flow down the hydraulic gradient during the waiting period; and (3) the orientation of the long axis of the field perpendicular to the regional hydraulic gradient. The adoption of cyclic injection and recovery option for the creation of the reserve eliminates the need of the first two steps but calls for several cycles of injection followed by recovery and adequate and consistent supply of water for injection over that period. An optimum field design and two alternative recharge options have been suggested based on the above observations.

Perceiving fingerspelling via point-light displays: The stimulus and the perceiver both matter

Signed languages such as American Sign Language (ASL) rely on visuospatial information that combines hand and bodily movements, facial expressions, and fingerspelling. Signers communicate in a wide array of sub-optimal environments, such as in dim lighting or from a distance. While fingerspelling is a common and essential part of signed languages, the perception of fingerspelling in difficult visual environments is not well understood. The movement and spatial patterns of ASL are well-suited to representation by dynamic Point Light Display (PLD) stimuli in which human movement is shown as an array of moving dots affixed to joints on the body. We created PLD videos of fingerspelled location names. The location names were either Real (e.g., KUWAIT) or Pseudo-names (e.g., CLARTAND), and the PLDs showed either a High or a Low number of markers. In an online study, Deaf and Hearing ASL users (total N = 283) watched 27 PLD stimulus videos that varied by Word Type and Number of Markers. Participants watched the videos and typed the names they saw, along with how confident they were in their response. We predicted that when signers see ASL fingerspelling PLDs, language experience in ASL will be positively correlated with accuracy and self-rated confidence scores. We also predicted that Real location names would be understood better than Pseudo names. Our findings supported those predictions. We also discovered a significant interaction between Age and Word Type, which suggests that as people age, they use outside world knowledge to inform their fingerspelling success. Finally, we examined the accuracy and confidence in fingerspelling perception in early ASL users. Studying the relationship between language experience with PLD fingerspelling perception allows us to explore how hearing status, ASL fluency levels, and age of language acquisition affect the core abilities of understanding fingerspelling.

Benthic foraminifera as proxies for the environmental quality assessment of the Kuwait Bay (Kuwait, Arabian Gulf): Morphological and metabarcoding approaches

The rapid urbanization and industrialization of Kuwait and the consequent effluent discharges into marine environments have resulted in a degradation of water and sediment quality in the coastal marine ecosystems such as in the Kuwait Bay. This study investigates the ecological response of benthic foraminifera (protists) to environmental stress in the Kuwait Bay. The traditional morphological approach was compared to the innovative environmental DNA (eDNA) metabarcoding to evaluate the ecological quality status (EcoQS). Forty-six surface sediment samples were collected from selected stations in the Kuwait Bay. To detect the pollution gradient, environmental parameters from water (e.g., salinity, pH, dissolved oxygen) and sediment (e.g., grain-size, trace metals, total organic carbon, total petroleum hydrocarbons) were measured at each station. Although the foraminiferal assemblages were different in the morphological and molecular datasets, the species turnover was congruent and statistically significant. Diversity-based biotic indices derived from both morphological and metabarcoding approaches, reflect the environmental stress gradient (i.e., organic and metal contaminations) in the Kuwait Bay. The lowest values of EcoQS (i.e., bad to poor) are found in the innermost part (i.e., Sulaibikhat Bay and Ras Kazmah), while higher EcoQS values occur in the outer part of the bay. This study constitutes the first attempt to apply the foraminiferal metabarcoding to assess the EcoQS within the Arabian Gulf and presents its advantages compared to the conventional morphological approach.

Impression Management on Instagram and Unethical Behavior: The Role of Gender and Social Media Fatigue

Impression management (IM) concerns can lead to significant psychological consequences, potentially engendering unethical behavior. Therefore, adopting the stressor-strain-outcome framework, this study explores the effects of IM concerns on unethical behavior through wellbeing, and whether IM on social media (i.e., Instagram) triggers fatigue and results in unethical behavior at work. The findings of two empirical studies (n = 480 and n = 299) in different settings (Kuwait and the UK) suggest that women experience higher effects from IM concerns compared with men in Kuwait, while no gender differences are found in the UK. The results also confirm that impression management on social media platforms triggers fatigue, in turn increasing unethical behavior at work. This study contributes to the IM literature by capturing the effect of Instagram activities on workplace behavior.

The effects of natural gas and oil consumption on CO2 emissions in GCC countries: asymmetry analysis

Oil and gas are key energy sources in the Gulf Cooperation Council (GCC) region. The present study examines the asymmetrical environmental effects of these energy sources and also tests the environmental Kuznets curve (EKC) from 1975 to 2019. In the long run, the EKC is corroborated in Kuwait and Saudi Arabia. But the EKC is not validated in the GCC Panel. Increasing oil consumption raises carbon dioxide (CO₂) emissions in all investigated GCC countries, and decreasing oil consumption reduces CO₂ emissions in Kuwait, Oman, Saudi Arabia, and the United Arab Emirates (UAE). The effect of oil consumption is found asymmetrical in Qatar and symmetrical in the rest of GCC countries. Increasing natural gas consumption (NGC) carries a positive effect in all investigated GCC countries, and decreasing NGC reduces emissions in Oman, Qatar, and the UAE. Moreover, NGC's effects are asymmetrically in all GCC countries except Qatar. In the panel estimates, both increasing and decreasing oil and NGC have positive effects on CO₂ emissions. The long-run effect of oil consumption on CO₂ emissions is larger than the effect of NGC in most GCC economies and panel results. In the short run, increasing and decreasing oil consumption and NGC have a positive effect on emissions in all investigated economies except Saudi Arabia. In the long run, coefficients of decreasing oil consumption are found significantly greater than coefficients of increasing NGC in Kuwait, Oman, Saudi Arabia, the UAE, and the whole GCC. This finding corroborates that increasing CO₂ emissions with increasing NGC is lower than decreasing CO₂ emissions with decreasing oil consumption. Hence, we recommend these countries switch from oil consumption to NGC to reduce overall CO₂ emissions.

Knowledge, Confidence, and Perception Toward Therapeutic Drug Monitoring Among Physicians and Pharmacists in Kuwait

BACKGROUND

Therapeutic drug monitoring (TDM) helps ensure an efficient and safe therapeutic outcome. This study assessed physicians' and pharmacists' knowledge, confidence, and perception regarding clinical pharmacokinetics and TDM.

METHODS

A cross-sectional survey that used a self-administered questionnaire was used. A stratified random sample of 322 physicians and pharmacists across 3 Kuwait public hospitals was surveyed. Descriptive and comparative statistical analyses were performed during data analysis. A multivariate logistic regression model was used to identify factors associated with low levels of knowledge and confidence and negative perceptions among the subjects.

RESULTS

The response rate was 88%. Overall, the respondents' mean total knowledge score percentage was low (50.3%), with no significant difference between the physicians' and pharmacists' scores ( P > 0.5); 60.4% of the participants (95% confidence interval: 54.9-65.6) felt confident when using TDM in their practice. Most participants expressed positive perceptions (90.1%; 95% confidence interval: 86.3-92.9) toward TDM. There was high agreement internally that pharmacists require some knowledge of TDM, should be asked by physicians in general for recommendations on the appropriate use of TDM, and should be able to provide relevant information regarding the appropriate use of TDM.

CONCLUSIONS

Physicians and pharmacists in this study had high confidence in-and the positive perceptions of-TDM and its clinical implications. The present study's findings indicate an urgent need for professional education and training in clinical pharmacokinetics and TDM and its clinical implications through continuous professional development programs and its integration within the curricula of medical and pharmacy schools.

When liquids and fricatives outrank stops: A Kuwaiti Arabic-speaking child with Down syndrome and protracted phonological development

This paper describes the phonological system of a monolingual Kuwaiti Arabic-speaking 9-year-old girl with Down Syndrome (DS) as part of a special crosslinguistic issue presenting individual profiles of children with protracted phonological development within the framework of constraints-based nonlinear phonology. Her responses to a 100-word speech test were audio-recorded and transcribed narrowly by two native speakers. Analyses showed low accuracy for word shapes (CV sequences), primarily because of expected deletion patterns in initial weak syllables and clusters, but also reflecting inaccuracies in segment length. Vowel match was also relatively low. For consonants, she unexpectedly showed lower accuracy for stops than typically later-developing liquids and fricatives. This case study provides researchers and speech-language pathologists with broader information about expected and unexpected patterns in children with DS and protracted phonological development in general.

Exploring the Use and Adoption of Wearable Physical Activity Trackers in Oil-Rich Nations: A Qualitative Study of Youth Perspectives from Kuwait

This study aimed to uncover participants' perspectives about the use of self-tracking wearables and describe the barriers and motivators for adopting them. Qualitative data were collected through semi-structured interviews. The analysis of the transcribed interviewed followed a thematic analysis approach and utilized the Framework method. The findings highlight the importance of wearables to increase physical activity health interventions targeting sedentary lifestyles.

Differential stuttering during conversation and oral reading in Kuwaiti-Arabic speakers: a note on diglossia

The current study aimed to explore the frequency and types of stuttering in the oral reading and conversational samples of Arabic adults who stutter (AWS). Twelve Kuwaiti-Arabic AWS (mean age: 27.3 years) participated in the study. Each participant's stuttering was analyzed in two speaking contexts -oral reading of a standard Arabic passage and spontaneous conversational speech. The results showed that among a majority of the participants the amount of stuttering in conversation was significantly lower than that of reading. However, no significant differences were found in disfluency types within and between samples. The higher occurrence of stuttering in reading may be related to the diglossic nature of Arabic. The linguistic and rhythmic distinctions between Modern Standard Arabic (MSA) and Kuwaiti dialectal Arabic are explored to further explain the findings.

Knowledge, attitude, and practice toward COVID-19 among the public in three Gulf countries - a cross-sectional survey

OBJECTIVE

This study investigated the knowledge, attitude, and practice toward COVID-19 among residents/citizens of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Kuwait.

PATIENTS AND METHODS

A cross-sectional online survey on 3,920 citizens/residents from three Gulf-countries (KSA, UAE, and Kuwait) was conducted between June 15 and August 25, 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 4 items on attitudes, and 7 items on practice towards prevention and control of COVID-19. The Survey link was constructed to be available in Arabic and English. Descriptive statistics of frequency distribution and percentages were calculated, and non-parametric tests were applied to compare the mean knowledge, attitude, and practice scores among different countries.

RESULTS

This study included participants from KSA (2,938, 74.9%), UAE (403, 10.3%), and Kuwait (579, 14.8%). The study subjects from KSA, UAE, and Kuwait showed significant differences in the mean knowledge (10.13, 10.52, and 9.19, p<0.001), attitude (2.84, 3.12, and 5.98, p<0.001), and practice (6.11, 5.98 and 5.38, p<0.001) scores towards COVID-19. In addition, Kuwaiti citizens and residents showed significantly lower knowledge, attitude, and practice scores toward COVID-19 than UAE and KSA participants. Participants from Kuwait showed significantly lower knowledge, attitude, and practice scores than the UAE and KSA. However, in general (38.2%), the study participants were optimistic about controlling Coronavirus. Nearly 48.6% started to take an immune-boosting diet to protect themselves from the Coronavirus.

CONCLUSIONS

Study participants from KSA, UAE, and Kuwait demonstrated adequate knowledge, positive attitude, and acceptable practices towards COVID-19 control. Electronic and social media should be effectively utilized to spread awareness of COVID-19 among the public.

A Study of Voice Handicap and Acoustic Measures in Arab Kuwaiti Prospective Professional Singers

INTRODUCTION

Despite its clinical significance, few studies have explored the applicability of the validated Arabic version of the Voice Handicap Index (VHI-Arab) in professional voice users, especially singers. The correlation between VHI-Arab scores and acoustic measures in this targeted group remains unclear. The aim of this study was to explore Arab Kuwaiti prospective professional singers' perception of voice handicap using the validated VHI-Arab. Additionally, we examined the association between VHI-Arab scores and acoustic measures such as fundamental frequency (F0), shimmer, jitter, and signal-to-noise ratio.

METHODS

VHI-Arab scores and acoustic measures of 100 adult prospective professional singers (50 females and 50 males) were compared with those of 100 adult controls (50 females and 50 males).

RESULTS

Female prospective professional singers differed significantly from female controls in terms of functional and physical subscale scores, total VHI-Arab scores, and shimmer and jitter values. Male prospective professional singers neither showed significant differences in VHI-Arab scores nor in acoustic measures; however, their shimmer values showed significant difference. There was no correlation between VHI-Arab scores and acoustic measures.

CONCLUSION

Kuwaiti prospective professional singers did not perceive their voice as handicapped. Female prospective professional singers had a better perception of their voice compared with female controls. The results of the current study suggest that the perception of voice handicap and acoustic measures are different attributes that do not correlate.

ICD-11 Morbidity Pilot in Kuwait: Methodology and Lessons Learned for Future Implementation

This paper reports on the first ICD-11 morbidity pilot for inpatient discharges in a public general hospital. We detail the pilot methodology, lessons learned in terms of facilitators and challenges, physician-reported opinion, and considerations for future implementation. The pilot included: engaging stakeholders; selecting the setting; building a common understanding of the discharge process; evaluating and preparing IT infrastructure; ICD-11 training; small-scale pre-pilot testing; implementing the pilot while providing on-site support and collecting data for analysis including a brief user-experience survey. Overall, physicians were satisfied with the experience. Facilitators for success included national health system influence, leadership commitment, a multidisciplinary team approach, physician-tailored training, using social media for training, and providing on-site support. Challenges included potential IT problems, and difficulties relating to training and engaging physicians. Issues to consider include DRG system requirements, and comparability of ICD-11 pilot results from different countries. In conclusion, ICD-11 can be successfully implemented for documenting diagnoses by physicians in a public hospital by installing the coding tool on the electronic hospital information system. Pilots can improve ICD-11 content by using the online proposal mechanism. Implementing ICD-11 requires effective change management, stakeholder-tailored communication, and innovative ideas for training to match the electronic nature of ICD-11 and its potential new users, physicians.

Violence Against Kuwaiti Women

The gendered patterns of violence against women are largely precipitated by dominant male gender roles that define masculinity. The purpose of this study was to understand women's encounter in abusive domestic relationships. Specifically, the research goal was to assess the extent, types, and severity of interpersonal violence (IPV) by intimate partners against married and divorced women in Kuwait. In addition, the research attempts to correlate the extent, types, and severity of IPV by intimate partners with characteristics of the study participants. The study was based on quantitative methodology. Results indicated that cultural, religious, and demographic factor values were among the highest causes of violence against women. The IPV against women in Kuwait City is reported by 71% for women who are physically abused, 81% for women who are sexually abused, 89% for women who are psychologically abused, 75% for women based on cultural and religious factors, and 65% for women battering. Clinical implications are provided to guide practitioners in identifying couples at risk and to formulate prevention and intervention strategies.

Bromate concentrations and pH values in bottled drinking water in Kuwait

The study objectives were to assess bromate concentrations in bottled drinking water sold at retail in Kuwait and assess pH values relationship to bromate concentrations. A cross-sectional study was conducted in 2019 where 120 bottled water samples were collected from supermarkets across six governorates in Kuwait. Samples represented local brands that used distilled or mineral water as well as imported brands that used mineral water only. The samples were analyzed for bromate concentrations and pH values. The overall mean bromate concentration was 4.02 µg/L (95% CI: 3.35-4.69) with concentration of 4.45 µg/L in locally distilled water significantly (P < 0.05) higher than that in imported mineral water samples (i.e., 1.34 µg/L). The overall bromate percent positive was 41.7% (n = 120) with 35.8% in locally distilled samples, significantly higher than that in imported mineral samples (5.8%). None of the local mineral bottled water samples had detectable bromate. Bromate concentrations in our samples were within the international allowable limits of less than 10 µg bromate/L (except for one local distilled sample that contained 14.9 µg bromate/L). The mean pH value was 7.39 (95% CI: 7.33-7.45). There was no significant relationship between pH values and bromate concentrations in our samples. Our findings proved that local and imported bottled water sold at retail in Kuwait was bromate safe.

The History of Dentistry in Kuwait

There is scant documentation of the origins of dentistry in countries of the Middle East. This paper aims to identify and detail the development of dentistry in one of the smaller countries in the Middle East, Kuwait that has played a pivotal role in a wide range of political and socio-economic developments in the past fifty years.

Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait

BACKGROUND

Potentially inappropriate medications are major health concerns for patients aged ≥65 years. To investigate the prevalence of potentially inappropriate medications, Beer's criteria can be used. We estimated the prevalence of potentially inappropriate medications prescription among patients aged ≥65 years admitted to Kuwait's largest hospital and identified the predictors of prescribing a potentially inappropriate medication.

METHODS

A cross-sectional study was conducted retrospectively using inpatient records from the medical department at the Hospital in Kuwait from 1 January 2019 to 31 December 2019. The latest version of Beer's criteria was used to identify potentially inappropriate medications in patients' medical records. Data were analyzed descriptively to estimate the prevalence of potentially inappropriate medications and to describe participant characteristics. The predictors of potentially inappropriate medications prescribing were determined using binary logistic regression.

RESULTS

A total of 423 medical records of patients were collected. The mean age of the patients admitted was 76 ± 7 years, and 222 of them (52.5%) were women. Upon hospital admission, potentially inappropriate medication was prevalent in 58.4% of patients. The most prevalent potentially inappropriate medications identified were proton pump inhibitors (27.3%), diuretics (21.5%), antipsychotic agents (9%), selective serotonin reuptake inhibitors (5%), and methyldopa (4%). Polypharmacy, Alzheimer's disease, depression, irritable bowel syndrome, hypothyroidism, chronic kidney disease were predictors of potentially inappropriate medications prescription.

CONCLUSION

A high prevalence of potentially inappropriate medication prescription was observed among patients aged ≥65 years admitted to a hospital in Kuwait. The most likely predictor of potentially inappropriate medication prescription was polypharmacy.

Baseline concentrations of pharmaceuticals in Kuwait's coastal marine environment

This study was carried out to provide baseline information on the concentrations of pharmaceuticals in Kuwait's coastal waters. Samples were collected over four sampling campaigns from various outfalls that occasionally discharged water into the marine environment and analyzed for a range of pharmaceuticals including analgesic/anti-inflammatories, antibiotics, anticoagulant, antidiabetic, antihelmintics, antihypertensives, antiplatelet agent, asthma medication, β-blocking agent, calcium channel blocker, diuretic, histamine H1 and H2 receptor antagonist, lipid regulators/cholesterol-lowering, prostatic hyperplasia, psychiatric drug, sedation and muscle relaxant, synthetic glucocorticoid, tranquilizer and x-ray contrast media. The levels varied between the detection limits of the method and a maximum of 28,183 ng/L for analgesics/anti-inflammatories. The highest pharmaceutical concentrations were in samples collected during the September campaign, possibly linked to the increased prescription of these medications to treat infectious diseases and flu prevalent in Kuwait during the winter months. The spatial variation is concentration is evident with KISR site being most polluted as hospital wastewater is discharged at the site. This study provides the first dataset on the concentrations of pharmaceuticals in the seawater in Kuwait and possibly the wider Arabian Gulf. Kuwait's coastal water pharmaceutical concentrations derived from this study exceed those reported from the Spanish coast, the Hong Kong harbour, the Bohai and the Yellow seas. More studies are needed to evaluate the environmental impact that these residues may have on non-target organisms.

Modelling the symmetrical and asymmetrical effects of global oil prices on local food prices: A MENA region application

This paper explores the complex nexus between the global oil prices and the food prices of the Middle East and North Africa (MENA) region during the period 2000-2020. Both linear and nonlinear models of the autoregressive distributed lag (ARDL) approach are adapted into panel data form to investigate the symmetrical and asymmetrical influence of oil prices on food prices. The key results are summarized: (i) the long-term effect of oil prices on food prices is significantly positive including both oil-exporting and oil-importing nations. The positive impact on oil exporters-due to higher oil revenues-is greater than importing nations, leading to an increased demand for food. Additionally, the effect on oil exporters is negative and significant in the short term but not significant for importers. (ii) The nonlinear ARDL panel analysis for the whole MENA sample confirms the presence of negative short-term asymmetric behaviour due to the heterogeneous response within the oil-importing and oil-exporting samples, while in the long term, the asymmetric effect is positive, indicating that food prices increase regardless of fluctuations in oil prices. (iii) The nonlinear ARDL results using time series affirm the absence of an asymmetric nexus among oil and food prices for some oil-exporting nations (including Kuwait, Saudi Arabia, United Arab Emirates) and Tunisia within the oil-importing group. However, the food prices of other countries are asymmetric to the oil price. This study provides recommendations that are useful to MENA countries to establish a stable mechanism for oil and food prices to ensure food security in the region.