Cigarette smoking and smokeless tobacco use among male south Asian migrants in the United Arab Emirates: a cross-sectional study.

BACKGROUND: Few data were available on smoking and smokeless tobacco use in South Asian migrants in the United Arab Emirates (UAE). This study aimed to identify the prevalence and correlates of cigarette smoking and smokeless tobacco use in male South Asian migrants in the UAE. METHODS: We used a cross-sectional study to recruit a random representative sample of male South Asian migrants, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities. We used multivariable logistic regression analysis to identify significant correlates of cigarettes smoking and smokeless tobacco use. RESULTS: 1375 South Asian migrant adult males participated in the study (response rate 76%) with a mean age of 34 years (SD ± 10). The overall prevalence of cigarette smoking was 28% (95%CI 25-30%) and smokeless tobacco use was 11% (95%CI 10-13%). The prevalence of current cigarette smoking was 21, 23, and 37% among participants from India, Pakistan and Bangladesh, respectively. The prevalence of current smokeless tobacco use was 6, 12, and 16% for Indian, Pakistani, and Bangladeshi participants, respectively. Among study participants, Bangladeshi nationality, hypertension, and alcohol use were significant correlates of current cigarette smoking. Significant correlates of smokeless tobacco use included increased age, less than college level education, alcohol use, and Pakistani or Bangladeshi nationality. CONCLUSIONS: Current smoking and smokeless tobacco use in South Asian migrants represent a significant public health burden in the UAE. Effective public health measures are needed to reduce tobacco use in this migrant population.

Heavy metal content of herbal health supplement products in Dubai - UAE: a cross-sectional study.

BACKGROUND: Lead, mercury, cadmium, chromium, and arsenic intoxication have been associated with the use of health supplement (HS) products. The aim of this study is to estimate the concentration of heavy metals in HS products that are on sale in Dubai, United Arab Emirates, premises and to compare estimated daily metal intake with regulatory standards. METHODS: Dubai-area premises selling HS products were identified by searching the Dubai Municipality database to identify all pharmacies, para-pharmacies and nutrition and healthcare shops. A total of 859 premises were identified in the Deira and Bur-Dubai areas. Data collection was performed between September 1 and December 12, 2016. During that period, all premises that had been identified within Dubai were visited and samples for laboratory testing were collected. RESULTS: A total of 200 HS products were tested for lead, mercury, cadmium, chromium and arsenic. High proportion of samples were found to contain metals less than the limits of the detection (LOD) of the method. It was found that 93% of products contained Arsenic (As) < LOD, 94.5% of lead (Pb) < LOD, 100% of Cadmium (Cd) < LOD, 99% of Mercury (Hg) < LOD and 23.5% of Chromium (Cr) < LOD. Using the single imputation method to account for LOD, estimates for the average daily intake of lead was 0.88 µg compared to the tolerable daily intake (TDI) of 20 µg, daily intake of mercury was 0.09 µg (TDI = 20 µg), daily intake of cadmium was 0.83 µg (TDI = 6 µg) while for arsenic it was 0.92 µg compared to the tolerable daily intake of 10 µg. The average daily intake of chromium was 7.57 µg with no internationally established TDI. Assuming users followed the manufacturers' instructions, daily intake of arsenic, lead and mercury would not exceed TDI for any of the 200 products. However, the daily intake of cadmium exceeded or approximated the TDI for three products. CONCLUSIONS: In this study we found low levels of metals in the products that were available for sale in Dubai. With few exceptions, if the products were used according to the suppliers' instructions, average daily intake of heavy metals will be well below the recommended tolerable daily intakes.

Mutaba'ah-Mother and Child Health Study: protocol for a prospective cohort study investigating the maternal and early life determinants of infant, child, adolescent and maternal health in the United Arab Emirates.

INTRODUCTION: Early life exposures, particularly environmental and parental lifestyle factors, have a major influence on children's health and development. Due to increasing interest in the early life developmental origins of diseases, many birth cohorts have been established. These studies constitute a repository of data which researchers use over many years to investigate emerging research questions. However, no such databank or cohort study is available in the United Arab Emirates (UAE). This project aims to establish a prospective mother and child cohort study in Al Ain (Abu Dhabi, UAE) to investigate the maternal and early life determinants of infant, child, adolescent and maternal health of the Emirati population. METHODS AND ANALYSIS: During the period 2017-2021, this study aims to recruit 10 000 pregnancies at approximately 12 weeks of gestation from hospitals and clinics in Al Ain city. For each mother/newborn pair, an initial dataset will be collected including anthropometric, physiological and biochemical measurements, medical interventions, circumstances of pregnancy, delivery details and neonatal and perinatal growth and health using a combination of questionnaires, interviews and medical record extractions. Baseline data will act as the starting point from which the children will be followed up and re-surveyed at intervals throughout their life course until the age of 16 years, to explore how familial, socioeconomic and lifestyle factors interact with genetic and environmental factors to influence health outcomes and achievements later in life. ETHICS AND DISSEMINATION: Ethical approval has been granted by the United Arab Emirates University Human Research Ethics Committee and the ethical committees of the participating institutions. Results will be widely disseminated via peer-reviewed manuscripts, conference presentations, media outlets and reports to relevant authorities.

Prevalence of, and factors associated with health supplement use in Dubai, United Arab Emirates: a population-based cross-sectional study.

BACKGROUND: Health supplement (HS) products that are available in the Emirate of Dubai (United Arab Emirates; UAE) contain chemicals that may adversely affect human health. This study aimed to investigate the prevalence of, and factors associated with HS consumption, knowledge, related adverse events, and reporting practices of adverse events amongst the general population in Dubai, UAE. METHODS: A cross-sectional household telephone survey using a computer-assisted questionnaire was conducted amongst a random representative sample (n = 1203) of the Dubai population that assessed HS use and knowledge. Dependent variables were supplement use and reports of adverse events while independent variables included socio-demographic factors, knowledge, attitudes, and practice. Logistic regression analysis was performed to identify factors independently associated with HS use. RESULTS: Among the 1203 participants in this study, 455 (37.8%) reported ever using HS. Amongst ever-users, reasons for use were to improve health (66.1%), for bodybuilding (9.9%), disease prevention (6.8%), and weight management (5.3%). The majority of users purchased their HS from pharmacies (88.4%) or were prescribed HS (46.6%). Vitamins were the most commonly used HS (87.9%) followed by minerals (10.5%) and sports nutrition products (10.5%). Only 2.9% of users experienced an adverse event associated with HS use which all resolved when the HS was discontinued. Only three of those affected reported the incident. Multivariate logistic regression analysis revealed that HS use was independently associated with female gender (adjusted odds ratio [AOR]; 3.26, 95% confidence interval [CI]: 2.26-4.70), higher income (AOR 2.41, 95% CI: 1.20-4.83), being a past-smoker (AOR 2.39, 95% CI: 1.27-4.48), having an allergy (AOR 1.75, 95% CI: 1.14-2.66), more frequent doctor visits (AOR 1.86, 95% CI: 1.02-3.39), taking prescribed medications (AOR 1.47, 95% CI: 1.04-2.06), and knowledge about HS (AOR 3.91, 95% CI: 2.26-6.76). CONCLUSIONS: Our study provides the first population-based estimates of HS use and HS-related adverse events in the Gulf region. Adverse events associated with HS are infrequent and this may be due to the well-developed regulatory framework in Dubai and the high level of knowledge amongst consumers who mainly consume vitamins and minerals on the advice of pharmacists or healthcare professionals.

Pediatric Multiple Sclerosis in the United Arab Emirates: Characteristics From a Multicenter Study and Global Comparison.

We delineate the clinical characteristics, incidence, and prevalence of pediatric-onset multiple sclerosis in Abu Dhabi, United Arab Emirates, from 2010 to 2014. Eighty-two patients (65% female) were identified. Fifty-three (64.6%) were Emiratis (45 from Abu Dhabi and 8 from 5 other emirates) and 29 were expatriates. Mean age of onset was 15.9 years overall, 15.3 years in males and 16.3 years in females. Patients with onset before age 12 years presented with visual symptoms while those with onset after age 12 years presented with a mixture of visual, motor and sensory symptoms. Interferon beta-1a was the most frequently used disease-modifying therapy (48%). In Abu Dhabi Emirati nationals, the age- and sex-adjusted prevalences were 26/100 000 for males and 36/100 000 for females. The total incidence in Emirati nationals from 2010 to 2014 was 2.3/100 000 for ages 10 to 14 years and 7.2/100 000 for ages 15 to 19 years. By comparison with international cohorts, the incidence of pediatric-onset multiple sclerosis in Abu Dhabi is higher whereas gender distribution is similar.

The effect of religion on the perception of health states among adults in the United Arab Emirates: a qualitative study.

OBJECTIVES: Investigate how religion may affect the perception of health states among adults in the United Arab Emirates and the implications for research on self-reported health and quality of life and the use of values in cost-effectiveness analysis. DESIGN: Qualitative analysis of short-structured interviews with adult Emiratis carried out by a market research agency.The COREQ criteria have been used where appropriate to guide the reporting of our findings. SETTING: Participants were recruited from shopping malls and other public places in the cities of Al Ain and Abu Dhabi. PARTICIPANTS: Two hundred adult Emiratis broadly representative of the Emirati population in terms of age and gender. RESULTS: Eighty one per cent of participants said that their perception of health states was influenced by their spiritual or religious beliefs. The two overarching themes that seemed to explain or classify these influences were 'fatalism' and 'preservation of life'. Subthemes included powerlessness to change what is preordained by God, fear of disability (particularly diminished mobility) and appreciation of health and life and the requirement to look after one's health. A final theme was that of acceptance, with respondents expressing a willingness to endure suffering and disability with patience in the expectation of rewards in the hereafter. CONCLUSIONS: Our results emphasise the need for further work to establish locally relevant value sets for Muslim majority countries in the Middle East and elsewhere for use in health technology assessment decision-making, rather than relying on value sets from other regions.

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

BACKGROUND: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. METHODS: We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. RESULTS: Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. CONCLUSIONS: From the existing research literature it is not possible to conclude whether UAE health system reforms are working. We recommend that research should continue in this area but that research questions should be more clearly defined, focusing whenever possible on outcomes rather than processes.

Prevalence of Diabetes among Migrant Women and Duration of Residence in the United Arab Emirates: A Cross Sectional Study.

BACKGROUND: The prevalence rate of type 2 diabetes mellitus (T2DM) is one of the highest in United Arab Emirates (UAE), however data for the expatriate population is limited. This study aimed to identify the prevalence of T2DM amongst migrant women and test the hypothesis that acculturation (measured by years of residency) is associated with an increased risk of T2DM. METHODS: This was a cross-sectional study and we recruited a representative sample (n = 599, 75% participation rate) of migrant women aged 18 years and over in Al Ain, UAE. The American Diabetes Association criteria were used to diagnose T2DM. An adapted WHO STEPS questionnaire was used to collect socio-demographic, lifestyle and clinical data. Logistic regression analysis was performed to identify correlates of T2DM including length of UAE residence. RESULTS: The mean age of participants was 34.1 (± 9.5) years. Of the study participants, based on HbA1C levels, 18.6% (95% CI: 13.9-24.4) had prediabetes and 10.7% (95% CI: 7.2-15.6) had T2DM. Prevalence of prediabetes was 8.5% for Filipinos, 16.7% for Arabs and 30.3% for South Asians. Similarly the prevalence of T2DM was 1.7% for Filipinos, 12.2% for Arabs and 16.7% for South Asians. Significant correlates of overall T2DM (measured and known diabetes) included length of UAE residence for more than 10 years (Adjusted Odds Ratio [AOR] 2.74, 95% CI: 1.21-6.20), age ≥40 years (AOR = 3.48, 95% CI: 1.53-7.87) and South Asian nationality (AOR 2.10, 95% CI: 0.94-4.70). CONCLUSION: Diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asians. Longer length of residence in the UAE is associated with a higher prevalence of diabetes.

Tracking the Implementation of Electronic Medical Records in Dubai, United Arab Emirates, Using an Adoption Benchmarking Tool.

In the United Arab Emirates (UAE), health services have developed greatly in the past 40 years. To ensure they continue to meet the needs of the population, innovation and change are required including investment in a strong e-Health infrastructure with a single transferrable electronic patient record. In this paper, using the Emirate of Dubai as a case study, we report on the Middle East Electronic Medical Record Adoption Model (EMRAM). Between 2011-2016, the number of participating hospitals has increased from 23 to 33. Currently, while 20/33 of hospitals are at Stage 2 or less, 10/33 have reached Stage 5. Also Dubai's median EMRAM score in 2016 (2.5) was higher than the scores reported from Australia (2.2), New Zealand (2.3), Malaysia (0.06), the Philippines (0.06) and Thailand (0.5). EMRAM has allowed the tracking of the progress being made by healthcare facilities in Dubai towards upgrading their information technology infrastructure and the introduction of electronic medical records.

Bayesian Contrast Measures and Clutter Distribution Determinants of Human Target Detection.

Human target detection is known to be dependent on a number of components: one, basic electro-optics including image contrast, the target size, pixel resolution, and contrast sensitivity; two, target shape, image type and features, types of clutter; and three, context and task requirements. Here, we consider a Bayesian approach to investigating how these components contribute to target detection. To this end, we develop and compare three different formulations for contrast: mean contrast, perceptual contrast, and a Bayesian-based histogram contrast statistic. Results on past detection data show how the latter contrast measure correlates well with human performance factoring out all other dimensions. As for clutter, our findings show that with large targets, there are effectively no clutter effects. Furthermore, clutter does not have a major effect on detection when it is not contiguous with the target even when it is smaller. However, except for large targets, when the target is contiguous with the clutter, detection clearly decreases as a function of the similarity of target and clutter features-creating type of "clutter camouflage". This Bayesian formulation uses priors based on the contrast histogram statistics derived from all the images, the image context, and implies that human observers have adapted their criteria to fit with the image set, context, and task.

Human brucellosis in the Emirate of Abu Dhabi, United Arab Emirates, 2010-2015.

BACKGROUND: Worldwide, human brucellosis remains an important and widespread infection. In the past, there were limited data on the occurrence of human brucellosis in the United Arab Emirates and the reported incidence appeared to be low compared with similar areas. In 2009, a new web-based infectious disease surveillance system was introduced in the Emirate of Abu Dhabi. This paper reports data from this new system on human brucellosis for the 6 years 2010 to 2015. METHODS: A dataset was extracted for each case of human brucellosis reported to the notification system for the 6 year period January 2010 to December 2015. Annual brucellosis rates by age-group, gender, nationality and, geographical region were calculated and compared. RESULTS: A total of 480 cases of brucellosis were reported. The overall crude notification rate was 3 · 3 per 100,000 population but higher rates were seen in certain population subgroups notably expatriate males of working age in the Eastern Region (approximately 10 per 100,000) and UAE nationals of all ages and both genders in Abu Dhabi (between 4 -- 24 per 100,000). CONCLUSIONS: These findings reflect environmental and behavioral factors linked to occupation and leisure time activities associated with the large number of small non-commercial livestock farms in Abu Dhabi. Controlling human brucellosis in these circumstances will be challenging.

How global MS prevalence is changing: A retrospective chart review in the United Arab Emirates.

BACKGROUND: Multiple Sclerosis (MS) is an autoimmune disorder leading to central nervous system inflammation. Traditionally, reported MS prevalence rates in the Middle East are low. Few studies include age/sex standardization giving an unreliable estimate of regional prevalence. OBJECTIVE: to determine the prevalence, incidence and characteristics of MS in Abu Dhabi, United Arab Emirates. METHODS: A retrospective chart review was conducted at the four largest hospitals in Abu Dhabi Emirate between 2010 and 2014. Data collected included MS type, age and symptoms at onset, expanded disability status scale, treatment, laboratory findings and family history. RESULTS: 510 patients were identified consisting of 318 (62.2%) Emiratis and 192 (37.6%) expatriates. Total crude prevalence rate was 18/100,000 (95% CI: 10-30/100,000). Crude prevalence rate in Emiratis was 57.09 (95% CI:50 to 63/100,000) but increased to 64.44 (95% CI: 57 to 72/100,000) when age standardized. Age-standardized incidence rate in Emiratis was 6.0 MS cases per 100,000 person-years (95% CI: 5.5 to 6.5 cases per 100,000 person-years). CONCLUSION: At 64.44/100,000, the Abu Dhabi Emirati population has one of the highest, most reliable prevalence rate on the Arab peninsula. Age/sex standardized prevalence rates, uncommonly reported in the Middle East, should be standard for all prevalence studies.

Frailty in Community-Dwelling Older People in Abu Dhabi, United Arab Emirates: A Cross-Sectional Study.

BACKGROUND: Frailty describes the aging-associated loss of physiological and psychological reserves, leading to an increased risk of adverse health outcomes. Many developed countries view frailty as a major priority for their health and social care systems. Less is known about frailty in less-developed countries. The purpose of this study was to determine the prevalence of frailty in a sample of community-dwelling older people in the United Arab Emirates (UAE). METHODS: This was a cross-sectional study of community-dwelling Emirati adults aged 55 years and older (n = 160) in Abu Dhabi, UAE. Data were collected at interview by questionnaire and physical measurements. Frailty was defined according to the criteria of the Fried Frailty Index. The prevalence of frailty and its association with selected independent variables were assessed. RESULTS: The overall prevalence of frailty (95% CI) was 47% (39-55). Higher levels of frailty were seen in older age groups, women, those who were non-married, those with recent hospital admission, those with comorbid conditions, those on more than five medications, and those with lower forced expiratory volume and mini-mental state examination score. After adjustment in a multiple logistic regression model, only age and gender were found to be independently associated with frailty. CONCLUSION: A high prevalence of frailty was found among older Emiratis. Given that frailty is associated with adverse health outcomes and can be a means of identifying opportunities for intervention in clinical practice and health policy, further attention and consideration within professional and public health policy circles are needed.

Association between acculturation, obesity and cardiovascular risk factors among male South Asian migrants in the United Arab Emirates--a cross-sectional study.

BACKGROUND: Approximately 65% of the United Arab Emirates (UAE) population are economic migrants from the low- and middle-income countries of South Asia. Emerging evidence suggests that expatriate populations from low or middle-income countries that migrate to high-income countries acculturate their lifestyle with the obesogenic behaviours of the host country. Previous research has focussed on migrant populations in the United States. The objective of this study was to assess the prevalence of obesity and explore the relationship between years of residency (surrogate measure for acculturation) and obesity among South Asian (from India, Pakistan and Bangladesh) male immigrants residing in the UAE. METHODS: A random sample of 1375 males was recruited from a mandatory residency visa health screening centre in Abu Dhabi (UAE). Employing a cross-sectional design, participants completed an interviewer-led adapted version of the World Health Organisation STEPS questionnaire, and anthropometric and blood pressure measurements were collected. Glycated haemoglobin (HbA1c) was measured in a random sub-sample (n = 100). Logistic regression was used to determine risk factors for being classified as obese, and to assess the relationship between years of residency and adiposity. RESULTS: The overall prevalence of body mass index-derived overweight and obesity estimates and waist-to-hip-derived central obesity rates was 615 (44.7%) and 917 (66.7%) males, respectively. Hypertension was present in 419 (30.5%) of the sample and diabetes in 9 (9.0%) of the sub-sample. Living in the UAE for six to 10 years or more than 10 years was independently associated with being classified with central obesity (adjusted odds ratio [AOR] 1.63 95% confidence intervals [CI] 1.13 - 2.35, p < 0.008; AOR 1.95 95% CI 1.26 - 3.01, p < 0.002; respectively) compared to residing in the UAE for one to five years. CONCLUSIONS: Our study revealed a high prevalence of overweight, central obesity and hypertension amongst a young South Asian male migrant population in the UAE. Study findings suggest a diminished 'Healthy Migrant Effect' with increased years of residency possibly due to greater acculturation and a transition in lifestyle behaviours. Health initiatives targeting the maintenance of a healthy body size, coupled with regular assessments of glucose control and blood pressure are urgently required in this population.

An Investigation of the Feasibility and Cultural Appropriateness of Stated Preference Methods to Generate Health State Values in the United Arab Emirates.

BACKGROUND: No five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) value sets are currently available in the Middle East to inform decision making in the region's health care systems. OBJECTIVES: To test the feasibility of eliciting EQ-5D-5L values from a general public sample in the United Arab Emirates (UAE) using the EuroQol Group's standardized valuation protocol. METHODS: Values were elicited in face-to-face computer-assisted personal interviews. Adult Emiratis were recruited in public places. Respondents completed 10 time trade-off tasks and 7 discrete choice experiment tasks, followed by debriefing questions about their experience of completing the valuation tasks. Descriptive analyses were used to assess the face validity of the data. RESULTS: Two hundred respondents were interviewed in December 2013. The face validity of the data appears to be reasonably high. Mean time trade-off values ranged from 0.81 for the mildest health state (21111) to 0.19 for the worst health state in the EQ-5D-5L descriptive system (55555). Health states were rarely valued as being worse than dead (6.2% of all observations; 10% of all valuations of 55555). In a rationality check discrete choice experiment task whereby a health state (55554) was compared with another that logically dominated it (55211), 99.5% of the respondents chose the dominant option. Most of the respondents stated that their religious beliefs influenced their responses to the valuation tasks. CONCLUSIONS: Our results suggest that it is feasible to generate meaningful health-state values in the UAE, though some adaptation of the methods may be required to improve their acceptability in the UAE (and other countries with predominantly Arab and/or Muslim populations).

Measles cluster at a university in the United Kingdom.

BACKGROUND: Measles remains an infection of public health importance. We describe a cluster of measles in a university setting between April and May 2007. CASE PRESENTATION: The outbreak took place over a period of six weeks and involved nine students, eight of whom lived in halls of residence. Due to the potential for significant spread in an institutional setting, a public health investigation was initiated to identify the source of the outbreak. Follow up of cases was undertaken proactively with the university and local general practitioners. Salivary fluid test kits and questionnaires were sent to suspected cases. Seven salivary test kits were returned, but only one questionnaire was returned. Four cases were confirmed as measles. Although seven students had been previously immunised, immunity was only demonstrated in three. CONCLUSIONS: Public health investigations were hampered by the poor return rate of questionnaire and oral fluid sampling kits despite proactive follow up by public health staff, as well as the break for summer vacation. Nevertheless, our report highlights the public health effort in investigating such outbreaks and the importance of reinforcing immunisation to college and university students.

Women's knowledge, attitude and practice towards menopause and hormone replacement therapy: a facility based study in Al-Ain, United Arab Emirates.

BACKGROUND: Hormone replacement therapy (HRT) is an effective treatment for menopausal symptoms like vasomotor symptoms, sleep disturbances, mood alteration, depression, urinary tract infection, vaginal atrophy and increased health risks for osteoporosis, cardiovascular diseases and loss of cognitive function. This study was conducted to determine knowledge, attitude and practice toward menopause among women in UAE. METHODS: A clinic-based cross-sectional study was carried out among women of age 40 and above. Study subjects were recruited from four Primary Health Care centres in Al Ain city. The participants were administered a questionnaire in Arabic and English, which included 33 items; socio-demographic variables, and questions related to knowledge, attitude and practices regarding menopause and HRT. RESULTS: Out of 177 study subjected selected, 150 (85%) completed the survey. Almost half of the participants (51%) had already experienced menopause. A substantial number of women had poor know knowledge about menopause (67%) and HRT (73%). Sixty percent of women had positive attitude towards menopause. Of the fifty three percent of women with symptoms, 35% of them did not use anything to relieve their symptoms. Knowledge about menopause varied significantly (p<0.05) with the level of education and nationality. The association between reported symptoms and attitude towards menopause and HRT was found to be statistically significant. Women with reported symptoms that were bothersome had positive attitude towards HRT uptake. CONCLUSION: The study indicated that there is poor knowledge about menopause and HRT among the participants. Level of knowledge was associated with the level of education. There was a positive attitude towards menopause, with women suffering the most from menopausal symptoms showing positive attitude towards HRT.

Financing health care in the United Arab Emirates.

Newcomers to the United Arab Emirates (UAE) health care system often enquire about the way in which UAE health services are financed particularly when funding issues affect eligibility for treatment. The UAE ranks alongside many western counties on measures of life expectancy and child mortality but because of the unique population structure spends less of its national income on health. In the past as a wealthy country the UAE had no difficulty ensuring universal access to a comprehensive range of services but the health needs of the UAE population are becoming more complex and like many countries the UAE health system is facing the twin challenges of quality and cost. To meet these challenges new models of health care financing are being introduced. In this brief article we will describe the evolution of UAE health financing, its current state and likely future developments.

An analysis of the health status of the United Arab Emirates: the 'Big 4' public health issues.

BACKGROUND: The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. METHODS: A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. RESULTS: The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. CONCLUSION: The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases.