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Alaa Badawi,1 Suzan Sayegh,2 Eman Sadoun,3 Mohamed Al-Thani,2 Paul Arora,4 Pierre S Haddad51Office of Biotechnology, Genomics and Population Health, Public Health Agency of Canada, Toronto, ON, Canada; 2Department of Public Health, 3Clinical Research Division, Supreme Council of Health, Doha, Qatar; 4Dalla Lana School of Public Health, University of Toronto, ON, Canada; 5Department of Pharmacology, Faculty of Medicine, University of Montreal, Montreal, QC, CanadaAbstract: A recent relationship between vitamin D deficiency and the risk of type 2 diabetes mellitus (T2DM) and insulin resistance has been established through several studies. Research suggests a correlation between serum vitamin D and glycemic status measures. The aim of this study was to investigate the relationship between the plasma vitamin D levels (25[OH]D) and the factors linked to insulin resistance in a representative sample of Canadians ranging in age from 16–79 years. Data were used from the Canadian Health Measures Survey where direct measures of health and wellness were reported from 1,928 subjects. These data were gathered from March 2007–February 2009 at 15 sites selected through a multistage sampling strategy. An inverse relationship between insulin resistance and plasma vitamin D level in both men and women was observed. This study provides additional evidence for the role of vitamin D in T2DM. If causally associated, the supplementation of vitamin D may help in preventing insulin resistance and subsequent T2DM.Keywords: HOMA-IR, plasma 25(OH)D, diabetes

Abstract: Introduction: Oral health has a significant impact on physical, social and mental well‐being of an individual. Qatar, like the rest of the world, is experiencing higher prevalence of oral health‐related problems. Objectives: To examine the oral health status and extent of preventive and curative needs among six‐year‐old school children in Qatar by key demographic indicators. Methods: Secondary data analysis of 1124 six‐year‐old private and government primary school children from the 2011 Qatar National Oral Health Survey was performed. Dental caries lesions status of primary dentition was assessed according to the WHO criteria. Descriptive statistics were carried out, and comparison among groups was executed by running t statistics. Logistic regression was performed to interpret the impact of various predictors. Results: Overall, 71.4% children presented with dental caries lesions with a higher prevalence among girls versus boys (73.8% versus 68.9%). The mean overall dmft was recorded as 4.2 with ±4.2 SD. Qatari children had 3.8 time odds of having dental caries lesions compared with non‐Qatari children (P < 0.001). Overall, 18.9% of children showed signs of poor periodontal health. Odds of having more periodontal disease were significant in Qatari boys (OR = 3.1 CI = 2.0, 4.7, P < 0.001) compared to non‐Qatari boys. On average, 3.6 teeth per student were in need of any treatment. Conclusion: This study indicated that only 28.6% of children aged six were free from caries lesions. The results urge to further strengthen the strategies and to improve oral hygiene by various evidence‐based interventions. [ABSTRACT FROM AUTHOR]

Introduction: Elevated sound levels in neonatal intensive care units may cause undesirable effects and influence the stability of vital signs in moderately sick newborn infants. Objective: To evaluate the effect of using earmuffs on the seven most common vital signs in newborns in NICUs. Methods: This is a prospective controlled study. All term and pre-term infants admitted to the NICU were randomized to either an 'earmuffs' or a 'no earmuffs' area and underwent hourly measurements and recording of vital signs during routine NICU activity for three consecutive days. Data were collected by sampling data from the routine continuous monitoring of heart rate (HR), respiratory rate (RR), oxygen saturation (OSAT), blood pressure (BP), FIO2 requirement, pain score (PS), and temperature (T). Exclusion criteria included neonates on high frequency ventilation, sedation and congenital anomalies with possible auditory system involvement. Results: The study included 182 infants; of them 100 infants completed the 72-hour measurements. Vital signs of fifty newborn infants in each group were recorded for a period of 72 hours. During this time, the observed linear increase in heart rate was significantly reduced within the earmuffs group (139 versus 146 beat per minute) with p value <0.001, which also exhibited a similar significant decrease in systolic BP, although there was no evidence of significant difference between-group effect for diastolic BP and mean blood pressure. The average RR in the EM group was significantly lower than the NEM group for the entire 72-hour period (0.001), while temperature showed no significant difference between the two groups across the same time-period. Earmuffs also conferred a small but significant improvement in the gradual increase of the average O2 saturation (p value = 0.01). Similar improvement due to earmuffs could also be seen in the infants' requirement for oxygen (days); the average oxygen requirement was 1.8 days versus 2.5 days with p value of <0.001. Conclusion: Wearing earmuffs inside the NICU had a positive effect on the infants' vital signs. [ABSTRACT FROM AUTHOR]

This paper examines Qatar's 2022 World Cup through the lens of liminality, presenting the intricate interplay between tradition, modernity, and human rights. By introducing liminality as an analytical tool, the paper explores how Qatar navigates traditional norms amidst global scrutiny, particularly concerning human rights issues such as migrant labour practices and cultural contestations around human rights. Employing liminality as a conceptual framework, this analysis offers a nuanced understanding of Qatar's endeavour to balance cultural authenticity with international expectations. I reveal why Qatar utilised the transient phase to implement reforms to its social and legal systems, aligning with international human rights while ensuring changes were akin with its cultural identity. The paper highlights the transient nature of change during the liminal phase of sport mega-events, emphasising both the opportunities and challenges presented for changes in Qatar. The paper unpacks Qatar continued navigation in the global stage as an extension of the initial liminal phase, demonstrating its engagements with processes of change and adaptation. The World Cup is a prime example that exposes the dual nature of sport mega events, serving as a springboard for social change, while also revealing underlying cultural and structural tensions. I conclude that Qatar utilised this liminal phase as a rite of passage, enabling the nation to traverse the terrain of modernity while testing the permeability of its cultural boundaries., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025 Al-Thani.)

Childhood primary dentition caries prevalence and experience is higher among Qatari than non-Qatari nationality children in Qatar but only this bivariate association has been described., Objectives: There were two objectives. First, to understand the variation of primary dentition caries among 4- to 8-year-old children in Qatar across nationality classified into four groups, and second, to explore whether the association persisted in the presence of socio-demographic and behavioural indicators., Methods: The study used data from the Qatar Child Oral Health Survey 2017 (QCOHS 2017). Detailed information was collected through a parental dual-language questionnaire and an oral epidemiological examination conducted by calibrated dentist examiners. Children in 20 kindergartens and 40 schools across Qatar were recruited. Data were weighted to represent the Qatar child population., Results: Overall, 1154 children aged 4-8 years old (48.9% female, 51.1% male) participated. Qatari children made up 26.3%, Non-Qatari (N-Q) Arabic children 44.2% N-Q Indian sub-continent 16.4% and N-Q Other 13.1%. There were no significant differences by nationality for age or sex, but differences existed for kindergarten/school type and parents' highest level of education. Among behavioural indicators, Qatari and N-Q Arabic children began toothbrushing later, and more N-Q Other children brushed 2+ times a day and had made a check-up visit in the last 12 months. More Qatari children were in the highest tertial for sugar intake and drank bottled water with no fluoride. All N-Q children had a significantly lower prevalence and experience of caries. The means ratio (95% CI) for N-Q Arabic (0.78; 0.65-0.94), Indian (0.58; 0.46-0.72) and other children (0.61; 0.42-0.88) were all significant against Qatari nationality children. Multivariable models showed an attenuation of the association with caries with the means ratio for N-Q Arabic (0.92; 0.73-1.16), Indian (0.79; 0.57-1.11) and other children (0.94; 0.61-1.44) being non-significant compared to Qatari nationality children. The variables which were significantly associated with caries were parental education, toothbrushing frequency, sugar intake and check-up visiting in the last 12 months in the multivariable models., Conclusions: Primary dentition caries in children resident in Qatar differed by nationality. The association of primary dentition caries with nationality was markedly attenuated and non-significant in the presence of socio-demographic and behavioural variables, pointing towards the importance of these variables as the pathways to improving primary dentition caries prevalence and experience of children in Qatar., (© 2024 The Author(s). Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Preventing local transmission of malaria from imported cases is crucial for achieving and maintaining malaria elimination. This study aimed to investigate the epidemiological characteristics of imported malaria cases and assess the distribution of malaria vectors in Qatar. Data from January 2016 to December 2022 on imported malaria, including demographic and epidemiological characteristics, travel-related information, and diagnostic results, were collected and analysed using descriptive statistics. Field surveys conducted in 2021-22 collected mosquitoes using various traps across Qatar. The collected samples underwent morphological and molecular characterization at Qatar University. A total of 2693 cases were reported, with a mean incidence of 13.5/100 000 population, decreasing from 18.8/100 000 in 2016 to 5.5/100 000 in 2020. Most cases were Plasmodium vivax (57.4%) followed by P. falciparum (40.4%). The median age was 32.9 ± 12.5 years, primarily males (86.7%), expatriates (99.6%) and notified during the hot months (July to September). Cases were mainly imported from the Eastern Mediterranean Region followed by the African and South-East Asia Region with no deaths and indigenous cases. Anopheles stephensi was identified as a widely distributed species, but none carried the Plasmodium pathogen. Despite no reports of local transmission, the presence of An. stephensi and favourable environmental conditions pose a risk in Qatar. Strengthening surveillance for imported malaria and reviewing epidemic protocols are necessary. Conventional field studies are imperative to address knowledge gaps in Anopheles mosquito ecology and biting habits in Qatar, accurately assessing the risk of local malaria transmission to support Qatar's malaria-free status., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Public Health Association.)

Purpose: This narrative literature review examines intersectional employee voice inequalities in a non-Western, high power distance context to develop a multilevel conceptual framework., Design/methodology/approach: The authors use Leininger's (1997, 2002) culture care model to explore multilevel influences on intersectional voice inequalities. The article applies insights from a review of 31 studies to the specific challenges of migrant palliative care (PC) nurses in Saudi Arabia., Findings: The themes identified in the review indicate how better transcultural communications might mitigate voice inequalities that influence migrant employee wellbeing and intentions to quit which result from cultural incongruities., Originality/value: The impact of national culture differences and intersectional inequalities on employee voice has largely been ignored in academic research. This paper offers unique insights drawing on culture care theory into intersectional voice challenges from a non-Western perspective in the underresearched setting of Saudi Arabia which is mid-way through a national transformation program. It starkly contrasts policy ambitions for advancing healthcare with discriminatory practices based on conservative attitudes which stifle migrant worker voices., (© Emerald Publishing Limited.)

Background: Pulmonary ionocytes have been identified in the airway epithelium as a small population of ion transporting cells expressing high levels of CFTR (cystic fibrosis transmembrane conductance regulator), the gene mutated in cystic fibrosis. By providing an infinite source of airway epithelial cells (AECs), the use of human induced pluripotent stem cells (hiPSCs) could overcome some challenges of studying ionocytes. However, the production of AEC epithelia containing ionocytes from hiPSCs has proven difficult. Here, we present a platform to produce hiPSC-derived AECs (hiPSC-AECs) including ionocytes and investigate their role in the airway epithelium., Methods: hiPSCs were differentiated into lung progenitors, which were expanded as 3D organoids and matured by air-liquid interface culture as polarised hiPSC-AEC epithelia. Using CRISPR/Cas9 technology, we generated a hiPSCs knockout (KO) for FOXI1, a transcription factor that is essential for ionocyte specification. Differences between FOXI1 KO hiPSC-AECs and their wild-type (WT) isogenic controls were investigated by assessing gene and protein expression, epithelial composition, cilia coverage and motility, pH and transepithelial barrier properties., Results: Mature hiPSC-AEC epithelia contained basal cells, secretory cells, ciliated cells with motile cilia, pulmonary neuroendocrine cells (PNECs) and ionocytes. There was no difference between FOXI1 WT and KO hiPSCs in terms of their capacity to differentiate into airway progenitors. However, FOXI1 KO led to mature hiPSC-AEC epithelia without ionocytes with reduced capacity to produce ciliated cells., Conclusion: Our results suggest that ionocytes could have role beyond transepithelial ion transport by regulating epithelial properties and homeostasis in the airway epithelium., (© 2024. The Author(s).)

Background Coronavirus disease (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it has resulted in a global pandemic. The COVID-19 pandemic has resulted in numerous reports on clinical outcomes and risk factors associated with morbidity and mortality. However, the extent to which nationality influences the severity of COVID-19 is not fully understood. Therefore, this study aimed to explore disparities in COVID-19 severity among individuals of different nationalities in Qatar. Methods This is a retrospective study. Secondary data were obtained from the Ministry of Public Health in Qatar. Patients of different nationalities were categorized into different groups based on the WHO regional classification, and the severity of COVID-19 across these groups was analyzed. Results Data were obtained for 96,728 patients. This study found a statistically significant difference in disease severity among nationalities. The highest number of patients were from the Eastern Mediterranean group (42.3%), followed by Southeast Asia (39.4%). The severity of COVID-19 was highest among the Eastern Mediterranean groups (40%), followed by those from Southeast Asia (38.5%) and the Western Pacific (12.4%). There was a significant correlation between disease severity and vaccination status. Conclusion The findings of this study provide novel perspectives on the severity of COVID-19 among individuals of various nationalities. Moreover, it emphasizes the importance of healthcare interventions to address disparities in COVID-19 morbidity and mortality within these groups. The results of this study provide a useful foundation for developing approaches to prevent and manage pandemics more effectively and reduce the number of cases and fatalities during future health crises., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ibrahim et al.)

Background: The prevalance of dental caries in children in Qatar is high, which necessitates preventive efforts., Aim: To identify the sociodemographic and behavioural correlates of dental caries in the primary dentition of children 4- to 8-year-olds in Qatar., Design: Weighted data from the Qatar Child Oral Health Survey 2017 were analysed for caries prevalence (dmft>0) and experience (dmft). Sociodemographic and behavioural variables were also drawn from the survey., Results and Conclusion: Among the 1154 children, caries prevalence was 69.3% (95%CI [63.4, 74.5]) and experience at 3.8 dmft (95%CI [3.3, 4.2]). The prevalence ratio (PR) 0.82 (0.72, 0.94) was lower among younger than in older children; those for non-Qatari nationality Arabic PR 0.91 (0.82, 1.00) and Other PR 0.75 (0.57, 0.99) than for Qatari nationality; those attending international kindergartens/schools PR 0.89 (0.80, 0.99) than independent schools; and whose parents had university-level education PR 0.85 (0.75,0.95) than did not. Caries prevalence was lower among those toothbrushing by age 3 years PR 0.88 (0.80,0.99) than later; children with low/intermediate sugar exposures PR 0.85 (0.74,0.97) and 0.89 (0.79,1.00) than those with high exposures; children with a dental check-up PR 0.68 (0.53,0.87) than those without; and children who drank bottled water with some fluoride PR 0.89 (0.80,0.99) than those who did not. Findings were similar for dmft. In conclusion caries prevalence varied but was high across sociodemographic correlates indicating vulnerablity. Interventions focusing on behaviours - such as toothbrushing, reducing sugar intake, check-up and encouraging intake of water with fluoride - are needed., (© 2023 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

Background: In 2022, the Surveillance Department of the Ministry of Public Health in Qatar adopted an integrated project called the Notification Enhancement Project (NEP) to enhance the infectious disease notification system. Efficient surveillance and notification promote early alerts and allow immediate interference in reducing morbidity and mortality from outbreaks. The project was designed to improve the knowledge, attitudes, practices, and notification processes of healthcare workers in Qatar by increasing their reporting rates., Methods: The strategy for comprehensively enhancing notifications was based on the observation and evaluation of the current notification system, the implementation of interventions, and post-evaluation follow-up. To implement the project, we relied on three aspects: effective methods used in previous relevant studies through a literature review, feedback received from healthcare workers, and suggestions from public health surveillance experts from the Ministry of Public Health, Qatar. A preassessment was conducted through an online survey by the Ministry of Public Health. The effectiveness of the different interventions was assessed by analyzing the data of notified patients reported through the Disease Surveillance and Reporting Electronic System. Pre- and postintervention assessments were performed by comparing the percentage of patients notified by healthcare providers with that of patients confirmed by healthcare providers in the laboratory to compare the notification rates over three time periods between January and December 2022., Results: There was significant improvement in the infectious disease notification process. A comparison before and after the implementation of the interventions revealed an increase in the communicable disease notification rate among healthcare workers. Pre- and postintervention data were compared. Infectious disease notification activities by healthcare workers increased from 2.5% between January and May 2022 to 41.4% between November and December 2022., Conclusion: This study highlights the efficiency of different interventions in correcting the underreporting of infectious diseases. Our findings suggest that implementing the Notification Enhancement Project significantly improves notification rates. We recommend continuing interventions through constant education and training, maintaining solid communication with HCWs through regular reminder emails and feedback, periodic assessment of the electronic notification system, and engagement of healthcare workers and other stakeholders to sustain and expand progress achieved through continuous evaluation., (© 2024. The Author(s).)

Cerebral small vessel disease (SVD) affects the small vessels in the brain and is a leading cause of stroke and dementia. Emerging evidence supports a role of the extracellular matrix (ECM), at the interface between blood and brain, in the progression of SVD pathology, but this remains poorly characterized. To address ECM role in SVD, we developed a co-culture model of mural and endothelial cells using human induced pluripotent stem cells from patients with COL4A1/A2 SVD-related mutations. This model revealed that these mutations induce apoptosis, migration defects, ECM remodeling, and transcriptome changes in mural cells. Importantly, these mural cell defects exert a detrimental effect on endothelial cell tight junctions through paracrine actions. COL4A1/A2 models also express high levels of matrix metalloproteinases (MMPs), and inhibiting MMP activity partially rescues the ECM abnormalities and mural cell phenotypic changes. These data provide a basis for targeting MMP as a therapeutic opportunity in SVD., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Population size and structure have a huge impact on health indicators. In countries with a high proportion of expatriates, there are some limitations in estimating, aggregating and reporting of the health indicators, and corrections may be required in the established estimation methodologies. We review the case of Qatar to see how its specific population characteristics affect its health indicators., Methods: We used routinely collected data and reviewed and calculated a selected list of health indicators for Qatari and non-Qatari populations residing in Qatar. Mortality and cancer incidence rates, stratified by nationality, were used for this purpose. Also, a direct method was used to estimate completeness of the death registry, compared to the mortuary data., Results: Age and sex distribution of Qatari and non-Qatari populations are completely different. Compared to the mortuary data, completeness of death registration for the total population was estimated at 98.9 and 94.3%, with and without considering overseas deaths, respectively. Both estimates were considerably higher than estimates from the indirect methods. Mortality patterns were different even after standardization of age and stratification of sex groups; male age-standardized mortality rates were 502.7 and 242.3 per 100,000 individuals, respectively for Qataris and non-Qataris. The rates were closer in female populations (315.6 and 291.5, respectively). The leading types of cancer incidents were different in Qataris and non-Qataris., Conclusions: Expatriates are a dynamic population with high-turnover, different from Qatari population in their age-sex structure and health status. They are more likely to be young or middle-aged and are less affected by age related diseases and cancers. Also, they might be at higher risks for specific diseases or injuries. Aggregating indicators of Qatari and non-Qatari populations might be mis-leading for policy making purposes, and common estimation correction approaches cannot alleviate the limitations. High-proportion of expatriate population also imposes significant errors to some of the key demographic estimates (such as completeness of death registry). We recommend a standardized approach to consider nationality in addition to age and sex distributions for analysis of health data in countries with a high proportion of expatriates., Competing Interests: MM-L was employed by Optimax Access LLC. AT, SK, SA, and MA-T work for the Ministry of Public Health in Qatar. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Moradi-Lakeh, Toumi, Khalifa, Doctor, Alyafei, Al Hamad, Al-Thani and Rashidian.)

The steady increase in smoking rates has led to a call for wide-reaching and scalable interventions for smoking cessation in Qatar. This study examined the feasibility and acceptability of an evidence-based smoking cessation program delivered by telephone for Qatari residents. A total of 248 participants were recruited through primary care centers and received five weekly scheduled proactive behavioral counseling calls from personnel trained in tobacco cessation and navigation to obtain cessation pharmacotherapy from clinics. Outcomes were assessed at end of treatment (EOT), and 1- and-3-month follow up. The Mann-Whitney test was used to compare the average number of participants recruited per month pre- and post-COVID. We recruited 16 participants/month, the majority (85.5%) attended at least one counselling session, and 95.4% used some of pharmacotherapy. Retention rates were 70% at EOT, 64.4% and 71.7% at 1- and 3-month follow up, respectively; 86% reported being 'extremely satisfied' by the program. Our ITT 7-day point prevalence abstinence was 41.6% at EOT, 38.4% and 39.3% at 1-and 3-month, respectively. The average number of participants recruited per month was significantly higher for pre vs. post-COVID (18.9 vs. 10.0, p -value = 0.02). Average number of participants retained at EOT per recruitment month showed a slight decrease from 8.6 pre- to 8.2 post-COVID; average number who quit smoking at EOT per recruitment month also showed a decrease from 6 to 4.6. The study results indicated that our telephone-based intervention is feasible and acceptable in this population and presents a new treatment model which can be easily disseminated to a broad population of Qatari smokers.

Importance: It is uncertain whether typical variants causing monogenic stroke are associated with cerebrovascular disease in the general population and why the phenotype of these variants varies so widely., Objective: To determine the frequency of pathogenic variants in the 3 most common monogenic cerebral small vessel diseases (cSVD) and their associations with prevalent and incident stroke and dementia., Design, Setting, and Participants: This cohort study is a multicenter population-based study of data from UK Biobank participants recruited in 2006 through 2010, with the latest follow-up in September 2021. A total of 9.2 million individuals aged 40 to 69 years who lived in the United Kingdom were invited to join UK Biobank, of whom 5.5% participated in the baseline assessment. Participants eligible for our study (n = 454 756, excluding 48 569 with incomplete data) had whole-exome sequencing and available data pertaining to lacunar stroke-related diseases, namely stroke, dementia, migraine, and epilepsy., Exposures: NOTCH3, HTRA1, and COL4A1/2 pathogenic variants in monogenic stroke; Framingham cardiovascular risk; and ischemic stroke polygenic risk., Main Outcomes and Measures: Primary outcomes were prevalent and incident stroke and dementia. Odds ratios (ORs) and hazard ratios (HRs) were adjusted for age, sex, ethnicity, exome sequencing batch, and top 10 genetic principal components., Results: Of the 454 756 participants (208 027 [45.8%] men; mean [SD] age, 56.5 [8.1] years), 973 participants carried NOTCH3 variants, 546 carried HTRA1 variants, and 336 carried COL4A1/2 variants. Variant carriers were at least 66% more likely to have had stroke. NOTCH3 carriers had increased vascular dementia risk (OR, 5.42; 95% CI, 3.11-8.74), HTRA1 carriers an increased all-cause dementia risk (OR, 2.17; 95% CI, 1.28-3.41), and COL4A1/2 carriers an increased intracerebral hemorrhage risk (OR, 3.56; 95% CI, 1.34-7.53). NOTCH3 variants were associated with incident ischemic stroke and vascular dementia. NOTCH3 and HTRA1 variants were associated with magnetic resonance imaging markers of cSVD. Cardiovascular risk burden was associated with increased stroke risk in NOTCH3 and HTRA1 carriers. Variant location was also associated with risk., Conclusions and Relevance: In this cohort study, pathogenic variants associated with rare monogenic stroke were more common than expected in the general population and associated with stroke and dementia. Cardiovascular risk burden is associated with the penetrance of such variants. Our results support the hypothesis that cardiovascular risk factor control may improve disease prognosis in individuals with monogenic cSVD variants. This lays the foundation for future studies to evaluate the effect of early identification before symptom onset on mitigating stroke and dementia risk.

(1) Background: Qatar does not have any indigenous cases of dengue; however, the influx of immigrants from dengue endemic countries, the environment, and climate suitability for Aedes vector mosquitoes suggest a potential risk for local transmission. In this study, we investigated various demographic factors to determine the epidemiological features of dengue in Qatar. (2) Methods: In the present retrospective study, we reviewed dengue notification data received at the national surveillance system, Ministry of Public Health, Qatar, between January 2013, and December 2021, and we analyzed the incidence of the dengue disease burden to identify factors that could contribute to the dissemination of the disease in Qatar. (3) Results: A total of 166 dengue fever seropositive cases were recorded during the study period in Qatar. The mean incidence was estimated to be 0.7/100,000 population, which increased from 0.7/100,000 in 2013 to 1.5/100,000 in 2019. The majority of the cases were male, between 20-50 years of age and notified during the hot months (June-September). Most of the patients had fever without hemorrhagic manifestations. There were no dengue related deaths during 2013-2021. (4) Conclusion: Dengue fever occurred more frequently among men than women, and its incidence is low among Qatari nationals. The presence of the most efficient vector, Aedes aegypti , in Qatar, if confirmed, poses a risk of local outbreaks. Therefore, regular vector surveillance is needed to assess the distribution, biting habits and abundance of vector mosquito species and the risk for mosquito-borne diseases.

Objectives: Manual and Craft Workers (MACWs), who constitute more than 80% of the population, were identified to be a vulnerable group to COVID-19 in Qatar. The goal of this study is to identify the limitations face MACWs in Qatar towards practicing the COVID-19 preventive measures and thereby designing behavioral change strategies. Methods: This is a qualitative research study in which individual interviews and focus group discussions were utilized for a deep understanding of the phenomenon from key informants. Four onlive individual interviews and four focus groups ( n = 55) were conducted and transcribed verbatim. Inductive qualitative analysis was followed to discover the themes of the interviews. Data were analyzed using constant comparative techniques. Results: Major themes elicited from the analysis revealed that the barriers to following COVID-19 preventive behaviors among migrant workers in Qatar included barriers related to knowledge and risk perception; lifestyle and habits; nature of work and living conditions, and barriers related to health communication, diversified cultures, and languages. Conclusion: The findings would support constructing culturally sensitive health education messages and planning for effective health communication campaigns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Al-Jayyousi, Nour, Suliman, Abed Alah, Ali, Abdeen, Al-Thani, Jaffrey, Al-Romaihi and Farag.)

Introduction. The cycle threshold (Ct) value in real-time PCR (RT-PCR) is where a target-specific amplification signal becomes detectable and can infer viral load, risk of transmission and recovery. Use of Ct values in routine practice is uncommon. Gap Statement. There is a lack of routine use of Ct values when reporting RT-PCR results in routine practice. Aim. To automatically insert Ct values and interpretive comments when reporting SARS-CoV-2 RT-PCR to improve patient management. Methodology. Routine Ct values across three different RT-PCR platforms were reviewed for concordance at presentation and clearance in patients with COVID-19. An indicative threshold (IT) linked to viral clearance kinetics was defined at Ct30 to categorize Ct values as low and high, reflecting high and low viral loads respectively. Results. The different gene targets of each platform showed high correlation and kappa score agreement ( P <0.001). Average Ct values were automatically generated with values ≤Ct30 reported as positive and >Ct30 as reactive; interpretive comments were added to all reports. The new reporting algorithm impacted on: physician interpretation of SARS-CoV-2 results; patient management and transfer; staff surveillance; length of stay in quarantine; and redefinition of patient recovery. Conclusion. Incorporation of Ct values into routine practice is possible across different RT-PCR platforms and adds useful information for patient management. The use of an IT with interpretive comments improves clinical interpretation and could be a model for reporting other respiratory infections. Withholding Ct values wastes useful clinical data and should be reviewed by the profession, accreditation bodies and regulators.

Introduction: We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries., Research Design and Methods: An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources., Results: Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar-for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial., Conclusions: T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study examines the levels of knowledge, attitude and practices (KAP) towards diabetes among Qatar nationals and long-term residents and its association with participants' selected demographics., Setting: A cross-sectional study conducted in public areas in all the eight municipalities of Qatar from July to October 2018., Participants: 2400 participants from the general public (nationals and long-term residents) stratified by gender, age and nationality across all geographic locations in Qatar., Primary and Secondary Outcome Measures: Responses were scored from 0% to 100% and KAP scores were classified as low (0%-49%), intermediate (50%-74%) or high (75%-100%). Analyses and comparisons were performed using descriptive statistics and χ 2 test at 5% level., Results: Most participants (54%) had an intermediate overall KAP score, 43% had a low score and only 3% had a high score. The knowledge scores were the lowest among participants, 69% had low, 29% had intermediate and only 2% had high scores. Participants scored better in attitude and practice; the percentages of participants who scored high, intermediate and low were 32%, 55% and 13% for attitude, and 37%, 33% and 30% for practice, respectively. Except for age, level of knowledge significantly varied by gender, nationality and diabetes-related diagnosis (p<0.001); attitude and practice levels differed significantly in all four factors. Areas where participants were deficient include: diabetes types, risk factors, signs and symptoms, complications, recommended daily exercise, normal fasting glucose level, preventive measures, management and control and understanding about complexity of diabetes., Conclusions: Participants generally have intermediate levels of positive attitudes and practices towards diabetes but low knowledge in diabetes-related factors. The data suggest that future communications should focus on educating the public and conduct mass campaigns about diabetes to improve knowledge especially targeting men and women, and both nationals and expatriates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Smoking self-efficacy, described as confidence in one's ability to abstain from smoking in high-risk situations is a key predictor in cessation outcomes; however, there is a dearth of research on factors that influence self-efficacy surrounding smoking behavior. This study examines factors associated with baseline self-efficacy among treatment seeking participants enrolled in a pilot feasibility smoking cessation study. Participants (n = 247) were daily male smokers, residents of Doha in Qatar (18-60 years) who were enrolled in a telephone-based smoking cessation study. Baseline assessments included self-efficacy, home smoking rules, socio-demographic variables, smoking history, and psychosocial characteristics. Factors associated with self-efficacy were assessed using multiple linear regression analysis. Results showed that after controlling for relevant variables, number of cigarettes smoked ([Formula: see text] = -0.22; 95% CI: -0.37, -0.06), having at least one quit attempt in the past year ([Formula: see text] = 2.30; 95% CI: 0.27, 4.35), and reporting a complete home smoking ban ([Formula: see text] = 3.13; 95% CI: 0.56, 5.70) were significantly associated with higher self-efficacy to quit smoking. These results provide data-driven indication of several key variables that can be targeted to increase smoking self-efficacy in this understudied population., Competing Interests: The authors declare that no competing interests exist.

Qatar, a country with a strong health system and a diverse population consisting mainly of expatriate residents, has experienced two large waves of COVID-19 outbreak. In this study, we report on 2634 SARS-CoV-2 whole-genome sequences from infected patients in Qatar between March-2020 and March-2021, representing 1.5% of all positive cases in this period. Despite the restrictions on international travel, the viruses sampled from the populace of Qatar mirrored nearly the entire global population's genomic diversity with nine predominant viral lineages that were sustained by local transmission chains and the emergence of mutations that are likely to have originated in Qatar. We reported an increased number of mutations and deletions in B.1.1.7 and B.1.351 lineages in a short period. These findings raise the imperative need to continue the ongoing genomic surveillance that has been an integral part of the national response to monitor the SARS-CoV-2 profile and re-emergence in Qatar., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Benslimane, Al Khatib, Al-Jamal, Albatesh, Boughattas, Ahmed, Bensaad, Younuskunju, Mohamoud, Al Badr, Mohamed, El-Kahlout, Al-Hamad, Elgakhlab, Al-Kuwari, Saad, Jeremijenko, Al-Khal, Al-Maslamani, Bertollini, Al-Kuwari, Al-Romaihi, Al-Marri, Al-Thani, Badji, Mbarek, Al-Sarraj, Malek, Ismail, Abu-Raddad, Coyle, Thani and Yassine.)

Public health control measures for communicable diseases are often based on the identification of symptomatic cases. However, emerging epidemiological evidence demonstrates the role of pre-symptomatic and asymptomatic transmissions of coronavirus disease 2019 (COVID-19). Understanding high-risk settings where transmissions can occur from infected individuals without symptoms has become critical for improving the response to the pandemic. In this review, we discussed the evidence on the transmission of severe acute respiratory syndrome coronavirus-2, its effect on control strategies, and lessons that can be applied in Qatar. Although Qatar has a small population, it has a distinct setting for COVID-19 control. It has a largely young population and is mostly composed of expatriates particularly from the Middle East and Asia that reside in Qatar for work. Further key considerations for Qatar and travel include population movement during extended religious holiday periods, screening and tracing of visitors and residents at entry points into the country, and expatriates living and working in high-density settings. We also consider how its international airport serves as a major transit destination for the region, as Qatar is expected to experience a rapid expansion of visitors while preparing to host the FIFA World Cup in 2022., (© 2021 Tawengi, Johnston, Albayat, Bansal, Ahmed, Sallam, Al-Romaihi, Al-Thani, Farag, Emara, licensee HBKU Press.)

In Qatar, tobacco is the leading preventable cause of death and disease. Telephone-based interventions for smoking are cost-effective and scalable interventions that are effective in promoting smoking behavior change. While many countries have implemented these services within their tobacco control programs, there is a distinct dearth of a telephone-based smoking cessation intervention that is adapted and tailored to meet the needs of people who smoke in Qatar. This study presents the protocol of a primary health care center integrated smoking quitline program in Qatar. Participants will be recruited from seven smoking clinics (recruitment sites). Trained clinic staff will provide brief advice on quitting followed by a referral to the quitline. Eligible participants (male smokers over 18 years of age) will complete baseline questionnaires and receive five weekly proactive counseling calls, an end-of-treatment assessment (approx. 1 week after Session 5), and 1- and 3-month follow-up assessments. The main aim of this study is to assess the feasibility and acceptability, which include the recruitment and retention rate, compliance to pharmacotherapy, and participant satisfaction. This is the first study to integrate an evidence-based smoking cessation intervention delivered via telephone within the healthcare system in Qatar. If effective, results can inform the development of a large-scale telephone-based program that widely reaches users of tobacco in Qatar as well as in the Middle East.

The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012. The objective of the study was to describe the epidemiology, risk factors, clinical characteristics, and outcome of MERS-CoV in Qatar. A total of 28 cases of MERS-CoV were identified, corresponding to an incidence of 1.7 per 1,000,000 population. Most patients had a history of contact with camels 15, travel to Kingdom of Saudi Arabia 7 or known contact with individuals with confirmed MERS-CoV infection 7. Majority of patients had acute kidney injury (AKI) 17 and 9 needed renal replacement therapy. All patients were hospitalized, 14 required critical care support. Overall, total of 10 died. The immediate cause of death was multiorgan failure with acute respiratory syndrome (ARDS) 9. MERS-CoV is a rare infection in the State of Qatar. There was no hospital outbreaks or healthcare worker reported infection. The infection causes severe respiratory failure and acute renal failure. Patients with AKI and on ventilator support carry higher risk of mortality., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Authors.)