Prevalence of Isolated Irritable Bowel Syndrome Among Adults in the Kingdom of Bahrain.

BACKGROUND: Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder encountered in clinical practice. In this study, we estimated the prevalence of isolated IBS and its associated demographic factors among the adult population in the Kingdom of Bahrain. METHODS: A cross-sectional study was conducted targeting adults in Bahrain aged 18 years and above. Individuals with a prior diagnosis of any bowel ailment were excluded. Data was acquired via a self-administered questionnaire. IBS-specific questions were derived from the validated Rome IV diagnostic questionnaire for adults. The scoring methodology inherent to this questionnaire was used for the diagnosis of IBS. The data collection process remained anonymous. Data was compiled using Excel spreadsheets, and the Statistical Package for Social Sciences (SPSS) was employed for analytical purposes. Associations between IBS and demographical or behavioral characteristics were explored using the Chi-square test. RESULTS: The prevalence of isolated IBS, adopting the Rome IV criteria, was 156 (18.3%) and IBS-M (mixed) type was 40 (38.1%) of these. IBS was predominantly higher among females compared to males (340 vs 235; 22.6% vs 11.9%). The majority of IBS cases (121, 21%) were in the 41-50 age group. A statistically significant association has been demonstrated between IBS and GERD using Pearson's chi-squared test (p-value = 0.000). Similarly, it was linked to indigestion (p-value = 0.00). CONCLUSIONS: Although the percentage appeared to be significantly higher than the global prevalence of 4% (using Rome IV criteria), our findings were equivalent to the reports conducted in the Middle East region. Integrating holistic patient assessments, including quality of life metrics, along with anxiety, depression, and vitamin D deficiency, will further enhance the understanding of IBS in Bahrain and its impact on the patients and the health services utilization.

Super-spreading social events for COVID-19 transmission: evidence from the investigation of six early clusters in Bahrain.

Introduction: This study aimed to characterize six early clusters of COVID-19 and derive key transmission parameters from confirmed cases that were traced between April and June 2020 in Bahrain. Methods: Pairs of "infector-infectee" allowed us to map the clusters and estimate the incubation period serial interval as the secondary attack rate. The chi-squared test, with a p-value computed using the Monte Carlo test, measured associations between categorical variables. Statistical analysis was performed using R software and the "data.tree, tidyverse" libraries. Results: From 9 April to 27 June 2020, we investigated 596 individuals suspected of COVID-19, of whom 127 positive cases were confirmed by PCR and linked in six clusters. The mean age was 30.34 years (S.D. = 17.84 years). The male-to-female ratio was 0.87 (276/318), and most of the contacts were of Bahraini citizenship (511/591 = 86.5%). Exposure occurred within the family in 74.3% (411/553), and 18.9% of clusters' cases were symptomatic (23/122 = 18.9%). Mapped clusters and generations increased after 24 May 2020, corresponding to "Aid El-Fitr." The mean incubation period was 4 days, and the mean serial interval ranged from 3 to 3.31 days. The secondary attack rate was 0.21 (95% C.I.) = [0.17-0.24]. Conclusion: COVID-19 transmission was amplified due to the high number of families mixing during "Aid El Fitr" and "Ramadhan," generating important clusters. Estimated serial intervals and incubation periods support asymptomatic transmission.

Prevalence and associated factors of binge eating disorder among Bahraini youth and young adults: a cross-sectional study in a self-selected convenience sample.

BACKGROUND: Binge eating disorder (BED) is defined as recurrent ingestion of an unusually large amount of food in a discrete period of time. BED has the highest prevalence of all eating disorders. Studies have shown a strong relationship between BED and both physical and psychological factors such as obesity, depression and anxiety. This research aimed to report the prevalence and associated factors of BED among Bahrainis (aged 15-30 years). METHODS: A total of 959 participants (aged 15-30 years) completed self-administered online questionnaires. BED was measured using the binge eating disorder Screener-7. The Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to measure depression and anxiety, respectively. RESULTS: Out of all participants, 21.2% had binge eating symptoms. A higher BMI, a restricted diet, depression and anxiety were associated with more frequent binge eating symptoms. Out of all associated factors, depression had the strongest association with binge eating, (rp = 0.371, p < 0.0001). However, sociodemographic variables including age and other medical conditions were not significantly associated with BED symptoms. CONCLUSION: In conclusion, the prevalence of BED symptoms was significantly high among the study participants. The results point out the crucial role of awareness of the interaction between obesity, depression and anxiety as potential risk factors for binge eating tendencies. Further research should examine their relationship with BED.

Binge eating disorder is an eating disorder characterized by the consumption of a large amount of food in a short period of time with loss of control over stopping accompanied by emotional stress during the episode. Studies have identified multiple risk factors that may contribute to binge eating, including lifestyle, psychological well-being of the individual, stress, genetics, family history, age and sex. The current study examined binge eating symptoms among adolescents and young adults aged 15­30 years to estimate the prevalence of the disorder in the Kingdom of Bahrain. Furthermore, participants were tested for depression and anxiety to investigate whether they were associated with the disorder. The results revealed that approximately one-fifth of the participants had binge eating symptoms. A high body mass index, depression and anxiety were significantly associated with binge eating symptoms. We hope this study will be reliable for use in epidemiological studies and further research.

Morbidities and Health-Seeking Behavior of Elderly Patients Attending Primary Health Care in the Kingdom of Bahrain.

Background: Understanding the health-seeking behaviors help in increasing the effectiveness and efficiency of the health-care system; however, there is lack of knowledge regarding the health-seeking behavior of the elderly population in the Kingdom of Bahrain. Objective: The objective of this study was to identify the morbidity profile and determine the health-seeking behavior of the elderly population. Methods: This cross-sectional study included all elderly patients (≥60 years) who attended four primary health-care centers that represent four governorates with the largest catchment area in the Kingdom of Bahrain between June 19 and August 31, 2021. Information concerning their sociodemographic data, morbidity profile and health-seeking behavior were collected through direct interviewing using a structured, predesigned and pretested questionnaire. Results: A total of 414 elderly patients were included, with the majority being Bahraini (89.1%) and male (55%). The most prevalent morbidity was hypertension (67.6%), followed by hyperlipidemia (54.7%), diabetes (52.6%), and arthritis (32.1%); arthritis was significantly more common among females than males (P < 0.001). The majority reported the reason for their visit being "repeat prescription" (32.1%). Almost one-third (28.2%) attempted self-management prior to their visit, and almost half (46.7%) reported seeking non-professional medical advice. The majority rated their health as good (39.4%) and moderate (38.2%). Less than one-third (28%) reported having had a health problem for which they did not attend to a health care facility. Conclusion: The study highlighted the morbidity profile and the health-seeking behavior among elderly population in Bahrain, which may serve as a point from which further efforts may be directed to improve the services.

Epidemiological assessment of SARS-CoV-2 reinfection.

OBJECTIVES: SARS-CoV-2 vaccination has been shown to reduce infection severity; however, the reinfection frequency among unvaccinated, partially vaccinated, and fully vaccinated individuals remains unclear. This study aims to elucidate the rates of and factors associated with such occurrences. METHODS: This retrospective epidemiological report included 1362 COVID-19 reinfection cases in Bahrain between April 2020 and July 2021. We analyzed differences in disease severity and reinfection characteristics among various vaccination statuses: fully vaccinated, interrupted vaccination, one-dose vaccination, postreinfection vaccination, and unvaccinated. RESULTS: Reinfection cases increased from zero per month in April-June 2020 to a sharp peak of 579 in May 2021. A significantly larger proportion of reinfected individuals were male (60.3%, P <0.0001). Reinfection episodes were highest among those 30-39 years of age (29.7%). The fewest reinfection episodes occurred at 3-6 months after the first infection (20.6%) and most occurred ≥9 months after the initial infection (46.4%). Most individuals were asymptomatic during both episodes (35.7%). Reinfection disease severity was mild, with vaccinated patients less likely to have symptomatic reinfection (odds ratio 0.71, P = 0.004). Only 6.6% of reinfected patients required hospitalization. One death was recorded; the patient belonged to the unvaccinated group. CONCLUSION: Vaccine-induced immunity and previous infection with or without vaccination were effective in reducing reinfection disease severity.

Innovations in Medical Education During the COVID-19 Era and Beyond: Medical Students' Perspectives on the Transformation of Real Public Health Visits Into Virtual Format.

Background: At the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Bahrain, the Public Health Program comprises two core components, namely, lectures and field visits (consumer products safety, communicable diseases control, and food safety). Digital transformation has innovated the medical educational activities during the COVID-19 pandemic where the real public health field visits were transformed into a virtual format. This study is aimed to examine the potential effect of converting the real public health field visit programs into a virtual format during the COVID-19 pandemic. Methods: All medical students who have submitted online feedback evaluation forms upon completing the Public Health Program in the academic years 2019-2020 (180 students; before the COVID-19 pandemic) and 2020-2021 (167 students; during the COVID-19 pandemic) were included in the study, a total sample size of 347 responses. Independent samples t-test was employed to compare students' feedback on Public Health Program before and during the COVID-19 pandemic while the Pearson chi-square test was used for categorical data. A p-value of <0.05 was considered statistically significant. Results: The mean score of students' satisfaction from the virtual program during the COVID-19 pandemic toward the consumer products safety and food safety field visits was significantly higher than that for students before the COVID-19 pandemic (the real field visits). However, there was no observed statistically significant difference for the Communicable Diseases Control visit. In addition, no significant differences were detected between the mean responses of male and female students toward all field visits, whether the feedback was provided before or during the COVID-19 pandemic. Conclusion: Transformation of real public health field visits into virtual format is acceptable and applicable during the COVID-19 era and maybe beyond.

Safety and Immunogenicity of COVID-19 BBIBP-CorV Vaccine in Children 3-12 Years Old.

BACKGROUND AND OBJECTIVES: In the current COVID-19 pandemic, children below the age of 12 could manifest COVID-19 symptoms and serve as a reservoir for the virus in the community. The present study was conducted to evaluate the reactogenicity, and immunogenicity of BBIBP-CorV, prior to involving this age group in the vaccination program in the kingdom of Bahrain. SUBJECTS AND METHODS: The study included 582 children from 3 to 12 years old of Bahraini and non-Bahraini nationality, all of which contributed to the reactogenicity study. Of those, 401 contributed to the immunogenicity study. All children received 2 doses of BBIBP-CorV inactivated virus 3 weeks apart. To assess reactogenicity, children were followed up for 5 weeks to evaluate any vaccine-related adverse events (AE). To assess immunogenicity, blood was collected on day 0 and day 35 to assess antibody titer against S, N, and neutralizing antibody. RESULTS: Of the 582 participants, (45.4%) were female, (54.61%) were male, with 49% in 9-12 age group. Of the 401 children contributing to the immunogenicity study, 274 (68.3%) had no prior exposure to COVID-19. The overall incidence of AE was 27.7%. No significant difference was found among different age groups. The most frequent AE was local (at the injection site) and occurred in 16% of children, followed by fever in 9.3%. No serious adverse events were reported. The Seroconversion rate was 100% among children with no prior exposure to COVID-19. Children with previous COVID-19 exposure had higher averages of anti-S (2379 U/mL compared to 409.1), anti-N (177.6 U/mL compared to 30.9) and neutralizing antibody (93.7 U/mL compared to 77.1) than children with no prior exposure at day 35. CONCLUSIONS: Two doses of COVID-19 BBIBP-CorV on the subjects aged between 3 to 12 has good safety and tolerance and can induce an effective immune response and neutralizing antibody titer.

The prevalence of asymptomatic and symptomatic COVID-19 in a cohort of quarantined subjects.

BACKGROUND: The frequency of asymptomatic SARS-CoV-2 infection with viral spread is unclear. Asymptomatic SARS-CoV-2 infection development and progression was investigated in subjects undergoing mandatory quarantine on airport arrival. METHODS: 2714 subjects were tested for SARS-CoV-2 and all were quarantined for 2 weeks. Viral retesting was undertaken on symptom development and routinely at 14 days if asymptomatic. Asymptomatic, positive patients underwent viral testing every 2 days to determine viral clearance. RESULTS: 188/2714 (6.9%) patients became SARS-CoV-2 positive. On arrival, 136/188 tested positive, with 44/188 (23.4%) symptomatic and 92/188 (48.9%) asymptomatic. All 92 patients remained asymptomatic and were retested every 2 days until viral clearance. 2526 quarantined subjects remained virus free at 14 days. Viral clearance did not differ between symptomatic and asymptomatic patients (12.6 ± 1.0 days and 12.1 ± 0.4 days, respectively). Of the 52/188 (27.7%) testing negative on arrival, 27/52 subsequently became positive and developed symptoms 2-13 days after arrival. 25/188 (13.3%) remained asymptomatic and tested positive at day 14, with viral testing undertaken every 2 days in these subjects; of these, 24 remained asymptomatic, with viral clearance at 9.4 ± 0.7 days - less than for those who were asymptomatic on arrival (p < 0.002). CONCLUSION: Asymptomatic patients with COVID-19 were more prevalent than those exhibiting symptoms, and are an infection reservoir.

Effects of Daily Low-Dose Date Consumption on Glycemic Control, Lipid Profile, and Quality of Life in Adults with Pre- and Type 2 Diabetes: A Randomized Controlled Trial.

Dates have a low glycemic index and are a source of antioxidants but, nevertheless, contain more than 70% sugar. This study aims to assess the effects of date consumption (three dates daily) on glycemic profile (HbA1c), body mass index (BMI), quality of life, and lipid profile, including total cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) in terms of safety for type 2 diabetic mellitus (T2DM) subjects. A randomized controlled trial was conducted with a sample of 100 T2DM subjects (39 male and 61 female) randomly assigned in two groups. The first group received three dates daily for 16 weeks, and the control group avoided date consumption. After a 16-week follow-up period, the study results showed an improvement of lipid profile with a statistically significant decrease in total cholesterol of ∆ = -0.209 mmol/L (confidence interval (CI) 95% -0.358, -0.059; p < 0.05) and in LDL of ∆ = -0.171 mmol/L (CI 95% -0.358, 0.016) in the group receiving three dates daily. Intra-group mean differences of BMI were not statistically different in both groups after 16 weeks of date consumption. Even HbA1c did not change, both within and between groups after date consumption (∆ = 0.087%; CI 95% -0.086, 0.261). Between groups, mean difference changes (intervention minus control) showed a statistically significant improvement of quality of life index of ∆ = ± 30.66 points (CI 95% 12.45, 48.23) due to the consequent improvement in mental health. Although the definitive effect of dose/intake response of date consumption on Hb1Ac, lipid profile, and BMI in T2DM subjects is still to be established, the study suggests that dates could potentially have a beneficial effect on lipid profile, especially in reducing total cholesterol and elevating HDL, because of its high polyphenolic content. In addition, a low-moderate consumption of dates did not impact glucose levels because of dates' low glycemic index.

Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain.

BACKGROUND: Type 2 diabetes is a growing health challenge in the Kingdom of Bahrain, and the disease exerts significant pressure on the healthcare system. The aim of this study was to assess the annual costs and understand the drivers of those costs in the country. METHODS: A sample of 628 patients diagnosed with type 2 diabetes were randomly selected from primary healthcare diabetes clinics, and the direct medical and indirect costs due to type 2 diabetes were analysed for a one-year period. The study used patients' medical records, interviews and standardised frequency questionnaires to obtain data on demographic and clinical characteristics, complication status, treatment profile, healthcare resource utilisation and absenteeism due to diabetes. The indirect costs were estimated by using the human capital approach. The direct medical and indirect costs attributable to type 2 diabetes were extrapolated to the type 2 diabetes population in Bahrain. RESULTS: In 2015, the total direct medical cost of type 2 diabetes was 104.7 million Bahraini dinars (BHD), or 277.9 million US dollars (USD), and the average unit cost per person with type 2 diabetes (1162 BHD, or 3084 USD) was more than three times higher than for a person without the condition (372 BHD, or 987 USD). The healthcare costs for patients with both micro- and macrovascular complications were more than three times higher than for patients without complications. Thus, 9% of the patients consumed 21% of the treatment costs due to complications. Complications often lead to hospital admission, and 20% of the patients consumed almost 60% of the healthcare costs attributable to type 2 diabetes due to hospital admissions. The indirect cost due to absenteeism was 1.23 million BHD (3.26 million USD). CONCLUSION: Type 2 diabetes exerts significant pressure on Bahrain's healthcare system - primarily due to costly diabetes-related complications. It is therefore important to optimise the management and control of type 2 diabetes, thereby reducing the risk of disabling and expensive complications.

An epidemiological study assessing the prevalence of human papillomavirus types in women in the Kingdom of Bahrain.

BACKGROUND: Persistent infection with high-risk (HR) human papillomavirus (HPV) causes cervical cancer, the fourth most frequent cancer in the Kingdom of Bahrain, with an annual incidence of four per 100,000 women. The aim of this study was to assess the prevalence and type distribution of HPV in Bahraini and non-Bahraini women attending routine screening. HPV prevalence was assessed by risk factors and age distribution. Health-related behaviors and HPV awareness were also studied. METHODS: This observational study was conducted between October 2010 and November 2011 in the Kingdom of Bahrain (NCT01205412). Women aged either ≥20 years attending out-patient health services for routine cervical screening or ≥16 years attending post-natal check-ups were enrolled. Cervical samples were collected and tested for HPV-DNA by polymerase chain reaction and typed using the SPF10 DEIA/LiPA25 system. All women completed two questionnaires on health-related behavior (education level, age at first marriage, number of marital partners, parity and smoking status) and HPV infection awareness. RESULTS: HPV DNA was detected in 56 of the 571 women included in the final analysis (9.8%); 28 (4.9%), 15 (2.6%) and 13 (2.3%) women were infected with single, multiple and unidentifiable HPV types, respectively. The most prevalent HPV types among the HPV positive women were HR-HPV-52 in eight (1.4%), HR-HPV-16, -31 and -51 in six women each (1.1%); low-risk (LR)-HPV-6 in four (0.7%); and LR-HPV-70, -74 in three women each (0.5%). Co-infection with other HR-HPV types was observed in 50% HPV-16-positive women (with HPV-31, -45 and -56) and in both HPV-18-positive women (with HPV-52). None of the health-related risk factors studied were associated with any HR-HPV infection. More than half of women (68.7%) had never heard about HPV, but most women (91.3%) in our study were interested in HPV-vaccination. CONCLUSION: HPV prevalence in Bahraini women was 9.8%. The most frequently observed HPV types were HR-HPV-52, -16, -31 and -51 and LR-HPV-6, -70 and -74. These are useful baseline data for health authorities to determine the potential impact of preventive measures including the use of prophylactic vaccines to reduce the burden of cervical cancer.