Caroline Barakat-Haddad

Prevalence of High Blood Pressure, Heart Disease, Thalassemia, Sickle-Cell Anemia, and Iron-Deficiency Anemia among the UAE Adolescent Population

This study examined the prevalence of high blood pressure, heart disease, and medical diagnoses in relation to blood disorders, among 6,329 adolescent students (age 15 to 18 years) who reside in the United Arab Emirates (UAE). Findings indicated that the overall prevalence of high blood pressure and heart disease was 1.8% and 1.3%, respectively. Overall, the prevalence for thalassemia, sickle-cell anemia, and iron-deficiency anemia was 0.9%, 1.6%, and 5%, respectively. Bivariate analysis revealed statistically significant differences in the prevalence of high blood pressure among the local and expatriate adolescent population in the Emirate of Sharjah. Similarly, statistically significant differences in the prevalence of iron-deficiency anemia were observed among the local and expatriate population in Abu Dhabi city, the western region of Abu Dhabi, and Al-Ain. Multivariate analysis revealed the following significant predictors of high blood pressure: residing in proximity to industry, nonconventional substance abuse, and age when smoking or exposure to smoking began. Ethnicity was a significant predictor of heart disease, thalassemia, sickle-cell anemia, and iron-deficiency anemia. In addition, predictors of thalassemia included gender (female) and participating in physical activity. Participants diagnosed with sickle-cell anemia and iron-deficiency anemia were more likely to experience different physical activities.

Health impacts of air pollution: a life course approach for examining predictors of respiratory health in adulthood.

PURPOSE This research applies a life course health development framework to examine the impacts of childhood exposure to air pollution on respiratory health in adulthood. METHODS This prospective cohort study uses data collected from children originally studied in the 1970/1980s, including exposure to air pollution, indoor exposures, sociodemographic variables, and health outcomes data. Thirty years later, a self-administered questionnaire was used to collect data from adulthood on health status, occupational and residential histories, socioeconomic status, and lifestyle. RESULTS Overall, 29% of respondents were diagnosed with at least one respiratory condition and 24% have persistent respiratory symptoms in adulthood. Significant neighborhood differences in exposure variables and adulthood health outcomes were found. Predictors of adulthood respiratory health include asthma diagnosis or chest illness in childhood, parental record of respiratory symptoms, other medical diagnosis in adulthood, fair/poor self-perceived health, smoking/exposure to smoking, and residing in a property built before 1950. Results suggest that exposure to ambient total suspended particulates in childhood is preventative for diagnosis with at least one respiratory condition in adulthood. CONCLUSION Findings suggest that long-term childhood exposure to air pollution does not predict respiratory conditions and symptoms in adulthood. However, respiratory health in childhood predicts adulthood respiratory health, thus suggesting that the health impacts of any exposures that impact respiratory health during critical or sensitive times in childhood are long term.

Genetic variation associated with the occurrence and progression of neurological disorders.

This paper presents an overview of genetic variation associated with the onset and progression of 14 neurological disorders, focusing primarily on association studies. The 14 disorders are heterogeneous in terms of their frequency, age of onset, etiology and progression. There is substantially less evidence on progression than onset. With regard to onset, the conditions are diverse in terms of their epidemiology and patterns of familial aggregation. While the muscular dystrophies and Huntingtons disease are monogenic diseases, for the other 12 conditions only a small proportion of cases is associated with specific genetic syndromes or mutations. Excluding these, some familial aggregation remains for the majority of cases. There is considerable variation in the volume of evidence by condition, and by gene within condition. The volume of evidence is greatest for Alzheimers disease, Parkinsons disease, multiple sclerosis and amyotrophic lateral sclerosis. As for common complex chronic diseases, genome wide association studies have found that validated genomic regions account for a low proportion of heritability. Apart from multiple sclerosis, which shares several susceptibility loci with other immune-related disorders, variation at HLA-DRB5 being associated both with Parkinsons disease and Alzheimers disease, and the association of the C9orf72 repeat expansion with ALS and frontotemporal degeneration, there was little evidence of gene loci being consistently associated with more than one neurological condition or with other conditions. With the exception of spina bifida, for which maternal MTHFR genotype is associated with risk in the offspring, and corroborates other evidence of the importance of folate in etiology, there was little evidence that the pathways influenced by genetic variation are related to known lifestyle or environmental exposures.

Does Chronic Exposure to Air Pollution in Childhood Impact Long-Term Respiratory Health?

This study seeks to examine the relationship between childhood exposure to air pollution and long-term respiratory health and to identify significant predictors of respiratory health in adulthood. Logistic regression modeling was undertaken using health and exposure data for 395 participants who resided during childhood in four distinct neighborhoods in Hamilton, Ontario, Canada. Significant predictors include exposure to SO2 in childhood, location of residence in childhood, sex, residential and occupational histories, stressful life events, and respiratory health in childhood. This study suggests that the health impacts of childhood exposure to air pollution are located beyond the short-term period that most research addresses.

Determinants of neurological disease: Synthesis of systematic reviews

&NA; Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome). Coffee and tea intake was associated with a decreased risk of onset of both dystonia and PD. Further understanding of the etiology of priority neurological conditions will be helpful in focusing future research initiatives and in the development of interventions to reduce the burden associated with neurological conditions in Canada and internationally. HighlightsWith population aging, the burden of neurological disease is increasing worldwide.Understanding the factors affecting the onset and progression of neurological disease through systematic review is essential for the development of strategies to reduce the burden of these diseases.Systematic review identified biological, demographic, environmental, genetic, lifestyle and pharmacological risk factors for specific neurological conditions.Several risk factors were associated with the onset of multiple conditions. Pesticides, for example, were associated with an increased risk of Alzheimers disease, amyotrophic lateral sclerosis, primary brain tumours, and Parkinsons disease.Helmet use was associated with a reduction in onset of neurotrauma, as well as all neurologic conditions for which head injury was a risk factor.The findings presented here should be viewed as provisional, pending a more in‐depth evaluation of the weight of evidence.Further research will also serve to fill current data gaps, particularly regarding risk factors for the progression of neurological disease.In the interim, the modifiable risk factors may be considered as potential candidates for the development of targeted interventions to reduce the burden of neurological disease in Canada and internationally.

Onset factors in cerebral palsy: A systematic review

&NA; Studies have noted several factors associated with the occurrence of Cerebral Palsy (CP), yet considerable uncertainty remains about modifiable factors related to disease onset. A systematic review was performed to identify existing systematic reviews and primary studies pertaining to targeted factors associated with the onset of CP. The following databases were searched: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Scopus, Web of Science, Cochrane Database of Systematic Reviews, CINHAL, ProQuest Dissertations & Theses, Huge Navigator, AARP Ageline. Variations of MeSH and keyword search terms were used. Critical appraisal was conducted on selected articles. Data extraction targeted reported factors, risk estimates, and 95% confidence intervals (CI). Findings identified two systematic reviews and three meta‐ analyses, as well as 83 studies of case control, cohort, and cross‐sectional methodological designs. Selected studies indicated that lower gestational age was associated with the onset of CP. Medical diagnoses for the mother, in particular chorioamnionitis, was found to be positively associated with onset of CP. Preeclampsia was reported to be either inconclusive or positively associated with CP onset. Low birth weight predominantly indicated a positive association with the onset of CP, while male gender showed mixed findings. The combination of male gender with pre‐term or low birth weight was also found to be positively associated with CP. Evidence was identified in the literature pertaining to specific factors relating to the onset of CP, in particular showing positive associations with lower gestational age and low birth weight. HighlightsCerebral Palsy (CP) is a group of heterogeneous non‐progressive neurodevelopmental conditions that affect the developing fetal or infant brain.These conditions may occur in utero, at birth, or during the first three years of life when the brain is developing.The worldwide prevalence rate of CP is 2.11 per 1000 live births.Following risk factors were found to be associated with the onset of CP—late preterm gestation age, primparity, low birth weight, and a low APGAR score, low arterial cord pH, clinical chorioamnionitis, multiple gestation/births.

Onset and progression factors in Parkinson’s disease: A systematic review

&NA; Current research has identified several factors thought to be associated with the onset and progression of Parkinsons Disease (PD); however, whether certain factors contribute to or are protective against PD remains unclear. As such, a systematic search of the literature was performed using variations of MeSH and keyword search terms to identify and summarize systematic reviews and primary studies pertaining to factors associated with the onset and progression of PD. Factors referred to both traditional risk factors and prodromal markers. The following databases were searched: MEDLINE, MEDLINE In‐Process, EMBASE, PsycINFO, Scopus, Web of Science, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations & Theses, AARP AgeLine, and PDGene. A quality assessment of included systematic reviews was completed using the validated Assessment of the Methodological Quality of Systematic Reviews (AMSTAR) tool. Data extraction targeted reported factors, risk estimates, and 95% confidence intervals (CI). Findings identified 11 systematic reviews of sufficient quality reporting factors for PD onset, and no systematic reviews reporting factors for PD progression. In addition, 93 primary articles were identified, of which, 89 articles addressed factors related to PD onset and 4 articles addressed factors related to the PD progression. Pesticide exposure, rural living, well‐water drinking, and farming occupation were consistently found to be positively associated with the onset of PD. Moreover, family history and polymorphisms to key genes were also found to be positively associated with the onset of PD. Conversely, coffee consumption, cigarette smoking, and some polymorphisms were consistently found to be negatively associated with the onset of PD. Urate was the only identified factor linked to the progression of PD; it was mostly found to be negatively associated with PD. In sum, the evidence was systematically found and summarized in the literature pertaining to factors related to the onset and progression of PD. HighlightsParkinsons disease (PD) is a neurodegenerative disorder marked by tremor, muscular rigidity, and slow, imprecise movement mainly affecting individuals over age 65. It is characterized by the death of dopaminergic neurons in the midbrain, which results in dopamine deficiency and impaired motor and non‐motor functions.PD is the second most common neurodegenerative disorder in the world after Alzheimers disease with a prevalence of 1 per 300 people in Canada with incidence increasing with age.Pesticide exposure, head injury, rural living, well‐water drinking, farming occupation, and family history of PD were identified as risk factors for PD onset.Constipation, depression, rapid eye movement (REM) sleep behavior disorder (RBD), erectile dysfunction, hip fractures, and olfaction are recognized as prodromal markers of this disease.Interventions aimed at reducing pesticide exposure and head injuries may reduce PD incidence.

Air Quality and Respiratory Health among Adolescents from the United Arab Emirates

Purpose. To examine the role of air quality in relation to chronic bronchitis, emphysema, asthma, wheeze, and dry cough among adolescents from the United Arab Emirates (UAE). Methods. A survey was administered on 6,363 adolescents from 9 UAE regions. Data consists of demographic, socioeconomic, residential, and behavioural variables, such as location of residence, residing near industry/gas stations/dumpsites/construction sites, residing near overhead power line/plants, exposure to tobacco, residential exposure, ethnicity, concern over air pollution, smoking, and purposely smelling gasoline fumes/glue/correctors/car exhaust/burning black ants. Logistic regression modeling was used to determine significant predictors of respiratory health. Results. Asthma prevalence was 12.3%, followed by chronic bronchitis (1.8%) and emphysema (0.5%). Overall 12.2% reported wheeze and 34.8% reported a dry nocturnal cough in the past year. Multivariate analyses suggest that sex is a significant predictor of asthma and dry cough. Exposure to tobacco and arts/crafts/ceramics/stain is significant predictor of respiratory health. Tobacco smoking and purposely smelling gasoline fumes/glue/correctors/car exhaust/burning black ants are significant predictors of wheeze and dry cough. Conclusions. This study suggests that exposure to air quality and behavioral factors such as smoking and purposely smelling gasoline fumes, glue, correctors, car exhaust, or burning black ants are significant predictors of respiratory health among UAE adolescents.

Primary health care use and health care accessibility among adolescents in the United Arab Emirates.

This study examined primary health care use and accessibility among adolescents living in the United Arab Emirates. In a cross-sectional study, we collected health care use, sociodemographic and residential data for a sample of 6363 adolescents. Logistic regression modelling was used to examine predictors of health care use. The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists. Local adolescents were more likely to attend public clinics/hospitals than private facilities, while the opposite was true for expatriates. In the previous 12 months 22.6% of the participants had not obtained the health care they needed and 19.5% had not had a routine health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mothers education and car ownership. Improvements to the health care sector may increase health care accessibility among adolescents.

Prevalence and predictors of over-the-counter medication use among adolescents in the United Arab Emirates

The patterns of over-the-counter medication (OTC) usage among adolescents living in the United Arab Emirates (UAE) remains largely understudied. The objectives of this study are: (1) to determine the profile of OTC use among UAE adolescents; and (2) to determine the biological or physical, psychological or behavioural, and social predictors of OTC use among the UAE adolescent population. Using a cross-sectional study design, data were collected on the prevalence of OTC use for a sample of 6363 adolescents. Overall, 51% of participants in this study reported OTC use. The most common form of OTC used was acetaminophen. Significant predictors of OTC use were: nationality (UAE, GCC, Arab / Middle East, Arab / Africa, Western, other); needed health care but did not receive it; sex (female); age (15-18 years); any medical diagnosis; unconventional drug use; spending more than 5 hours using TV and computer daily; and using prescription medicines. Thus, there is a need to develop public health policies and strategies that promote appropriate use of OTC in the population.