MPOWER, needs and challenges: trends in the implementation of the WHO FCTC in the Eastern Mediterranean Region

Background: WHO MPOWER aims to help countries prioritize tobacco control measures in line with the WHO Framework Convention on Tobacco Control. Objectives: This paper assessed the progress and challenges in implementing the 6 priority policies of MPOWER in countries of the WHO Eastern Mediterranean Region since 2011. Methods: A checklist was developed and scores assigned based on the MPOWER indicators [maximum score 37]. MPOWER data for the Region in the 2015 and 2017 tobacco control reports were extracted and scored. Data from similar analyses for 2011 and 2013 were also included. Countries were ranked by scores for each indicator for 2015 and 2017 and for overall scores for 2011 to 2017. Results: The Islamic Republic of Iran, Egypt and Pakistan had the highest scores in 2015 [33, 29 and 27 respectively] and the Islamic Republic of Iran, Pakistan and Yemen had the highest scores in 2017 [34, 31 and 27 respectively]. The indicators with the highest and lowest combined score for all countries were for advertising bans and compliance with smoke-free policies: 67 and 18 respectively in 2015, and 73 and 15 respectively in 2017. Most countries [15/22] had higher total scores in 2017 than 2015: Afghanistan, Bahrain and Syrian Arab Republic had the greatest increases. The total score for the Region increased from 416 out of a maximum score of 814 in 2011 to 471 in 2017. Conclusions: Although notable achievements have been made in the Region, many challenges to policy implementation remain and require urgent action by governments of the countries of the Region

Tobacco control in Oman: it's time to get serious!

Tobacco use is the world's leading cause of preventable morbidity and mortality. Although Oman remains a country with the lowest tobacco use in the Arab Gulf States, the prevalence of tobacco use is projected to increase to 33.3% by 2025. In 2005, Oman acceded to the World Health Organization's Framework Convention on Tobacco Control, an international treaty with numerous obligations aiming to reduce the global burden of tobacco use. This paper documents, for the first time, Oman's experience in tobacco control by providing a descriptive analysis of the evolution of tobacco control policies in relation to the country's international obligations. In order to curb tobacco use and maintain current low prevalence levels, the paper concludes that Oman needs to accelerate action in adopting the highest attainable policies recommended by the World Health Organization's MPOWER package

Trends in the risk for cardiovascular disease among adults with diabetes in Oman

This study aimed to investigate trends in the estimated 10-year risk for developing cardiovascular disease [CVD] among adults with diagnosed diabetes in Oman. In addition, the effect of hypothetical risk reductions in this population was examined. Data from 1,077 Omani adults aged >/=40 years with diagnosed diabetes were collected and analysed from three national surveys conducted in 1991, 2000 and 2008 across all regions of Oman. The estimated 10-year CVD risk and hypothetical risk reductions were calculated using risk prediction algorithms from the Systematic COronary Risk Evaluation [SCORE], Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe [DECODE] and World Health Organization/International Society of Hypertension [WHO/ISH] risk tools. Between 1991 and 2008, the estimated 10-year risk of CVD increased significantly in the total sample and among both genders, regardless of the risk prediction algorithm that was used. Hypothetical risk reduction models for three scenarios [eliminating smoking, controlling systolic blood pressure and reducing total cholesterol] identified that reducing systolic blood pressure to

Metabolic syndrome and its components secondary analysis of the world health survey, Oman

The study aimed to describe the prevalence of metabolic syndrome [MS] and its components among Omani adults. Methods: The 2008 Oman World Health Survey dataset was used to determine the national prevalence of MS. Logistic regression using all key sociodemographic, clinical and behavioural variables was used to identify the associations of independent variables with MS. Results: The age-adjusted prevalence of MS was 23.6%. MS was significantly associated with age, marital and work status and wealth level. MS was more common for people aged 50 years and older compared to the youngest cohort [OR 3.6, CI: 2.4-5.3; P <0.001] and in people who were married or employed [OR 1.6, CI: 1.3-2.1; P <0.001 and OR 1.3, CI: 1.1-1.8; P = 0.043, respectively] compared to their unmarried and unemployed counterparts. MS was also more common in people in the second lowest wealth quintile [OR 1.6, CI: 1.2-2.2; P = 0.05] compared to the lowest quintile and in those who sat for more than six hours per day [OR 1.3, CI: 1.1-1.7; P - 0.035]. Conclusion: One in four adults had MS in Oman. This may fuel the epidemic of non-communicable diseases [NCDs] in Oman, particularly given the increasingly elderly population. Urgent action is required to ensure quality patient care at all levels of the healthcare system. Further research on behavioural risk factors is needed. Developing and implementing a multisectoral strategy to prevent NCDs should be at the top of the current health agenda for Oman

epidemiology of acute coronary syndrome in Oman. Results from the Oman-RACE study

This study aimed to evaluate the epidemiology and coronary risk factors of acute coronary syndrome [ACS] in Oman. Data were collected through a prospective, multinational, multicentre survey of consecutive patients, hospitalised over a 5-month period in 2007 with a diagnosis of ACS, in Yemen and five Arabian Gulf countries [Oman, Bahrain, Kuwait, Qatar, United Arab Emirates]. Here we present data of Omani patients aged >/= 20 years who received a provisional diagnosis of ACS and were consequently admitted to 14 different hospitals. There where 1,340 confirmed ACS episodes in 748 men and 592 women [median age 61 years]. The overall crude incidence rate of ACS was 338.9 per 100,000 person-years [P-Y]. The age-standardised rate [ASR] of ACS was 779 and 674 per 100,000 P-Y for men and women, respectively. The ASR male-to-female rate ratio was highest in the ST-elevation myocardial infarction [STEMI] group [2.26, 95% confidence interval [[CI], 1.63 to 3.15] followed by the non-STEMI [NSTEMI] group [1.68, 95% CI 1.28 to 2.21] and unstable angina [0.79, 95% CI 0.66 to 0.99]. Unstable angina accounted for 55%, STEMI for 26% and NSTEMI for 19% of ACS cases. Among the coronary risk factors, there was a high prevalence of hypertension [68%], diabetes mellitus [DM] [36%], hyperlipidaemia [63%], and overweight/obesity [65%], with a relatively low rate of current tobacco use [11%]. Our study confirms a high incidence of ACS in Omanis and supports the notion that the cardiovascular disease epidemic is also sweeping developing countries

Baseline characteristics, management practices, and long-term outcomes of middle eastern patients in the second gulf registry of acute coronary events [Gulf RACE-2]

Limited data are available on patients with acute coronary syndromes [ACS] and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes of in such a population. A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up. ACS patients included those with ST-elevation myocardial infarction [STEMI] and non-ST-elevation acute coronary syndrome [NSTEACS], including non-STEMI and unstable angina. The registry collected the data prospectively. Between October 2008 and June 2009, 7930 patients were enrolled. The mean age [standard deviation], 56 [17] years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes [interquartile range, 210 minutes]; 22.3% had primary percutaneous coronary intervention [PCI] and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2%, and at 1 year after hospital discharge the mortality was 9.4%; 1-year mortality was higher in STEMI [11.5%] than in NSTEACS patients [7.7%; P<.001].Compared to developed countries, ACS patients in Arabian Gulf countries present at a relatively young age and have higher rates of metabolic syndrome features. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures are low. Long-term mortality rates increased severalfold compared with in-hospital mortality

retrieval system for patients with avoidable blindness due to diabetic retinopathy who do not present for ophthalmic assessment in Oman

Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters [patients who do not present or [no-show]] with Sight Threatening Diabetic Retinopathy [STDR]. We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009. Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy [DR] and medical retina specialists manage DR in Oman. A person with proliferative stage of DR [PDR] and/or Diabetic Macular Edema [DME] in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital. We registered 654 STDR cases, of which 494 [75%] were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 [66.4%] defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases [85%] had poor glycemic control. Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus

Regional variability in hospital mortality in patients hospitalized with st-segment elevation myocardial infarction: findings from the gulf registry of acute coronary events

To study the short-term mortality from ST-segment elevation myocardial infarction [STEMI] in the Arabian Gulf region of the Middle East, and to examine whether these geographically and culturally related countries had similar or different outcomes. The Gulf Registry of Acute Coronary Events recruited consecutive acute coronary syndrome patients from six Middle Eastern countries over a 5-month period. Of 6,706 patients recruited, 2,626 [39%] had STEMI, and a total of 165 patients died in hospital, with a crude mortality rate of 6.3%. However, mortality rates varied geographically between 10% in Yemen, 9.6% in Oman and 3.3% in the other countries. The unadjusted odds ratio of mortality for Yemen was 3.2 [95% CI: 2.2-4.7], and 3.1 [95% CI: 1.9-4.8] for Oman, compared to other Gulf countries. Even after adjusting for age and gender, the mortality remained significantly higher, almost double, in Oman and Yemen compared to other countries. This could be understood in the light of significant differences in a number of practice pattern variables such as reperfusion therapy, timely presentation and use of evidence-based medications. We found significant variability in STEMI mortality among Gulf Arab countries and identified areas requiring further efforts to reduce excess mortality in the region

Relationship between admitting nonfasting blood glucose and in-hospital mortality stratified by diabetes mellitus among acute coronary syndrome patients in Oman

Hyperglycemia in patients admitted for acute coronary syndrome [ACS] is associated with increased in-hospital mortality. We evaluated the relationship between admitting [nonfasting] blood glucose and in-hospital mortality in patients with and without diabetes mellitus [DM] presenting with ACS in Oman. Data were analyzed from 1551 consecutive patients admitted to 15 hospitals throughout Oman, with the final diagnosis of ACS during May 8, 2006 to June 6, 2006 and January 29, 2007 to June 29, 2007, as part of Gulf Registry of Acute [>7-<9 mmol/l], moderate hyperglycemia [>/= 9-<11 - mmol/l], and severe hyperglycemia [7-<9 mmol/l], moderate hyperglycemia [>/= 9-<11 - mmol/l], and severe hyperglycemia [>/= 11 mmol/l]. of all, 38% [n=584] and 62% [n=967] of the patients were documented with and without a history of DM, respectively. Nondiabetic patients with severe hyperglycemia were associated with significantly higher in-hospital mortality compared with those with euglycemia [13.1 vs 1.52%; P<0.001], mild hyperglycemia [13.1 vs 3.62%; P = 0.003], and even moderate hyperglycemia [13.1 vs 4.17%; P = 0.034]. Even after multivariate adjustment, severe hyperglycemia was still associated with higher in-hospital mortality when compared with both euglycemia [odds ratio [OR], 6.3; p<0.001] and mild hyperglycemia [OR, 3.43; P = 0.011]. No significant relationship was noted between admitting blood glucose and in-hospital mortality among diabetic ACS patients even after multivariable adjustment [all P values >0.05]. Admission hyperglycemia is common in ACS patients from Oman and is associated with higher in-hospital mortality among those patients with previously unreported DM

incidence of lung cancer in the Gulf cooperation council countries

Lung cancer is the most common cancer in the world, with an estimated number of 1.3 million new cases as of 2002. This is the first report from the countries that comprise the Gulf Cooperation Council [GCC]. All the primary lung cancer cases registered in the Gulf Center for Cancer Registration during 1998 to 2001 were used to calculate the age-standardized incidence rate [ASR] per 100 000 person-years by the direct standardization method. Overall, there were 1607 [1261 males, 346 females] primary lung cancer cases registered during this period with the male to female ratio of 3.6:1. The highest ASR was in Bahrain [34.3 for males, 12.1 for females] followed by Qatar [18.5 for males, 5.5 for females] and Kuwait [13.8 for males, 4.0 for females]; the lowest rate was in Saudi Arabia [4.8 for males, 1.3 for females]. The mean age at diagnosis for males ranged from 68.7 years in Bahrain to 59.2 years in Oman. For females it ranged from 68.2 years in Bahrain to 58.0 years in Oman. Squamous cell carcinoma in males [except in Qatar] and adenocarcinoma in females were the predominant histological type. Cancer of the lung is one of the common cancers among males in all the GCC countries and ranks second among Bahraini females. Adenocarcinomas were more common in women than men