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The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases—especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis—increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world—although these disorders do still persist in LICs—whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. Bill & Melinda Gates Foundation.

5 From 2011 to 2022, the age-standardised cancer mortality rate increased from 56·1 to 59·1 per 100 000 people for males and from 58·1 to 62·8 per 100 000 people for females. 4,5 In Bahrain, the three leading cancers among males are lung (15·1 per 100 000 people), colorectal (14·8 per 100 000 people), and prostate (13·4 per 100 000 people) cancer; whereas in females, they are breast (58·5 per 100 000 people), colorectal (12·4 per 100 000 people), and corpus uteri (8·2 per 100 000 people) cancers. 4 In the Gulf Cooperation Council countries, colorectal cancer is the most common cancer among males, except for Kuwait, where it is second, and is among the top three cancers in females after breast and thyroid cancer. The corresponding prevalence rates of overweight are 38·7% of males and 32·9% of females, obesity in 33·0% of males and 42·5% of females, and insufficient physical activity 35·7% of males and 42·8% of females, as reported by the World Obesity Observatory. 6 A crucial component of cancer control is the development and implementation of a comprehensive national cancer control plan (NCCP). Saudi Arabia is actively working on its next NCCP, Qatar has established its Qatar Cancer Plan, the UAE has updated its cancer policy into a comprehensive plan, while like Jordan, Bahrain lacks an NCCP. 1–3,7 The Bahrain Cancer Society has had a crucial role in educating women about the early detection of breast cancer for more than 20 years.

Background One third of Bahraini adult (20–64 years) males and 7.0% of females use some form of tobacco. The corresponding rates for cigarette and waterpipe tobacco smoking (WTS) are 11.0% and 6.0%, respectively. The objective of the study was to determine the knowledge on tobacco smoking and past smoking related behavior of male patients attending the Quit Tobacco Clinics (QTC) in Bahrain. Methods A sample of 339 male clinic attendees was taken proportional to the population distribution in the three QTC at Al Hoora Health Center, Hamad Kanoo Health Center, and Bank of Bahrain and Kuwait Health Center. Data collection was performed until the sample size was completed (September 2015 to December 2016). Knowledge on the health effects of cigarette and WTS was examined based on 10 statements on cigarette and similar ones on WTS. Respondents “agreeing” with the statements were considered knowledgeable and those “disagreeing” or responding “don’t know”, not knowledgeable. All the “agree” responses for cigarette/WTS were summed across the 10 health effects and average health knowledge scores for cigarette/WTS were computed. Results Most of the study participants were Bahraini nationals, ever married and educated with at least secondary level. The majority (65.8%) of participants smoked a single type of tobacco product, and the rest, two (28.0%) or three or more (6.2%). Age of starting cigarette and WTS was 16.2 ± 4.0 and 19.3 ± 6.7 years, respectively. The majority (81%) smoked in the presence of other family members and 26.3% in the presence of a child. 76.2% smoked in the presence of others in their cars. 18.9% of the attendees had quit smoking at the time of interview. 81% of the participants knew about the hazards of both cigarette and WTS with a significantly higher ( p  = 0.0001) mean knowledge score for cigarette (93.3 ± 3.0%) than WTS (85.2 ± 2.1%). Conclusion The relative lack of knowledge on the hazards of WTS in a sample of Arab country population with an increasing trend of WTS warrants the attention of health policy makers in the country and region.

This review aimed to examine trends in cancer research in the Arab world and identify existing research gaps. A search of the MEDLINE® database (National Library of Medicine, Bethesda, Maryland, USA) was undertaken for all cancer-related publications published between January 2000 and December 2013 from seven countries, including Bahrain, Kuwait, Iraq, Lebanon, Morocco, Palestine and Sudan. A total of 1,773 articles were identified, with a significant increase in yearly publications over time ( <0.005). Only 30.6% of the publications included subjects over the age of 50 years old. There was a dearth of cross-sectional/correlational studies (8.8%), randomised controlled trials (2.4%) and systematic reviews/meta-analyses (1.3%). Research exploring cancer associations mainly considered social and structural determinants of health (27.1%), followed by behavioural risk factors (14.1%), particularly tobacco use. Overall, more cancer research is needed in the Arab world, particularly analytical studies with high-quality evidence and those focusing on older age groups and associations with physical activity and diet.

Background: Three global reports issued by the World Health Organization (WHO) track and report on trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys. Aims: This review aimed to compare regional and country-level projections for current tobacco smoking as presented in the WHO trend reports. These changes were considered in the context of improved monitoring and tobacco control policies. Methods: Regional and country-level results in the WHO trend reports were considered in terms of the projected percentage point increase of current tobacco smoking between 2000 and 2025. Data on national surveys and policy implementation came from the relevant WHO reports. Results: In the 2019 trend report, the prevalence of current tobacco smoking among males is projected to decrease by less than 2 percentage points by 2025. Eight countries featured in both the 2015 and 2019 WHO trend reports. Seven of these countries indicated a more encouraging projection (a decline in their projected increase between 2000 and 2025) for current male tobacco smoking in the 2019 report than in the 2015 report. For five out of these seven countries, their monitoring and tobacco control policy implementation improved over the same period. Conclusion: Countries in the Region should implement additional national surveys to improve the accuracy of prevalence estimates, allow further projections to be performed and motivate policy-makers to make positive policy changes. Solutions to under-reporting biases during surveys should be considered. Governments should use trend projections to guide effective tobacco control policies to reduce tobacco use in the Region.

Introduction: Males have a higher prevalence of waterpipe tobacco smoking (WTS) than females in most Eastern Mediterranean Region (EMR) countries, with a smaller gender gap than that of cigarette smoking. The objective of this study was to determine gender differences among university students with respect to WTS initiation, smoking behavior, tobacco flavors, and expenditure on WTS, in four EMR countries. Methods: A cross-sectional online survey was conducted based on convenient samples of ever waterpipe smokers among university students in four EMR countries (Egypt, Jordan, Occupied Palestinian Territories, and the United Arab Emirates) in 2016. The total samples included 2470 participants. Study participants were invited through flyers, university portals, emails and Facebook, followed by emails with links to the internet survey. Results: Females (80.4%) were more likely than males (66.4%, p< 0.001) to be in the younger age group (18 – 22 years) and they were less likely to be current waterpipe smokers (females, 60.0%; males 69.5%, p< 0.001). Twothirds of students across both genders smoked their first waterpipe at the age of 15 – 19 years, with more females starting with family members. Over one-third of males and 14.9% of the females usually smoked ≥ 10 heads (p< 0.001). About half (46.6%) of females smoked for less than half an hour compared to 30.5% of males (p< 0.001). Only 1% of females smoked non-flavored tobacco compared to 11% of males (p< 0.001). There was a significant (p=0.05) positive correlation (r=0.808) with respect to tobacco flavor usually smoked between males and females with apple/double apple being the most popular. Conclusions: There were gender differences in WTS in several aspects. The study has implications for educational establishments, tobacco control and women civil society groups, as well as policymakers.

Background Cultural factors influence attitudes toward death, and gender disparities are evident. Prior studies show that medical students have limited knowledge about death and are uncomfortable with it. Moreover, there is limited research that has examined factors that influence medical students’ knowledge and attitudes toward death. Objectives The objectives of the study were to compare cultural and gender differences in relation to knowledge and attitudes toward loss and grief and to screen for complicated grief among medical students at the Arabian Gulf University and the University of Toronto. Methods A cross-sectional study was disseminated to medical students at both universities in 2022. The variables in the survey included four parts: demographic characteristics of the participants, religious observance, history of encountering loss of a loved one, grief following loss, attitude toward death, and learning about how to deal with grief and death during medical school. The brief grief questionnaire and the death attitude profile-revised scales were used. Results The study sample consisted of 168 medical students, with 74.1% being female. Complicated grief scores were higher among Arabian Gulf University students (3.87 ± 2.39) than among University of Toronto students (2.00 ± 1.93) and were higher for participants with a higher degree of religious observance in both schools (p  < 0.05). Death avoidance ( p  = 0.003), approach acceptance ( p  < 0.001), and escape acceptance ( p  = 0.038) domains were significantly higher among Arabian Gulf University students than among University of Toronto students. Almost three-quarters of University of Toronto students reported not being taught about grief, compared to 54% of Arabian Gulf University students. Conclusions Arabian Gulf University medical students scored higher on complicated grief, most likely due to cultural and religious factors. Females at both institutions as well as those who indicated a higher level of religious observance reported higher scores of complicated grief. The study highlights how cultural and religious beliefs influence medical students’ attitudes toward death and bereavement. It provides valuable insight into the knowledge and attitudes of medical students toward loss.

[This corrects the article DOI: 10.1371/journal.pone.0103732.].

Waterpipe tobacco smoking (WTS) continues to be very common in the Eastern Mediterranean Region (EMR), partially because of cultural acceptance but also because of misconceptions of its harm. This paper aimed to describe the beliefs towards waterpipe harm of university students who smoked waterpipe in five EMR countries. This study was conducted in 2016 across five EMR countries: Egypt, Jordan, Occupied Palestinian Territories, Oman and United Arab Emirates (UAE). Participants were recruited from among university students in each country. Students' characteristics, smoking behavior, flavor preference and knowledge of WTS harm were collected using an internet-based survey. Participants were included if they were ever waterpipe tobacco smokers and between 18 and 29 years of age. Bivariate analyses assessed variations in student-perceived WTS harm across the countries. Linear regression analysis was used to assess WTS perceived harm differences between students in the different countries. A total of 2 544 university students participated from the five countries. Among ever smoking students, 66% reported WTS in the past 30 days, with the highest proportions (40%) from Occupied Palestinian Territories (OPT) and (41%) Jordan. Dual smoking of waterpipe and cigarettes was highest among students from Egypt. Most participants from the five countries had high level of perceived harm related to WTS during pregnancy. Less than 50% of the students believed that WTS could lead to the death of the smoker, can be harmful for non-smokers and have an addictive effect. Female students, those older than 22 years, and those who didn't smoke waterpipe in the last 30 days significantly had a higher level of WTS perceived harm. Participating students believed that cigarettes are more addictive and contain more nicotine compared to waterpipe. Misperceptions of waterpipe harm are common among university students in the five EMR countries. Immediate public health action is needed, including enforcement of waterpipe tobacco control regulations along with awareness campaigns.

A serious worldwide effort to strengthen research based knowledge translation (KT) has begun in recent years and some countries, particularly developed ones, are trying to incorporate KT in their health and health research systems. Keeping in mind the recent economic depression and the need to perform more efficient research, we aimed to assess and compare the KT status of selected health research institutes in the Eastern Mediterranean Regions' countries, and to identify their strengths and weaknesses in the field. After finding the focal points that would steer the focus group discussions (FGDs) and help complete the 'Self Assessment Tool for Research Institutes' (SATORI) tool, each focal point held two FGDs in which researchers, research authorities and other individuals specified in detail further in the study were held. The scores obtained by each institute were evaluated quantitatively, and the transcriptions were analyzed qualitatively with OpenCode software. For ease of analysis the 50 items of the SATORI were classified into 7 main domains: 'priority setting', 'research quality and timeliness', 'researchers' KT capacities', 'facilities and pre-requisites of KT', 'processes and regulations supporting KT', 'interaction with research users', and 'promoting and evaluating the use of knowledge'. Based on the scoring system, the strongest domain was 'research quality and timeliness'. 'Priority setting' was the weakest domain of all. The remaining domains were more or less equal in strength and were not in a favorable state. The qualitative findings confirmed the quantitative findings. The main problem, it seems, is that a KT climate does not exist in the region. And despite the difference in the contexts, there are many similarities in the region's institutes included in this study. Collaborative efforts can play a role in creating this climate by steering countries towards KT and suggesting regional strategic directions according to their needs.