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PubMed1998

Single- versus multi-item scales in measuring death anxiety.

The author investigated the reliability and concurrent validity of a Likert-type single-item test asking for a self-rating of death anxiety in two Arabic countries: Egypt and Kuwait. A total of 1,439 participants were divided into 9 male and female subsamples and were tested by a single item of death anxiety, along with three psychometric multi-item instruments (i.e., Templer's Death Anxiety Scale, Thorson and Powell's Revised Death Anxiety Scale, and the Arabic Scale of Death Anxiety). The single- and multi-item scales had high reliabilities. All of the thirteen correlations between the single-item and the multi-item scales of death anxiety among men and women were statistically significant (p less than .001) and positive. They ranged from .30 to .66, with a median of .51. It was concluded that single-item assessment can be reliable across time (test-retest = .82) and that it correlates moderately with multi-item instruments.

Adolescent↗
PubMedDate not supplied

Prevalence of contraceptive use: trends and issues.

This article discusses the sources of data for estimates of contraceptive use, including their reliability and validity. Data from sample surveys and from censuses are presented by countries from the 1960s to the present time. Tables on proportions of users by method of contraception for various time periods are included. The relationship between contraceptive use and level of fertility is also shown. Contraceptive use has increased rapidly in much of Asia and Latin America, but much less so in Arab countries and sub-Saharan Africa. Worldwide, about 400 million of the 800-850 million married couples of reproductive age practice contraception; of these, about 340 million use a modern method. Sterilization is the most widely practiced method of contraception in the world, with tubal ligations far outnumbering vasectomies.

Contraception↗
PubMed2004

Premigration exposure to political violence among independent immigrants and its association with emotional distress.

Although the distinction between independent immigrants and refugees has an impact on policy, services, and public opinion because it implies differences in resettlement needs, few recent studies have documented the validity of this assumption. In this population-based survey of recent migrants in Quebec (N = 1871), immigration status (refugee, independent, or sponsored immigrant) is examined in relation to premigration exposure to political violence and refugees' emotional distress, assessed with the SCL-25. A higher percentage of refugees reported exposure to political violence in their homeland, but the percentages of exposed independent (48%) and sponsored (42%) immigrants were unexpectedly high. Emotional distress was significantly higher among Chinese respondents who had witnessed acts of violence and in subjects from Arab countries who reported persecution. These results suggest that service providers and policy makers should not assume that independent immigrants have not been exposed to political violence before their migration.

Adolescent↗
PubMed1994

Autosomal recessive disorders among Arabs: an overview from Kuwait.

Kuwait has a cosmopolitan population of 1.7 million, mostly Arabs. This population is a mosaic of large and small minorities representing most Arab communities. In general, Kuwait's population is characterized by a rapid rate of growth, large family size, high rates of consanguineous marriages within the Arab communities with low frequency of intermarriage between them, and the presence of genetic isolates and semi-isolates in some extended families and Bedouin tribes. Genetic services have been available in Kuwait for over a decade. During this time it has become clear that Arabs have a high frequency of genetic disorders, and in particular autosomal recessive traits. Their pattern is unique and some disorders are relatively common. Examples are Bardet-Biedl and Meckel syndromes, phenylketonuria, and familial Mediterranean fever. A relatively large number of new syndromes and variants have been delineated in Kuwait's population, many being the result of homozygosity for autosomal recessive genes that occurred because of inbreeding. Some of these syndromes have subsequently been found in other parts of the world, negating the concept of the private syndrome. This paper provides an overview of autosomal recessive disorders among the Arabs in Kuwait from a personal perspective and published studies, and highlights the need for genetic services in Arab countries with the goal of prevention and treatment of genetic disorders.

Chromosome Aberrations↗
PubMed2004

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries.

BACKGROUND: Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. METHODS: The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. RESULTS: All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2-9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2-7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. CONCLUSIONS: This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum.

Cohort Studies↗
PubMed2006

Hypothesis: Correction of low vitamin D status among Arab women will prevent heart failure and improve cardiac function in established heart failure.

Vitamin D deficiency is common in Arab countries particularly among women. This is the result of a low dietary intake of the vitamin, limited exposure to sunlight (a paradox in view of the high sunshine figures), skin colour, obesity and high parity. Apart from its adverse effects on bone in women and their offspring, vitamin D deficiency has the potential to cause or exacerbate heart failure through a number of mechanisms including activation of the renin-angiotensin system and increased arterial pressure. Accordingly, we propose that ensuring adequate vitamin D levels in Arab women will have a much greater impact on health than just the prevention of bone disease. In particular, we suggest that prevention and correction of vitamin D deficiency will reduce the incidence of heart failure and, for Arab women with established heart failure and vitamin D deficiency, improve cardiac function.

Arabs↗
PubMed2006

Bone mineral density of the spine and femur in healthy Moroccan women.

Bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DXA) are widely used to diagnose osteoporosis and assess its severity. Previous studies show the necessity to establish reference data for bone mass measurements for each particular population. Such data are lacking for the Moroccan population. The aim of this study was to determine spine and femur BMD reference values for the Moroccan female population and to compare them with values from western and other Arab countries. A cross-sectional study of 569 Moroccan women, (randomly selected in the area of Rabat, the capital of Morocco, aged between 20 and 79 yr) was carried out to establish reference values of BMD. Measurements were taken at the lumbar spine and proximal femurs using DXA (Lunar Prodigy Vision, GE). The data were compared with published normative data taken by United States (U.S.), European, Kuwaiti, Lebanese, and Saudi women over 6 decades of age. The percentage of osteoporosis in postmenopausal women using our reference curve was compared to that observed when the other curves (US, European and Arab) implemented in the Lunar machine was used. Our results showed that the Moroccan women showed the expected decline in BMD at both sites with age after peaking at 20-29 years of age. Moroccan females have lower BMD at the spine than U.S., Europeans, and Kuwaitis (approximately 10-12% for patients older than 50 yr). The BMD values of the total femur in Moroccan females were close to western (European and American), and Kuwaitis, but higher than Lebanese and Saudis. Using our reference database, 37.9% of postmenopausal women had spine osteoporosis vs. 39.6% and 23.4% using US/European and Arabic Lunar reference values respectively. At the femurs, 6.7% had osteoporosis vs. 2.5% using the Arabic Lunar reference values. In conclusion, our study emphasizes the importance of using population-specific reference values for BMD measurements to avoid over or underdiagnosis of osteoporosis.

Absorptiometry, Photon↗
PubMed2006

A community study on emotional distress among Arab and Jewish Israelis over the age of 60.

BACKGROUND: The elderly constitute a vulnerable group for psychopathology, yet research on their mental health among both Arab and Jews in Israel remains limited. The same is the case in Arab countries. This paper reports on the contrasting distribution of the mean emotional distress (ED) scores and rates of suspected clinical cases, and their related risk factors, among community residents over the age of 60. METHODS: Several national agencies conducted a survey on 5,055 elderly individuals to investigate their health status, including ED. The interview included socio-demographic and behavioral health items, as well as a modified 12 item-GHQ as a measure of ED. Total ED scores and prevalence rates for suspected psychopathology were calculated. Their respective risk factors were examined using univariate and multivariate methods. RESULTS: The ED scores were highest among Muslim Arabs (4.9), followed by Christian Arabs (4.2), Jews (3.1) and Druzes (2.8). Their estimated prevalence rates were 43.4%, 37.0%, 21.4%, and 17.0%, respectively. The gradient of these results remained unchanged in the multivariate analysis for ED scores adjusting for confounding variables. In contrast, logistic regression analysis controlling for confounding variables did not find a differential risk for suspected psychopathology between Arabs and Jews. CONCLUSION: Conceivably, the higher demoralization scores among elderly Arabs are associated with their minority status affiliation, as well as with the rapid social changes that have taken place in their midst. A cultural response style may be entertained as a possible explanation. However, these factors do not impact the risk for suspected psychopathology where no differential risk was noted after adjustments for confounders.

Age Distribution↗
PubMed1997

Emerging viral pathogens in long-term expatriates (I): Hepatitis E virus.

Hepatitis E virus (HEV) is one of the so-called 'emerging' viral pathogens, whose role is increasingly being recognized. To estimate the risk of HEV infection during long-term stays in HEV-endemic countries, 500 serum samples obtained from development aid workers and their family members who had spent on average 9 years in HEV-endemic regions were tested for antibodies against HEV by ELISA and Immunoblot. We found seroprevalence rates of 5-6% with no significant differences related to gender or area of upbringing (raised in an HEV-endemic vs. nonendemic region). Seroprevalence rates did not increase with increasing number of stays or number of expatriate years. None of 77 children and adolescents tested was positive for anti-HEV. The Indian subcontinent showed the highest seropositive rate with 10%. In subjects returning from West and Central Africa, East Africa, South-east Asia and Latin America seroprevalence rates were around 7%. We found a comparatively low seroprevalence rate of 2.1% for the Arab countries and the Middle East. Our results show that there definitely is a risk for long-term expatriates to acquire HEV infection; however, in most of our cases infection seems to have been non- or oligo-symptomatic.

Adolescent↗
PubMed1994

The spectrum of beta thalassaemia mutations in the UAE national population.

The beta thalassaemia alleles in 50 beta thalassaemia heterozygotes originating from many parts of the United Arab Emirates (UAE) have been characterised using the allele specific priming technique of the polymerase chain reaction (PCR). The IVSI-5 (G-->C) mutation was found to be present in 66%, while six other alleles occurred at the much lower frequencies of 2% to 8%. These were codon 8/9 (+G), IVSI-1, 3' end (-25 bp), codon 5 (-CT), IVSII-1 (G-->A), codon 30 (G-->C), and codon 15 (G-->A). The mutation types and percentages are compared with other Mediterranean Arab countries and neighbouring areas. It is proposed that IVSI-5 and other Asian Indian mutations were introduced into the UAE by population migration from the region previously known as Baluchistan. These findings should be useful for genetic counselling and the development of a first trimester prenatal diagnosis programme based on direct detection of mutations in the UAE.

Base Sequence↗
PubMed1998

Homocysteine levels and coronary heart disease in Syria.

BACKGROUND: Coronary artery disease and disturbances of lipid levels are common in Arab countries. OBJECTIVE: To assess homocysteine as a cardiovascular risk factor. METHOD: We compared 133 men with angiographically documented coronary heart disease with 130 age-matched asymptomatic men. RESULTS: Cases had more hypertension and diabetes and higher levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, fibrinogen, and homocysteine than did controls. The homocysteine level distribution of cases was shifted toward higher concentrations (P < 0.05) compared with those in controls. When patients with one-vessel, two-vessel, and three-vessel disease were compared, only levels of fibrinogen and homocysteine were associated with the numbers of vessels involved. Homocysteine level was not correlated to fibrinogen and lipid concentrations. A multiple regression analysis revealed that only age (P = 0.06) and smoking (P = 0.04) were marginally related to homocysteine concentrations. Homocysteine concentrations in cases were significantly different than those in controls, even after adjustment for all covariates (P < 0.006). CONCLUSION: Hyperhomocysteinemia is independently associated with coronary artery disease in Arab men. Furthermore, fibrinogen concentrations are also an important risk factor for Arab men.

Adult↗
PubMed2006

Thyrotrophin and free thyroxine trimester-specific reference intervals in a mixed ethnic pregnant population in the United Arab Emirates.

BACKGROUND: Physiological alterations in the homeostatic control of thyroid hormones cause changes in thyroid function tests in pregnant women. A lack of method, trimester and population-specific reference intervals for free thyroxine (FT4) and thyrotrophin (TSH) makes interpretation of FT4 and TSH levels in pregnancy difficult. We established trimester-specific reference intervals for TSH and FT4 in a mixed ethnic population of pregnant women attending two antenatal clinics in the United Arab Emirates. METHODS: TSH and FT4 result from 1140 women with uncomplicated singleton pregnancy were available. The 95% reference intervals were determined for TSH and FT4 for each trimester for Arab women from the United Arab Emirates and other Arab countries and Asian women. RESULTS: Suppressed TSH levels in the first trimester recovered to non-pregnant levels in the third trimester. There was a significant difference in TSH levels between trimesters 1 and 2, and 2 and 3 (p<0.0005). There was no significant difference in the TSH levels between the various ethnic groups. Mean FT4 levels decreased with each progressive trimester in all groups. There were significant differences in FT4 levels between all three trimesters (p<0.005), especially between the first and second trimesters. FT4 differed significantly between UAE nationals and Asians in the first and second trimesters (p<0.005). CONCLUSIONS: In general, the findings were in keeping with earlier reports. Use of trimester-specific reference intervals should help in the appropriate interpretation of thyroid hormone results in the mixed UAE population.

Adolescent↗
PubMed1993

Avicenna's approach to cardiac diseases.

Abu Ali el Husain Bin Abdullah Bin Sina (980-1037 A.D.) known as 'Sheik et Rayees, Ibne-e-Sina' in Arab countries and 'Avicenna' in Western countries, was the first man who considered the psychology and emotions of human beings from physiological point of view, and gave the then, possible explanation of different emotional states and their effects on human body. He related psychology with medicine and proved that all emotional states e.g. pleasure, grief, anger and worry and the others are deeply concerned with the shape of the heart, types of blood and body fluids (humours). Not only he proved this but has also described the management and treatment of these conditions, and was the pioneer in this field. He discussed the action of drugs on heart and mentioned their indications and contra-indications. He based the morality and behaviour of a person on the temperament of the heart and spirit. According to him, appraising the particular characteristic behaviour of a person, information may be obtained about the temperament of the heart and spirit. He is of the opinion that different attributes of a person, e.g. boldness, cowardliness, misery, benevolence, happiness, sorrowfulness, worries and anger, etc. can be controlled and managed medically. Nobody, before him, had shed any light on this subjet.

Arab World↗
PubMed2003

Familial Mediterranean fever mutation frequencies and carrier rates among a mixed Arabic population.

OBJECTIVE: Familial Mediterranean Fever (FMF) is an autoinflammatory periodic disorder characterized by febrile and painful attacks due to inflammation involving the serosal membranes. The gene implicated in this disorder, MEFV, has been cloned and mutations in its coding regions have been identified. We aimed at identifying the frequency of MEFV mutations and carrier frequency in a mixed Arabic population. METHODS: We identified 29 probands from 29 unrelated sibships segregating the disorder and representing the affected individual cohort. We screened 200 anonymous deoxyribonucleic acid (DNA) samples, representing a healthy adult cohort, for the mutations found to be common in the affected individual cohort. We also, screened anonymous DNA samples from 4 Arabic countries, namely, Egypt (231), Syria (225), Iraq (176) and the Kingdom of Saudi Arabia (107) thus enlarging our healthy adult cohort. The study was carried out between 1999 and 2002 at Jordan University of Science and Technology, Irbid and the University of Jordan, Amman, Jordan. RESULTS: Out of the 58 alleles of the 29 probands, only 31 mutations were identified and M694V and V726A are the most common. The mutation E148Q was the most common among the healthy adult cohort, but was not present in affected individuals. The collective mutant allele frequency "q" was 0.101. The expected carrier rate was 18.1% (one in 5.5) while the observed carrier rate was 18.4% (one in 5.4). CONCLUSION: E148Q has reduced penetrance and thus, a proportion of the individuals genetically affected with FMF remain asymptomatic. M694I and M680I are more prevalent in the affected individuals cohort, which points to their higher penetrance. The overall carrier rate is one in 5, but the selective heterozygote advantage could not be demonstrated in this study due to the relatively small sample size.

Adult↗
PubMed1997

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates.

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.

Adolescent↗
PubMed1993

Prevalence of hepatitis B, C, and D virus markers in Yemeni patients with chronic liver disease.

A serological survey for hepatitis B, C, and D markers was carried out in the Yemen Republic. Serum samples from 243 pregnant females, 294 male blood donors, and 108 patients with chronic liver disease were examined. Hepatitis B surface antigen (HBsAg) was found in 18.5% healthy individuals and 24.1% patients with chronic liver disease (P = 0.03). Evidence of any marker for hepatitis B virus (HBV) infection was found in 59.8% healthy individuals and 75.9% of patients with chronic liver disease (P = 0.0016). HBeAg was detected in 32.1% of the HBsAg-positive pregnant females, indicating that vertical transmission probably plays a part in forming the pool of HBV carriers. Vaccination against HBV as part of the extended programme of immunisation (EPI) is recommended. Antibodies to hepatitis D were found in only 2 of 100 HBsAg-positive sera. Antibodies to hepatitis C (anti-HCV) were found in 2.1% healthy individuals and 21.5% patients with chronic liver disease (P = 0.0001). These results indicate that hepatitis B is hyperendemic in the Yemen Republic but that hepatitis D is very uncommon. The prevalence of anti-HCV is higher than in Europe and similar to neighbouring Arab countries. Infection with both HBV and HCV are important causes of chronic liver disease in the Yemen Republic.

Adult↗
PubMed2004

Molecular epidemiology of hepatitis C virus in Iran as reflected by phylogenetic analysis of the NS5B region.

Hepatitis C virus (HCV) subtypes were determined in 125 Iranian patients by phylogenetic analysis within the NS5B or 5'-UTR/core regions. Subtypes 1a and 3a were predominant accounting for 47 and 36%, whereas 1b and 4 accounted for 8 and 7%. This subtype distribution differs from that of Turkey and Pakistan, where subtypes 1b and 3a dominate and also from neighbouring Arabic countries where subtype 4 is the prevalent genotype. The Iranian 1a and 3a strains formed subclusters in the dendrogram indicating that these subtypes are indigenous to Iran. In contrast, the 1b strains intermixed with strains derived worldwide. Subtype 1a was frequent in South Iran (70%), while 3a was more prevalent in North-West Iran (83%), a region with a high proportion of Turkish inhabitants. Patients infected by blood products had more frequently subtype 1a (57%), while younger drug users had more frequently subtype 3a (54%). Genotype 4 was over-represented among haemodialysis patients in Tehran. One strain, most similar to genotype 5, was highly divergent in the NS5B region and further analysis is needed to assess the systematic status of this strain. In half of the patients with unknown source of infection only the 5'-UTR could be amplified, most of which were from North-West Iran and from patients younger than those with unknown source of infection with typable strains, mean age 29 versus 43 years. In conclusion, the NS5B sequence data revealed population based subtype patterns in Iran, the further study of which may help to understand the molecular epidemiology of HCV in a low-endemic area.

5' Untranslated Regions↗
PubMed2001

Aphrodisiacs past and present: a historical review.

The drug Viagra (sildenafil) has drawn public attention to aphrodisiacs. The search for such substances dates back millennia. Aphrodisiacs can be classified by their mode of action into 3 types: those that increase (1) libido, (2) potency, or (3) sexual pleasure. Various substances of animal and plant origin have been used in folk medicines of different cultures; some have been identified pharmacologically, allowing for understanding of their mechanisms of action. For increasing libido, ambrein, a major constituent of Ambra grisea, is used in Arab countries. This tricyclic triterpene alcohol increases the concentration of several anterior pituitary hormones and serum testosterone. Bufo toad skin and glands contain bufotenine (and other bufadienolides), a putative hallucinogenic congener of serotonin. It is the active ingredient in West Indian "love stone" and the Chinese medication chan su. The aphrodisiac properties are likely of central origin, as are the other effects of the drug. For increasing potency, Panax ginseng used in traditional Chinese medicine, works as an antioxidant by enhancing nitric oxide synthesis in the endothelium of many organs, including the corpora cavernosa; ginsenosides also enhance acetylcholine-induced and transmural nerve stimulation-activated relaxation associated with increased tissue cyclic guanosine monophosphate, hence the aphrodisiac properties. For increasing sexual pleasure, cantharidin ("Spanish fly") is a chemical with vesicant properties derived from blister beetles, which have been used for millennia as a sexual stimulant. Its mode of action is by inhibition of phosphodiesterase and protein phosphatase activity and stimulation of beta-receptors, inducing vascular congestion and inflammation. Morbidity from its abuse is significant. The ingestion of live beetles (Palembus dermestoides) in Southeast Asia and triatomids in Mexico may have a basis similar to cantharidin. It is of paramount importance for the physician to be aware of the options available to help his or her patients, and to advise them in using the correct drugs while avoiding "miracle" remedies that could be potentially harmful.

Aphrodisiacs↗