Aram Halimi

INTRODUCTION: The Knowledge, Attitudes, and Practices (KAP) model is a foundational tool in public health research. KAP surveys play a vital role in this process by gauging a population's current level of knowledge about a specific health issue. Rigorous evaluation is essential for ensuring the validity and reliability of KAP studies. Therefore, in this study, a comprehensive checklist for reporting Knowledge, Attitude, and Practices (KAP) Studies was developed. METHODOLOGY: This study was conducted using a systematic six-step roadmap. A comprehensive review of available relevant quality assessment tools led to the development of specific new items. An expert panel reviewed the initial draft, and after corrections were made, the second draft was finalized and subjected to psychometric analysis by experts. RESULTS: The development of ChecKAP (Checklist for Reporting Items for Knowledge, Attitude, and Practice) represents a significant contribution to KAP studies. The final tool consists of 46 items across 8 fields: title (1 item), abstract (6 items), keywords (1 item), introduction (6 items), method (11 items), findings (7 items), discussion (15 items), and conclusion (1 item). CONCLUSION: ChecKAP assesses the inherent complexity of KAP research methods and ensures consistent reporting. It fills an important gap in the KAP research literature and serves a dual purpose. First, it acts as a quality assessment tool for reviewers, enabling them to evaluate the methodological rigor and clarity of submitted manuscripts. Second, it serves as a guideline for authors, promoting a more systematic and transparent approach to reporting.

Abstract Background Breast cancer (BC) is one of the most burdensome cancers worldwide. Despite advancements in diagnostic and treatment modalities, developing countries are still dealing with increasing burdens and existing disparities. This study provides estimates of BC burden and associated risk factors in Iran at the national and subnational levels over 30 years (1990–2019). Methods Data on BC burden for Iran were retrieved from the Global Burden of Disease (GBD) study from 1990 to 2019. GBD estimation methods were applied to explore BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to risk factors based on the GBD risk factors hierarchy. Moreover, decomposition analysis was performed to find the contribution of population growth, aging, and cause-specific incidence in the total incidence change. Age-standardized rates (per 100,000 population) and 95% uncertainty intervals (UI) were reported based on sex, age, and socio-demographic index (SDI). Results Age-standardized incidence rate (ASIR) increased from 18.8 (95% UI 15.3–24.1)/100,000 in 2019 to 34.0 (30.7–37.9)/100,000 in 2019 among females and from 0.2/100,000 (0.2–0.3) to 0.3/100,000 (0.3–0.4) among males. Age-standardized deaths rate (ASDR) increased slightly among females from 10.3 (8.2–13.6)/100,000 in 1990 to 11.9 (10.8–13.1)/100,000 in 2019 and remained almost the same among males—0.2/100,000 (0.1–0.2). Age-standardized DALYs rate also increased from 320.2 (265.4–405.4) to 368.7 (336.7–404.3) among females but decreased slightly in males from 4.5 (3.5–5.8) to 4.0 (3.5–4.5). Of the 417.6% increase in total incident cases from 1990–2019, 240.7% was related to cause-specific incidence. In both genders, the BC burden increased by age, including age groups under 50 before routine screening programs, and by SDI levels; the high and high-middle SDI regions had the highest BC burden in Iran. Based on the GBD risk factors hierarchy, high fasting plasma glucose (FPG) and alcohol were estimated to have the most and the least attributed DALYs for BC among females, respectively. Conclusions BC burden increased from 1990 to 2019 in both genders, and considerable discrepancies were found among different provinces and SDI quintiles in Iran. These increasing trends appeared to be associated with social and economic developments and changes in demographic factors. Improvements in registry systems and diagnostic capacities were also probably responsible for these growing trends. Raising general awareness and improving screening programs, early detection measures, and equitable access to healthcare systems might be the initial steps to tackle the increasing trends.

Aim: This qualitative study investigates the impact of cultural practices on children's health in the United Arab Emirates (UAE) by examining the use of traditional remedies and home treatments by mothers. Methods: Twenty-five participants, all mothers who had employed traditional treatments or home remedies for their children during periods of illness, were included in the study. The participants represented a diverse range of educational backgrounds, from school diploma holders to university degree graduates, with ages spanning from 20 to 50 years. Hailing from different Arabic countries and cultural subgroups, the majority of participating mothers were from the UAE. Results: Through in-depth interviews, three major themes emerged from the participants' experiences. Firstly, a strong connection between culture, religion, and healthcare practices was evident. Many mothers opted for cultural remedies as their first line of defense against illnesses due to the practices' strong foundations in their cultural heritage. Herbal remedies, Quranic healing, and other traditional methods were perceived to be both effective and spiritually comforting, reinforcing participants' sense of cultural identity. Secondly, participants highlighted unintended consequences of relying solely on traditional treatments. Some instances were reported where the use of ineffective remedies resulted in delays in seeking appropriate medical care for their children, potentially compromising their health. Additionally, certain misconceptions regarding the safety and efficacy of traditional remedies were identified, emphasizing the need for evidence-based healthcare education. Conclusion: This qualitative study sheds light on the intricate interplay between culture, traditional remedies, and children's health in the UAE. The incorporation of diverse participants from various Arabic countries and cultural subgroups enriches the study's applicability to broader Arabic cultures. By recognizing the significance of cultural healthcare practices and striking a balance with evidence-based care, healthcare providers can create a more inclusive and effective healthcare environment for children in the UAE. Future research should explore diverse samples and develop targeted interventions to further advance cultural awareness and understanding in healthcare practices.

BACKGROUND: Mental and behavioural disorders account for a large proportion of the burden of diseases in Iran. Identifying the pattern of change can help in policy making and provision of mental health services. We aimed to analyse the burden of mental disorders (excluding substance use disorders) in Iran at national and subnational levels with data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. METHODS: We used data from 1990 to 2019 on anxiety disorders, attention-deficit hyperactivity disorder, autism spectrum disorders, bipolar disorder, conduct disorder, depressive disorders, eating disorders, idiopathic developmental intellectual disability, schizophrenia, and other mental disorders in Iran and its 31 provinces. We calculated total disability-adjusted life-years (DALYs), age-standardised DALYs, and prevalence rates in 1990 and 2019, as well as the percentage change between these time periods. FINDINGS: Mental disorders accounted for 1 159 410 (4·6%) of 25 007 732 all-cause DALYs in Iran in 1990 and 2 053 871 (10·3%) of 19 828 721 in 2019. Although total DALYs for mental disorders increased by 77·1% (95% uncertainty interval 76·7 to 77·6%) during this period, age-standardised DALY rate increased by 1·8% (-4·1 to 7·7%). The overall patterns of change were similar at the subnational level as the national level, although the rates differed between provinces with a highest-to-lowest ratio of 1·22 for age-standardised DALY rates in 2019. INTERPRETATION: The increase in the burden of mental disorders in Iran is higher than the general trend in the world. The slight change in age-standardised DALYs suggests that the increase is mainly attributable to changes in the size and structure of the population. Considering the absolute and relative increase in the burden of mental disorders during the past 30 years at national and provincial levels, there is an urgent need to address the determinants of mental health and upgrade mental health services across all levels of care in Iran. FUNDING: Bill & Melinda Gates Foundation.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD), a globally prevalent behavioural disorder, remains underdiagnosed, particularly among adults. This issue is exacerbated in the Arab region due to stigma and insufficient healthcare facilities and professionals. Despite the United Arab Emirates (UAE) efforts to improve mental healthcare, shortcomings persist. No studies in the UAE currently assesses the appropriateness of the screening system for ADHD and other behavioural issues. Furthermore, prevalence rates of ADHD, particularly within the young adult population, are absent. AIM: To estimate the prevalence of ADHD amongst young adults attending university in UAE and examine its relationship with gender and academic outcomes. METHODS: A cross-sectional, correlational design was used. Young adults in their first year at university were recruited from different academic institutions across the UAE. The study utilized the Adult ADHD Self-Report Scale (ASRS) for data collection. RESULTS: A sample of 406 young adults, aged between 18 and 20 years of age were recruited. Approximately, 34.7% (n = 141) reported symptoms suggestive of probable ADHD. Significantly lower grade point average marks were observed in participants with ADHD symptoms (M = 3.15) compared to those without (M = 3.35). Females reported symptoms of probable ADHD at higher rates than males, indicating possibly a potential screening deficiency and a potential stigma consequence. CONCLUSIONS: The study demonstrates a high prevalence of probable ADHD in young adults, particularly among females attending university in the United Arab Emirates. Implications for early screening, service provision, and greater professional health training on this disorder are required.