Publications by authors named "Frederick Robert Carrick"

25 Publications

  • Page 1 of 1

Population awareness of cardiovascular disease risk factors and health care seeking behavior in the UAE.

Am J Prev Cardiol 2021 Dec 25;8:100255. Epub 2021 Sep 25.

Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates.

Objectives: We aimed to determine the awareness, knowledge, and attitude of people residing in Dubai, United Arab Emirates, regarding cardiovascular disease (CVD) risk factors. Our aim was to further identify prospects to increase awareness of modifiable CVD risk factors and influence behavior.

Methods: This observational study was conducted in Dubai: a global city in the United Arab Emirates. Participants were selected using simple randomization approach in primary health care centers, and a questionnaire was implemented based on literature review.

Results: Out of 1020 individuals approached, 738 agreed to participate in the study (response rate of 72%).The majority of participants surveyed had good knowledge and attitude toward CVD (528, 71.5% and 445, 60% respectively); yet, poor/fair practice related to CVD risk factors (553, 75%). Predictive Margins of Knowledge Scores were significant for age (<.01), academic level (<.0001), and nationality (<.0001) (Table 5). Participants aging 40-49, non-UAE subjects, and university/Postgraduate academic level scored better on the knowledge. Demographics predictor for practice score was highly significant for age (=.0001) and BMI (=.0001). Those aging ≥50 and obese participants scored higher on practice toward CVD risk factors. Knowledge score was significant predictor of practice and attitude toward CVD risk factors (=.0001, <.0001).

Conclusions: Although more than half of the current study participants had high knowledge and attitude toward CVD, their behaviors were not satisfactory. It is necessary to establish more effective educational interventions intended to promote positive health behaviors. Public health providers need to explain to the public that knowledge and proper actions regarding the reduction of risk factors are associated with reduced CVD and mortality.
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http://dx.doi.org/10.1016/j.ajpc.2021.100255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495097PMC
December 2021

Accelerated Wound Healing Using a Novel Far-Infrared Ceramic Blanket.

Life (Basel) 2021 Aug 26;11(9). Epub 2021 Aug 26.

College of Medicine, University of Central Florida, Orlando, FL 32816, USA.

Introduction: Wounds are associated with ranges of simple to complex disruption or damage to anatomical structure and function. They are also associated with enormous economic and social costs, increasing yearly, resulting in a severe impact on the wellbeing of individuals and society. Technology that might accelerate wound healing is associated with many benefits to injured people.

Methods: BALBc mice underwent symmetrical excisional wounds through the panniculus carnosus. They were divided into a treatment group placed on an autonomous ceramic far-field infrared blanket (cIFRB) and a control group maintained under standard conditions. We also expanded and cultured adipose tissue-derived mesenchymal stem cells (MSCs) on cIFRB and compared them to standard conditions subjected to a scratch injury to compare survival, proliferation, and wound healing.

Results: The wound healing of the cIRFB treatment group was significantly faster than the control group of mice. The wound-healing effect of mesenchymal stem cells on cIRFB was also increased and associated with significant migration to the wound area.

Conclusions: Wound healing is improved in a mouse model exposed to cFIRB. The ceramic blanket also promotes survival, proliferation, increased migration, and wound healing of MSCs without affecting their survival and proliferation. The utilization of cFIRB in cellular biology and medical applications may be promising in many situations currently explored in animal and human models. This technology needs no direct or battery power source and is entirely autonomous and noninvasive, making its application possible in any environment.
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http://dx.doi.org/10.3390/life11090878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469926PMC
August 2021

Pregnant women's perceptions of physical activity: Adaptation of the pregnancy physical activity questionnaire in Dubai, a multicultural society.

J Public Health Res 2021 Aug 4. Epub 2021 Aug 4.

Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai.

Background: There are major health benefits of physical activity (PA) during pregnancy, yet there is scant data about a woman's knowledge and understanding of these benefits globally.

Design And Methods: We aimed to evaluate the knowledge, attitude, and practice of pregnant women in the United Arab Emirates concerning exercise.   We wanted to investigate why some women exercise while others do not exercise during pregnancy. We used a cross-sectional study using a paper-based questionnaire involving pregnant women at antenatal clinics in the Dubai health Authority. The Modified form of Pregnancy Physical Activity Questionnaire (PPAQ) was adapted in both Arabic and English and used in this study.

Results:  Women aging 25-35 that had a higher educational level, were employed, having 1 or 2 previous pregnancies, and having better knowledge on the benefits of Physical Activity (PA) during pregnancy had better exercise profiles.

Conclusions: Our results demonstrate that the majority of the women that participated in our study were shown to have low PA during pregnancy. Better education and communication of the benefits of PA during pregnancy are needed to improve exercise among pregnant women in the UAE population. We found that improved education of women specific to PA with involvement of a healthcare provider were associated with an increase in PA during pregnancy.
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http://dx.doi.org/10.4081/jphr.2021.2261DOI Listing
August 2021

Large variations in disease severity, death and ICU admission of 2993 patients infected with SARS-CoV-2: The potential impact of genetic vulnerability.

J Infect Public Health 2021 Jul 22;14(7):886-891. Epub 2021 Apr 22.

Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates. Electronic address:

Background: The COVID-19 pandemic has had an immeasurable impact, affecting healthcare systems, the global economy, and society. Exploration of trends within the existing COVID-19 data may guide directions for further study and novel treatment development. As the world faces COVID-19 disease, it is essential to study its epidemiological and clinical characteristics further to better understand and aid in its detection and containment.

Methods: We aimed to study the clinical characteristics of patients infected with COVID-19 in Dubai, a multi-national Society.

Results: Our findings demonstrate that during the first wave of the COVID-19 epidemic, age, gender, and country of origin were associated with more severe cases of COVID-19, higher risk for hospitalization and death. Male individuals between 41 and 60 years of age from India had the most significant hospitalization and death predictor (p=.0001). The predictors for COVID-19 related deaths were slightly less than UAE Nationals by individuals from GCC (p=.02) that were followed closely behind by Pilipino (p=.02) and Arabs (p=.001).

Conclusion: The vulnerability of individuals to infection and in the spectrum of COVID-19 symptoms remains to be understood. There are large variations in disease severity, one component of which may be genetic variability in responding to the virus. Genomics of susceptibility to COVID-19 infection and the wide variation in clinical response to COVID-19 in patients should become active investigation areas.
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http://dx.doi.org/10.1016/j.jiph.2021.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061633PMC
July 2021

Women's knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates.

Menopause 2021 05 10;28(8):918-927. Epub 2021 May 10.

Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.

Objectives: We aimed to evaluate the awareness, knowledge, and perception of middle-aged women regarding menopause and hormone therapy (HT).

Methods: This observational study was conducted on pre-, peri-, post-, and surgically menopausal women (n = 591) from January 2020 until June 2020 in Dubai. A structured questionnaire was developed based on previous literature to assess participants' knowledge and awareness of menopause and HT. The questionnaire was implemented by face-to-face interview. Factors associated with the degree of menopausal knowledge were identified.

Results: Majority (498, 82%) of participant women had fair to poor overall knowledge on menopause, did not know whom HT is used for (404, 48%), and for whom it is contradicted (455, 77%). Knowledge on menopause and HT was highly associated with better attitudes (P < 0.001 and P < 0.001, respectively).Furthermore, the greater the knowledge on menopause, the better the knowledge of HT (P < 0.001). Education was the primary factor that played a significant role in having better knowledge or attitudes. Nationality showed an association with better attitudes on menopause, with non-Arabs having better attitudes than Arabs and UAE nationals.

Conclusions: Community medicine educators and primary healthcare providers need to prepare tailored premenopausal and postmenopausal educational interventional programs for further educating women and preparing them for this phase of their lives.
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http://dx.doi.org/10.1097/GME.0000000000001783DOI Listing
May 2021

Barriers to healthcare seeking, beliefs about ovarian cancer and the role of socio-economic position. A cross-sectional multilevel study in Dubai, a multicultural society.

J Public Health Res 2021 Mar 24;10(3). Epub 2021 Mar 24.

Health Regulation Sector, Dubai Health Authority, Dubai.

Background: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult. This study aimed to determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer.

Design And Methods: A structured questionnaire was designed and adapted from the validated cancer awareness measure.

Results: The recognition level of ovarian cancer symptoms among women in this study varied from 12-51%, and the most alarming ones, back pain, eating difficulties, and persistent abdominal pain, were missed by most of the surveyed women. The most recognized ovarian cancer risk factors were never being pregnant, having a history of infertility, and going through menopause, while the least recognized was having personal or family history of breast cancer. Non-UAE nationals women with higher educational levels had better knowledge of ovarian cancer compared to their peers.

Conclusions: A change or implementation model is highly recommended in order to improve women's awareness of ovarian cancer symptoms. Strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical help should help to increase ovarian cancer awareness and reduce a delay in the diagnosis.
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http://dx.doi.org/10.4081/jphr.2021.2073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419630PMC
March 2021

Fixation stability as a biomarker for differentiating mild traumatic brain injury from age matched controls in pediatrics.

Brain Inj 2021 01 24;35(2):209-214. Epub 2020 Dec 24.

Centre for Mental Health Research in Association, University of Cambridge, Cambridge, UK.

Objectives: Traumatic brain injury (TBI) is an increasingly significant health concern worldwide, compounded by the difficultly in detection and diagnosis. Fortunately, a growing body of research has identified oculomotor behavior, specifically fixations, saccades and smooth pursuit eye movements as a promising endophenotype for neurotrauma. To date, limited research exists using fixation stability in a comparative study to indicate the presence of a mild TBI (mTBI), especially in the pediatric population.

Methods: The present study examined data from 91 individuals clinically diagnosed with mTBI and a further 140 age- and gender-matched controls. They all completed the RightEye fixation stability test using a remote eye tracker. Participants were compared on five fixation metrics: Bivariate Contour Ellipse Area (BCEA), Convergence Point, Depth, Disassociated Phoria, and Targeting Displacement.

Results: Results were analyzed using one-way univariate ANOVAs, ROC analysis, and stepwise logistic regression. BCEA results revealed significant differences between groups with the mTBI group showing a larger gaze spread, indicative of less ability to keep the eyes close to the target without deviating.

Conclusions: Fixation stability is detrimentally impacted by mTBI in pediatric patients, and the oculomotor test can be used to differentiate between those with and without an mTBI.
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http://dx.doi.org/10.1080/02699052.2020.1865566DOI Listing
January 2021

Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers.

Brain Sci 2020 Dec 17;10(12). Epub 2020 Dec 17.

Department of Neurology, Carrick Institute, Cape Canaveral, FL 32920, USA.

Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the modified Clinical Test of Sensory Integration in Balance (mCTSIB). However, the mCTSIB is a standard group of tests relying largely on eyes-open and -closed standing positions with the head in a neutral position, associated with probability of missing postural instabilities associated with head positions off the neutral plane. Postural stability scores are compromised with changes in head positions after concussion. The position of the head and neck induced by statically maintained head turns is associated with significantly lower stability scores than the standardized head neutral position of the mCTSIB in Post-Concussion Syndrome (PCS) subjects but not in normal healthy controls. This phenomenon may serve as a diagnostic biomarker to differentiate PCS subjects from normal ones as well as serving as a measurement with which to quantify function or the success or failure of a treatment. Head positions off the neutral plane provide novel biomarkers that identify and differentiate subjects suffering from PCS from healthy normal subjects.
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http://dx.doi.org/10.3390/brainsci10121003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766169PMC
December 2020

Oculomotor Behavior as a Biomarker for Differentiating Pediatric Patients With Mild Traumatic Brain Injury and Age Matched Controls.

Front Behav Neurosci 2020 12;14:581819. Epub 2020 Nov 12.

Centre for Mental Health Research in association with University of Cambridge, Cambridge, United Kingdom.

Importance: Children have the highest incidence of mild traumatic brain injury (mTBI) in the United States. However, mTBI, specifically pediatric patients with mTBI, are notoriously difficult to detect, and with a reliance on traditional, subjective measurements of eye movements, the subtle but key oculomotor deficits are often missed.

Objective: The purpose of this project is to determine if the combined measurement of saccades, smooth pursuit, fixations and reaction time represent a biomarker for differentiating pediatric patients with mild traumatic brain injury compared to age matched controls.

Design: This study used cross-sectional design. Each participant took part in a suite of tests collectively labeled the "Brain Health EyeQ" to measure saccades, smooth pursuit, fixations and reaction time.

Participants: The present study recruited 231 participants - 91 clinically diagnosed with a single incident mTBI in the last 2 days as assessed by both the Glasgow Coma Scale (GCS) and Graded Symptoms Checklist (GSC), and 140 age and gender-matched controls ( = 165 male, = 66 female, age = 14.20, = 2.78).

Results: One-way univariate analyses of variance examined the differences in performance on the tests between participants with mTBI and controls. ROC curve analysis examined the sensitivity and specificity of the tests. Results indicated that together, the "Brain Health EyeQ" tests were successfully able to identify participants with mTBI 75.3% of the time, providing further validation to a growing body of literature supporting the use of eye tracking technology for mTBI identification and diagnosis.
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http://dx.doi.org/10.3389/fnbeh.2020.581819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690212PMC
November 2020

A review of gestational diabetes mellitus management, risk factors, maternal and neonatal outcomes in two major maternity hospitals in the United Arab Emirates: A report from Dubai.

J Neonatal Perinatal Med 2020 ;13(4):555-562

University of Central Florida College of Medicine, Orlando, FL USA.

Objectives: This study was conducted in order to explore and analyze the status of gestational diabetes (GDM) amongst pregnant women in Dubai, United Arab Emirates (UAE); a country with high prevalence of diabetes. We aimed to describe GDM-associated risk factors and clinical outcomes of pregnant women and their neonates. Our objective was to contribute to the broader literature on reproductive health disparities and to inform efforts to improve GDM care at our region.

Methods: Chart review of case records were used to collect data on both maternal and neonatal parameters and outcomes during the specified study period from two main maternity hospitals in Dubai.

Results: UAE national women with GDM were more prone to be obese or overweight compared to non-UAE women (p < 0.0001, and p < 0.0001 respectively). In addition, UAE national women with GDM had higher history of GDM in previous pregnancies (p < 0.0001) and more family history of diabetes (p < 0.0001).The neonate admission into NICU was significantly associated with cesarean section (p < 0.0001), twins (p < 0.0001), preeclampsia (p = 0.02), receiving MgSO4 (p = 0.02), birth weight less than 2500 g (p < 0.0001), low Apgar scores (p < 0.0001), baby with congenital anomaly (p < 0.0001), and neonatal hypoglycemia (p < 0.0001).

Conclusions: Our results demonstrate that pregnant women with GDM who are UAE nationals and have higher parity need to be under special attention during their pregnancy in order to improve both maternal and neonatal outcomes.
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http://dx.doi.org/10.3233/NPM-200410DOI Listing
September 2021

Perceived Academic and Psychological Stress among Adolescents in United Arab Emirates: Role of gender, age, depression, and high expectation of parents.

Psychiatr Danub 2019 Sep;31(Suppl 3):331-337

Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.

Introduction: Academic learning is the most important source of stress among young students worldwide and appears to be quite severe in eastern countries. We aimed to examine the relationship between academic stress and depression among adolescents.

Methods: A cross-sectional study was conducted among adolescents in United Arab Emirates using the Perceived Stress Scale - 14 (PSS-14) and Educational Stress Scale (ESS) for Adolescents (English and Arabic versions).

Results: The overall PSS was high in 186 (20%) of the respondents, and moderate in 695 (76%). A multiple regression model of predictors of the PSS showed statistically significant correlations between the total PSS-14 scores and age (p<0.0004), gender (p<0.0001), and grade (p<0.001). A multiple regression model of the PSS-14 questionnaire as predictors of the ESSA revealed that Four variables on PSS-14 were statistically significant predictors of the ESSA: history of depression (p<0.0001), content with academic achievement (p<0.0001), high academic expectation of parents (p<0.003), and a believe capable of meeting parental expectations (p<0.0001).

Conclusions: Adolescents with severe academic stress need to be identified early. We suggest that an interdisciplinary team in the schools including student advisors and counselors be developed to further address stressors. In addition, students should be taught different stress management techniques such as cognitive behavioral skills to improve their ability to cope with school demands. The identification of stressors may lead to strategies that might address the quality of teaching and mental health evaluation among adolescents.
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September 2019

Pattern and determinants of contraceptive usage among women of reproductive age in the United Arab Emirates.

J Family Med Prim Care 2019 Jun;8(6):1931-1940

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Cambridge, UK.

Introduction: Women in the UAE and Muslim countries are a largely understudied population with significant disparities in knowledge to most basic health concerns and family planning. Our objective was to identify UAE contraceptive knowledge similarities and variances to other world regions, and to inform efforts to improve contraceptive care at Arab world and Muslim countries.

Methods: Structured questionnaire consisting of socio-demographic characteristics, knowledge, beliefs and attitudes related to contraception methods.

Results: The use of effective contraception methods was associated with higher educational levels of UAE national women who desired to conceive. These women had knowledge of contraception that was associated with an identified impact of their spouse on their choice of contraception. Religion plays an essential role in knowledge on the risk of contraception and safe type of contraceptive methods in the UAE. Statistically significant predictors of having knowledge on different methods of contraception were nationality, < 0.002; education level, < 0.03; number of marriages < 0.002; monthly income, < 0.04; and the number of children, < 0.015.

Conclusions: Our results demonstrate that higher education and communication of the benefits and risks of different types of contraceptive methods are needed to improve the use of contraception in the UAE population. We recommend additional training in this area for healthcare providers. The involvement of the spouse in the mutual understanding of contraception and its choice coupled with third party insurance coverage may decrease knowledge and utilization gaps further assisting in providing a best contraceptive method.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_390_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618233PMC
June 2019

Prevalence of Undiagnosed Depression in Patients With Type 2 Diabetes.

Front Endocrinol (Lausanne) 2019 3;10:259. Epub 2019 May 3.

Dubai Health Authority, Dubai, United Arab Emirates.

Type 2 Diabetes Mellitus (T2DM) is the most prevalent type of diabetes among adults and constitutes around 90% of all cases. Substantial evidence demonstrates that depression in the context of diabetes is associated with a wide range of adverse consequences such as reduced adherence to the prescribed treatment regimen, lower quality of life, higher fasting glucose and HbA1c levels, and higher health expenditures. This study was conducted to assess the depression among T2DM patients attending diabetic clinics, primary healthcare centers (PHC), Dubai Health Authority (DHA). Depressive symptoms were assessed by using both Arabic and English version of the Beck Depression Inventory. Out of 1,050 diabetic patients approached, 559 were within our inclusion criteria and agreed to participate in this study (Response rate of 53%). The mainstream of the participants had T2DM for <10 years (393, 70%), were under oral hypoglycemic treatment only (479, 86%), and had good medication adherence (526, 94%). The overall depression prevalence using a cutoff of 16 was 17%. When we assessed the level of depression amongst participants in association with their sociodemographic and clinical characteristics, there was a significant difference between age groups ( < 0.00001); gender ( < 0.0001); nationality ( < 0.00001); educational level ( < 0.00001); and employment status ( < 0.0001). The type of clinic in which the T2DM patients were attending (e.g., diabetes mini-clinic vs. General Family Clinic) was also significantly associated with depression ( < 0.0001). Our results demonstrate that the intensive service being given in a diabetes mini-clinic compared to routine PHC clinics appears to benefit the psychological aspects of T2DM patients in the UAE population resulting in a lower incidence of depression than commonly seen in a diabetic population. We have identified a need for the establishment of these mini-clinics in each PHC clinics; and the development of campaigns and educational programs, both for health care providers and the public to decrease depression in T2DM patients in this region.
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http://dx.doi.org/10.3389/fendo.2019.00259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509230PMC
May 2019

Implementing Resident Research Program to Enhance Physicians Research in the United Arab Emirates.

Int J Appl Basic Med Res 2019 Apr-Jun;9(2):75-79

Department of Neurology, Carrick Institute, Cape Canaveral, FL, USA.

Objectives: The Dubai Residency Training Program (DRTP) commenced in the year 1993; then, a "Residency Research Program (RRP)" has implemented from 2011 to promote research among young physicians. This study was conducted by the Dubai Health Authority to review the RRP to assess its effectiveness in meeting original objectives and generating desired outcomes.

Methods: Source documents such as the chronicles of the DRTP, communication between the stakeholders, resident feedback, research director, and program director reports were accessed and retrospectively reviewed.

Results: Seven research workshops and ten advanced statistics courses were held. Ten scholarships were provided to the residents for "Introduction to Clinical Research Training" held by Harvard Medical School. Of 370 residents, a total of 156 residents submitted their research proposal, of which 128 residents presented their thesis. Nineteen residents presented their research on international conferences, 12 published their study, and 9 got award locally.

Conclusions: Efforts are focused on improving the quality of the research projects, as well as getting residents involved in research that leads eventually to publication. Research is a major component of DRTP; nevertheless, it is challenging for residents to conduct research successfully because of some barriers inherent in residency training. This experience was the first in the United Arab Emirates, and we believe that this paper will contribute to the integrating research in residency programs by the educators and academics in across countries within the region.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_183_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477951PMC
May 2019

Colorectal Cancer Risk Awareness and Screening Uptake among Adults in the United Arab Emirates

Asian Pac J Cancer Prev 2018 Aug 24;19(8):2343-2349. Epub 2018 Aug 24.

Primary Healthcare Sector, Dubai Health Authority, Dubai, United Arab Emirates. Email:

United Arab Emirates initiated the colorectal cancer (CRC) screening on 2013. Yet, one of the barriers to participation in CRC screening is lack of knowledge about the importance of CRC, its risk factors, and the benefits that could be gained through screening. We aimed in this study to identify knowledge, attitude, and behavioral factors among the public that are associated with willingness to undergo CRC screening. A structured bilingual questionnaire in English and Arabic was designed by a multidisciplinary team and through a review of the literature. The survey consisted of four functional domains: socio-demographic characteristics, knowledge, attitude, and practice related questions. It was encouraging that more than 65% of the total participants surveyed for the study were aware of CRC and their main source of information was media (395, 66%). However, the majority (379, 64%) were thinking that CRC is not common, and did not hear of the screening test for CRC (401, 67%). An overall evaluation of the answers revealed a poor level of knowledge on risk factors of CRC, and only 40% correctly identified fecal occult blood as main test for CRC prevention. Surprisingly, 95% of participants mentioned that the CRC screening was not recommended to them by a physician. This is the first report analyzing the awareness, attitude and practice of UAE population and assessing the barriers for CRC screening. Our results demonstrate that better education and communication of the benefits of early detection of CRC should be addressed to improve the screening in UAE population. There is need for campaigns and educational programs, both for health care providers and public. Media might play a significant role in this aspect and new policies need to focus more on increasing community awareness on cancer preventive measures in UAE.
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http://dx.doi.org/10.22034/APJCP.2018.19.8.2343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171396PMC
August 2018

Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study.

J Family Med Prim Care 2018 Mar-Apr;7(2):435-441

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Cambridge, UK

Introduction: Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE.

Methods: A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap.

Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout.

Conclusions: This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_199_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060937PMC
August 2018

Emergency peripartum hysterectomy in the Dubai health system: A fifteen year experience.

Turk J Obstet Gynecol 2018 Mar 28;15(1):1-7. Epub 2018 Mar 28.

Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Department of Neurology and Senior Research, Cambridge, United Kingdom.

Objective: To determine the incidence, demographic data, risk factors, indications, outcome and complications of emergency peripartum hysterectomy (EPH) performed in two major tertiary care hospitals in Dubai, and to compare the results with the literature.

Materials And Methods: The records of all women who underwent EPH from January 2000 to December 2015 in two major tertiary care hospitals in Dubai were accessed and reviewed. Maternal characteristics, hysterectomy indications, outcomes, and postoperative complications were recorded using descriptive statistics to describe the cohort.

Results: There were 79 EPH out of 168.293 deliveries, a rate of 0.47/1000 deliveries. The most common indications for hysterectomy were abnormal placentation (previa and/or accreta) and uterine atony. The majority of hysterectomies were subtotal (70%). The complications were dominated by massive transfusion, urinary tract injuries, one case of maternal death, and one case of neonatal death.

Conclusion: The main indication for EPH was abnormal placentation in scarred uterus and uterine atony. The major method of prevention of EPH is to assess women's risks and to reduce the number of cesarean section deliveries, by limiting the rate of primary cesareans. This is challenging in the United Arab Emirates (UAE) where the culture is for high gravidity and high parity. Recommendations to act to reduce primary and repeated cesareans should be included on the national agenda in UAE.
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http://dx.doi.org/10.4274/tjod.55492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894529PMC
March 2018

Professionalism among multicultural medical students in the United Arab Emirates.

Med Educ Online 2017 ;22(1):1372669

d Bedfordshire Centre for Mental Health Research , University of Cambridge , Cambridge , UK.

Background: Moral competencies and ethical practices of medical professionals are among the desired outcomes of academic training. Unfortunately, academic dishonesty and misconduct are reported from medical colleges across the world. This study investigates the level of academic dishonesty/misconduct among multicultural medical students.

Objective: The aim of this study is to investigate the level of academic dishonesty/misconduct among multicultural medical students.

Design: Validated and customized version of Dundee Polyprofessionalism Inventory-1 detailing lapses of professionalism in undergraduate health professions education was used to determine the perceived prevalence and self-reported lapses of academic integrity in this study.

Results: This study shows that the majority (458/554, 83%) of medical students have admitted to acts of academic dishonesty mentioned in the questionnaire. Approximately 42% (231/554) of the students have given proxy for attendance and 71% of them considered this as an offense. Similarly, 12% (66/554) have copied from the record books of others, and 86% (477/554) have considered it unethical. In addition, 5% (28/554) of the students revealed forging a teacher's signature in their record or logbooks, with 16% (91/554) of them reporting that they have seen others forge signatures.

Conclusion: This is the first multi-center, multi-cultural and multi-ethnic study involving a large number of participants that addresses academic professionalism among medical students in the Middle East. Certainly, the paucity of data limits definitive conclusions about the best approach to prevent academic misconduct in the UAE medical schools. Yet, the results of our study are anticipated not only to benefit the UAE but also to find application in the Arab world, with similar medical school programs, values, culture and tradition.
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http://dx.doi.org/10.1080/10872981.2017.1372669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653941PMC
April 2018

Head-Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients.

Front Neurol 2017 22;8:414. Epub 2017 Aug 22.

Neurology, Carrick Institute, Cape Canaveral, FL, United States.

Context: Approximately 1.8-3.6 million annual traumatic brain injuries occur in the United States. An evidence-based treatment for concussions that is reliable and effective has not been available.

Objective: The objective of this study is to test whether head-eye vestibular motion (HEVM) therapy is associated with decreased symptoms and increased function in postconcussive syndrome (PCS) patients that have been severely impaired for greater than 6 months after a mild traumatic brain injury.

Design: Retrospective clinical chart review.

Setting And Participants: Tertiary Specialist Brain Rehabilitation Center.

Interventions: All subjects underwent comprehensive neurological examinations including measurement of eye and head movement. The seven modules of the C3 Logix Comprehensive Concussion Management System were used for pre- and postmeasurements of outcome of HEVM therapy.

Materials And Methods: We utilized an objective validated measurement of physical and mental health characteristics of our patients before and after a 1-week HEVM rehabilitation program. We included only PCS patients that were disabled from work or school for a period of time exceeding 6 months after suffering a sports concussion. These subjects all were enrolled in a 5-day HEVM rehabilitation program at our Institutional Brain Center with pre- and post-C3 Logix testing outcomes.

Results: There were statistical and substantive significant decreases in PCS symptom severity after treatment and statistical and substantive significant increases in standardized assessment of concussion scores. The outcomes were associated with positive changes in mental and physical health issues. This is a retrospective review and no control group has been included in this study. These are major limitations with retrospective reviews and further investigations with prospective designs including a randomized controlled study are necessary to further our understanding.

Conclusion: Head-eye vestibular motion therapy of 5 days duration is associated with statistical and substantive significant decreases of symptom severity associated with chronic PCS.
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http://dx.doi.org/10.3389/fneur.2017.00414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572417PMC
August 2017

Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum.

Front Neurol 2017 24;8:349. Epub 2017 Jul 24.

Health Professions Education, MGH Institute of Health Professions, Boston, MA, United States.

Context: Medical Education can be delivered in the traditional classroom or novel technology including an online classroom.

Objective: To test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy.

Design: Randomized controlled trial. A total of 274 subjects enrolled in a Neuro-otology training program for non-Neuro-otologists of 25 h held over a 3-day period. Subjects were randomized into a "control" group attending a traditional classroom and a "trial" group of equal numbers participating in an online synchronous Internet streaming classroom using the Adobe Connect e-learning platform.

Interventions: Subjects were randomized into a "control" group attending a traditional classroom and a "treatment" group of equal numbers participating in an online synchronous Internet streaming classroom.

Main Outcome Measures: Pre- and post-multiple choice examinations of VOR, Movement, Head Turns, Head Tremor, Neurodegeneration, Inferior Olivary Complex, Collateral Projections, Eye Movement Training, Visual Saccades, Head Saccades, Visual Impairment, Walking Speed, Neuroprotection, Autophagy, Hyperkinetic Movement, Eye and Head Stability, Oscilllatory Head Movements, Gaze Stability, Leaky Neural Integrator, Cervical Dystonia, INC and Head Tilts, Visual Pursuits, Optokinetic Stimulation, and Vestibular Rehabilitation.

Methods: All candidates took a pretest examination of the subject material. The 2-9 h and 1-8 h sessions over three consecutive days were given live in the classroom and synchronously in the online classroom using the Adobe Connect e-learning platform. Subjects randomized to the online classroom attended the lectures in a location of their choice and viewed the sessions live on the Internet. A posttest examination was given to all candidates after completion of the course. Two sample unpaired tests with equal variances were calculated for all pretests and posttests for all groups including gender differences.

Results: All 274 subjects demonstrated statistically significant learning by comparison of their pre- and posttest scores. There were no statistically significant differences in the test scores between the two groups of 137 subjects each (0.8%, 95% CI 85.45917-86.67952;  = 0.9195). A total of 101 males in the traditional classroom arm had statistically significant lower scores than 72 females (0.8%, 95% CI 84.65716-86.53096;  = 0.0377) but not in the online arm (0.8%, 95% CI 85.46172-87.23135;  = 0.2176) with a moderate effect size (Cohen's  = -0.407).

Conclusion: The use of a synchronous online classroom in neuro-otology clinical training has demonstrated similar outcomes to the traditional classroom. The online classroom is a low cost and effective complement to medical specialty training in Neuro-Otology. The significant difference in outcomes between males and females who attended the traditional classroom suggests that women may do better than males in this learning environment, although the effect size is moderate.

Clinical Trial Registration: Clinicaltrials.gov, identifier NCT03079349.
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http://dx.doi.org/10.3389/fneur.2017.00349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523077PMC
July 2017

Eye-Movement Training Results in Changes in qEEG and NIH Stroke Scale in Subjects Suffering from Acute Middle Cerebral Artery Ischemic Stroke: A Randomized Control Trial.

Front Neurol 2016 22;7. Epub 2016 Jan 22.

Institute of Neurology and Neurosurgery , Havana , Cuba.

Context: Eye-movement training (EMT) can induce altered brain activation and change the functionality of saccades with changes of the brain in general.

Objective: To determine if EMT would result in changes in quantitative electroencephalogram (qEEG) and NIH Stroke Scale (NIHSS) in patients suffering from acute middle cerebral artery (MCA) infarction. Our hypothesis is that there would be positive changes in qEEG and NIHSS after EMT in patients suffering from acute MCA ischemic stroke.

Design: Double-blind randomized controlled trial.

Setting And Participants: Thirty-four subjects with acute MCA ischemic stroke treated at university affiliated hospital intensive care unit.

Interventions: Subjects were randomized into a "control" group treated only with aspirin (125 mg/day) and a "treatment" group treated with aspirin (125 mg/day) and a subject-specific EMT.

Main Outcome Measures: Delta-alpha ratio, power ratio index, and the brain symmetry index calculated by qEEG and NIHSS.

Results: There was strong statistical and substantive significant improvement in all outcome measures for the group of stroke patients undergoing EMT. Such improvement was not observed for the "control" group, and there were no adverse effects.

Conclusion: The addition of EMT to a MCA ischemic stroke treatment paradigm has demonstrated statistically significant changes in outcome measures and is a low cost, safe, and effective complement to standard treatment.
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http://dx.doi.org/10.3389/fneur.2016.00003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722822PMC
February 2016

Short- and Long-Term Effectiveness of a Subject's Specific Novel Brain and Vestibular Rehabilitation Treatment Modality in Combat Veterans Suffering from PTSD.

Front Public Health 2015 1;3:151. Epub 2015 Jun 1.

Carrick Institute , Cape Canaveral, FL , USA ; Electrical and Computer Engineering, University of Wyoming , Laramie, WY , USA.

Introduction: Treatment for post-traumatic stress disorder (PTSD) in combat veterans that have a long-term positive clinical effect has the potential to modify the treatment of PTSD. This outcome may result in changed and saved lives of our service personnel and their families. In a previous before-after-intervention study, we demonstrated high statistical and substantively significant short-term changes in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores after a 2-week trial of a subject's particular novel brain and vestibular rehabilitation (VR) program. The long-term maintenance of PTSD severity reduction was the subject of this study.

Material And Methods: We studied the short- and long-term effectiveness of a subject's particular novel brain and VR treatment of PTSD in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. We analyzed the difference in the CAPS scores pre- and post-treatment (1 week and 3 months) using our subjects as their matched controls.

Results: The generalized least squares (GLS) technique demonstrated that with our 26 subjects in the 3 timed groups the R (2) within groups was 0.000, R (2) between groups was 0.000, and overall the R (2) was 0.000. The GLS regression was strongly statistically significant z = 21.29, p < 0.001, 95% CI [58.7, 70.63]. The linear predictive margins over time demonstrated strong statistical and substantive significance of decreasing PTSD severity scores for all timed CAPS tests.

Discussion: Our investigation has the promise of the development of superior outcomes of treatments in this area that will benefit a global society. The length of the treatment intervention involved (2 weeks) is less that other currently available treatments and has profound implications for cost, duration of disability, and outcomes in the treatment of PTSD in combat veterans.
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http://dx.doi.org/10.3389/fpubh.2015.00151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450724PMC
June 2015

In-situ verification of accuracy, precision and resolution of force and balance platforms.

Biomed Sci Instrum 2014 ;50:171-8

University of Wyoming, Laramie.

It is common practice in laboratories to check for accuracy, precision and resolution of instrumentation before using it inresearch. For force platforms used in gait analysis and balance measures, most of these verifications are done in staticconditions, i.e., applying known weights in known locations on the surface of the instrument, measuring what the output is,and comparing it with what it should be. However, this is not a realistic simulation of a subject standing on the instrument,as the Center of Pressure (CoP) varies continuously over time and covers a good portion of the area of support. Otherauthors have proposed a device to assess how well a force platform measures a time-changing CoP trace by comparing themathematically known, spiral-shaped trace generated by a rotating mass with what is measured by the force platform.Changing mass and rotation speed allows evaluation of a wide range of frequencies and areas of support. In this paper, thedifferent in-situ verification techniques most commonly mentioned in the literature were investigated from a theoreticalpoint of view and then compared using commercially available balance platforms, to assess their ability to verify accuracyand resolution of force platforms.
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February 2016

Frequency content of standard posturographic measures - biomed 2013.

Biomed Sci Instrum 2013 ;49:48-53

University of Wyoming-Laramie.

Although still considered experimental by some, computerized posturography is becoming more and more the standard assessment of balance and neuromuscular control mechanisms while standing. However, there is no consensus as to the data acquisition parameters to be used. Depending on which posturography school one belongs to, acquisition frequencies vary from a few Hz all the way to 1 kHz, and little attention is usually given to the post-sampling filter cut-off frequency (implemented either in the hardware or in the software used to acquire the data), often without realizing the consequences such choices will have on the results. But the sampling and the filter cut-off frequencies are particularly important when dealing with spectral analysis or when secondary measurements such as the center of pressure coordinates, sway path length, velocity or acceleration are calculated from the measured forces and moments. In this paper, frequency content of vertical ground reaction force and center of pressure path coordinates excursion were determined for 946 subjects of both genders, with various age, height, body type, health status and nationality. The results of this spectral analysis made it possible to draw some general conclusions as to what should be a proper acquisition frequency for posturographic data.
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February 2016
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