Improving influenza vaccination rate among primary healthcareworkers in Qatar

The purpose of this study was to improve influenza vaccination, and determine factors influencing vaccine declination among health care workers (HCW) in Qatar. We launched an influenza vaccination campaign to vaccinate around 4700 HCW in 22 Primary Health Care Corporation (PHCC) centers in Qatar between 1st and 15th of November, 2015. Our target was to vaccinate 60% of all HCW. Vaccine was offered free of charge at all centers, and information about the campaign and the importance of influenza vaccination was provided to employees through direct communication, emails, and social media networks. Staff were reported as vaccinated or non-vaccinated using a declination form that included their occupation, place of work and reasons for declining the vaccine. Survey responses were summarized as proportional outcomes. We exceeded our goal, and vaccinated 77% of the target population. Only 9% declined to take the vaccine, and the remaining 14% were either on leave or had already been vaccinated. Vaccine uptake was highest among aides (98.1%), followed by technicians (95.2%), and was lowest amongst pharmacists (73.2%), preceded by physicians (84%). Of those that declined the vaccine, 34% provided no reason, 18% declined it due to behavioral issues, and 21% declined it due to medical reasons. Uptake of influenza vaccine significantly increased during the 2015 immunization campaign. This is attributed to good planning, preparation, a high level of communication, and providing awareness and training to HCW with proper supervision and monitoring. 1 2017 by the authors. Licensee MDPI, Basel, Switzerland.Acknowledgments: We would like to thank all staff for participation in the 2015 influenza vaccination campaign at the PHCC. Members of the Health protection at MoPH and PHCC communicable disease control team are highly acknowledged for assistance with implementation. This Study was funded by the Ministry of Public Health.Scopu

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Islamists and non-Islamists in the Egyptian opposition: Patterns of conflict and cooperation

This dissertation examines how relations between different actors in the Egyptian opposition have contributed to the endurance of authoritarianism in Egypt over the past three decades. In this dissertation, I argue that the durability of authoritarianism in Egypt, and elsewhere in the Arab world, is not simply a function of regime strength and cohesion, as the conventional wisdom maintains, but that it is also a function of important divisions and mobilizational asymmetries between different actors in the opposition, particularly between Islamists and non-Islamists. I argue that ideological divisions and mobilizational asymmetries have impeded successful cooperation and alliance building between Islamists and non-Islamists and have thus inhibited broad based mobilization against the authoritarian regime, even during moments of regime crisis. These divisions have also lowered the cost of repression and allowed the authoritarian regime to successfully play off different forces against one another in order to ensure its continued hegemony

The association of single nucleotide polymorphism of interleukin-21 gene and serum interleukin-21 levels with systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a common autoimmune disorder which commonly results from the combined effects of a large number of genes. Variations in the DNA sequence in the Interleukin-21 (IL-21) gene may lead to altered IL-21 production and/or activity which can affect an individual’s susceptibility to SLE. IL-21 is a novel class I cytokine produced by activated CD4+ T cells, natural killer T cells and T helper (Th) cells. There is increasing evidence that IL-21 contributes to the pathogenesis of SLE due to its biological activity. Aim of the study: To investigate the association between single nucleotide polymorphism (SNP) of IL-21 rs2221903 gene and serum IL-21 levels with SLE and to detect the possible association between IL-21 serum levels and the pathogenesis of the disease. Subjects and methods: This study was conducted on 30 SLE patients and 20 age and sex matched healthy controls. Serum IL-21 levels were measured using enzyme-linked immunosorbent assay (ELISA) technique and SNP of IL-21 rs2221903 gene was detected by genotyping assay, using real time polymerase chain reaction (RT-PCR). Results: Serum Il-21 levels were significantly higher in patients compared with controls (p < 0.001). Patients with high activity index of SLE had significantly higher levels of serum IL-21 (p value < 0.001). A statistically significant association was found between the T allele of SNP rs2221903 and SLE, whereas; no association between SNP of IL-21 rs2221903 genotypes and SLE or serum IL-21 levels could be detected. Conclusion: IL-21 plays an important role in the immune-pathogenesis of SLE and could be used as a possible target for novel immunotherapy. The T allele of SNP rs2221903 suggests that the IL-21 gene may contribute to an inherited predisposition to SLE

Assessment of Anxiety, Depression, Attitude, and Coping Strategies of the Egyptian Population during the COVID-19 Pandemic

Background: The COVID-19 pandemic has imposed several challenges on different populations all around the world, with stress being identified as one of the major challenges. This study aims to investigate the impact of COVID-19-induced stress on the prevalence and severity of anxiety and/or depression, factors that predict the development of anxiety and/or depression, and coping strategies in the Egyptian population during the COVID 19 outbreak. Subjects and Methods: This is an observational cross-sectional online study. The questionnaire of our study included five sections: demographic and clinical data, attitude towards COVID-19, the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), and a specifically prepared and standardized Arabic version of a coping strategies scale. The questionnaire was uploaded on 20 May 2020 at 1 p.m. and closed on 7 July 2020 at 8 a.m. Results: The study questionnaire was completed by 283 Egyptians, with mean age 34.81 ± 11.36 years, of which 17% had been infected with COVID-19. The responses showed that 62.9% had moderate anxiety, whereas 12.4% had severe anxiety. Moreover, 13.8% had moderate depression, and 14.1% had severe depression. Our study demonstrated that age, mental status, and being infected with COVID-19 correlated with depression, whereas only age correlated with anxiety. Interestingly, our data showed that anxiety and depression were negatively correlated with some coping strategies during the COVID-19 pandemic. Conclusions: Pandemics, such as the COVID-19 pandemic, imposes stress on individuals, which leads to the development of anxiety and/or depression. Several factors, which could be population-dependent, may help predict the development of anxiety or depression. We show the factors correlated with depression and anxiety during the COVID-19 pandemic in the Egyptian population. Furthermore, certain personal coping strategies during the COVID-19 pandemic are negatively correlated with anxiety and depression. Therefore, our study sheds light on the importance of studying factors in each population that can lead to pandemic-induced psychological complications and those that can relieve such complications

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