Assessment of the quality and content of clinical practice guidelines (CPGs) for vitamin D and for immigrants using the AGREE-II instrument: a protocol for systematic review.

INTRODUCTION: Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants, which is attributed to ethnic variations, place or region of birth, skin pigmentation, clothing style, and resettlement-related changes in diet, physical activity, and sun exposure. Current recommendations in clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants. CPGs may also lack guidance for physicians on vitD supplementation for immigrants. Moreover, there are concerns about the overall quality of these CPGs. OBJECTIVES: This systematic review will collate and critically appraise CPGs relevant to immigrants' health and vitD. Moreover, we will evaluate whether the CPGs of vitD including recommendations for immigrants and clarify whether the CPGs of immigrants include recommendations on vitD. METHODS: A systematic search of Ovid MEDLINE® ALL, EMBASE, and Turning Research Into Practice (TRIP) electronic databases, guideline repositories, and gray literature will be conducted to identify relevant CPGs. Two reviewers will independently evaluate the methodological quality of the retrieved guidelines using the Appraisal of Guidelines, Research, and Evaluation-II (AGREE-II) instrument. CPGs scoring ≥60% in at least four domains, including "rigor of development," will be considered high quality. CONCLUSION: Evaluating the quality and content of relevant CPGs may support researchers in developing national and global guidelines for immigrants. Furthermore, it may support vitD testing, nutritional counseling, and supplementation for vulnerable immigrant sub-populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021240562.

Vitamin D and Chronic Diseases among First-Generation Immigrants: A Large-Scale Study Using Canadian Health Measures Survey (CHMS) Data.

Background: Nearly 22% of the Canadian population are first-generation immigrants. We investigated immigrants' health status and health deterioration over time in terms of the prevalence of chronic diseases (CDs) and their relationship to vitD status. Methods: We used cycles three (2012-2013) and four (2014-2015) of the Canadian Health Measures Survey. These data contained unique health information and direct physical/blood measures, including serum 25-hydroxyvitamin D (S-25(OH)D). Indicators of health status and deterioration were the prevalence of CDs diagnosed by healthcare professionals, self-reported general and mental health, and CD-related biomarkers. Results: The data (n = 11,579) included immigrants from more than 153 countries. Immigrants were healthier than non-immigrants for most health status measures. The prevalence of CDs was higher among those who migrated to Canada aged ≥ 18 years. A longer time in Canada after immigration was associated with a higher risk for CDs. The mean S-25(OH)D was lower among immigrants, higher among patients with CDs, and inversely associated with glycated hemoglobin, total cholesterol/high-density lipoprotein ratio, immunoglobulin E, serum ferritin, and blood hemoglobin. After adjusting for covariates, no association was found between S-25(OH)D and the prevalence of CDs. Conclusions: Lower levels of accumulated S-25(OH)D among immigrants may impact their health profile in terms of CD-related biomarkers, which partially explains immigrants' health deterioration over time. We recommend further longitudinal research to investigate immigrants' vitD and health deterioration.

Melanin levels in relation to vitamin D among first-generation immigrants from different ethnic groups and origins: A comparative national Canadian cross-sectional study.

Introduction: Immigrants to Western countries tend to have darker skin than native-born populations. We examined the relationship between skin melanin and serum vitamin D (vitD) [S-25(OH)D] levels and explored whether melanin levels explained S-25(OH)D variations between immigrants and native-born Canadians. This study offers novel findings as no such study has been conducted. Methods: We used a national cross-sectional population-based design with data from the Canadian Health Measures Survey (CHMS). Skin melanin levels among first-generation immigrants based on their ethnicity and origin/country of birth were compared with white and native-born populations. We assessed the association between S-25(OH)D and melanin after adjusting for independent variables related to S-25(OH)D, melanin level, and immigration status. Results: Of 11,579 participants, 21.9% were immigrants aged 3-79 years (mean age 39.23 years). Compared with non-immigrants, immigrants had lower S-25(OH)D levels (mean: 51.23 vs. 62.72; 95% CI: 8.37, 14.62; P < 0.001) but higher melanin levels (mean [SE]: 17.08 [0.25] vs. 16.29 [0.29]; 95% CI: -1.29, -0.281; P = 0.004). Melanin did not differ by length of stay in Canada but was weakly positively correlated (r = 0.088, P < 0.001) with S-25(OH)D. Sex (male), age (≥18 years), summer/fall seasons, sunlight exposure, sunscreen non-use, smoking, and alcohol consumption were associated with higher melanin levels, whereas indoor tanning use was not. Conclusion: Skin melanin levels were associated with sociodemographic and behavioral characteristics. Immigrants had higher melanin levels, but melanin did not differ by length of stay in Canada. The weak positive correlation between melanin and S-25(OH)D suggested confounding factors may impact the relationship between melanin levels, S-25(OH)D, and immigration status.

Vitamin D Status among First-Generation Immigrants from Different Ethnic Groups and Origins: An Observational Study Using the Canadian Health Measures Survey.

One in five Canadians are first-generation immigrants. Evidence suggests the baseline risk for vitamin D (vitD) deficiency is increased among immigrants who move from equatorial to northern countries. We investigated the prevalence and determinants of vitD deficiency/insufficiency among first-generation immigrants compared with native-born Canadians and identified explanatory covariables. We used a cross-sectional design with data from the national Canadian Health Measures Survey (Cycles 3 and 4) (11,579 participants aged 3-79 years). We assessed serum 25-hydroxyvitamin D (S-25(OH)D) levels, sociodemographic and environmental factors, immigration status, length of time in Canada, vitD-rich food intake, ethnicity, and place of birth. Immigrants had lower mean S-25(OH)D than non-immigrants (51.23 vs. 62.72 nmol/L, p < 0.001). Those with younger age at the time of immigration (<18 years) had a high risk for low vitD, and S-25(OH)D levels increased with the length of time they had lived in Canada. The highest deficiency levels were in immigrants born in Morocco, India, and Lebanon compared with native-born Canadians. Ethnicity was the factor most strongly associated with S-25(OH)D. Compared with the white ethnic grouping, the Japanese had the highest level of vitD deficiency, followed by Arabs and Southeast Asians. Ethnic variations, dietary intake, and lifestyle factors are the main predictors of/explanatory factors for vitD status among Canadian immigrants.

Effects of Diabetes Prevention Education Program for Overweight and Obese Subjects with a Family History of Type 2 Diabetes Mellitus: A Pilot Study from the United Arab Emirates.

OBJECTIVES: The association of obesity and family history of type 2 diabetes mellitus (T2DM) provides an opportunity for risk stratification and prevention, as these two conditions are the most well-known risk factors for T2DM. We aimed to test the feasibility and effects of a diabetes mellitus prevention education program designed for overweight and obese Emirati people with at least one parent with T2DM. METHODS: We conducted a pilot study using a pre-post design without a control arm at the Diabetes Center at Tawam Hospital in Al Ain, UAE. Overweight and obese subjects with at least one parent with T2DM were invited to participate. Three study assessments were conducted at baseline, three months, and six months including a questionnaire, anthropometry, and laboratory assessments. Interventions included three individualized or family-engaged counseling sessions based on the DiAlert protocol. The study outcomes included awareness of risks and prevention opportunities to T2DM, behavior changes in nutrition and exercise, decreased waist-circumference, and clinical/metabolic/inflammatory markers. Pre-post changes were analyzed using repeated-measures analysis of variance. RESULTS: One hundred twenty-two overweight or obese individuals were approached. Forty-four individuals met the eligibility criteria, and 32 individuals (35.0±9.0 years; 75.0% female) completed the study. At six months, there were significant improvements in the glycated hemoglobin levels (p = 0.007), high-density lipoprotein (p < 0.049), serum creatinine (p < 0.025), estimated glomerular filtration rate (p = 0.009), and adiponectin levels (p < 0.024). Sixteen of 32 participants had ≥ 2 cm reduction in waist circumference. They demonstrated notable physical and laboratory improvements in moderate-vigorous activity, average activity counts per day, tumor necrosis factor-alpha, and interleukin-6 total cholesterol, triglyceride, and low-density lipoprotein. CONCLUSIONS: Offering family-oriented diabetes education to people at risk for T2DM is well received and has favorable effects on relevant risk factors. Better testing with large-scale randomized controlled studies is needed, and implementing similar educational programs for the Emirati population seems warranted.

ALK inhibitors for non-small cell lung cancer: A systematic review and network meta-analysis.

BACKGROUND: We sought to assess the relative effects of individual anaplastic lymphoma kinase (ALK) inhibitors for the treatment of non-small cell lung cancer (NSCLC). METHODS: We searched MEDLINE, Embase, Cochrane CENTRAL, and grey literature (July 23, 2019) for randomized controlled trials (RCTs) that included participants with ALK- or ROS1-positive NSCLC who received any ALK inhibitor compared with placebo, another ALK inhibitor, or the same ALK inhibitor at a different dose. The primary outcome was treatment-related death. Secondary outcomes were overall survival (OS), progression-free survival (PFS), and serious adverse events. Data were pooled via meta-analysis and network meta-analysis, and risk of bias was assessed. PROSPERO: CRD42017077046. RESULTS: Thirteen RCTs reporting outcomes of interest among participants with ALK-positive NSCLC were identified. Treatment-related deaths were rare, with 10 deaths attributed to crizotinib (risk difference v. chemotherapy: 0.49, 95% credible interval [CrI] -0.16 to 1.46; odds ratio 2.58 (0.76-11.37). All ALK inhibitors improved PSF relative to chemotherapy (hazard ratio [95% CrI]: crizotinib 0.46 [0.39-0.54]; ceritinib 0.52 [0.42-0.64]; alectinib 300 BID 0.16 [0.08-0.33]; alectinib 600 BID 0.23 [0.17-0.30]; brigatinib 0.23 [0.15-0.35]), while alectinib and brigatinib improved PFS over crizotinib and ceritinib (alectinib v. crizotinib 0.34 [0.17-0.70]; alectinib v. ceritinib 0.30 [0.14-0.64]; brigatinib v. crizotinib 0.49 [0.33-0.73]; brigatinib v. ceritinib 0.43 [0.27-0.70]). OS was improved with alectinib compared with chemotherapy (HR 0.57 [95% CrI 0.39-0.83]) and crizotinib (0.68 [0.48-0.96]). Use of crizotinib (odds ratio 2.08 [95% CrI 1.56-2.79]) and alectinib (1.60 [1.00-2.58]) but not ceritinib (1.25 [0.90-1.74), increased the risk of serious adverse events compared with chemotherapy. Results were generally consistent among treatment-experienced or naïve participants. CONCLUSION(S): Treatment-related deaths were infrequent among ALK-positive NSCLC. PFS may be improved by alectinib and brigatinib relative to other ALK inhibitors; however, the assessment of OS is likely confounded by treatment crossover and should be interpreted with caution.

Study protocol: Worldwide comparison of vitamin D status of immigrants from different ethnic origins and native-born populations-a systematic review and meta-analysis.

BACKGROUND: A growing body of literature indicates that, worldwide, immigrants experience health deterioration after their arrival into their adopted country, and moreover, they have lower vitamin D compared to the native-born population. We plan to review if the levels of vitamin D are comparable between different ethnic groups in different regions of the world with those of native-born populations and to identify the possible associations between vitamin D deficiency and disease status among immigrants. METHODS/DESIGN: A systematic review and meta-analysis will be conducted following the methods of the Cochrane handbook for systematic reviews. A literature search was performed to identify studies on immigrants and vitamin D. The primary outcome is vitamin D levels, and the secondary outcome is any vitamin D deficiency-related disease. Study design and participant characteristics will be extracted, including ethnicity, country of birth and/or origin, and the host country. Descriptive and meta-analytic summaries of the outcomes will be derived. Distiller-SR and RevMan will be used respectively for data management and meta-analysis. DISCUSSION: This systematic review may partially help clarify vitamin D-related health deterioration in migrants; moreover, to develop a global guideline that specifies sub-populations, in which the evidence and vitamin D-related recommendations might differ from the overall immigrant population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018086729.

Correction: Screening for osteoporosis: A systematic assessment of the quality and content of clinical practice guidelines, using the AGREE II instrument and the IOM Standards for Trustworthy Guidelines.

[This corrects the article DOI: 10.1371/journal.pone.0208251.].

Association between Depression and Factors Affecting Career Choice among Jordanian Nursing Students.

BACKGROUND: Although stress reaction is high among nursing staff and nursing students in the Middle East and its effect on life is known, there are scant studies reporting on these clinical and social features. In addition, there are no studies reporting on factors that influence career choice among this group. AIM: This study aimed to investigate factors that influence career choice among nursing students and their possible association with depressive symptoms. METHOD: Participants were 150 (84.7% response rate) nursing students randomly selected from each academic year at the Nursing College/Jordan University of Science and Technology. Participants consented and completed the socio-demographic data collection sheet. The Arabic version of the Beck Depression Inventory-II Scale was used to assess participants with respect to depressive symptoms. A modified list of factors influencing career choice and a Likert scale to assess the level of sadness and the degree of religiosity were used as well. RESULTS: Students ranked the most important three factors influencing their career selection as family decision, religious factors, and the desire to care for others. The prevalence of depression among the sample was 26%. Students who had a desire to care for others were less likely to suffer from depression and those who chose nursing as their career due to religious factors were significantly less depressed than those who did not. Meanwhile, students who chose nursing under family pressure or because of a lack of alternative opportunities were more depressed. The odds ratio for depressive symptoms was 0.24 when students chose nursing because of religious factors, whereas it was 4.92 when the family strongly influenced the student's career decision and 3.61 when a nursing career was the only perceived opportunity available. CONCLUSION: The main factors associated with depression among this sample of nursing students were pressure from their family to choose a nursing career and having no other career or employment opportunities. Religiosity was negatively associated with depression and may act as a protective factor; however, future studies using longitudinal designs will need to confirm this hypothesis.

Molecular and cellular response of earthworm Eisenia andrei (Oligochaeta, Lumbricidae) to PCDD/Fs exposure.

The acute toxicity of polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs) was investigated in the earthworm Eisenia andrei using filter paper toxicity test. Protein content, catalase (CAT) activity, and histology of intestinal wall (chloragogen cells and intestinal epithelium) were investigated in earthworms exposed for 48 h to 0 (control), 0.5, 1.0, and 1.5 ng/cm2 PCDD/Fs. The results showed an increase in the total protein content 1.56- (p = 0.104), 1.66- (p = 0.042), and 2.26-fold (p < 0.001), respectively, compared to control. The average ± standard deviation of tissular CAT activity showed no significant differences; it was 36.01 ± 7.65, 36.17 ± 9.45, 36.08 ± 9.80, and 40.01 ± 6.98 U/g tissue, respectively. However, the average specific activity of CAT ± standard deviation was significantly decreased (p < 0.001) at all doses compared to control; it was 2.93 ± 0.42, 1.93 ± 0.53, 1.80 ± 0.38, and 1.53 ± 0.44 U/mg protein, respectively. There was a progressive damage in both of the intestinal villi and the chloragogenous tissue associated with the incrementing doses. Since the toxic mixture altered the investigated biomarkers of E. andrei within 48 h, the cellular and molecular alterations resulted from the filter paper contact test could be utilized as a rapid toxicity assessment tool of environmental contamination with dioxins/furans and to assess consequent potential adverse effects on soil biota and other organisms in the ecosystem.

Secondary association of PDLIM5 with paranoid schizophrenia in Emirati patients.

Schizophrenia is a clinically and genetically heterogeneous disorder of unknown etiology. PDLIM5 variants have been linked to schizophrenia and other related neuropsychiatric disorders and upregulated in the brain of schizophrenia patients suggesting a possible pathogenic role in disease progression. The aim of this study is to examine the potential association of schizophrenia in Emirati patients with previously reported variants in PDLIM5, PICK1, NRG3 or DISC1 genes. Consequently, we found a secondary association between PDLIM5 variants and the paranoid subtype of schizophrenia in Emirati Arabs suggesting that PDLIM5 may represent a determinate/marker for schizophrenia subtype specification. However, no associations were found with variants in PICK1, NRG3 or DISC1 genes.

Behavioral correlation with television watching and videogame playing among children in the United Arab Emirates.

OBJECTIVE: Television viewing and videogame use (TV/VG) appear to be associated with some childhood behavioral problems. There are no studies addressing this problem in the United Arab Emirates. METHODS: One hundred ninety-seven school children (mean age, 8.7 ± 2.1 years) were assessed. Child Behavior Checklist (CBCL) subscale scores and socio-demographic characteristics were compared between children who were involved with TV/VG more than 2 hours/day and those involved less than 2 hours/day (the recommended upper limit by The American Academy of Pediatrics). RESULTS: Thirty-seven percent of children who were involved with TV/VG time of more than 2 hours/day scored significantly higher on CBCL syndrome scales of withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, internalizing problems, externalizing problems and the CBCL total scores compared with their counterparts. Moreover, these children were younger in birth order and had fewer siblings. After controlling for these confounders using logistic regression, we found that TV/VG time more than 2 hours/day was positively associated with withdrawn (p = 0.008), attention problem (p = 0.037), externalizing problems (p = 0.007), and CBCL total (p = 0.014). CONCLUSION: Involvement with TV/VG for more than 2 hours/day is associated with more childhood behavioral problems. Counteracting negative effects of the over-involvement with TV/VG in children requires increased parental awareness.

Learning disorder and blood concentration of heavy metals in the United Arab Emirates.

Children are frequently exposed to toxic metals in the environment, and their developing central nervous system is particularly vulnerable to their effects. This study examined the blood level of heavy metals in children with learning disorder (LD) as compared to children without LD in the United Arab Emirates (UAE). Significantly high blood concentrations of seven heavy metals were found in children with LD. Further analysis using forward stepwise logistic regression showed that molybdenum levels and family history of developmental problems were the best predictors of LD. Our findings suggest the need for monitoring for toxic metals in the environment.

Suicidal behavior and attitudes among medical students in the United Arab Emirates.

BACKGROUND: Few studies have investigated suicidal behavior and attitudes of medical students. We are not aware of any previous reports emerging from the Arab world. AIMS: To investigate suicidal behavior and attitudes among medical students in the United Arab Emirates (UAE). METHOD: The prevalence of suicidal ideation and attempts as well as attitudes toward suicide and reactions to a hypothetical suicidal friend were assessed using a self-report survey. Furthermore, the survey included the self-assessment of the current mood and religiosity, and socio-demographic information. RESULTS: A group of 115 medical students (mean age 20.7 years, 59.1% female) participated in the survey. The prevalence of lifetime suicidal ideation was 17.5% and of suicide attempts 1.8%. In general, students showed very low acceptability of suicide, strong beliefs in the punishment after death, and highly endorsed communicating problems with parents. Moreover, high acceptance of and support for a suicidal friend were found. Sadness was associated with higher acceptability of suicide and fewer beliefs in punishment after death. Religiosity was associated with less acceptability of suicide, seeing suicide in context of mental illness, communicating problems with parents, and greater support for a suicidal friend. CONCLUSIONS: The prevalence of suicidal ideation and attempts among medical students in the UAE was in the lower range in international comparison. Negative attitudes toward suicide were accompanied by a strong support for a suicidal friend, and both were related to religiosity.

Suicide rates in the national and expatriate population in Dubai, United Arab Emirates.

BACKGROUND: Reports on suicide from the Gulf region are scarce. Dubai is a city with a large expatriate population. However, total and gender-specific suicide rates for the national and expatriate populations are not known. AIMS: To investigate total and gender-specific suicide rates in the national and expatriate population in Dubai and to elicit socio-demographic characteristics of suicide victims. METHODS: Registered suicides in Dubai from 2003 to 2009, and aggregated socio-demographic data of suicide victims were analysed. Suicide rates per 100,000 population were calculated. RESULTS: Suicide rate among expatriates (6.3/100,000) was seven times higher than the rate among the nationals (0.9/100,000). In both groups, male suicide rate was more than three times higher than the female rate. Approximately three out of four expatriate suicides were committed by Indians. The majority of suicide victims were male, older than 30 years, expatriate, single and employed, with an education of secondary school level and below. CONCLUSION: Further research on risk factors for and protective factors against suicide, particularly among the expatriate population, is needed. Epidemiological monitoring of suicide trends at the national level and improvement of UAE suicide statistics would provide useful information for developing suicide prevention strategies.

Attention deficit hyperactivity disorder and environmental toxic metal exposure in the United Arab Emirates.

No systematic studies have been carried out on the effects of toxic metals on childhood behavior in the Gulf Region including the UAE. The relationship between blood levels of heavy metals and Attention Deficit Hyperactivity disorder (ADHD) were explored in school-aged children of UAE and it was found that increased blood concentrations of lead (Pb), manganese (Mn) and zinc (Zn) were significantly associated with ADHD. The findings suggest that monitoring for exposure to heavy metal levels and education on potential child health hazards related to them are indicated.

Help-seeking behaviour of patients attending the psychiatric service in a sample of United Arab Emirates population.

BACKGROUND: Many patients suffering from psychiatric disorders seek non-professional care before attending specialized services. AIMS: To study the help-seeking behaviour of patients referred to the psychiatric department of Al-Ain Hospital, which is the main university teaching hospital in UAE. METHODS: This study was a descriptive cross-sectional epidemiological survey. All new patients attending the psychiatry out-patient clinic at Al-Ain Hospital were screened for nine consecutive months from March to November 2003 inclusive. RESULTS: The sample consisted of 106 patients (52 male; 54 female). Prior to presenting to the psychiatric service, 44.8% consulted faith healers, 31% of whom had had a previous experience with them; 45% reported some improvement but their symptoms recurred later, while 47% reported no improvement. In 8% their symptoms worsened for the current episode. Treatments received were herbal (29.8%) and prayer (70.2%). Of the sample, 43.4% consulted a primary care physician before presenting to the secondary psychiatric care. CONCLUSION: In this sample a sizable number of patients sought alternative methods of treatment before attending the specialized psychiatric services.