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BACKGROUND: Human Papilloma Virus (HPV) infection is a significant public health concern in the Gulf Cooperation Council countries, being widely prevalent and the main risk factor for cervical cancer. We aimed to assess knowledge and perception towards HPV, acceptability of the HPV vaccine, and HPV vaccination rates among university students in Education City, Doha, Qatar. METHODS: This cross-sectional survey utilized proportional quota-sampling, with quotas based on university, sex, and nationality, to recruit students from seven universities between February and September 2022. The English language questionnaire requested socio-demographic information, knowledge, and attitudes about HPV infection and the vaccine. The chi-square test, Student t-test, Mann-Whitney-Wilcoxon tests and multivariable ordinal logistic regression were used to assess differences in proportion, mean, and median according to broad HPV knowledge categories. RESULTS: Three hundred and ninety-eight students were recruited (response rate = 82.3%), of whom 251 (63.1%) were female. Mean age was 21.7 years. Eighty-nine (22.4%, 95% CI 18.4-26.8%) students had poor knowledge about HPV, 220 (55.3%, 95% CI 50.2-60.2%) students had some awareness, and 89 (22.4%, 95% CI 18.4-26.8%) students were knowledgeable. Age, nationality, and field of study influenced the students' knowledge about HPV. Only 25 (6.3%) students had previously been vaccinated against HPV. However, 71% of the unvaccinated students reported being willing to get vaccinated if recommended by their healthcare provider. CONCLUSIONS: Overall, 77.7% of the student population had some-to-good levels of knowledge about HPV-related infection, cancer, and vaccination. There are gaps in the student population's understanding and knowledge about HPV. Increasing knowledge can be key toward shared decision-making for HPV vaccination among eligible populations. Targeted public health campaigns and integration into childhood vaccination programs should be critical first steps, especially as most of the surveyed students had a positive outlook on getting vaccinated. Healthcare professionals should be incentivized to increase their HPV knowledge and communication skills, while policymakers can work toward easing barriers in integrating HPV vaccinations in the immunization schedule and encouraging overall HPV vaccination uptake.

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Objective: We aimed to investigate the association between university students' dietary patterns, their demographics and lifestyle in a cross-sectional study in Qatar. Participants: 370 students in eight universities in Qatar enrolled between February 2017 and February 2018. Methods: Based on a structured questionnaire, dietary patterns were identified using principal component analysis, and their associations with student characteristics were assessed using logistic regression. Results: Four dietary patterns were identified. The 'fast food' pattern was associated with being younger and male (p-values ≤ 0.1). The 'traditional diet' pattern was associated with not skipping meals or eating when bored (p-values = 0.1). The 'healthy diet' pattern was associated with regular exercise and having time to eat healthy foods (p-values ≤ 0.01). The 'protein shake' pattern was associated with being male and engaging in more vigorous physical activity (p-values ≤ 0.01). Conclusions: Our findings provide a roadmap for the prioritization of population-specific interventions in university students within Qatar and the region.

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Qatar has a high obesity and type 2 diabetes mellitus (T2DM) burden. This study aimed to (1) determine the prevalence of overweight, obesity, and T2DM in 13-17-year-old adolescents and (2) evaluate associations with adolescents' lifestyle and breastfeeding history, parental weight, and familial T2DM history. A cross-sectional study (double-stage cluster sampling) was conducted in 2018-2020 using a self-administered parental and adolescent questionnaire. In the results, 23.4% of the adolescents (107/459) were overweight; 19.9% (91/459) were obese; and 37.6% (171/459) had evidence of central obesity. Random blood sugar (RBS) was suggestive of prediabetes (≥140 mg/dL) for 23 (5.0%) adolescents and T2DM (≥200 mg/dL) for none. In multivariable analysis, obesity was significantly associated with no breastfeeding (OR = 3.17, 95% CI: 1.09-9.26) compared to breastfed adolescents for ≥6 months, with first-degree family history of T2DM (OR = 2.27; 95% CI: 1.22-4.27), with maternal obesity (OR = 2.40; 95% CI: 1.01-5.70), and with acanthosis nigricans in adolescents (OR = 19.8; 95% CI: 8.38-46.9). Central obesity was significantly associated with maternal obesity (OR = 2.21; 95% CI: 1.14-4.27) and with acanthosis nigricans (OR = 3.67; 95% CI: 1.88-7.18). Acanthosis nigricans (OR = 4.06; 95% CI: 1.41-11.7) was the only factor associated with elevated RBS. Addressing future disease burden among adults in Qatar will require extensive health and well-being programs, focused on healthy lifestyles and behaviors such as nutritious diets, physical activity, stress management, and self-care.

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Physical inactivity is a leading risk factor for non-communicable diseases worldwide. This study investigated physical activity (PA) level among university students in Qatar and assessed other lifestyle and demographic factors associated with PA. A cross-sectional study was conducted between February 2017 and February 2018. A self-administered questionnaire, comprising questions from the International Physical Activity Questionnaire and other validated questionnaires, was used to assess PA and other lifestyle behaviors, including sedentary behavior, stress, sleep, dietary habits, and smoking habits. The results were reported according to the STROBE guidelines. A total of 370 students (response rate = 95.6%) were recruited from eight universities via quota sampling. The prevalence of physically active students­as per the World Health Organization's recommendation for PA of 150−300 min/week­was 64.9% (75.2% in males and 58.3% in females). Females and students >20 years old were half as likely to be active compared with males and younger students. More males enjoyed getting regular exercise (83.6% vs. 67.7%, p-value = 0.002). Time spent sitting was similar during weekdays and weekends (mean time ± SD = 480.8 ± 277.7 min/week vs. 492.1 ± 265.0 min/week). Sports facilities and green spaces appear to help increase PA among university students in Qatar. Public health interventions should focus on improving PA-related perception and knowledge among students to further increase PA participation.

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Cystic fibrosis (CF) is a progressive monogenetic disorder that causes persistent pulmonary disease, but also affects other organ systems, including the digestive tract. Recent advances in treatment and care of patients with CF, including the use of new and highly effective CF transmembrane conductance regulator modulators, have led to a dramatic increase in survival. Young patients with CF now can expect to live to or beyond middle age, when cancer is more frequent. Patients with CF now are known to face an increased risk of digestive tract cancer, particularly cancer of the colon. The risk, which could be triggered by associated CF-related conditions or other genetic mechanisms, is even greater in patients who received a transplant. Also some evidence suggests that adenomatous polyps develop more frequently in patients with CF and at an earlier age than in patients without CF. To reduce the excess risk of intestinal cancer in patients with CF, the Cystic Fibrosis Foundation has developed colonoscopy-based guidelines. For nontransplanted patients, colonoscopy should begin at 40 years of age, with rescreening at 5-year intervals; the screening interval should be shortened to 3 years if adenomatous polyps are discovered. For transplanted patients, screening should start at 30 years of age, or within 2 years of the transplant operation. Before colonoscopy, it is essential for patients with CF to undergo a special, more intensive bowel preparation than normally used for those without CF. Whether the new drugs that have dramatically improved morbidity and mortality for patients with CF will alter the risk of cancer is unknown and needs to be assessed in future studies.

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Objective: University students face high levels of stress-related factors, such as an unfamiliar environment, challenging workload, and uncertainty about their ability to succeed. Participants: A total of 370 students in Qatar who consented to participate between February 2017 and February 2018. Methods: This cross-sectional study assessed perceived stress [using a validated 4-point perceived stress scale (PSS-4)], as well as diet, exercise, body mass index, sleep, and life satisfaction. Results: Among students aged 18-39 (mean = 20.1 ± 3.0 years), PSS-4 scores varied between 0 and 16 (mean = 7.4 ± 3.4). Elevated stress was significantly associated with female sex, country of origin, residing off-campus, eating when bored, lack of self-discipline, disturbed sleep, and low levels of life satisfaction. Furthermore, students with PSS-4 scores above the median level were 2.3 times likelier to report difficulty concentrating on academic work. Conclusion: Elevated stress levels are present in university students in Qatar. Strengthening coping skills may improve health and academic performance.

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INTRODUCTION: We previously described a scoring system to identify patients with harmless acute pancreatitis as defined by absence of pancreatic necrosis, no need for artificial ventilation or dialysis, and non-fatal course. This scoring system, the Harmless Acute Pancreatitis Score (HAPS), can be quickly calculated from three parameters: absence of abdominal tenderness or rebound, normal hematocrit and normal creatinine level. We aim to assess the positive predictive value (PPV) of the HAPS by performing a meta-analysis of subsequently published studies. METHODS: We performed a literature search using Pubmed, Web of ScienceTM and Google Scholar. We used random effects models, with maximum likelihood estimates, to estimate the PPV of HAPS. We produced forest plots and used the I2 statistic to quantify heterogeneity. RESULTS: Twenty reports covering 6374 patients were identified. The overall PPV based on 16 studies that closely followed the original description of the HAPS system was 97% (95%CI 95-99%) with significant heterogeneity (I2 = 76%; P < 0.01). For 11 studies in which HAPS was used to identify patients with mild AP, the overall PPV dropped to 83% (74-91%). For 8 studies in which HAPS was used to predict non-fatal course the overall PPV was 98% (97-100%). CONCLUSION: The HAPS, if used as originally defined, accurately identifies patients with non-severe AP who will not require ICU care and facilitate selection of patients who can be discharged after a short stay on a general ward or can even be cared for at home. This could free hospital beds for other purposes and decrease healthcare costs.

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INTRODUCTION AND STUDY AIMS: The underlying population of global regions varies widely and is a major determinant of regional cancer differences. The aims were to: (1) estimate the cancer burden in Gulf Cooperation Council (GCC) countries in 2040 for the ≥70 population and (2) assess the public health implications for this cancer increase. METHODS: We used Global Cancer Observatory (GLOBOCAN) estimates of cancer incidence and mortality for people aged 70 years or more in GCC countries from 2018 to 2040 from the International Agency for Research on Cancer. For population growth, we used data for the same period from the Population Division of the United Nations Department of Economic and Social Affairs. From these, we calculated the predicted increase in the number of cancer cases and cancer deaths from 2018 to 2040 and the proportion of cases/deaths represented by those aged 70+ for the 2 time periods. FINDINGS: In the GCC countries, the predicted number of newly diagnosed cancers and cancer deaths in the older population will increase by 465% and 462% respectively due to demographic changes-greater than other countries in the World Health Organization Eastern Mediterranean Region, or in countries of similar economic development. The largest predicted increases will be for Qatar and the United Arab Emirates. Based on the predicted population age, cancer burden among older people in the GCC countries will increase by approximately 460%. CONCLUSION: By the year 2040, the relationship between cancer and age will cause a 4- to 5-fold increase in the cancer burden in the GCC. These predictable changes will require additional planning and resources to provide appropriate healthcare.

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While the coronavirus disease 2019 (COVID-19) pandemic wreaked havoc across the globe, we have witnessed substantial mis- and disinformation regarding various aspects of the disease. We conducted a cross-sectional study using a self-administered questionnaire for the general public (recruited via social media) and healthcare workers (recruited via email) from the State of Qatar, and the Middle East and North Africa region to understand the knowledge of and anxiety levels around COVID-19 (April-June 2020) during the early stage of the pandemic. The final dataset used for the analysis comprised of 1658 questionnaires (53.0% of 3129 received questionnaires; 1337 [80.6%] from the general public survey and 321 [19.4%] from the healthcare survey). Knowledge about COVID-19 was significantly different across the two survey populations, with a much higher proportion of healthcare workers possessing better COVID-19 knowledge than the general public (62.9% vs. 30.0%, p < 0.0001). A reverse effect was observed for anxiety, with a higher proportion of very anxious (or really frightened) respondents among the general public compared to healthcare workers (27.5% vs. 11.5%, p < 0.0001). A higher proportion of the general public tended to overestimate their chance of dying if they become ill with COVID-19, with 251 (18.7%) reporting the chance of dying (once COVID-19 positive) to be ≥25% versus 19 (5.9%) of healthcare workers (p < 0.0001). Good knowledge about COVID-19 was associated with low levels of anxiety. Panic and unfounded anxiety, as well as casual and carefree attitudes, can propel risk taking and mistake-making, thereby increasing vulnerability. It is important that governments, public health agencies, healthcare workers, and civil society organizations keep themselves updated regarding scientific developments and that they relay messages to the community in an honest, transparent, unbiased, and timely manner.

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BACKGROUND: Population health (PH) research capacity and performance are essential pillars of evidence-based practice to help address health inequalities. Best evidence is provided by systematic reviews (SRs). None of the published bibliometric analysis specifically assess the production of SRs on PH in the Middle East and North Africa (MENA). The aim of our study is to investigate publication patterns and time trends of SRs reporting PH in the MENA region to evaluate the state of PH research performance in the region. METHOD: The study protocol was developed a priori (protocol registration number: CRD42017076736). PubMed was searched. Two independent reviewers screened 5747 identified articles. We investigated author affiliation and collaboration, yearly citations of the SRs and journal information. Joinpoint regression was used to explore these characteristics overtime. RESULTS: Our meta-research included 387 SRs published between 2008 and 2016 which reported data on PH in 20 MENA countries. Publication of SRs increased over time in journals with impact factor < 4 and in the categories of yearly number of citations < 50 (p values ≤ 0.0024). Authors belonging to the region published increasingly (p value = 0.0001) over time. Thirty percent of the SRs were from authors solely from the region, while an additional 30% were from the region collaborating with Western country authors. Of these collaborative reviews, 79% were led by authors from the region. However, collaboration in the region (with the exclusion of collaboration with Western country authors) was rare (0.8%). These authors from the region published more in open-access journals while authors from Western countries collaborating or not with authors from the region published more in hybrid or non-open-access journals (p value < 0.0001). Collaboration between authors from MENA and Western countries led to published SRs in journals with impact factor ≥ 10. Systematic reviews with global coverage were published more by authors from Western countries, while SRs with country-level coverage were published by authors from the region (p value < 0.0001). CONCLUSION: The incremental trend of PH SR publications on MENA likely reflects the ongoing improvement in research performance in the region. Authors from the region appear to be taking a lead role in conducting and disseminating MENA PH research. Open-access journals are a major contributor in facilitating MENA research dissemination. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42017076736.

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BACKGROUND: There is a worldwide shortage of health care workers. This problem is particularly severe in the Gulf Cooperation Council (GCC) countries because of shortages in certain medical disciplines, due to a lack of nationally-trained professionals and a less developed educational system compared to other high income countries. Consequently, GCC countries are heavily dependent on an expatriate health care workforce; a problem exacerbated by high turnover. We discuss challenges and potential strategies for improving and strengthening capacity building efforts in health care professions in the GCC. MAIN TEXT: In the GCC, there are 139 schools providing professional health education in medicine, dentistry, pharmacy, nursing, midwifery, and other specialties. Health education school density reported for the GCC countries ranges between 2.2 and 2.8 schools per one million inhabitants, except in Oman where it is 4.0 per one million inhabitants. The GCC countries rely heavily on expatriate health professionals. The number of physicians and nurses in the GCC countries are 2.1 and 4.5 per 1000 respectively, compared to 2.8 and 7.9 among member countries of the Organisation for Economic Cooperation and Development (OECD). Interestingly, the number of dentists and pharmacists is higher in the GCC countries compared to OECD countries. A nationally trained health care workforce is essential for the GCC countries. Physiotherapy and occupational therapy are two identified areas where growth and development are recommended. Custom-tailored continuing medical education and continuing professional development (CPD) programs can augment the skills of health practitioners, and allow for the expansion of their scope of practice when warranted. CONCLUSION: Capacity building can play an essential role in addressing the major health challenges and improving the overall quality of health care in the region. Efforts aimed at increasing the number of locally-trained graduates and developing and implementing need-based CPD programs are vital for capacity building and lifelong learning in health care professions.

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Zika virus is an emerging infection transmitted in multiple ways. In 2016 we assessed the level of knowledge about Zika virus transmission in an underserved, predominantly Hispanic, mixed gender population living in suburban New York City, many of whom potentially travel to affected regions. Based on a convenience sample of 147 participants, 134 (91%) were aware of Zika virus transmission by mosquitoes; 116 (79%) knew about transmission from a pregnant female to the fetus; and 89 (61%) were aware of sexual transmission. Age, marital status, education, and native language were unrelated to knowledge (P > 0.10). Women, however, were significantly more likely than men to know about sexual transmission (P = 0.023) and about maternal transmission to the fetus (P = 0.044). Travel to Zika virus endemic areas was unrelated to level of knowledge (P = 0.40). Greater awareness of the risk of sexual transmission of Zika virus is needed for at risk populations in the US, especially for males.

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AIM: To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa (MENA) region to map evidence gaps. METHODS: We conducted an overview of systematic reviews (SRs) following an a priori developed protocol (CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and meta-analyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus (HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody (anti-) prevalences and incidences in different at-risk populations; the HCV viremic (RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population (GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > 100. RESULTS: We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages (recent and prior HCV transmissions). They also synthesized the data over long periods of time (e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1% (study dates not reported) in the United Arab Emirates to 2.1%-13.5% (2003-2006) in Pakistan and 14.7% (2008) in Egypt. Data were not identified for Bahrain, Jordan, or Palestine. Good quality estimates of anti-HCV prevalence in the GP were reported for Algeria, Djibouti, Egypt, Iraq, Morocco, Pakistan, Syria, Sudan, Tunisia, and Yemen. Anti-HCV incidence estimates in the GP were reported only for Egypt (0.8-6.8 per 1000 person-year, 1997-2003). In Egypt, Morocco, and the United Arab Emirates, viremic rates in anti-HCV-positive individuals from the GP were approximately 70%. In the GP, the viremic prevalence varied from 0.7% (2011) in Saudi Arabia to 5.8% (2007-2008) in Pakistan and 10.0% (2008) in Egypt. Anti-HCV prevalence was lower in blood donors than in the GP, ranging from 0.2% (1992-1993) in Algeria to 1.7% (2005) in Yemen. The reporting quality of the outcomes in blood donors was good in the MENA countries, except in Qatar where no time framework was reported for the outcome. Some countries had anti-HCV prevalence estimates for children, transfused patients, contacts of HCV-infected patients, prisoners, sex workers, and men who have sex with men. CONCLUSION: A substantial proportion of the reported outcomes may not help policymakers to develop micro-elimination strategies with precise HCV infection prevention and treatment programs in the region, as nowcasting HCV epidemiology using these data is potentially difficult. In addition to providing accurate information on HCV epidemiology, outcomes should also demonstrate practical and clinical significance and relevance. Based on the available data, most countries in the region have low to moderate anti-HCV prevalence. To achieve HCV elimination by 2030, up-to-date, good quality data on HCV epidemiology are required for the GP and key populations such as people who inject drugs and men who have sex with men.

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