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The exposure of concrete to elevated temperatures is known to cause diverse severe damages in concrete composites. Hence, measures to improve the performance of concrete during exposure to fire are continually proposed. The present study investigated the postfire residual strength and morphology of concrete incorporating natural rubber latex exposed to elevated temperature. Four different concrete mixes were considered for the investigation, namely, a control sample made without natural rubber latex, the second sample containing 1% natural rubber latex, the third sample containing 1.5% natural rubber latex, and the fourth sample containing 3% of natural rubber latex. The concrete samples (150 mm cubes and 100 × 200 mm cylinders) were exposed to varying temperatures 300°C, 800°C, and 1000°C, after the curing process. Nondestructive tests using Schmidt rebound hammer and ultrasonic pulse tester were carried out on samples. The compressive strength and split-tensile strength of concrete cubes and cylinders, respectively, were determined. Micrographs and elemental distribution in the sample were studied using the scanning electron microscopy (SEM-EDX) apparatus. It could be seen from the results that the concrete strength properties reduced as the exposure temperature increased. The results also showed that NRL could be sparingly utilized as a concrete admixture, at 1% content. The performance of concrete was not stable at over 300°C when NRL addition was above 1%.

The World Health Organization (WHO) MPOWER measures are a set of highly effective tobacco control measures drawn from the WHO Framework Convention on Tobacco Control (FCTC), designed to help countries reduce the prevalence of tobacco use. The WHO Report on the Global Tobacco Epidemic is published biennially to monitor global implementation of these measures.This review aimed to critically assess the status of MPOWER implementation in the Eastern Mediterranean Region.Data were collected for WHO Reports on the Global Tobacco Epidemic, focusing on the most recent 2019 edition. Regional population coverage figures were calculated using this data and population figures for the countries of the Region.Between 2007 and 2018, for any MPOWER measure, there were 29 cases of countries progressing to the highest level of achievement; 23 cases of countries progressing to the intermediate levels from the lowest level; 12 cases of countries falling from the highest level; and 18 cases of countries falling to the lowest level. 57.7% of people are covered at the highest level for the monitoring measure; 63.7% for the smoke-free policies measure; 6.7% for the cessation measure; 60.7% for the health warnings measure; 37.4% for the mass media measure; 29.4% for the advertising bans measure; and 16.1% for the taxation measure.Countries must work comprehensively to improve tobacco control. Regional priorities should include lifting more people out of lowest level coverage for the health warnings and mass media measures, increasing taxation on tobacco products and improving access to cessation services.وضع مكافحة التبغ في إقليم شرق المتوسط: تقدم في تطبيق التدابير الستة (MPOWER).فاطمة العوا، دوجلاس بيتشير، جواد اللواتي، رءوف الابشيهي، هبة جودة، تشارلز فريزر.تدابير منظمة الصحة العالمية الستة هي مجموعة من التدابير ذات الكفاءة العالية لمكافحة التبغ، وهي مبنية على اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ، وتهدف إلى مساعدة البلدان على تقليص معدل انتشار تعاطي التبغ. ويُنشَ تقرير منظمة الصحة العالمية بشأن وباء التبغ العالمي كل عامين بغرض رصد تطبيق هذه التدابير على مستوى العالم.هدف هذا الاستعراض إلى إجراء تقييم نقدي لحالة تطبيق التدابير الستة في إقليم شرق المتوسط.جُعت البيانات نحو إعداد تقارير منظمة الصحة العالمية بشأن وباء التبغ العالمي، مع التركيز على أحدث نسخة لعام 2019. وحُسبت أرقام التغطية السكانية الإقليمية باستخدام هذه البيانات وأرقام تعداد السكان لبلدان الإقليم.كانت هناك 29 حالة لبلدان تتقدم نحو أعلى مستويات الإنجاز، و23 حالة لبلدان تتقدم من أدنى المستويات نحو مستويات متوسطة، و12 حالة لبلدان تهبط من أعلى المستويات، و18 حالة لبلدان تهبط إلى أدنى المستويات، وذلك بين عامي 2007 و2018 وفيما يخص أي تدبير من مجموعة التدابير الستة. وشملت أعلى مستويات تدبير الرصد 57.7٪ من الأشخاص، و63.7٪ في تدبير السياسات الخاصة بالأماكن الخالية من التدخين، و6.7٪ في تدبير الإقلاع عن التدخين، و60.7٪ في تدبير التحذيرات الصحية، و37.4٪ في تدبير وسائل الإعلام، و29.4٪ في تدبير حجب الدعاية للتبغ، و16.1٪ في تدبير فرض الضرائب.يتعين على البلدان العمل بشمولية من أجل تحسين مكافحة التبغ. وينبغي أن تتضمن الأولويات الإقليمية رفع المزيد من الأشخاص من أدنى مستويات التغطية في تدابير التحذيرات الصحية ووسائل الإعلام، وزيادة الضرائب على منتجات التبغ، وتحسين الوصول إلى خدمات الإقلاع عن التدخين.Situation de la lutte antitabac dans la Région de la Méditerranée orientale : progrès dans la mise en œuvre des mesures MPOWER.Les mesures MPOWER mises en place par l’Organisation mondiale de la Santé (OMS) constituent un ensemble de recommandations très efficaces en matière de lutte antitabac issues de la Convention-cadre de l’OMS pour la lutte antitabac, destinée à aider les pays à réduire la prévalence de la consommation de tabac. Le rapport de l’OMS sur l’épidémie mondiale de tabagisme est publié tous les deux ans afin de suivre la mise en œuvre au niveau mondial de ces mesures.La présente étude avait pour objectif d’évaluer de manière critique la situation concernant la mise en œuvre des mesures MPOWER dans la Région de la Méditerranée orientale.Les données ont été collectées en vue de la rédaction des rapports de l’OMS sur l’épidémie mondiale de tabagisme, en privilégiant l’édition 2019 qui est la plus récente. Les chiffres concernant la couverture de la population régionale ont été calculés à l’aide de ces données et des chiffres de la population des pays de la Région.Entre 2007 et 2018, pour toute mesure MPOWER, on a observé 29 cas de pays ayant progressé au plus haut degré d’exécution ; 23 cas de pays étant passé du niveau le plus faible au niveau intermédiaire ; 12 cas de pays ayant régressé par rapport au plus haut niveau ; et 18 cas de pays ayant régressé au degré le plus bas. Cinquante-sept pour cent de la population est couverte au plus haut niveau d’exécution en ce qui concerne la mesure de suivi ; 63,7 % concernant la mesure relative aux politiques sur les environnements sans fumée ; 6,7 % pour la mesure relative au sevrage ; 60,7 % concernant la mesure relative aux mises en garde sanitaires ; 37,4 % concernant la mesure relative aux médias ; 29,4 % concernant la mesure relative à l’interdiction de la publicité et 16,1 % concernant la mesure relative à la taxation.Les pays doivent travailler de manière globale afin de renforcer la lutte antitabac. Les priorités régionales devraient inclure le passage du niveau de couverture le plus bas à un niveau supérieur pour un plus grand nombre de personnes en ce qui concerne les mesures relatives aux mises en garde sanitaires et aux médias, l’augmentation de la taxation sur les produits du tabac et l’amélioration de l’accès aux services de sevrage.

Push-out-shear tests were used in this study to analyze lag screw connections in timber-concrete composite (TCC) slabs based on the embedment depth. The goal of this research is to look into the relationship between shear capacity and embedment depth in TCC, as well as to investigate the embedment strength of the wood. Experiments were carried out at different embedment depths (5.08 cm, 7.0 cm, and 8.9 cm). The prepared samples were examined in order to determine the failure modes and provide an accurate assessment of the influence of embedment depth on TCC slabs. The investigation on the embedment strength of the wood was performed then for the analysis of the crushing of wood fibers, lag screw yielding strength, and maximum load applied at embedment depths of 6.6 cm and 7.0 cm. The results indicate that between 5.08 cm and 7.0 cm, there was an apparent improvement in the relationship between embedment depth (ED) and shear capacity of TCC slabs in terms of the shear strength, while a significant difference was observed between 7.0 cm and 8.9 cm. The study suggests that the ED of the TCC slab should be maintained at around 7.33 times the diameter of the lag screw.

Objective: To evaluate the association of dual versus single antiplatelet therapy with major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Subjects and Methods: Data were analyzed from 3,559 patients with a diagnosis of ACS admitted to 29 hospitals in 4 Arabian Gulf countries (Bahrain, Kuwait, Oman, and United Arab Emirates) from January 2012 to January 2013. Dual antiplatelet therapy (DAPT), consisting of aspirin and clopidogrel, was compared to aspirin alone. MACE included 12-months cumulative stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons, post discharge. Analyses were performed using multivariable logistic regression. Results: A total of 74% (n = 2,634) of the patients were on DAPT. At 12-month follow-up, patients on DAPT were significantly less likely to experience MACE events (adjusted OR [aOR] 0.73; 95% CI: 0.61–0.86; p < 0.001). Lower cardiovascular (CV) event rates were also consistent across the following MACE components; MI (aOR 0.66; 95% CI: 0.49–0.88; p = 0.005), all-cause mortality (aOR 0.69; 95% CI: 0.51–0.94; p = 0.018), and readmissions for cardiac reasons (aOR 0.79; 95% CI: 0.66–0.95; p = 0.011). Conversely, DAPT was adversely associated with increased risk of stroke/TIA (aOR 1.68; 95% CI: 1.05–2.69; p = 0.030). Conclusions: DAPT, compared to aspirin therapy alone, was generally associated with better CV outcomes after an ACS event. However, DAPT was adversely associated with increased risk of stroke/TIA in ACS patients in the Arabian Gulf.

Objectives: We sought to investigate the epidemiology of lung cancer and its trends in Oman over 20 years. Methods: We analyzed all cases of primary lung cancer reported to the Oman National Cancer Registry between 1996 and 2015. The World Standard Population was used to obtain age-standardized incidence rates (ASR) of lung cancer per 100 000. Analyses were conducted using univariate statistics. Results: A total of 956 cases of primary lung cancer cases were registered in Oman between 1996 and 2015, with a male to female ratio of 3:1. In men, the ASR was 8.2 per 100 000, while in females it was 2.6 per 100 000 over the entire study period. There were no statistically significant differences in the ASR among men or women when the data was divided over three calendar periods (1996–2005, 2006–2015, and 1996–2015) (p= 0.332 and p=0.577, respectively). There was also no increasing trend in the incidence of lung cancer. The risk of lung cancer onset commenced in the 30–34 year age group and the mean age at diagnosis was 60.0 years for men and 61.0 years for women. Adenocarcinoma was the most common type of lung cancer among Omanis with a higher proportion in females compared to males. Conclusions: Oman has one of the lowest incidence rates of lung cancer in the world with no evidence of an increasing trend of this cancer type. This could be attributed to low uptake of tobacco smoking among both sexes. National authorities should capitalize on this finding to avoid any future lung cancer epidemics especially those driven by tobacco use.

The Sultanate of Oman has experienced rapid development over the last thirty years and has constructed environmentally friendly and sustainable infrastructure while it continues to find economical alternative resources to achieve the goals of the Oman 2040 vision. The primary concerns are preserving natural resources and reducing the impact of carbon dioxide (CO₂) emissions on the environment. This review aims to encourage the sustainable use of reclaimed asphalt pavement (RAP) materials in pavement construction and focuses primarily on employing RAP materials in new pavement projects. Currently, new construction projects utilise a significant percentage of demolished asphalt pavement to save costs and natural resources. The key issue that arises when mixing RAP into new asphalt mixtures is the effects on the mixtures’ resistance to permanent disfigurements, such as fatigue cracks, that influence asphalt mixture performance. Numerous studies have assessed the impact of using RAP in asphalt mixtures and found that RAP increases the stiffness of asphalt mixtures, and thus improves rutting resistance at high temperatures. Nevertheless, the findings for thermal and fatigue cracking were found to be contradictory. This review will address the primary concerns regarding the use of RAP in asphalt pavements, and aims to encourage highway agencies and academic researchers in the Gulf countries to develop frameworks for the practical usage of RAP in the construction of sustainable pavement systems.

Aims/Introduction To investigate and forecast type 2 diabetes mellitus epidemic, its related risk factors and cost in Oman by 2050. Materials and Methods An age‐structured mathematical model was used to characterize type 2 diabetes mellitus epidemiology and trends in Oman between 1990 and 2050. The model was parametrized using current and quality data, including six nationally representative population‐based epidemiological surveys for type 2 diabetes mellitus and its key risk factors. Results The projected type 2 diabetes mellitus prevalence increased from 15.2% in 2020 to 23.8% in 2050. The prevalence increased from 16.8 and 13.8% in 2020 among women and men to 26.3 and 21.4% in 2050, respectively. In 2020, 190,489 Omanis were living with type 2 diabetes mellitus compared with 570,227 in 2050. The incidence rate per 1,000 person‐years changed from 8.3 in 2020 to 12.1 in 2050. Type 2 diabetes mellitus’ share of Oman’s national health expenditure grew by 36% between 2020 and 2050 (from 21.2 to 28.8%). Obesity explained 56.7% of type 2 diabetes mellitus cases in 2020 and 71.4% in 2050, physical inactivity explained 4.3% in 2020 and 2.7% in 2050, whereas smoking accounted for, The prevalence of type 2 diabetes mellitus in Oman was projected to grow by 57% by 2050, whereas the incidence was projected to grow by 200% by 2050. By 2050, type 2 diabetes mellitus will consume 30% of Oman’s health expenditure. The type 2 diabetes mellitus epidemic in Oman is driven by the high obesity level.

Objectives: We sought to investigate the epidemiology of thyroid cancer and its trends in Oman over a 20-year period. Methods: We analyzed all cases of primary thyroid cancer reported to the Oman National Cancer Registry between 1996 and 2015. Age-standardized incidence rates (ASR) were calculated using the World Standard Population. Joinpoint regression was used to assess trends and obtain annual percentage changes (APC) in incidence rates with 95% confidence intervals (95% CI) and p-values at the alpha = 0.050 level. Gender-specific APC was used to project thyroid cancer incidence rates in Oman over the next 20 years. Population attributable fraction was calculated for obesity and current non-smoking. Results: A total of 1285 cases of primary thyroid cancer cases were registered in Oman between 1996 and 2015, with a female to male ratio of 4:1. In men, the ASR was 2.0 per 100 000 while in females it was 7.6 per 100 000 (p < 0.010). Over 80.0% of thyroid tumors were of a papillary type and 19.0% follicular type. Statistically significant trends for thyroid cancer were detected in women from 2008–2015 (APC = 14.3%, 95% CI: 8.0–20.9, p < 0.010) and among both genders (APC = 16.7%, 95% CI: 4.9–29.9, p < 0.010). If current trends continue, thyroid cancer incidence will increase to 3.1, 16.6, and 11.8 per 100 000 by 2040 in men, women, and both genders, respectively. Nearly 10.0% of thyroid cancer can be prevented by controlling obesity in the Omani population. Conclusions: Oman has had moderate incidence rates of thyroid cancer with an increasing trend among women. Since projections estimate that the rates of this disease will double in women over the next 20 years, health authorities should consider providing sufficient resources to manage this condition and establish prevention programs that address obesity as part of the strategy for the prevention and control of noncommunicable diseases.

Objectives: We sought to develop and validate a diabetic risk score model as a non-invasive and self-administered screening tool to be used in the general Omani population. Methods: The 2008 World Health Survey (WHS) data from Oman (n = 2720) was used to develop the risk score model. Multivariable logistic regression with the backward stepwise method was implemented to obtain risk factors regression coefficients for sex, age, educational attainment, marital status, place of residence, hypertension, body mass index (BMI), waist circumference, tobacco use, daily fruit and vegetable intake, and weekly physical activity. The model coefficients were multiplied by a factor of five to allocate each variable category a risk score. The total score was calculated as the sum of these individual scores. The score was validated using another Omani cohort (Sur Survey 2006 dataset, n = 1355) by calculating the area under the receiver-operating characteristic (ROC) curve (AUC), and optimal score sensitivity and specificity were determined. Results: A robust diabetes risk score model was produced composed of eight variables (age, sex, education level, marital status, place of residence, hypertension, smoking status, and BMI) with an optimal cutoff point of ≥ 15 to classify persons with possible prevalent type 2 diabetes mellitus (T2DM). At this cutoff point, the model had a sensitivity of 71.1%, specificity of 74.4%, and AUC of 0.80 (95% confidence interval (CI): 0.78–0.82), when internally validated (in the WHS 2008 cohort). When the model was externally validated (using the Sur 2006 cohort), the optimal cutoff point for the score was ≥ 13, with a lower sensitivity (54.0%), higher specificity (79.0%), and an AUC of 0.74 (95% CI: 0.70–0.78). In contrast, the test of the old Omani, Kuwaiti, Saudi, and Finnish diabetes risk scores in our study populations showed poor performance of these models among Omanis with poor sensitivity (29% to 63.5%) and reasonable specificity (70% to 80%). Conclusions: The developed diabetes risk score for screening prevalent T2DM, provides an easy-to-use self-administered tool to identify most individuals at risk of this condition in Oman. The score incorporates eight diabetes-associated risk factors that can also act as a tool to increase people’s awareness about the importance of diabetes-related risk factors and provide information for policymakers to establish diabetes prevention programs.

AIMS To evaluate the impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs)/ Angiotensin Receptors Blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in Acute Heart Failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East. METHODS AND RESULTS Data was analysed from 2,683 consecutive patients admitted with AHF and Left Ventricular Ejection Fraction (LVEF) (

Cancer (IARC) estimated that over 18 million new cases of cancer were diagnosed and nearly 10 million people lost their lives to this group of diseases. Yet, cancer is not invincible and can be abated through effective cancer control programs that implement evidence-based strategies for prevention, early detection, treatment, palliation, and making the best use of available resources. Such programs aim to reduce cancer incidence, its associated morbidity and mortality, and improve quality of life. However, this requires careful planning, continuous monitoring and evaluation of processes, and output and outcome indicators to assess whether program objectives are achieved. One of the most common methods to obtain such indicators is through cancer surveillance systems in the form of population-based cancer registries that systematically collect, analyze, and report cancer data of a well-defined geographical area.

Tobacco use is the world’s leading cause of preventable morbidity and mortality. Although Oman remains a country with the lowest tobacco use in the Arab Gulf States, the prevalence of tobacco use is projected to increase to 33.3% by 2025. In 2005, Oman acceded to the World Health Organization’s Framework Convention on Tobacco Control, an international treaty with numerous obligations aiming to reduce the global burden of tobacco use. This paper documents, for the first time, Oman’s experience in tobacco control by providing a descriptive analysis of the evolution of tobacco control policies in relation to the country’s international obligations. In order to curb tobacco use and maintain current low prevalence levels, the paper concludes that Oman needs to accelerate action in adopting the highest attainable policies recommended by the World Health Organization’s MPOWER package.

We investigated the role of systolic blood pressure (SBP) in relation to in-hospital and postdischarge mortality in patients admitted with acute heart failure (AHF). The SBP of 4848 patients aged ≥18 years admitted with AHF was categorized into 5 groups: ≤90, 91 to 119, 120 to 139, 140 to 161, and >161 mm Hg. After adjusting for several confounders, multivariate logistic regression models showed that admission SBP was a significant predictor of mortality among both patients with preserved left ventricular function (defined as left ventricular ejection fraction [LVEF] ≥40%) and patients with left ventricular dysfunction (LVEF 161 mm Hg), respectively. We conclude that low admission SBP is an independent predictor of mortality in patients with AHF. The higher the admission SBP, the better the prognosis, regardless of age or LVEF.

WHO MPOWER aims to help countries prioritize tobacco control measures in line with the WHO Framework Convention on Tobacco Control.This paper assessed the progress and challenges in implementing the 6 priority policies of MPOWER in countries of the WHO Eastern Mediterranean Region since 2011.A checklist was developed and scores assigned based on the MPOWER indicators (maximum score 37). MPOWER data for the Region in the 2015 and 2017 tobacco control reports were extracted and scored. Data from similar analyses for 2011 and 2013 were also included. Countries were ranked by scores for each indicator for 2015 and 2017 and for overall scores for 2011 to 2017.The Islamic Republic of Iran, Egypt and Pakistan had the highest scores in 2015 (33, 29 and 27 respectively) and the Islamic Republic of Iran, Pakistan and Yemen had the highest scores in 2017 (34, 31 and 27 respectively). The indicators with the highest and lowest combined score for all countries were for advertising bans and compliance with smoke-free policies: 67 and 18 respectively in 2015, and 73 and 15 respectively in 2017. Most countries (15/22) had higher total scores in 2017 than 2015: Afghanistan, Bahrain and Syrian Arab Republic had the greatest increases. The total score for the Region increased from 416 out of a maximum score of 814 in 2011 to 471 in 2017.Although notable achievements have been made in the Region, many challenges to policy implementation remain and require urgent action by governments of the countries of the Region.مبادرة التحرّر من التبغ، الاحتياجات والتحديات: الاتجاهات السائدة في تنفيذ اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ في إقليم شرق المتوسط.غلام رضا حيدري، غازي زعتري، جواد بن أحمد اللواتي، فاطمة العوا، هبة فؤاد.تهدف مبادرة منظمة الصحة العالمية للتحرّر من التبغ إلى تحديد الأولويات المتعلقة بتدابير مكافحة التبغ تمشياً مع اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ. ولقد قامت هذه الدراسة بتقييم التقدم المحرز والتحديات المُصادفة في تنفيذ السياسات الست ذات الأولوية لمبادرة التحرر من التبغ في بلدان إقليم شرق المتوسط منذ عام 2011.تم تصميم قائمة مرجعية وإسناد درجات على أساس مؤشرات مبادرة التحرر من التبغ (بحد أقصى 37 درجة). واشتُقّت بيانات المبادرة المتعلقة بالإقليم في عامي 2015 و 2017 والواردة في تقارير مكافحة التبغ وأسندت إليها درجات. كما أُدرجت بيانات مشتقة من تحليلات مماثلة لعامي 2011 و 2013. وصُنفت البلدان حسب الدرجات المسندة لكل مؤشر لعامي 2015 و 2017 وحسب المجموع الكلي للدرجات في الفترة من 2011 إلى 2017.سجّلت جمهورية إيران الإسلامية ومصر وباكستان أعلى الدرجات في عام 2015 (33 و 29 و 27 درجة على التوالي)، في حين سجّلت جمهورية إيران الإسلامية وباكستان واليمن أعلى الدرجات في عام 2017 (34 و 31 و 27 درجة على التوالي). وسجّل مؤشراً حظر الإعلان عن التبغ والامتثال لسياسات حظر التدخين أعلى وأدني درجة مجمّعة لجميع البلدان (67 و 18 على التوالي) في عام 2015 و (73 و 15 على التوالي) في عام 2017. وحقق معظم البلدان (15/22) مجموع درجات أعلى في عام 2017 منه في عام 2015 : حيث سجلت الجمهورية العربية السورية وأفغانستان والبحرين أعلى الزيادات. وارتفع مجموع درجات الإقليم من 416 درجة، من أصل 814 وهي الدرجة القصوى في عام 2011 ، إلى 471 درجة في عام 2017.على الرغم من الإنجازات المهمة التي تحقّقت في الإقليم، لا يزال هناك الكثير من التحديات القائمة على مستوى تنفيذ السياسات، وهو ما يتطلب اتخاذ إجراءات عاجلة من جانب حكومات دول الإقليم.Programme MPOWER – besoins et défis : tendances dans la mise en oeuvre de la Convention-cadre de l’OMS pour la lutte antitabac dans la Région de la Méditerranée orientale.Le programme MPOWER de l’OMS vise à aider les pays à accorder la priorité aux mesures de lutte antitabac, conformément à la Convention-cadre de l’OMS pour la lutte antitabac.La présente étude a évalué les progrès et les défis de la mise en oeuvre des six politiques prioritaires du programme MPOWER dans les pays de la Région OMS de la Méditerranée orientale depuis 2011.Une liste de contrôle a été mise au point et des scores ont été assignés sur la base des indicateurs MPOWER (score maximum de 37). Des données sur le programme MPOWER dans la Région en 2015 et en 2017 publiées dans des rapports sur la lutte antitabac ont été extraites et se sont vues attribuer une note. Des données issues d’analyses similaires pour les années 2011 et 2013 ont également été incluses. Les pays ont été classés selon les notes attribuées pour chaque indicateur pour 2015 et 2017, et pour l’ensemble des scores pour 2011 et 2017.La République islamique d’Iran, l’Égypte et le Pakistan ont obtenu les scores les plus élevés pour 2015 (33, 29 et 27 respectivement), et la République islamique d’Iran, le Pakistan et le Yémen ont obtenu les scores les plus élevés pour 2017 (34, 31 et 27 respectivement). Les indicateurs comportant les scores combinés les plus élevés et les plus bas pour l’ensemble des pays concernaient les interdictions de publicité et la conformité avec les politiques non-fumeur en 2015 (67 et 18 respectivement) et en 2017 (73 et 15 respectivement). La plupart des pays (15/22) ont obtenu des scores totaux plus élevés en 2017 qu’en 2015 : l’Afghanistan, Bahreïn et la République arabe syrienne, affichaient les augmentations les plus importantes. Le score total pour la Région a connu une augmentation, passant de 416 pour un score maximum de 814 en 2011, à 471 en 2017.Bien que des réalisations considérables soient à noter dans la Région, de nombreux défis entravant la mise en oeuvre des politiques demeurent et requièrent une intervention de toute urgence au niveau des gouvernements des pays de la Région.

Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.

We compared baseline characteristics, clinical presentation, and in-hospital outcomes between Middle Eastern Arabs and Indian subcontinent patients presenting with acute coronary syndrome (ACS). Of the 7930 patients enrolled in Gulf Registry of Acute Coronary Events II (RACE II), 23% (n = 1669) were from the Indian subcontinent. The Indian subcontinent patients, in comparison with the Middle Eastern Arabs, were younger (49 vs 60 years; P < .001), more were males (96% vs 80%; P < .001), had lower proportion of higher Global Registry of Acute Coronary Events risk score (8% vs 27%; P < .001), and less likely to be associated with diabetes (34% vs 42%; P < .001), hypertension (36% vs 51%; P < .001), and hyperlipidemia (29% vs 39%; P < .001) but more likely to be smokers (55% vs 29%; P < .001). After multivariable adjustment, the Middle Eastern Arabs were less likely to be associated with in-hospital congestive heart failure (odds ratio [OR], 0.65; 95% confidence interval [CI]: 0.50-0.86; P = .003) but more likely to be associated with recurrent ischemia (OR 1.33; 95% CI: 1.03-1.71; P = .026) when compared to the Indian subcontinent patients. Despite the baseline differences, there were largely no significant differences in in-hospital outcomes between the Indians and the Middle Eastern Arabs.

Hypertension is a significant predictor for cardiovascular diseases and is the most important preventable or modifiable cause of morbidity and mortality from these diseases. Undiagnosed cases of hypertension and poor control are important factors in controlling hypertension worldwide, including Oman.The aim of this study was to identify the important risk factors and predictors of the state of unawareness of the presence of hypertension, as well as the risk factors for poor control of blood pressure, among hypertensive patients.Data from Oman World Health Survey (OWHS), 2008, were used in this study. The OWHS adopted a multistage stratified cluster sampling to select study participants. An interview questionnaire was used to collect data related to risk factors. Other parameters included blood pressure, anthropometric and biochemical measurements.The prevalence of hypertension in Oman was estimated to be 41.5%. Of those who were hypertensive, three-quarters of them (75.7%) were unaware of being hypertensive and 65.5% of them had inadequately controlled hypertension. Male sex, higher wealth, and paying fewer visits to health facilities were found associated with high proportions of unawareness and high proportion of uncontrolled hypertension.The study highlights high levels of unawareness of being hypertensive and high proportion of uncontrolled hypertension in Oman that need to be considered when developing health policies and strategies. Intersectorial collaborative and innovative strategies that focus on improving awareness, detection, and control of hypertension should be considered, especially with attention to young adults and men.

There is an increasing burden of obesity and obesity-related noncommunicable diseases in Gulf Cooperation Council countries, including Oman. This descriptive, epidemiological study assessed physical activity among 2977 Omani adults using a population-based household survey in 2008. Overall, 54.2% of men and 41.6% of women were physically active; the rate was higher in younger cohorts and varied significantly by region of residence. Physical activity related to the transportation (walking and cycling) domain was higher than in the leisure or work domains. Unmarried men aged 30-39 years were twice as likely to be physically active (OR 2.25) and unmarried women aged 40+ years were half as likely to be active (OR 0.58) than their married counterparts. Young women not working were less active (OR 0.18) than working women. Higher education was significantly associated with leisure activity for men aged 30+ years and women aged 40+ years. Further research to understand regional variations and to identify culturally appropriate strategies to promote physical activity is required.الوبائيات الوصفية للنشاط البدني لدى البالغين العمانيين: المسح الصحي العالمي لعُمان في عام 2008.روث مابري، مجدي مرسي، جواد أحمد اللواتي، نيفيل أُوين.هناك تزايد في عبء السمنة والأمراض غر السارية المرتبطة بالسمنة في بلدان مجلس التعاون الخليجي؛ با فيها سلطنة عان. وقد قيَّمت هذه الدراسة الوبائية الوصفية النشاط البدني لدى 2977 بالغاً عمانياً باستخدام مسح أسَي سكاني في عام 2008. فكان - بالإجمال - %54.2 من الرجال و %41.6 من النساء نشيطين بدنياً، وكان المعدل أعى لدى الفئات الأصغر سناً، وشديد التباين باختاف منطقة الإقامة. وكان النشاط البدني المرتبط بمجال المواصات (المي وركوب الدراجات) أعى من النشاط الذي يبذل في مجالات الترفيه أو العمل. وكان النشاط البدني لدى الرجال غر المتزوجن ممن هم بأعار 39-30 عاماً ضعف نشاط نظرائهم المتزوجن (OR=2.25) ، ولدى النساء غر المتزوجات اللواتي تجاوزن ال 40 سنة نصف نشاط نظيراتهن المتزوجات (OR=0.58). وكانت الشابات اللواتي لا يعملن أقل نشاطاً (OR=0.18) من النساء العامات. وكان هناك ارتباط كبر بن التعليم العالي وبن النشاط الترفيهي لدى الرجال الذين تزيد أعمارهم عن 30 سنة والنساء اللواتي تجاوزن ال 40 سنة. هناك حاجة إلى مزيد من البحوث لفهم التباينات الإقليمية ولتحديد اسراتيجيات ملائمة ثقافياً لتعزيز النشاط البدني.Épidémiologie descriptive de l’activité physique chez des adultes omanais : enquête de 2008 à Oman dans le cadre de l'enquête sur la santé dans le monde.Le fardeau de l’obésité et des maladies non transmissibles liées à l’obésité est en augmentation dans les pays du Conseil de Coopération du Golfe, notamment à Oman. La présente étude épidémiologique descriptive a évalué l’activité physique de 2977 adultes omanais à l’aide d’une enquête de population auprès des ménages en 2008. Globalement, 54,2 % des hommes et 41,6 % des femmes avaient une activité physique ; le taux était supérieur dans les cohortes plus jeunes et variait significativement en fonction de la région de résidence. L’activité physique liée aux déplacements (marche et vélo) était plus fréquente que l’activité physique professionnelle ou de loisir. Les hommes célibataires entre 30 et 39 ans étaient deux fois plus susceptibles d’être physiquement actifs (OR 2,25) alors que les femmes célibataires âgées de plus de 40 ans étaient deux fois moins actives (OR 0,58) que les femmes mariées. Les femmes jeunes sans emploi étaient moins actives physiquement (OR 0,18) que les femmes occupant un emploi. Un niveau d’études supérieur était nettement associé à une activité physique de loisir chez les hommes de plus de 30 ans et les femmes de plus de 40 ans. Des recherches plus approfondies pour comprendre les variations régionales et identifier des stratégies culturellement appropriées visant à promouvoir l’activité physique sont nécessaires.

Background: Recent reports have suggested that there are gender differences in the presentation of young adults with acute coronary syndromes (ACS). How these differences may affect ACS outcomes remains unclear, however. The aim of the current study was to examine the prognostic impact of gender in young adults with ACS in a multicenter multinational ACS registry from the Middle East. Methods: For a period of 9 months in 2008 to 2009, 7,930 consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. A cohort of 3933 patients in the age group 55 years and younger were selected of whom 552 were women (14%). Gender differences in presentation and clinical features were examined. Multivariate analysis of in-hospital and one year mortality was also performed. Results: The mean age for women was 46 years and for men 48 years. Women had significantly higher rates of diabetes mellitus (50.4% vs. 30.7%), hypertension (57.4% vs. 34.5%), obesity (32% vs. 17%), dyslipidemia (37.5% vs. 26%) and renal impairment (4.1% vs. 1.2%) whereas men were more likely to be smokers (72.4% vs. 14%) [all P Conclusions: Our study shows that female gender independently and significantly increases the risk of immediate and long term mortality in young patients with ACS.

OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mellitus (DM) can cause silent myocardial ischemia, however there is limited research examining how the cardiac symptoms reported by patients with DM presenting with acute coronary syndromes (ACS) can affect the immediate and long term outcomes. The aim of the current study was to examine the prognostic impact of lack of chest pain symptoms in DM patients presenting with ACS and enrolled in a multicenter multinational ACS registry from the Middle East. METHODS: For a period of 9 months in 2008 to 2009, 7,930 consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. A cohort of 3135 patients with DM were selected of whom 2686 (85.7%) presented with chest pain while 449 patients (14.3%) had no chest pain. Clinical features and outcomes were examined and compared among the two groups. RESULTS: Diabetic patients without chest pain were 5 years older and had significantly higher rates of hypertension (76.1% vs. 63.2%), prior myocardial infarction (35.9% vs. 24.3%), chronic kidney disease (CKD) (17.1% vs. 5.9%) and had significantly higher GRACE risk scores (55.3% vs. 21.4%) at presentation compared to patients with chest pain [All P CONCLUSIONS: DM patients with ACS presenting without chest pain are at an increased risk of immediate and long term mortality. Understanding the factors associated with atypical presentations of ACS in patients with DM may help in the earlier detection and more appropriate management of these high risk patients.