Health-related quality of life in patients with diabetic foot ulcers in the Arab world: a systematic review

OBJECTIVE

To conduct a systematic review to identify the impact of diabetic foot ulceration (DFU) on health-related quality of life (HRQoL) in individuals within the Arab world.

METHOD

A PRISMA-guided systematic search for HRQoL studies in Arab populations was conducted in CINAHL, PubMed, Scopus and EBSCO. Relevant studies were critically appraised using the STROBE statement checklist.

RESULTS

A total of five studies were included. Three studies originated from Saudi Arabia, one from Jordan and one from Tunisia. The studies consistently demonstrated lower (poorer) HRQoL in patients with DFU, and worse HRQoL compared with both patients with diabetes and no DFU, and with healthy subjects.

CONCLUSION

This review confirmed the negative impact of DFU on HRQoL in individuals with diabetes. It also highlights the scarcity of HRQoL studies from the Arab world. However, given that all studies included were conducted between 2013-2019, this could reflect a growing interest in DFU and HRQoL in the Arab world, and could potentially indicate that more studies will follow. In light of this, there is a need for a renewed focus on the completion of a high-quality standardised approach to research in this region.

Investigation of germline variants in Bahraini women with breast cancer using next-generation sequencing based-multigene panel

Germline variants in BRCA1 and BRCA2 (BRCA1/2) genes are the most common cause of hereditary breast cancer. However, a significant number of cases are not linked to these two genes and additional high-, moderate- and low-penetrance genes have been identified in breast cancer. The advent of next-generation sequencing (NGS) allowed simultaneous sequencing of multiple cancer-susceptibility genes and prompted research in this field. So far, cancer-predisposition genes other than BRCA1/2 have not been studied in the population of Bahrain. We performed a targeted NGS using a multi-panel covering 180 genes associated with cancer predisposition to investigate the spectrum and frequency of germline variants in 54 women with a positive personal and/or family history of breast cancer. Sequencing analysis revealed germline variants in 29 (53.7%) patients. Five pathogenic/likely pathogenic variants in four DNA repair pathway-related genes were identified in five unrelated patients (9.3%). Two BRCA1 variants, namely the missense variant c.287A>G (p.Asp96Gly) and the truncating variant c.1066C>T (p.Gln356Ter), were detected in two patients (3.7%). Three variants in non-BRCA1/2 genes were detected in three patients (1.85% each) with a strong family history of breast cancer. These included a monoallelic missense variant c.1187G>A (p.Gly396Asp) in MUTYH gene, and two truncating variants namely c.3343C>T (p.Arg1115Ter) in MLH3 gene and c.1826G>A (p.Trp609Ter) in PMS1 gene. Other variants of uncertain significance (VUS) were also detected, and some of them were found together with the deleterious variants. In this first application of NGS-based multigene testing in Bahraini women with breast cancer, we show that multigene testing can yield additional genomic information on low-penetrance genes, although the clinical significance of these genes has not been fully appreciated yet. Our findings also provide valuable epidemiological information for future studies and highlight the importance of genetic testing, and an NGS-based multigene analysis may be applied supplementary to traditional genetic counseling.

Transient Anosmia and Dysgeusia in COVID-19 Disease: A Cross Sectional Study

Objective

This study aims to explore the prevalence of anosmia and dysgeusia and their impact on COVID-19 patients.

Methods

This is a cross-sectional study. Patients diagnosed with COVID-19 between 1st October 2020 and 30th June 2021 were randomly selected from a national COVID-19 registry. COVID-19 cases were diagnosed using molecular testing method which measured the viral E gene. The Anosmia Reporting Tool, and a brief version of the questionnaire on olfactory disorders were used to measure the outcomes via telephone interviews. Data were analysed using SPSS 27 statistics software.

Results

A total of 405 COVID-19 adults were included in this study, 220 (54.3%) were males and 185 (45.8%) were females. The mean±SD age of participants was 38.2 ± 11.3 years. Alterations in the sense of smell and taste were reported by 206 (50.9%), and 195 (48.1%) of the patients, respectively. Sex and nationality of participants were significantly associated with anosmia and dysgeusia (p < 0.001) and (p-value=0.001) respectively. Among patients who experienced anosmia and dysgeusia, alterations in eating habits (64.2%), impact on mental wellbeing (38.9%), concerns that the alterations were permanent (35.4%), and physical implications and difficulty performing activities of daily living (34%) were reported.

Conclusion

Anosmia and dysgeusia are prevalent symptoms of COVID-19 disease, especially among females. Although transient, anosmia and dysgeusia had considerable impact on patient's life. Neuropsychological implications of COVID-19 in acute infection phase and prognosis of anosmia and dysgeusia in COVID-19 are areas for further exploration.

Quality of Life of Emirati Women with Breast Cancer

To examine the quality of life (QoL) of Emirati women with breast cancer (BC) and determine its relationships with their sociodemographic characteristics and clinical factors. The study will play a leading role in providing information about the QoL of Emirati women with BC and will help in recognizing the aspects of QoL in BC survivorship that requires special attention. A population-based cross-sectional study was conducted on 250 Emirati women using a multistage stratified clustered random sampling. The participants were interviewed face-to-face using a structured questionnaire composed of sociodemographic variables, reproductive characteristics, and the European Organization for Research and Treatment of Cancer Quality of Life Cancer-Specific version (EORTC QLQ-C30, v.3.0) and the EORTC QoL Breast Cancer-Specific version (EORTC QLQ-BR23) translated into Arabic. Emirati BC survivors reported good QoL overall. The most bothersome symptoms were sleep disturbance, fatigue, pain, hair loss and arm symptoms. Emirati women scored average on all functional scales, which indicates mediocre functioning, but high on the symptom scales, which indicates worse symptoms. Factors associated with a decline in the domains of QoL included higher age, lower income, and history of metastases, mastectomy, and lymph node dissection.

Psychological Impact of COVID-19 on University Students in Bahrain

Background COVID-19 is an ongoing event that has affected millions worldwide financially, socially, and psychologically; university students have also felt the devastating impact. Therefore, assessing how students have been affected psychologically is important, which is explored in this study. Methods This cross-sectional study took place in two institutions in Bahrain between October and December 2021. A survey assembled from pre-validated questionnaires was sent through Google Forms after receiving ethics approval. Data were analyzed using network plot analysis and linear regression analysis. Results Out of 292 responses, the most common demographic observed were vaccinated Bahraini females living with families at a mean age of 21.21 (SD±3.447). The mean scores for the Generalized Anxiety Disorder Scale (GAD-7), Centered for Epidemiological Studies-Depression scale (CES-D), and Stigma Scale were 10.55 (SD ± 6.144), 18.75 (SD ± 9.147), and 25.40 (SD ± 3.428), respectively. The significant associations on ANOVA observed were stigma score and living status (p-value = 0.002), stigma, and alcohol consumption (p-value = <0.001). Statistically significant predictors of the outcomes in this study included gender for depressive symptoms (p-value = 0.013) and alcohol consumption for stigma (p-value = 0.017). Discussion The stigmatization of the pandemic may additionally influence sub-threshold depressive and anxiety-related symptoms in university students. Concluding from the results of this study, the psychological impact of the pandemic is significant among university students and needs to be addressed in institutions in Bahrain.

Validation of Physical Examination Perceived Self-Efficacy Instrument for Undergraduate Nursing Students

BACKGROUND

Numerous studies have revealed that nursing students perceive lack of confidence as one of the key barriers to performing physical examination; however, it is not empirically measured. This study aimed to test the psychometric properties of the Physical Examination Perceived Self-Efficacy Instrument.

METHOD

The study included three phases: in Phase 1, 51 items were constructed; in Phase 2, 7 field experts rated items for relevancy; and in Phase 3, the instrument was piloted to a convenience sample of 238 students.

RESULTS

The analysis yielded six factors with a factor loading >0.40. The corrected item-total correlation ranged from 0.6 to 0.87. Cronbach's alpha ranged from .84 to .98. The interscale correlation of the instrument was statistically significant (p < .001).

CONCLUSION

We found that the instrument is a psychometrically robust measure of self-efficacy of performing physical examination. The instrument could provide a better understanding of the association between perceived self-efficacy and students' academic performance. [J Nurs Educ. 2022;61(1):36-40.].

Influence of CYP2C9, VKORC1, and CYP4F2 polymorphisms on the pharmacodynamic parameters of warfarin: a cross-sectional study

BACKGROUND

Warfarin is the most commonly evaluated drug in pharmacogenetic-guided dosing studies. However, gaps remain regarding the influence of the genetic polymorphisms of CYP2C9, VKORC1, and CYP4F2 on specific pharmacodynamic parameters like the warfarin sensitivity index (WSI), prothrombin time international normalized ratio (PT-INR), and log-INR variability.

METHODS

A cross-sectional study was conducted in non-smoking adults receiving warfarin for at least 6 months. Their demographics, diagnoses, warfarin dosing regimen, concomitant drugs, PT-INR, and bleeding episodes were obtained. CYP2C9 (rs1057910-*3 and rs1799853-*2 alleles), CYP4F2 (rs2108622), and VKORC1 (rs9923231) polymorphisms were assessed using real-time polymerase chain reaction. Three genotype groups (I-III) were defined based on the combined genetic polymorphisms of CYP2C9 and VKORC1 from the FDA's recommendations. Key outcome measures included anticoagulation control, time spent in therapeutic range, stable warfarin dose, WSI, log-INR variability, and Warfarin Composite Measure (WCM).

RESULTS

The study recruited 236 patients; 75 (31.8%) carried a functional CYP2C9 variant allele, and, 143 (60.6%) had at least one T allele in CYP4F2 and 133 (56.4%) had at least one T allele in VKORC1. Groups' II and III CYP2C9 and VKORC1 genotypes were observed with reduced stable warfarin dose, increased WSI, higher log-INR variability, and increased bleeding risk. The presence of *2 or *3 allele in CYP2C9 was observed with reduced stable warfarin doses akin to the presence of T alleles in VKORC1; however, the doses increased with T alleles in CYP4F2.

CONCLUSION

The evaluated genetic polymorphisms significantly influenced all the pharmacodynamic parameters of warfarin. Evaluating CYP2C9, VKORC1, and CYP4F2 genetic polymorphisms prior to warfarin initiation is likely to optimize therapeutic response.

Psychological Impact of COVID-19, Isolation, and Quarantine: A Cross-Sectional Study

PURPOSE

The COVID-19 pandemic has resulted in mandatory isolation and quarantine. The objective of this study was to describe and compare the psychological impacts of COVID-19 isolation and quarantine.

METHODS

This was a cross-sectional retrospective study. Participants were Bahrainis aged >18 years who had undergone either isolation or quarantine. Eligible participants were identified from the COVID-19 contacts (quarantine) and cases (isolation) database of Bahrain. Validated questionnaires for self-reported depression (Center for Epidemiological Studies - depression [CES-D]), posttraumatic stress (Impact of Event Scale - revised [IES-R]), and perceived stigma (Stigma Scale [SS]) were administered.

RESULTS

Mean CES-D, IES-R, and SS scores were 16.76±5.65, 13.50±14.67, and 25.29±7.99, respectively. In sum, 40% (205 of 502) of participants showed clinically significant depression, and <20% (98 of 502) had indications of some posttraumatic distress, with greater depression and distress in those isolated than those quarantined. Perceived stigma was reported by 53.4% (268 of 502) of participants, more prominent among those quarantined. Depression and posttraumatic stress scores were significantly higher in females, college students, those with a history of mental health conditions, knowing a COVID-19 fatality, and experiencing social conflict. Age was a significant variable correlated with all three scales, with younger participants indicating more distress, depression, and stigma. Duration of segregation was significantly correlated with CES-D, score showing more depressive symptoms as the duration of isolation increased. Significant predictors were age, sex, history of mental illness, and COVID-19 status.

CONCLUSION

Isolated and quarantined individuals reported depression, perceived stigma, and to a lesser extent distress. Psychological interventions identifying and targeting people with different-severity psychological burdens are in urgent need.

Reliability and Validity of the Arabic Version of the EORTC QLQ-C30 and QLQ-BR23 Questionnaires

OBJECTIVE

To evaluate the psychometric properties of the Arabic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires.

MATERIALS AND METHODS

A cross-sectional study was carried out. A total of 337 subjects were recruited from the Oncology Centre in Bahrain and 239 consented to participation. The European Organization for Research and Treatment-QOL questionnaire and breast cancer-specific module (EORTC QLQ-C30 and QLQ-BR23) were used to measure the HRQOL among women with breast cancer. All statistical tests were performed using SPSS Version 20. The reliability of the EORTC QLQ-C30 and QLQ-BR23 questionnaires was examined using Cronbach's alpha test. The construct validity of both questionnaires was tested using the exploratory factor analysis.

RESULTS

Exploratory factor analysis results of EORTC QLQ-C30 showed that Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.878 and Bartlett's Test of Sphericity is <0.001. The extracted four-factor model explained 51.52% of the total variance. Relating to EORTC-QLQ-BR23, the KMO value was 0.735 and Bartlett's Test of Sphericity showed a significance of p<0.001 and extracted a three-factor model which explained a total variance of 46.05%. The Cronbach's alpha coefficient results for EORTC QLQ-C30 and QLQ BR-23 were 0.927and 0.844 respectively which reflects high internal consistency.

CONCLUSION

The EORTC QLQ-C30 and QLQ-BR23 questionnaires are feasible and promising instruments to measure the levels of HRQOL among Arabic-speaking women with breast cancer in future studies with some suggested modifications in some of the domains or items.

Menopause-Specific Quality of Life among Emirati Women

To investigate the quality of life (QOL) of menopausal Emirati women aged 40-64 years and determine its relationship with their sociodemographic characteristics. A community-based cross-sectional study was conducted on 70 Emirati women using multistage stratified clustered random sampling. The participants were interviewed face-to-face using a structured questionnaire comprising sociodemographic variables, reproductive characteristics, and the Menopause-Specific Quality of Life (MENQOL) questionnaire. The most common symptom among the study participants was 'aching in the muscles'. The participants had a moderate level of bothersome symptoms; in addition, vasomotor symptoms were reported by 61%, while sexual symptoms were only reported by one-third of the participants. There were no significant differences between the menopausal status in any of the four domains of the MENQOL questionnaire. Additionally, there were no significant differences between the mean scores of the four MENQOL domains and all predictors. This study highlights the importance of educating women about menopause and its symptoms.

Knowledge towards human papilloma virus (HPV) infection and attitude towards its vaccine in the Kingdom of Bahrain: cross-sectional study

OBJECTIVES

To determine the level of awareness of human papilloma virus (HPV) infection and to assess attitudes towards receiving the vaccine among men and women in Bahrain.

DESIGN

A cross-sectional study. An interview-based questionnaire was used to measure HPV knowledge and attitude towards HPV vaccine.

SETTING

Ten randomly selected primary health centres (PHCs) in the Kingdom of Bahrain.

PARTICIPANTS

408 PHC attendees, including 268 women and 140 men aged 18-65 years. Only residents from Bahrain and English or Arabic speakers were invited to participate.

PRIMARY AND SECONDARY OUTCOME MEASURES

Extent of awareness of HPV infection, acceptance of HPV vaccine and describing the results in association to gender, educational level and other demographics.

RESULTS

A response rate of 91.4% was achieved, with a majority being female responders as opposed to male responders (65.7% vs 34.3%, respectively). Only 13.5% of the participants had heard of HPV, with female gender and employment in the health sector (p<0.001 for both) having a significant association with awareness of HPV. The majority of the participants (76%) were willing to take the vaccine if recommended, with 84.8% believing that both genders should be vaccinated. However, 48.5% were concerned about possible side effects from the vaccine and 83.6% wanted reassurance that the vaccine will protect against HPV. More than 90% of the participants agreed on the need for educating the community about the HPV infection.

CONCLUSION

Despite the limited knowledge about HPV infection among the study's participants, there is a favourable attitude towards the HPV vaccine. These data can support the initiation of a nationwide HPV immunisation programme.

The prevalence and incidence of diabetic foot ulcers among five countries in the Arab world: a systematic review

OBJECTIVE

There is a rising incidence of diabetes worldwide; however there seems to be a higher incidence and prevalence rates in the Arab world when compared with the global average. ¹ Out of the top 10 countries with the highest prevalence rates, six are Arab countries and almost 20.5 million people in that part of the world live with diabetes. Despite this, published scientific research from the 22 Arab countries is limited and seems to be of lower quality when compared with the rest of the developed world. ² Therefore, our aim was to explore the contribution of the different Arab countries in the world literature, to identify the diabetic foot ulcer (DFU) prevalence and incidence rates and to quality appraise these studies.

METHOD

A systematic review, following PRISMA guidelines, was undertaken to identify the incidence and prevalence of DFUs in the Arab world. The following databases were searched: PubMed, Embase CINAHL, Web of Science (Scopus), Global Health and EBSCO Results: A total of nine papers were identified. The mean prevalence of DFU in Saudi Arabia was 11.85% (4.7-19%), in Egypt was 4.2% (1-7.4%), in Jordan was 4.65% (4-5.3%), in Bahrain was 5.9% and in Iraq was 2.7%. A single study identified DFU incidence in Saudi Arabia as 1.8% between 2009-2010.

CONCLUSION

The mean prevalence rates of DFU were highest in Saudi Arabia and Bahrain and lowest in Iraq. Saudi Arabia had the only reported incidence study, thus findings could not be compared to other countries of the Arab world. There were no studies identified during our search reporting prevalence rates of DFU in 17 of the 22 Arab countries. It is clear that further research is required to determine the incidence and prevalance of DFUs in the Arab world and that progress is needed in order to improve the quality of research conducted in those countries.

Methodological approaches for assessing the cost of diabetic foot ulcers: a systematic literature review

Objective:

To evaluate the methodological approaches used to assess the cost consequences of diabetic foot ulcers (DFUs) in published scientific papers.

Method:

A systematic literature search was conducted in PubMed, Embase, Scopus, Web of Science and CINAHL. English language papers reporting on the cost of DFUs were identified. Additionally, bibliographies were inspected to identify other relevant cost studies. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective and data collection approach in each of the included studies.

Results:

Relatively few studies of the cost consequences of DFUs were found (n=27). Most studies were conducted in Western countries with only five studies from countries in Asia and Africa. The identified studies used different study designs, epidemiological approaches, data collection strategies, and data sources, which in turn made a systematic comparison of cost estimates difficult. Detailed descriptions of the applied costing method and other methodological aspects were often limited or absent. Many studies only reported costs from a health-care payer's perspective and disregarded the costs to patients, their families and wider society.

Conclusion:

The costs of DFUs have been assessed using a wide range of different methodological approaches often restricted to the healthcare payer's perspective. Therefore, the cost analyses may fail to consider the true societal costs of DFUs.

Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

BACKGROUND: Health Information disclosure is the cornerstone in respecting the patients&rsquo; autonomy and beneficence, particularly in the context of serious illness. Some Middle Eastern cultures prioritise beneficence over patient autonomy. This may be used as a justification when patient&rsquo;s family takes over the decision-making process. Although guidelines and protocols regarding information disclosure are fast evolving, there are no sufficient data regarding the application of these guidelines in the clinical context. The objective of this study is to explore the truth disclosure practices of physicians in Bahrain. METHOD: In this cross sectional study, a random sample of 234 physicians was obtained from the database of Salmaniya Medical Complex (the largest public hospital in Bahrain). We used self-administered 21-item questionnaire to assess the practices and attitudes of physicians regarding disclosure of information to patients with serious illnesses. RESULTS: A total of 200 physicians completed the questionnaire with a response rate of 69.6%. The question about the usual policy of disclosure revealed that 62.5% (125) of the doctors would always disclose the diagnosis to the patients, 26% (52) would often disclose the diagnosis and only 1% would never disclose the real diagnosis to a competent adult. Only 15% of the physicians would never make exceptions to their policy of &ldquo;telling the patient&rdquo; while all remaining physicians (85%) made exceptions to their policy either often, occasionally or rarely. The most common reason for not disclosing the diagnosis was family request (39.5%). About 64.5% of the physicians were not aware of any existing protocol or policy for diagnosis disclosure to patients. There was no statistically significant association between doctors&rsquo; policy of disclosure and other demographic variables. CONCLUSION: Most physicians opt to disclose the truth; however, the majority would make exceptions at some point particularly upon family request. Regional truth disclosure policies should take into consideration the interplay and balance between patient autonomy and the role played by the family in the decision-making process.

Career Choices Among Medical Students and Factors Influencing Their Choices

BACKGROUND: Physicians&rsquo; specialty choices have a direct impact on medical workforce. As medical students progress through medical school, it is observed that their interests in specialties change due to one reason or another. The aim of this study is to firstly identify factors that influence medical students&rsquo; career choices using a cross sectional study. Secondly, to analyze which factors are the most influential with the aim of informing the work force and curriculum developers and thus enhance the employability of graduates. METHODS: A computer generated random sample of 131 medical students was taken from the preclinical second-year medical students at the Royal College of Surgeons in Ireland-Medical University of Bahrain. Questionnaires were distributed face to face and later retrieved for data collection and analysis. RESULTS: Eighty-four (70%) students responded to the survey. Thirty-two (38.1%) of the respondents were male and fifty-two (61.9%) were female. The top three preferred specialty choices were Surgery 22 (26.5%) followed by Internal medicine 12 (14.5%) and Paediatrics 11 (13.3%). The most popular factor in specialty choice was interesting field and the least popular factor was geographical location of the hospital or health instituation. CONCLUSION: The top three career choices were selected because those students felt they were interesting fields. The least important factors were geographical location of the hospitals or health instituations, media influence and financial reasons respectively.

Burnout Syndrome in Medical Students in the Kingdom of Bahrain

OBJECTIVES: To assess stress and burnout, and identify common stressors, among medical students in the Kingdom of Bahrain. STUDY DESIGN: A cross-sectional study with students being evaluated from March to September 2017 at two medical colleges in the Kingdom of Bahrain. METHODOLOGY: Survey conducted on a total sample of 533 clerkship-training students with a total of 347 respondents. The instruments used were Cohen&rsquo;s Perceived Stress Scale; the Maslach Burnout Inventory; and a common stressors questionnaire. RESULTS: 65% (347/533) of the students from the two medical colleges responded to the questionnaire. It was found that the mean (SD) of Cohen stress score in this study was 21.76 (5.60), with a stress and burnout prevalence of 47% and 43.43% respectively. A high percentage of respondent students (68%) also exhibited high emotional exhaustion scores &gt; 14. More than half of the respondents (53.3%) exhibited high cynicism score &gt; 6. Statistically significant differences were observed across gender categories with Cohen mean score, emotional exhaustion and cynicism. Multiple linear regressions revealed gender to be the only statistically significant predictor of the Cohen score (p. value 0.042). CONCLUSION: Clerkship medical students displayed high levels of both stress and burnout prevalence. Medical educators must be aware of the early signs, causes and consequences of student stress. They should also be able to encourage students to improve their mental and physical health, promote mental well-being and teach stress management.

Introducing women's health in the higher education curriculum: An innovative experience in advancing women's health

This article was migrated. The article was marked as recommended. Women go through several stages and changes throughout their life time. Hence, their health needs differ according to their life stage. More importantly, women are perceived as the decision-makers for the source of health care for their families. The object of this project is to integrate women's health into higher education curriculum with the aim of empowering women with the knowledge they need to take control of their own health through making informed health decisions, and to seek appropriate and timely care and managing the processes of illness and wellness. I designed an undergraduate course in women's health that addresses the main health issues across the life span of women from local and global perspectives.I developed a stepwise process, or framework, for including women's health course in the undergraduate curriculum of the Royal University for Women in the Kingdom of Bahrain. The course was offered as an elective module pertaining to 3 credits and comprising 3hours of teaching per week. This pioneer experience of introducing women's health to non-medical university students is innovative and supports the notion of "Healthy women hold up a healthy world". Informed women ensure future informed health decisions. This experience will be evaluated and reflected upon with the hope of expanding it to other universities.

Knowledge, attitudes, and practices regarding cervical cancer and screening among women visiting primary health care Centres in Bahrain

Background

Cervical cancer is one of the most common cancers among women, with 80% of the cases occurring in developing countries. Cervical cancer is largely preventable by effective screening programs. This has not been possible with opportunistic screening and its low use in the Kingdom of Bahrain. The objective of this study was to explore the knowledge, attitudes, and practices of women attending primary care health centres for cervical cancer screening.

Methods

This was a cross-sectional study of 300 women attending primary health care centres in Bahrain. We used a validated tool comprised of 45 items to collect data through face-to-face interviews between December 2015 and February 2016. Descriptive data are presented for demographic data, and frequency distributions with percentages are presented for each item of the knowledge and attitude questionnaire.

Results

The mean age ± SD of the participants was 37.24 ± 11.89 years, they were mostly married (221; 73.7%), and had a high school or higher education (261; 87%). Over 64% (194 participants) had never heard of a Pap smear procedure and only 3.7% (11 participants) had heard about the human papillomavirus (HPV) vaccine. Nearly 64% (192 participants) believed that a Pap smear was helpful in detecting pre-cancer and cancer of the cervix, and 44.3% (133 participants) believed that they should have a Pap smear at least every 3 years. Regarding the practice, only 40.7% (122 participants) had a Pap smear in their lifetime. The majority of participants felt embarrassed when examined by a male doctor (250, 83.3%) and few underwent a Pap smear screening if they were never married (69, 23.0%).

Conclusions

The participants demonstrated a wide range of knowledge and attitudes towards cervical cancer screening. However, the majority demonstrated positive attitudes towards the HPV vaccine.

A Cross-Sectional Survey Study to Assess Prevalence and Attitudes Regarding Research Misconduct among Investigators in the Middle East

Background

Recent studies from Western countries indicate significant levels of questionable research practices, but similar data from low and middle-income countries are limited. Our aims were to assess the prevalence of and attitudes regarding research misconduct among researchers in several universities in the Middle East and to identify factors that might account for our findings.

Methods

We distributed an anonymous questionnaire to a convenience sample of investigators at several universities in Egypt, Lebanon, and Bahrain. Participants were asked to a) self-report their extent of research misconducts, as well as their knowledge of colleagues engaging in similar research misconducts and b) provide their extent of agreement with certain attitudes about research misconduct. We used descriptive, bivariate, and multivariate logistic regression statistics to analyze the data.

Results

Data from 278 participants showed a high prevalence of misconduct, as 59.4% of our respondents self-reported to committing at least one misbehaviors and 74.5% reported having knowledge of any misbehaviors among any of their colleagues. The most common type of self-report misconduct was "circumventing research ethics regulations" (50.5%) followed by "fabrication and falsification" (28.6%). A significant predictor of misconduct included a lack of "prior ethics training".

Conclusion

Scientific misconduct represents a significant issue in several universities in the Middle East. The demonstration that a lack of "prior ethics training" was a significant predictor of misconduct should lead to educational initiatives in research integrity. Further studies are needed to confirm whether our results can be generalized to other universities in the Middle East.

Prevalence of tobacco smoking among health-care physicians in Bahrain

BACKGROUND

There is a clear shift in smoking habits among the Middle Eastern population with a recent and alarming increase in the prevalence of waterpipe (shisha) smoking. This phenomenon has not yet been studied sufficiently across the physician population. Therefore, we set out to establish the smoking status of primary healthcare physicians in the kingdom of Bahrain.

METHODS

A self-administered questionnaire was distributed to a random sample of 175 out of the total 320 primary care physicians. Descriptive analysis was performed on all data and associations between variables were tested using Fishers Exact t test with statistical significance set as P-value < 0.05.

RESULTS

One hundred and fifty two physicians agreed to participate in the study. Sixty seven percent of physicians were females and the mean (SD) age was 45 (10) years. The majority of the physicians were married (93%) and of Bahraini nationality (76%). Ever-smokers were 11% of the population while current smokers corresponded to 8.6%. Waterpipe was the most common method of tobacco smoking followed by cigarettes. Among male physicians, the prevalence of current 'waterpipe only' smokers was 12%, followed by 4% and 2% corresponding to 'cigarette only' smokers and both, respectively. There were only three female smokers in the population, two 'waterpipe only' smokers and one cigar smoker. Of those who smoked waterpipe (n = 9; 6%), 33% smoked daily, 44% smoked weekly and 22% smoked at least once a month. Current smoking status was associated with male gender (P < 0.001) and showed a male to female smoking ratio of (10:1).

CONCLUSION

Waterpipe smoking rates exceeded cigarette smoking among the population of physicians in Bahrain. Prevalence of smoking remains unacceptably high among male physicians. Assessment of physicians' knowledge of the harmful effects of waterpipe tobacco smoking is warranted to plan future interventions.

Association study of energy homeostasis genes and antipsychotic-induced weight gain in patients with schizophrenia

INTRODUCTION

Marked inter-individual variation has been observed with respect to the risk of weight gain and related metabolic disturbances during antipsychotic treatment, which in part could be explained by heritability. Such adverse effects have been proposed to occur through drug-induced mechanisms involving both the central nervous system and different peripheral tissues.

METHODS

We genotyped tagSNPs in several genes ( ADIPOQ, PRKAA1, PRKAA2, PRKAB1, PRKAG1, PRKAG2, PRKAG3, FTO and FABP3) that regulate lipid and energy homeostasis for their possible association to antipsychotic-induced weight gain.

RESULTS

In a sample of 160 patients of German origin with schizophrenia who had been monitored with respect to body weight, we found marked association between antipsychotic-related changes in BMI and 6 markers in the adiponectin gene ( ADIPOQ).

DISCUSSION

These findings support previous observations (in patients' serum) that adiponectin is involved in antipsychotic-mediated metabolic adverse effects.