Health risk factors, status and service utilisation of adults in primary health care settings in Qatar: The HEALTHSIGHT study protocol.

BACKGROUND: The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease. Qatar which has a significantly high prevalence of NCDs with early on set. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar's publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol. METHODS: The proposed study will use a cross sectional study design involving a random sample of participants enrolled across all 31 PHCC health centers. Individuals aged 18 and above years old registered with PHCC and hold a valid health card and contact information on PHCC's electronic medical records (EMR) will be eligible for inclusion. A stratified random sample not proportional to size sampling technique will be employed to obtain a representative sample size of the PHCC population (N = 6000). Participants will be scheduled for an appointment at a PHCC health centre where a data collector will obtain informed consent, collect vital sign information and administer a questionnaire. A phlebotomist will collect a blood sample. Health service utilization data will be extracted from PHCC's EMR. DISCUSSION: Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar's primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar. The proposed protocol provides an example of a robust nationwide study that be undertaken in short duration using limited resource which can be undertaken in other similar settings.

Primary care dental professionals' experiences of sharp injuries in Qatar: A cross-sectional study.

Objectives: Very few studies assess sharp injuries solely among dental professionals globally. This study aims to understand the experiences of sharp injuries among primary care dental professionals in Qatar. Methods: This is a cross-sectional study where dental professionals working at the Primary Health Care Corporation (PHCC), a public sector healthcare organization and Qatar's largest primary care provider with 27 primary healthcare centers in Qatar, were invited to participate. An online questionnaire was administered to understand participants' experience of sharp injuries and access to occupational health services and training. Findings: A total of 114 dental professionals participated in this study. In total, 68.42% (N=78) of participants reported experiencing a sharp injury in the 12 months prior to the survey. Majority (N=58; 75.36%) of the reported causes of sharp injuries were related to dental explorers (N=31; 40.26%) and dental injection needles (N=27; 40.26%). Of those who had experienced a sharp injury, 84.47% (N=87) did not report them. Conclusion: In conclusion, the results highlight that sharp injuries are common among primary care dental professionals, and despite having good access to occupational support services, most dental professionals did not report their injuries. Continuous education and training programs must be implemented to improve knowledge and raise awareness to reduce the burden of sharp injuries among dental professionals. More studies from other dental settings are needed to better understand dental professionals' experiences of sharp injuries in Qatar and elsewhere.

Healthcare Professionals' Attitudes Toward Patients With Mental Illness: A Cross-Sectional Study in Qatar.

Background: Negative attitudes toward mental illness by Health Care Professionals (HCP) have been reported in many countries across the world. Stigmatizing attitudes by HCP can have adverse consequences on people with mental illness from delays in seeking help to decreased quality of care provided. Assessing such attitudes is an essential step in understanding such stigma and, if needed, developing and testing appropriate and culturally adapted interventions to reduce it. Aims: To assess physicians and nurses attitudes toward mental illness and to determine associated factors with different levels of stigma. Methods: A cross-sectional survey was conducted among Physicians and Nurses. The Mental Illness Clinician's Attitudes (MICA) scale was used to assess attitudes toward mental illness. MICA scores range between 1 and 6 with higher values indicating higher stigmatizing attitudes. Demographic and work related information were also gathered. Descriptive statistics along with multivariate linear and multivariate logistic regression models were used. Results: A total of 406 nurses and 92 doctors participated in the study. The nurses' mean MICA score was significantly higher than that of the physicians. Among nurses, being Asian and working in a geriatric, rehabilitation and long-term care facility were associated with lower MICA scores. Among physicians, being female or graduating more than 1 year ago were also associated with lower MICA scores. Conclusion: Stigmatizing attitudes toward people with mental illness by healthcare workers are present in Qatar. They are higher among nurses as compared to physicians. Factors associated with higher stigmatizing attitudes could be used in creating appropriate intervention to reduce the magnitude of the problem.

Antibody Response to SARS-CoV-2: A Cohort Study in Qatar's Primary Care Settings.

BACKGROUND: Globally, countries are rolling out Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quarantine policies and vaccination programs. Research studies are needed in helping understand the likelihood of acquired immunity to reinfection and identify priority groups for vaccination to inform them. This study aimed to assess period prevalence and longitudinal changes in antibody levels after SARS-CoV-2 infection in Qatari primary care settings. METHODS: A cohort study design with 2 data collection phases was undertaken-Phase 1 (conducted in July 2020) and Phase 2 (conducted in October 2020). A stratified random sampling technique by age, gender and nationality was utilized to identify the study sample. The total sample size required for the study was estimated to be 2102. Participants were invited to an appointment where they were administered a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin G immunoassay tests. RESULTS: A total of 943 individuals participated in both Phase 1 and Phase 2. In this cohort, seroprevalence of SARS-CoV-2 was found to be 12% (N = 113) in Phase 1 and 17.2% (N = 162) in Phase 2. Of the 113 participants who were seropositive in Phase 1, 38.1% (CI 29.5-47.2%, N = 43) had a reduction, 54.9% (CI 45.7-63.8%, N = 62) had no change, and 7.1% (CI 3.4-12.9%, N = 8) had an increase in IgG titer in Phase 2. All (N = 18) participants aged 10 to 17 years retained their antibodies. The proportion of men who retained their antibodies was slightly higher compared to women-92.5% (N = 74) and 87.9% (N = 29) respectively. Similarly, symptomatic individuals (97.8%; N = 45) had a higher antibody retention compared with asymptomatic individuals (86.4%; N = 57). CONCLUSIONS: This study provides preliminary information on the longitudinal changes in antibody levels after SARS-CoV-2 infection. These findings will help inform quarantine policies and vaccination programs.

Diabetes, hypertension and dyslipidemia medication prescribing in Qatari primary care settings: a retrospective analysis of electronic medical records.

BACKGROUND: Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice. METHODS: The study was undertaken in Qatar's publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported. RESULTS: A total 81,569 individuals were included (18-29 years 2.4%; 30-39 years 11.7%; 40-49 years 25.4%; 50-59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%). CONCLUSIONS: In Qatar's primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence.

Epidemiology of SARS-CoV2 in Qatar's primary care population aged 10 years and above.

BACKGROUND: There is an urgent need to elucidate the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and characterize its potential impact. Investing in characterising the SARS-CoV2 will help plan and improve the response to the pandemic. Furthermore, it will help identify the most efficient ways of managing the pandemic, avoiding public health policies and interventions that may be unduly restrictive of normal activity or unnecessarily costly. This paper describes the design and reports findings of a population based epidemiological study undertaken to characterise SARS-CoV2 in Qatar using limited resources in a timely manner. METHODS: Asymptomatic individuals ≥10 years registered with Qatar's publicly funded primary health provider were eligible. A stratified random sampling technique was utilized to identify the study sample. Participants were invited to an appointment where they completed a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin M and G immunoassay tests. Data collected were analyzed to calculate point and period prevalence by sociodemographic, lifestyle and clinical characteristics. RESULTS: Of 18,918 individuals invited for the study, 2084 participated (response rate 10.8%). The overall point prevalence and period prevalence were estimated to be 1.6% (95% CI 1.1-2.2) and 14.6% (95% CI 13.1-16.2) respectively. Period prevalence of SARS-CoV2 infection was not considerably different across age groups (9.7-19.8%). It was higher in males compared to females (16.2 and 12.7% respectively). A significant variation was observed by nationality (7.1 to 22.2%) and municipalities (6.9-35.3%). CONCLUSIONS: The study provides an example of a methodologically robust approach that can be undertaken in a timely manner with limited resources. It reports much-needed epidemiological data about the spread of SARS-CoV2. Given the low prevalence rates, majority of the population in Qatar remains susceptible. Enhanced surveillance must continue to be in place, particularly due to the large number of asymptomatic cases observed. Robust contact tracing and social distancing measures are key to prevent future outbreaks.

Internalized Stigma in Persons With Mental Illness in Qatar: A Cross-Sectional Study.

Stigma impacts persons with mental illness (PWMI), their families and network of friends, the public and health care professionals. Stigma is a major barrier for PWMI to seeking treatment, which contributes to the burden of disease, disability, and mortality. Research on stigma is relatively scant in the Middle East region and particularly in Qatar. To address stigma effectively in each culture, it is essential to study its nature in the context where the PWMI experience stigma. The purpose of this study was to assess the prevalence of internalized stigma in PWMI in Qatar. A cross-sectional study of PWMI receiving outpatient mental health services in Qatar was done. We interviewed 417 PWMI using a modified 18-item version of the short form of the Internalized Stigma of Mental Illness (ISMI) Scale. Descriptive and regression models were used to analyze the data. The Cronbach alpha for the modified 18-items ISMI was 0.87. Participants' average score on this scale was 2.07 ± 0.38 with 41 (9.8%) of them scoring more than 2.5 which is considered "high" stigma score. In multivariate logistic regression, high stigma (modified ISMI score >2.5) was significantly higher among PWMI with no formal education and among those who reported lower levels of social support. The reported levels of internalized stigma in this vulnerable population of Qatar fall at the lower spectrum reported worldwide. An anti-stigma education program designed for the context of Qatar emphasizing on education and support for PWMI may be conducive to creating an all-inclusive society.

COVID-19 Surveillance in the Primary Health Care Population of Qatar: Experience of Prioritizing Timeliness Over Representativeness When Sampling the Population.

SARS-CoV2 a new emerging Corona Virus Disease in humans, which called for containment measures by many countries. The current paper aims to discuss the impact of two different sampling methodologies when executing a drive through COVID-19 survey on the quality of estimated disease burden measures. Secondary data analysis of a pilot cross-sectional survey targeting Qatar's primary health care registered population was done. Two groups with different sampling methods were compared for estimating COVID-19 point prevalence using molecular testing for nasopharyngeal swabs. The first group is a stratified random sample non-proportional to size (N = 260). A total of 16 population strata based on age group, gender, and nationality were sampled. The second group is the Open invitation group (N = 841). The results showed that the two groups were obviously and significantly different in age and nationality. Besides, reporting of COVID-19 symptoms was more frequent in the open invitation group (28.2%) than the random sample (16.2%). The open invitation group overestimated the symptomatic COVID-19 prevalence rate by more than four times, while it overestimated the asymptomatic COVID-19 cases by a small margin. The overall prevalence rate of active COVID-19 cases in the open invitation sample (13.3%) was almost double that of the random sample (6.9%). Furthermore, using population sampling weights reduced the prevalence rate to 0.8%. The lesson learned here is that it is wise to consider the magnitude of bias introduced in a surveillance system when relying on convenient sampling approaches in response to time constraints.