Midwakh/dokha tobacco use in the Middle East: much to learn.

Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally.

Computer use and vision-related problems among university students in ajman, United arab emirate.

BACKGROUND: The extensive use of computers as medium of teaching and learning in universities necessitates introspection into the extent of computer related health disorders among student population. AIM: This study was undertaken to assess the pattern of computer usage and related visual problems, among University students in Ajman, United Arab Emirates. MATERIALS AND METHODS: A total of 500 Students studying in Gulf Medical University, Ajman and Ajman University of Science and Technology were recruited into this study. Demographic characteristics, pattern of usage of computers and associated visual symptoms were recorded in a validated self-administered questionnaire. Chi-square test was used to determine the significance of the observed differences between the variables. The level of statistical significance was at P < 0.05. The crude odds ratio (OR) was determined using simple binary logistic regression and adjusted OR was calculated using the multiple logistic regression. RESULTS: The mean age of participants was 20.4 (3.2) years. The analysis of racial data reveals that 50% (236/471) students were from Middle East, 32% (151/471) from other parts of Asia, 11% (52/471) from Africa, 4% (19/471) from America and 3% (14/471) from Europe. The most common visual problems reported among computer users were headache - 53.3% (251/471), burning sensation in the eyes - 54.8% (258/471) and tired eyes - 48% (226/471). Female students were found to be at a higher risk. Nearly 72% of students reported frequent interruption of computer work. Headache caused interruption of work in 43.85% (110/168) of the students while tired eyes caused interruption of work in 43.5% (98/168) of the students. When the screen was viewed at distance more than 50 cm, the prevalence of headaches decreased by 38% (50-100 cm - OR: 0.62, 95% of the confidence interval [CI]: 0.42-0.92). Prevalence of tired eyes increased by 89% when screen filters were not used (OR: 1.894, 95% CI: 1.065-3.368). CONCLUSION: High prevalence of vision related problems was noted among university students. Sustained periods of close screen work without screen filters were found to be associated with occurrence of the symptoms and increased interruptions of work of the students. There is a need to increase the ergonomic awareness among students and corrective measures need to be implemented to reduce the impact of computer related vision problems.

Self-Reported Use of Complementary and Alternative Medicine among the Health Care Consumers at a Tertiary Care Center in Ajman, United Arab Emirates.

BACKGROUND: Complementary and alternative medicine (CAM) covers a wide range of approaches, including herbal medicine, manual healing techniques, traditional therapies and mind-body interventions. CAM is widely used throughout the world to treat a variety of illnesses and to maintain health. AIM: Complementary and alternative medicine (CAM) is popular across the world, and is widely practiced. Utilization pattern and reasons for use and non-use among patients attending a tertiary care center are assessed in this study. SUBJECTS AND METHODS: One hundred and thirty-five patients of different nationalities, above the age of 18 years, Gulf Medical College Hospital and Research Centre, Ajman, UAE, were interviewed using an open-ended structured questionnaire. In addition to socio-demographic characteristics, the acceptability, utilization pattern and reasons for use and non-use were elicited from the participants after obtaining consent from them. PASW 18 version was used to perform Chi-square test and descriptive statistics. RESULTS: Among the 135 participants were 20-81 years old, those from the Far East used most 85.7% (6/7), then Pakistan 38.5% (15/39) and India 23% (16/70). The most common system used was homeopathy. Physicians advised 28.2% (11/39) of users, whereas others used non-medical information. Around 71.8% (28/39) reported good outcome for themselves and family; however, only 10% (4/39) recommended it to others. Most of the users, 75% (101/135), were not sure whether CAM was based on scientific evidence, while 18% (24/135) felt it was. Good previous experience and less treatment complications were the most common reasons for using CAM and non-use due to lack of knowledge or need. CONCLUSION: About one-third of the seekers of modern medicine care also use CAM, and mostly without physician advice; hence, the importance of discussing the same while taking the clinical history. In view of the belief that CAM has fewer side-effects, there is even more need for physician-initiated discussion.

Introducing geriatric health in medical training in Ajman, United Arab Emirates: A co-curricular approach.

BACKGROUND: Medical students' knowledge and understanding of the elderly will affect the quality of care to the rising population of older adults which points to a need to identify geriatric health training methods appropriate for the region and curriculum. Therefore the study assessed the effect of a co- curricular introductory workshop on knowledge regarding geriatric health and attitude towards the elderly among fourth year medical students in a medical university METHOD: A quasi-experimental before-after study, with control was conducted at Gulf Medical College among 60 medical students from discipline-based curriculum in year IV during May-June 2010 of whom 16 had opted (attendees) to undergo the introductory course, a five day workshop of 10 hours duration. Pre- and post-testing used self-administered questionnaires for demographic variables: age, gender, nationality, close contact with older people; a quiz on old people's health, and Kogan's Old People Scale (KOPS) for attitude. The difference in scores on quiz and KOPS were compared for the attendees and 26 non-attendees who participated in both pre and post testing. RESULTS: The attendees group had 38% male and 62% female participants and the non-attendees group had 21% and 79% respectively. The groups were not significantly different in age, sex, nationality and close contact with the elderly. The scores on the quiz and KOPS showed no statistically significant difference between the two groups before or after the workshop. Almost all the participants evaluated the workshop very positively especially the interaction with healthy elderly and inmates of old people's home. CONCLUSION: A 10-hour introductory co-curricular workshop made no significant change in the knowledge on geriatric health or attitude of fourth year medical students though they reported it as a very enriching experience. A reflective report may have been a better assessment tool and the impact on their clinical practice cannot be predicted.

Opinion of nurses regarding breast cancer screening programs.

AIM: Found to be effective in its treatment. The increased incidence of breast cancer supports the implementation of breast cancer screening programs. The present study evaluates the opinion among nurses regarding breast cancer screening programs in United Arab Emirates (UAE). MATERIALS AND METHODS: The study population included 154 nurses practicing at different hospitals in United Arab Emirates (UAE), all nurses who participated in the breast cancer awareness programme organized by Gulf Medical University, Ajman, UAE. A self-administered, pretested, structured, close-ended questionnaire was used for data collection. Statistical Analysis was performed using Predictive Analytic Software (PASW 17). RESULTS: The participants' age ranged between 20 and 59 years. Fifty percent of the participants strongly agreed with the early detection of breast cancer by performing breast self examination. Thirty-nine percent were of the opinion that women aged 40 years and older should have a mammogram every year and continue to do so and 25.3% strongly felt that women in their 20s and 30s should have clinical breast examination as part of their periodic health examination by health professionals. 33.8% of the respondents strongly agree on providing information on the benefits and limitations of BSE to the female population. Twenty-six percent of the participants strongly agree that women at high risk should get magnetic resonance imaging and mammogram done every year. CONCLUSION: The present study indicates the need for providing workplace training programs thus equipping them with better knowledge and enhancing their service among the general population.

Knowledge about standard precautions among university hospital nurses in the United Arab Emirates.

Standard/universal precautions reduce the risk of transmission of bloodborne infections among patients and health care workers. This study was conducted to assess the awareness and knowledge of standard precautions among nurses in a university teaching hospital in Ajman, United Arab Emirates. All nurses working in the hospital were given a structured, self-administered, anonymous questionnaire: 101 nurses participated (range of experience from < 1 to 22 years). Overall 97.0% of respondents were familiar with the concept of standard precautions. Of these 61.2% believed that the blood and body fluids of all patients are potentially infectious irrespective of their diagnostic status, while 27.6% thought only diagnosed patients and 11.2% only suspected cases are potentially infectious. Less than half agreed that standard precautions aimed to protect both health care workers as well as patients (45.9%). The study highlights a need to implement a programme to improve knowledge on standard precautions.

Knowledge about standard precautions among university hospital nurses in the United Arab Emirates

Standard/universal precautions reduce the risk of transmission of bloodborne infections among patients and health care workers. This study was conducted to assess the awareness and knowledge of standard precautions among nurses in a university teaching hospital in Ajman, United Arab Emirates. All nurses working in the hospital were given a structured, self-administered, anonymous questionnaire: 101 nurses participated [range of experience from < 1 to 22 years]. Overall 97.0% of respondents were familiar with the concept of standard precautions. Of these 61.2% believed that the blood and body fluids of all patients are potentially infectious irrespective of their diagnostic status, while 27.6% thought only diagnosed patients and 11.2% only suspected cases are potentially infectious. Less than that standard precautions aimed to protect both health care workers as well as patients [45,9%]. The study highlights a need to implement a programme to improve knowledge on standard precautions

Nurses' attitude and practice in providing tobacco cessation care to patients.

INTRODUCTION: Patients respond very positively with nurses when they talk to them about their health related problems. METHODS: This cross sectional study was carried out among nurses working in Gulf Medical College hospital and Research centre, Ajman, UAE to assess the their attitude in providing tobacco cessation counselling or advise to their patients and potential barriers they face in providing tobacco cessation care. 108 nurses participated in the study. RESULTS: Among the nurses 87% were females, the majority were aged between 25 and 34 years, and 46.3% had a work experience of less than 5 years. Among the nurses who participated in the survey, 99.1% felt that the hospital stay was a suitable time for nurses to create awareness on tobacco and health to the patients and had a positive attitude towards creating awareness on tobacco and health to the patients. Only 0.9% had a negative attitude towards creating awareness on tobacco and health and they felt that patients might not listen to them. All nurses, irrespective of their socio-demographic characteristics had a positive attitude to motivating patients to quit tobacco use. Currently, 70.4% regularly advise their patients to avoid tobacco products. Potential barriers pointed out by nurses were: lack of time (6.3%) patients may not appreciate it (90.6%) and not part of their job (3.1%). CONCLUSION: The study concludes that nurses have a positive attitude in providing tobacco cessation care to their patients and they can utilize their unique knowledge and know-how to promote tobacco cessation and prevent the spread of this public health crisis. Providing advice and support for tobacco cessation by nurses would increase the chance of patients stopping tobacco use. This will create an enabling environment and greater potential for public health persons to fight the epidemic with greater vigour

Lifestyle riskfactors of noncommunicable diseases: awareness among school children.

BACKGROUND: Currently, the health scenario is riddled with the burden of noncommunicable diseases. AIM: The aim of this study is to assess the awareness of school children regarding the risk factors of noncommunicable diseases (NCD). SETTING AND DESIGN: Three hundred and seventy-five school children, studying in classes 6 to 10, formed the study subjects. MATERIALS AND METHODS: The school selected for the study was a government school, located in a rural area. The socioeconomic status of the children was mainly in the upper lower and lower class. Students from the 6 to 10 grades formed the study subjects and from among them, a random sample of 375 children were selected for the study. A close-ended questionnaire relating to 3 most commonly occurring NCDs, namely, Cancer, Cardiovascular Diseases (CVD), and Diabetes Mellitus (DM) was administered to the students. STATISTICAL ANALYSIS: Frequency and proportions were used to analyze the data. RESULTS: It is found that awareness among the school children regarding lifestyle risk factors of NCDs is not satisfactory. The areas of least knowledge were found to be regarding passive smoking, early age at marriage, and reuse of cooking oil as risk factors for NCD. CONCLUSION: The study recommends the need for curriculum-based health education regarding the prevention aspects and motivation of the children to incorporate healthy lifestyle practices into their daily lives.

Smokeless tobacco consumption among school children.

BACKGROUND: More than one-third of the tobacco consumed regionally is of smokeless form. AIMS: To determine the prevalence and pattern of smokeless tobacco use among school children. SETTINGS AND DESIGN: This cross-sectional study was conducted among children in 5 randomly selected high schools in Kannur district, Kerala, India. MATERIALS AND METHODS: This cross-sectional study was conducted among 1200 children. A self-administered questionnaire was used for data collection. STATISTICAL ANALYSIS: PASW 17 software was used for data analysis. RESULTS: The mean age of the students was 14.4 years with a standard deviation (SD) of 1.2 years, and 8.5% (CI, 7.1-10.2) of the participants were tobacco users. Smokeless tobacco was used by 2% (CI, 1.2-3.4) of the participants. None of the female students used tobacco products. Among the tobacco users, the mean age at the start of any tobacco use was 12.8 years with an SD of 1.1 years. The minimum age was 12 years and the maximum was 14 years. More than 50% smokeless tobacco users started their habit at the age of 12 years; 38.5% of them started at the age of 13 years and remaining at the age of 14 years. The 84.6% smokeless tobacco users were using it 2-3 times a week and 39% of them revealed that the tobacco products were purchased from shops located near the schools. Among the users, one used to keep the quid in the mouth for more than half an hour. CONCLUSION: The study concludes that there is a need to educate the children regarding the hazards associated with tobacco consumption.

Need to establish tobacco smoke zones in public places in Kerala.

BACKGROUND: Second-hand smoke is a grave hazard to both smokers and nonsmokers. AIMS: To assess the attitude of general public toward establishing smoke zones in public places. SETTINGS AND DESIGN: A cross-sectional survey was conducted among people residing in one randomly selected municipality of Kannur district in Kerala state, India. MATERIALS AND METHODS: A total of 1000 individuals participated in the study. An open-ended, semi-structured, interviewer-administered questionnaire, which was pilot tested was used to collect information from people willing to participate in the study. STATISTICAL ANALYSIS: Descriptive statistics was used. Statistical analysis was performed by using PASW 17. RESULTS: 73.1% of the total participants indicated a positive attitude toward establishing smoke zones in public places. All female participants and 69.7% of male participants had positive attitude toward establishing smoke zones in public places. Most nonsmokers (83.2%) showed a positive attitude toward establishing smoke zones. A statistically significant (P < 0.001) association was observed between smoking habit and attitude toward establishing smoke zones in public places. Among males, a statistically significant (P < 0.001) association was observed between age and attitude toward the need for smoke zones. As age increased, the attitude toward establishing tobacco smoke zone in public places was found to become more positive. CONCLUSION: Most of the participants had positive attitude to prohibition of smoking in public places in order to safe guard the public from the harmful effects of Environmental Tobacco Smoke.

Scope and extent of participation of female volunteers in tobacco control activities in Kerala, India.

BACKGROUND: In India, NGOs play a key role in creating a supportive environment for the control of tobacco consumption. AIMS: This study was conducted to assess the scope and the extent to which community-based women organizations are involved in tobacco control activities. To assess the scope and extent of participation in tobacco control activities according to the sociodemographic characteristics and also the extent to which they have participated in tobacco control activities. SETTINGS AND DESIGN: The participants were Kudumbasree volunteers from the rural areas of Kannur district of Kerala state, India. This population-based study adopted a cross-sectional design. MATERIALS AND METHODS: A self-administered, structured, close-ended, pre-tested questionnaire was prepared and used to collect data from 1000 female volunteers who participated in the study. STATISTICAL ANALYSIS: Chi-square test was used to compare nonparametric variables, such as education, marital status, and age with attitude toward tobacco control activities. RESULTS: Age of the participants ranged from 17 to 53 years. The association between education level and positive attitude to participate in tobacco control activities was found to be statistically significant (P < 0.001). A statistically significant association between participation in tobacco control activities and marital status (P < 0.001) was observed. With regard to education and readiness/willingness to participate in tobacco control activities, in all the education groups more than 90% were willing to participate in tobacco control activities. Among the ever married participants, 98% were willing to participate in antitobacco activities. Old age, husband working in a beedi factory, or not being able to make frequent visits were the reasons reported for their unwillingness of the remaining people. CONCLUSION: Based on the findings, a set of Kudumbasree volunteers were trained in tobacco and health to work in the community.

Less demand for tobacco smokers in the marriage market.

BACKGROUND: In order to control the tobacco scourge, an array of measures is required. AIMS: To determine the attitude of unmarried females toward tobacco smokers and ascertain their attitude toward marrying a smoker. SETTINGS AND DESIGN: Female students from randomly selected colleges in Kannur district, Kerala state, India, were the participants for this cross-sectional study. MATERIALS AND METHODS: Sample consisted of 1800 unmarried female students from two colleges. A self-administered, structured, close-ended pilot-tested questionnaire was used for data collection. Data were collected after obtaining verbal consent from them. STATISTICAL ANALYSIS: Data collected were entered into an excel spread sheet and analyzed using PASW 17 software. RESULTS: The participants' age ranged between 17 and 25 years. About 59.6% revealed that their parents (father) used tobacco products. Of those with no family history of tobacco use, 96.5% had negative attitude toward tobacco smokers, whereas of the participants with family history of tobacco use among parents, 89% were with a negative attitude toward tobacco use or their parent's habit. This association was found to be statistically significant (P < 0.001); 79% expressed negative attitude toward their male co-students who use tobacco products. Of the total, 99.3% expressed their unwillingness to marry a person with the habit of tobacco use, whereas 0.7% were willing to marry a person with tobacco habit with the belief that they could bring about a change in their male partner's tobacco habit. CONCLUSION: More comprehensive tobacco control activities can be undertaken in the community and colleges by incorporating female students as facilitators.

Neuronal death in amyotrophic lateral sclerosis (ALS): what can we learn from genetics?

Amyotrophic lateral sclerosis (ALS) is a difficult disease to study as it is mostly sporadic and rapidly progressive. Identification of genes causing familial ALS (FALS) has been instrumental in advancing our understanding of ALS pathogenesis, most notably with the use of mutant superoxide dismutase 1 (SOD1) models of disease. For 15 years SOD1 models have been the backbone of ALS research, but no effective reatments have been developed. However, recent advances have been made in the genetics of ALS with the identification of mutations in TAR DNA binding protein (TDP-43) and fused in sarcoma/translocated in liposarcoma (FUS), both of which have roles in RNA-processing and gene expression. Molecular links between ALS and frontotemporal dementia (FTD) are also suggested by linkage of ALS-FTD to chromosome 9. The study of the genetics of sporadic ALS (SALS) has been less fruitful, although this may change as we enter the era of resequencing. Further important clues as to the causes of ALS will come from the identification of other gene mutations that cause FALS, variants that increase susceptibility to SALS, and genetic factors that modify the ALS phenotype.