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ObjectiveTo explore and compare barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia.DesignA qualitative interview study with thematic analysis of transcripts.Participants67 patients with self-discovered breast symptoms were included in the analysis. Of these, 36% were of Malay ethnicity, 39% were Chinese and 25% Indian, with an average age of 58 years (range 24–82 years). The number of women diagnosed at early stages of cancer almost equalled those at advanced stages. Approximately three-quarters presented with a painless lump, one-quarter experienced a painful lump and 10% had atypical symptoms.SettingUniversity hospital setting in Singapore and Malaysia.ResultsPatients revealed barriers to early presentation not previously reported: the poor quality of online website information about breast symptoms, financial issues and the negative influence of relatives in both countries, while perceived poor quality of care and services in state-run hospitals and misdiagnosis by healthcare professionals were reported in Malaysia. The pattern of presentation by ethnicity remained unchanged where more Malay delayed help-seeking and had more advanced cancer compared to Chinese and Indian patients.ConclusionsThere are few differences in the pattern of presentation and in the reported barriers to seek medical care after symptom discovery between Singapore and Malaysia despite their differing economic status. Strategies to reduce delayed presentation are: a need to improve knowledge of disease, symptoms and causes, quality of care and services, and quality of online information; and addressing fear of diagnosis, treatment and hospitalisation, with more effort focused on the Malay ethnic group. Training is needed to avoid missed diagnoses and other factors contributing to delay among health professionals.

Background : The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods : A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results : The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion : The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. To access the supplementary material to this article please see Supplementary files under Article Tools online.

Background There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia. Methods Within the Singapore Malaysia Breast Cancer Registry we identified all consecutive patients diagnosed with breast cancer between 1993 and 2007 at the National University Hospital in Singapore (high income country, n  = 2,141) and the University of Malaya Medical Center in Kuala Lumpur, Malaysia (middle income country, n  = 3,320). We compared demographics, tumor characteristics, treatment patterns, and survival between patients from both countries. Results In Malaysia, patients were less often diagnosed with in situ breast cancer (adjusted odds ratio [ORadj] 0.2; 95 % confidence interval [95 % CI] 0.1–0.3), more likely to be diagnosed with late stage (III and IV) disease (ORadj for stage III 1.6; 95 % CI 1.3–2.0; ORadj for stage IV 1.2; 95 % CI 1.1–1.4) as compared to patients from Singapore. Univariate analysis showed that Malaysian patients were at a 72 % increased risk of death as compared to Singaporeans. After adjusting for other prognostic factors, the risk decreased by only 5 % (ORadj 1.67, 95 % CI 1.44–1.92). Conclusions Differences in way of presentation (except stage and tumor size) and treatment of breast cancer patients from the two countries are small. The overall survival of breast cancer patients from Malaysia is much lower than that of Singaporean patients.

Breast cancer screening can reduce morbidity and mortality and improve the survival rate for this malignancy. Low participation in screening programs has been attributable to many factors including lack of knowledge. The aim of this study was to assess breast cancer screening knowledge, attitudes and practices among women of screening age (≥40 years old) in the city of Al Ain, United Arab Emirates (UAE). A cross-sectional survey was conducted in 2013 using the Breast Cancer Awareness Measure (CAM). Four out of twelve cultural and religious community centers in Al Ain city were randomly selected. Two hundred and forty seven women were interviewed. Chi Square test and regression analysis were used to analyze the data. Despite the increase in the uptake of screening modalities in our study group, a lack of knowledge about breast cancer screening is still evident. Almost half (44.8%) of women who never had a Clinical Breast Exam (CBE) and 44.1% of women who never had a mammography expressed a lack of knowledge about the existence of these screening techniques. Nearly one third of the participants interpreted the presence of a breast lump incorrectly and, moreover, expressed fewer worries about the nature of the lump than would normally be expected. The National screening program needs to be improved and directed towards more efficient and targeted utilization of resources. Healthcare professionals play a major role in alerting women to the importance of periodic screening.

Background Different methods have attempted to obtain consensus on occupational health issues. The objective of this paper is to describe a modified three-stage Delphi process that uses a wireless audience response system to enable consensus to be attained in a single day and to maximise response rates. The modified Delphi approach required: a) agreeing the topic/s of interest for which consensus is sought, b) identifying key stakeholders whose opinions are required; c) assembling the stakeholders for a one-day event. Participants’ opinions were recorded primarily through use of a system of individual wireless audience response devices (‘clickers’) linked to a computer. Providing immediate feedback enabled the audience to consider the group’s views before proceeding to the next stage. From an initial round of responses, participants were asked to narrow their choices to any five preferred options. A third round was conducted, using the ‘clickers’ to rank 5 of the most popular group options. Through this iterative exercise, stakeholder consensus was achieved after three decision rounds. Results The use of the modifications and the wireless audience response system described enabled stakeholders to provide a group view on specific occupational health issues e.g. priorities or barriers or resources needed. Completing the three-stage iterative exercise in a day maximised the response rate with advantages for both the participants and the researchers. Careful design of the protocol is essential, with a team familiar with information technology to ensure smooth execution of the various stages. Conclusions Modification of the Delphi method with the use of a wireless audience participation system facilitates rapid consensus.

Background ADHD is a common neurodevelopmental disorder that persists into adulthood. Its symptoms cause impairments in a number of social domains, one of which is employment. We wish to produce a consensus statement on how ADHD affects employment. Methods This consensus development conference statement was developed as a result of a joint international meeting held in July 2010. The consensus committee was international in scope (United Kingdom, mainland Europe, United Arab Emirates) and consisted of individuals from a broad range of backgrounds (Psychiatry, Occupational Medicine, Health Economists, Disability Advisors). The objectives of the conference were to discuss some of the occupational impairments adults with ADHD may face and how to address these problems from an inclusive perspective. Furthermore the conference looked at influencing policy and decision making at a political level to address impaired occupational functioning in adults with ADHD and fears around employing people with disabilities in general. Results The consensus was that there were clear weaknesses in the current arrangements in the UK and internationally to address occupational difficulties. More so, Occupational Health was not wholly integrated and used as a means of making positive changes to the workplace, but rather as a superfluous last resort that employers tried to avoid. Furthermore the lack of cross professional collaboration on occupational functioning in adults with ADHD was a significant problem. Conclusions Future research needs to concentrate on further investigating occupational functioning in adults with ADHD and pilot exploratory initiatives and tools, leading to a better and more informed understanding of possible barriers to employment and potential schemes to put in place to address these problems.

Background There is an established trend towards an increasing number of authors per article in prestigious journals for medicine and health sciences. It is uncertain whether a similar trend occurs to the same extent in journals for specific medical specialties. Methods Journals focusing on occupational medicine were selected for analysis with regard to single or multiple-authorship per peer-reviewed paper. Data were collected from PubMed for publications between 1970 and 2007. These were analysed to calculate the average number of authors per multiple-author article per year and the percentage of single-author articles per year. The slope and average of these journals were then compared with that of previously studied non-occupational medicine journals. Results The results confirm a trend towards a linear increase in the average number of authors per article and a linear decrease in the percentage of single-author articles. The slope for the average number of authors for multiple-author articles was significantly higher in the Journal of Occupational and Environmental Medicine than in the other occupational medicine journals. Computational analysis of all articles published showed that Occupational Medicine (Oxford) had a significantly higher percentage of single-author articles than the other occupational medicine journals as well as major journals previously studied. Conclusion The same trend towards multiple authorship can be observed in medical specialty journals as in major journals for medicine and health sciences. There is a direct relationship between occupational journals with higher impact factors and a higher average number of authors per article in those journals.

Background South Asian males constitute the largest proportion of the United Arab Emirates (UAE) population. Minimal data is available on the prevalence of hypertension among South Asian immigrants in the UAE. We determined the prevalence, associated factors, awareness, treatment, and control of hypertension among male South Asian immigrants from India, Pakistan and Bangladesh residing in the UAE. Methods We recruited a representative sample (n = 1375; 76.4 % participation rate) of South Asian adult (≥18 years) immigrant males, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities in Al Ain, UAE (January-June 2012). Blood pressure, height, body mass, waist and hip circumference data were obtained using standard protocols. Information related to socio-demographics, lifestyle factors, history of diagnosis and treatment of hypertension was collected through a pilot-tested adapted version of the STEPS instrument, developed by the World Health Organization for the measurement of non-communicable disease risk factors at the country level . Results Mean age of participants was 34.0 years (95 % confidence interval (CI): 33.4, 34.5 years) and the overall prevalence of hypertension was 30.5 % (95 % CI 28.0, 32.8). In this study, 62 % of study participants had never had their blood pressure measured. Over three quarters (76 %) of the sample classified as hypertensive were not aware of their condition. Less than half (48.5 %) of the sample that were aware of their hypertension reported using antihypertensive medication and only 8.3 % had their hypertension under control (<140/90 mmHg). Hypertensive participants were more likely to be overweight (adjusted odds ratio (AOR) = 1.43; 95 % CI 1.01, 2.01); obese (AOR = 2.49; 95 % CI: 1.51, 4.10); have central obesity (AOR = 2.01; 95 % CI 1.37, 2.92); have a family history of hypertension (AOR = 1.51; 95 % CI 1.05, 2.17); and were less likely to walk 30 minutes daily (AOR = 1.79; 95 % CI 1.24, 2.60). Conclusions The prevalence of hypertension in a representative sample of young male South Asian immigrants living in the UAE was relatively high. However, the awareness, treatment, and control of hypertension within this population were very low. Strategies are urgently needed to improve the awareness and control of hypertension in this large population of migrant workers in the UAE.

The United Arab Emirates (UAE), as a rapidly developing country in the Middle East, is in a good position to contribute to global health. It can share its experience of dealing with public health problems characteristic of a desert environment, and it can learn from the experience of other nations in tackling challenges posed by globalization. The health issues particular to the region include heat stress, the effects of consanguineous marriages on families and society, and exposure to occupational and environmental hazards. As in many other developed countries, the UAE also has public health problems associated with smoking, road traffic accidents, and obesity. The experience of other countries in dealing with infectious diseases has helped the UAE implement preventive measures to cope with infections such as the recent H1N1 pandemic. International collaboration has advantages to the UAE in managing problems pertaining to global public health.