Ravinder Mamtani

Medical education and research environment in Qatar: a new epoch for translational research in the Middle East.

Recent advances in medical technology and key discoveries in biomedical research have the potential to improve human health in an unprecedented fashion. As a result, many of the Arab Gulf countries, particularly Qatar are devoting increasing resources toward establishing centers of excellence in biomedical research. However, there are challenges that must be overcome. The low profile of private medical institutions and their negligible endowments in the region are examples of such challenges. Business-type government controlled universities are not the solution for overcoming the challenges facing higher education and research programs in the Middle East.During the last decade, Qatar Foundation for Education, Science and Community Development has attracted six branch campuses of American Institutions of higher learning to the Education City in Qatar, a 2500-acre area, which is rapidly becoming a model of integrating higher education and research in the region. Not-for profit, time-tested education institutions from abroad in public-private partnership with local organizations offer favorable conditions to build robust research programs in the region. Weill Cornell Medical College in Qatar (WCMC-Q) of Cornell University is an example such an institution. It is the first and only medical school in Qatar.WCMC-Qs interwoven education, research and public health based framework lays a sturdy foundation for developing and implementing translational medicine research programs of importance to the State of Qatar and Middle Eastern nations. This approach is yielding positive results. Discoveries from this program should influence public policy in a positive fashion toward reducing premature mortality and morbidity due to diabetes, obesity, heart disease and cancer, examples of health conditions commonly encountered in Qatar.

Metals and Disease: A Global Primary Health Care Perspective

Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations.

Use of complementary and alternative medicine among midlife Arab women living in Qatar.

The prevalence of use of complementary and alternative medicine (CAM) is widespread and is growing worldwide. This cross-sectional study in Qatar examined the use of CAM and its correlates among Arab women in their midlife years. Women aged 40-60 years (n = 814) were recruited at primary care centres in Qatar and completed a specially designed, pre-tested questionnaire. Overall, 38.2% of midlife women in Qatar had used CAM in the previous 12 months. Nutritional remedies and herbal remedies were the most commonly used CAM therapies, followed by physical methods. Qatari nationality and higher level of education were independently associated with CAM use. Menopause transition status was not independently associated with use of CAM. The prevalence of CAM use by women in Qatar was high, consistent with other reports worldwide. It is essential to educate and inform patients and health-care providers about the benefits and limitations associated with CAM.

Motor vehicle injuries in Qatar: time trends in a rapidly developing Middle Eastern nation

Despite their wealth and modern road systems, traffic injury rates in Middle Eastern countries are generally higher than those in Western countries. The authors examined traffic injuries in Qatar during 2000–2010, a period of rapid population growth, focusing on the impact of speed control cameras installed in 2007 on overall injury rates and mortality. During the period 2000–2006, prior to camera installation, the mean (SD) vehicular injury death rate per 100 000 was 19.9±4.1. From 2007 to 2010, the mean (SD) vehicular death rates were significantly lower: 14.7±1.5 (p=0.028). Non-fatal severe injury rates also declined, but mild injury rates increased, perhaps because of increased traffic congestion and improved notification. It is possible that speed cameras decreased speeding enough to affect the death rate, without affecting overall injury rates. These data suggest that in a rapidly growing Middle Eastern country, photo enforcement (speed) cameras can be an important component of traffic control, but other measures will be required for maximum impact.

Prevalence and determinants of metabolic syndrome in Qatar: results from a National Health Survey

Objectives To determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar. Design National health survey. Setting Qatar National STEPwise Survey conducted by the Supreme Council of Health during 2012. Participants 2496 Qatari citizens aged 18–64 representative of the general population. Primary and secondary outcome measures Measure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome. Results Waist circumference ≥102 for men and ≥94 cm for women was the best predictor of the presence of other determinants of metabolic syndrome (raised blood pressure, fasting blood glucose, triglycerides and reduced high-density lipoprotein cholesterol). Using these values, we identified 28% of Qataris with metabolic syndrome, which is considerably lower than the estimate of 37% calculated using the International Diabetes Federation (IDF) criteria. Restricting the analysis to participants without known elevated blood pressure, elevated blood sugar or diabetes 16.5% would be classified as having metabolic syndrome. In a multivariable logistic regression analysis, the prevalence of metabolic syndrome increased steadily with age (OR=3.40 (95% CI 2.02 to 5.74), OR=5.66 (3.65 to 8.78), OR=10.2 (5.98 to 17.6) and OR=18.2 (7.01 to 47.5) for those in the age group ‘30–39’, ‘40–49’, ‘50–59’, ‘60–64’ vs ‘18–29’; p<0.0001), decreased with increasing educational attainment (OR=0.61 (0.39 to 0.96) for those who attained ‘secondary school or more’ compared with ‘less than primary school’; p=0.03) and exercise (OR=0.60 (0.42 to 0.86) for those exercising ≥3000 vs <600 MET-min/week; p=0.006) but was not associated with smoking or diet. Conclusions Waist circumference was the best measure of obesity to combine with other variables to construct a country-specific definition of metabolic syndrome in Qatar. Approximately 28% of adult Qatari citizens satisfy the criteria for metabolic syndrome, which increased significantly with age. Education and physical activity were inversely associated with this syndrome.

Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study

BackgroundIn Qatar traffic injuries and fatalities are of serious concern. Mobile phone use whilst driving has been associated with increased risk of vehicular collisions and injuries. Seat belt use has been demonstrated to save lives and reduce the severity of road traffic injuries. Whereas previously published studies may have looked at all front passengers, this study aims to obtain reliable estimates of the prevalence of seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar. Additionally, we aim to investigate the association of these behaviors with other variables namely gender, time of the day and type of vehicle.MethodsAn observational study on 2,011 vehicles was conducted in 2013. Data were collected at ten sites within Doha city over a two-week period. Two trained observers surveyed each car and recorded observations on a data collection form adapted from a form used in a 2012 Oklahoma observational study. Associations were assessed using the Chi-squared test or Fisher’s exact test. A p-value of .05 or less was considered statistically significant.ResultsOverall, 1,463 (72.7 %) drivers were found using a seat belt (95 % CI: 70.8–74.7 %) and 150 (7.5 %) their mobile phones (95 % CI: 6.3–8.6 %) during the observation period. Mobile phone use was significantly associated with not using a seat belt and driving a sport utility vehicle. Significantly lower rates of seat belt use were observed in the early morning and late afternoon. No gender differences were observed.DiscussionSeatbelt use in Doha was found to be similar to countries in the region but lower than those in western countries. Also, studies from other high-income locations, reported lower rates of mobile phone use while driving than in Doha.ConclusionsDespite road traffic crashes being one of the leading causes of death in Qatar, three out of 10 drivers in Doha, Qatar, do not use a seat belt and about one in 12 use a mobile phone while driving. More efforts, in the form of awareness campaigns and increased law enforcement, are needed to improve compliance with laws requiring seat belt use and prohibiting mobile phone use while driving.

Migrants, healthy worker effect, and mortality trends in the Gulf Cooperation Council countries

The Gulf Cooperation Council (GCC) countries namely, Bahrain, Kuwait, Oman, Qatar, United Arab Emirates (UAE), and Saudi Arabia, have experienced unique demographic changes. The major population growth contributor in these countries is young migrants, which has led to a shift in the population age pyramid. Migrants constitute the vast proportion of GCC countries’ population reaching >80% in Qatar and UAE. Using Global Burden of Disease Study 2015 (GBD 2015) and United Nations data, for the GCC countries, we assessed the association between age-standardized mortality and population size trends with linear and polynomial regressions. In 1990–2015, all-cause age-standardized mortality was inversely proportional to national population size (p-values: 0.0001–0.0457). In Bahrain, Qatar, Oman, and Saudi Arabia, the highest annual decrease in mortality was observed when the annual population growth was the highest. In Qatar, all-cause age-specific mortality was inversely proportional to age-specific population size. This association was statistically significant among the 5–14 and 15–49 age groups, which have the largest population size. Cause-specific age-standardized mortality was also inversely proportional to population size. This association was statistically significant for half of the GBD 2015-defined causes of death such as “cirrhosis and other chronic liver diseases” and “HIV/AIDS and tuberculosis”. Remarkably, incoming migrants to Qatar have to be negative for HIV, hepatitis B and C, and tuberculosis. These results show that decline in mortality can be partly attributed to the increase in GCC countries’ population suggesting a healthy migrant effect that influences mortality rates. Consequently, benefits of health interventions and healthcare improvement are likely to be exaggerated in such countries hosting a substantial proportion of migrants compared with countries where migration is low. Researchers and policymakers should be cautious to not exclusively attribute decline in mortality within the GCC countries as a result of the positive effects of health interventions or healthcare improvement.

Adolescent prediabetes in a high-risk Middle East country: a cross-sectional study

Objective To estimate the prevalence of prediabetes in adolescents living in a high-risk country and to detect risk factors associated with this disorder. Design Survey questionnaire combined with physical measurements and blood sugar determination. Setting Doha, capital city of Qatar. Participants A total of 1694 male and female students aged 11–18 years without previously diagnosed diabetes enrolled in four schools. Main outcome measure Blood sugar measurements. Other measured variables included gender, height, weight, abdominal circumference, country of origin, family history of diabetes and frequency of exercise. Results Using a random blood sugar ≥7.8 mmol/L or a fasting blood sugar ≥5.5 mmol/L as cutpoints, we identified 4.2% of students (56 boys, 15 girls) as probable prediabetics. In a multivariate model, being boys (OR 3.2, 95% CI 1.7–6.2), having a diabetic parent (OR 1.9, 95% CI 1.1–3.2) or having a waist-to-height ratio >0.5 (OR 1.8, 95% CI 1.1–3.0) were significantly associated with being a prediabetic. The parental origin of diabetes had a differential effect upon blood sugar. The mean random blood sugar in students with a maternal inheritance pattern of diabetes was 5.61 mmol/L ± 1.0, compared to 5.39 mmol/L ± 0.89 in students with a paternal inheritance pattern (p = 0.02). Conclusions In a country with a high risk of adult diabetes, we identified 4.2% of students aged 11–18 as being prediabetic. Risk factors associated with prediabetes included male gender, family history of diabetes and waist-to-height ratio >0.5.

Impact of migrant workers on the Human Development Index

IntroductIonIn 1990, to help public health officials, politicians and key leaders compare human wellbeing, the UN Development Programme created the Human Development Index (HDI).1 The aim was to create an index that was based on available country- specific data, whilst being transparent and suffi- ciently robust enough to withstand scientific scru- tiny. The index is now widely used to compare world countries, and government leaders pay close attention to the individual rank of each country.The HDI is based on the concept that people are the real wealth of a nation. The originators of the HDI recognised that there are three essential components required for humans to develop to their maximum ability: health, education and income. There is general agreement that if any one of these elements is absent, individual achievement will be severely limited. Currently, the composite index is obtained by first normalising each individual component to a maximum value of unity so that all are on a comparable scale. Then the overall HDI is computed by taking the geometric mean of the three individual index val- ues.2 The health component of the index is based solely on life expectancy at birth, and the wealth component is based upon the gross national income per capita. Since 2011, the education part of the HDI is calculated by combining two separate measures: mean schooling years for adults and expected school years for children entering the school system. The geometric mean of these two values comprises the education index.For countries with large numbers of guest workers, mean years of schooling is likely to be low, because the majority of guest workers are unskilled labourers with a lower educational level than the citizen population. In contrast, the expected number of school years component would be relatively unaffected by guest workers because it is based upon students currently enrolled in the educational system.The aim of this report is to determine the impact of guest worker status on the composite HDI ranking score. We focused on the 93 countries classified as high or very high human development because this group has the highest concentration of migrant guest workers.MethodWe used published HDI data from the UN Human Development Programme 2010 or the most recent year to examine country rankings for all the countries ranked in the high or very high HDI groups.2 As an estimate of the number of migrant guest workers, we used the percentage of migrant workers aged 40-45 in the total popula- tion from available data in the UN migration data- base or, if unavailable, data from the World Bank.3,4 To determine the impact of migrant sta- tus on HDI, we plotted the country-specific rank- ing of each of the three individual HDI compo- nents (education, health, income) against migrant status. We also plotted each of the three compo- nents against the overall HDI, using a marker to identify those countries with the highest propor- tion of migrant workers.We used linear least squares analyses to study the relationship between migrant status and HDI as well as the individual components of the HDI. For outcomes that appeared non- linear, we used locally weighted scatterplot smoothing (Lowess) to fit the data. For comparing continuous variables between groups of coun- tries, we used t-tests. All p-values are two-sided, with a predetermined significance level of .05.ResultsData for both HDI and migrant status were availa- ble for 89 of the 93 countries listed in the UN high or very high development group. When we plot- ted the educational component of the HD against the percentage of migrants in these countries, we noted a biphasic curve with an inflexion point when the percentage of migrant workers in the population reached 30%. After this level was reached, there was a robust negative correlation between the educational component of the HDI and percentage of migrant workers (R = 0. …

Gray literature in systematic reviews on population health in the Middle East and North Africa: protocol of an overview of systematic reviews and evidence mapping

BackgroundSystematic review (SR) guidelines recommend extending literature search to gray literature in order to identify all available data related to the review topic. We aim to conduct an overview of SRs on population health in the Middle East and North Africa (MENA), to assess the methodology of these SRs, to produce an evidence map highlighting methodological gaps in SRs regarding gray literature searching, and to aid in developing future SRs by listing gray literature sources related to population health in MENA.Methods/designWe will conduct an overview of SRs based on the Cochrane Handbook for Systematic Reviews of Interventions. This overview will be reported following PRISMA 2009 guidelines. Using comprehensive search criteria, we will search the PubMed database to identify relevant SRs published since 2008. Our primary outcomes are gray literature sources and study-level quality in the gray literature. We will include MENA countries with Arabic, English, French, and/or Urdu as primary official languages and/or media of instruction in universities. Two reviewers will independently conduct a multilevel screening on Rayyan software. Extraction of relevant data will be done on Statistical Package for the Social Sciences (SPSS) software. The methodological quality of included SRs will be assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Any disagreements will be resolved by discussion and consensus.We will estimate the overall proportion of SRs that used gray literature as one of their data sources. Subgroup analyses will be conducted to identify characteristics of these gray literature sources. Chi-squared and t tests will be used to determine whether the differences between subgroups are statistically significant. Additionally, an evidence gap map will be constructed to highlight characteristics and quality of the gray literature used in SRs on population health in MENA and emphasize existing gaps in gray literature searching. We will also list gray literature sources identified in the included SRs stratified by country and research topic.DiscussionThis overview will comprehensively assess the overall quality of the SRs on population health issues in MENA. Our findings will contribute to the improvement of population health research practices in MENA.Systematic review registrationThe systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 October 2018 (registration number CRD42017076736 (Syst Rev 2:4, 2013).