Health literacy in a high income Arab country: A nation-wide cross-sectional survey study.

INTRODUCTION: Health literacy is a powerful predictor of health outcomes, but remains a global challenge. There is a paucity of published data and limited understanding of the health literacy of patients in the Middle East. The purpose of this study was to assess the patient health literacy levels in the United Arab Emirates (UAE) and identify associated demographic characteristics. METHODS: A cross-sectional survey of adult patients attending public and private hospitals and primary care clinics was conducted across the UAE between January 2019 and May 2020. Chi-square test was used to analyze the association between health literacy and demographic variables. Ordinal regression was adopted to analyze the data for statistically significant independent variables. RESULTS: 2349 of 2971 patients responded (79% response rate). Slightly less than one-quarter (23.9%) of patients surveyed demonstrated adequate health literacy. Over a third of women respondents (31.7%) possessed adequate health literacy, as compared to only 13% of men surveyed (p<0.001). Participant age was significantly (p<0.001) associated with health literacy levels, with approximately 50% of participants above age 50 years (51-75 years) demonstrating inadequate health literacy. Education was also positively correlated with health literacy. Adequate health literacy levels were twofold higher (30.5%, p<0.001) in patients with high school education, as compared to patients without secondary education. CONCLUSIONS: The high proportion of patients with inadequate health literacy in our study confirms that the health literacy deficit is a challenge in the UAE. Targeted interventions are needed to improve health literacy, particularly for older individuals, to optimize healthcare utilization and improve individual and population health outcomes.

Vaccination Rate and Incidence of COVID-19 and Case Fatality Rate (CFR): A Correlational Study Using Data From 2019 to 2021

Introduction: COVID-19 has infected over 300 million people and killed almost five million people worldwide. The rapid development and deployment of vaccines almost a year after the initial outbreak was poised to contain the pandemic and enable the mobilization of the people and the economy. Vaccine deployment and containment of the pandemic have been far from uniform across the world. There is a lack of a clear understanding of the correlation between the COVID-19 vaccination rates and the incidence of the COVID-19 disease and COVID-19 mortality. Aim: The study aims to determine the correlation between the COVID-19 vaccination rate and the bi-weekly incidence rate of the COVID-19 disease to better understand the correlation between the vaccination rate and the COVID-19-related fatality in various countries. Materials and methods: Data from vaccination and the case fatality rate were ed until September 15, 2021, and from October 15 to October 31, respectively, for the various countries categorized based on their income levels. The bi-weekly COVID-19 incidence rate per million population and the case fatality rate was analyzed using SPSS version 27 (IBM Corp., Armonk, NY), followed by frequencies and percentages. Spearman rank correlation was used to determine the relationship between the variables. Results: A total of 191 countries were included in the study. The vaccination rate ranged from 0.03% to 82.1%, CFR from 0.14% to 32.1%, and the bi-weekly incidence rate ranged from zero to 1,283 per million population. A positive correlation was observed between vaccination rate and bi-weekly incidence rate (+0.57), whereas a negative correlation was observed between vaccination rate and CFR (-0.34). The results indicate a moderate positive correlation between vaccination rate and bi-weekly incidence rate and a weak negative correlation between vaccination rate and case fatality rate. Discussion and conclusion: Our study is interesting for the observation that the bi-weekly incidence rate of COVID-19 positively correlated with the rate of vaccination. In contrast, the vaccination rate correlated negatively with the case fatality rate. Although several factors may have contributed to the increased incidence rates for COVID-19, these observations refute the myth that COVID-19 vaccination offers complete protection from reinfection, especially in the backdrop of easing pandemic containment measures by some countries. An increase in the vaccination rate is certainly a positive contributor to the decreasing case fatality observed.

Methylprednisolone Treatment Versus Standard Supportive Care for Adult COVID-19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients.

A myriad of symptoms presented by severely ill mechanically ventilated COVID-19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients, with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. COVID-19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for COVID-19, the current study aimed to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID-19 patients with severe COVID pneumonia. Data were collected retrospectively from the electronic patient medical records, and interrater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome, and the chi-square test was used to determine the association between the outcomes and other independent variables. Sixty-one percent (43/70) of the COVID-19 ARDS patients received standard supportive care, and the remainder were administered, methylprednisolone (minimum 40 mg daily to a maximum 40 mg q 6 h). A 28-day all-cause mortality rate, in the methylprednisolone group, was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone-treated group, was significantly lower (p < 0.01) when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU length of stay, and ventilator days in mechanically ventilated COVID-19 patients with respiratory distress syndrome.

Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population.

BACKGROUND: Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. METHODS: Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. RESULTS: From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6-16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 - 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4-58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 - 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5-154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 - 123.8), p < 0.001). CONCLUSION: Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.

Virtual Clinical Encounter Examination (VICEE): A novel approach for assessing medical students' non-psychomotor clinical competency.

INTRODUCTION: The Corona Virus Disease-19 (COVID-19) pandemic disrupted medical education across the world. Online teaching has grown rapidly under lockdown. Yet the online approach for assessment presents a number of challenges, particularly when evaluating clinical competencies. The aim of this study was to investigate the feasibility, acceptability, reliability and validity of an online Virtual Clinical Encounter Examination (VICEE) to assess non-psychomotor competencies (non-procedure or manual skills) of medical students. METHOD: Sixty-one final year medical students took the VICEE as part of the final summative examination. A panel of faculty experts developed the exam cases and competencies. They administered the test online via real-time interaction with artificial intelligence (AI) based virtual patients, along with faculty and IT support. RESULTS: Student and faculty surveys demonstrated satisfaction with the experience. Confirmatory factor analysis supported convergent validity of VICEE with Direct Observation Clinical Encounter Examination (DOCEE), a previously validated clinical examination. The observed sensitivity was 81.8%, specificity 64.1% and likelihood ratio 12.6, supporting the ability of VICEE to diagnose 'clinical incompetence' among students. CONCLUSION: Our results suggest that online AI-based virtual patient high fidelity simulation may be used as an alternative tool to assess some aspects of non-psychometric competencies.

Case fatality rates of COVID-19 across the globe: are the current draconian measures justified?

Aim: The current study assessed the case fatality rate (CFR) across different income level countries of the world, and the virulence pattern of COVID-19, against the backdrop of panic and uncertainty faced by many governments, who are trying to impose draconian containment measures to control the outbreak. Subjects and Methods: Data on confirmed cases and number of deaths due to coronavirus infection were retrieved from the WHO as on 30 March 2020, and examined for the various income level countries, per the World Bank criteria. The CFR was calculated country-wise and estimated for the various groups such as low, lower-middle, upper-middle, and high-income, and the data was analyzed. Results: The overall CFR for the high income countries was 5.0%, compared with a CFR of 2.8% for low-income countries. The upper-middle-income countries showed a CFR of 4.3%, while the lower-middle-income countries stood at 3.7%. The results from our study predict that the maximum CFR in high-income countries will be contained at approximately 5% (95% CI). The CFR for the low, lower-middle, and upper-middle-income countries will range between 2.8 and 4.3% (95% CI). Conclusion: COVID-19, irrespective of its transmissibility, produces a lower CFR compared with that of SARS-Cov and MERS-Cov, although COVID-19 has infected eight times more countries than MERS-Cov and SARS-Cov, and caused a higher number of deaths. The nation-wide lockdown measures to prevent the spread of the virus may be reconsidered, given the hardships for the population and their impact on the economic system.