One-Person Companies: The Kuwait Legal Framework in a Comparative Perspective

Interpreting mortality trends in the GCC countries: The healthy migrant effect

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Findings on the Burden of Sickle Cell Disease and Impact on the Quality of Life of Patients and Caregivers in Gulf Cooperation Council Countries

The prospective observational Dialysis Outcomes and Practice Patterns Study (DOPPS) was initiated in late 2012 in national samples of hemodialysis (HD) units (n = 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For many years, guidelines have recommended single pool Kt/V ≥1.2 as the minimum adequate dose for chronic HD patients. Here, we report initial DOPPS results regarding HD practices related to dialysis dose achievement in the GCC. A total of 928 adult HD patients were included in this analysis from 41 centers representing all six GCC countries. Baseline descriptive statistics (e.g., mean, standard deviation, median, interquartile range, or percentage) were calculated for the study sample. Results were weighted according to the fraction of HD patients sampled within each participating study site. Mean age varied between 51 years in Bahrain, Oman, and Saudi Arabia, 55 years in the United Arab Emirates (UAE) and Kuwait, and 62 years in Qatar. Mean body mass index (BMI) was the lowest in Oman patients (23.9 kg/m 2 , but the remaining GCC countries had mean BMIs of 25.7-28.9 kg/m 2 and substantial fractions of overweight patients. Median dialysis vintage ranged from 1.52 years in Kuwait to 3.52 years in Oman. Mean treatment time per session varied from 202 min in Saudi Arabia to 230 min in Qatar while mean blood flow rate (BFR) ranged between 267 mL/min in Oman and 310 mL/min in Saudi Arabia. Interdialytic weight gain varied considerably among GCC countries between 3.1 and 4.0 kg. Central venous catheter use was high among GCC countries, ranging from 29% in Oman to 56% in Kuwait, with other countries averaging 30-40% catheter use. Data were available only for 50-76% of patients in four GCC countries (Kuwait, Qatar, Saudi Arabia, and UAE) for calculating single pool Kt/V to indicate dialysis adequacy. When calculated for patients with vintage >1 year and dialyzing three times per week, mean single pool Kt/V was highest in Qatar and the UAE (1.50-1.51), intermediate in Kuwait (1.35), and lowest in Saudi Arabia (1.29). A higher risk of mortality was observed for patients having a single pool Kt/V <1.2 (vs. ≥1.2) [hazard ratio (HR) = 1.71, 95% confidence interval [CI]: 1.01-2.92]. Achievement of Kt/V in the GCC, although lower than in other DOPPS regions such as Europe/ANZ and North America, was similar to that in Japan. Japan and the GCC also share the practice of having a lower blood volume filtered per HD session per kg body weight. These findings suggest that increasing mean BFR and treatment time in the GCC, along with reducing catheter use, would substantially increase overall achievement of Kt/V >1.2 in the GCC, and hence, may improve survival. These mortality findings will need to be confirmed with up-coming GCC-DOPPS 6 analysis.

The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) initiated data collection in national samples of hemodialysis (HD) units (total of 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in late 2012. Here, we report initial results regarding mineral bone disorders (MBDs) and its management in the GCC countries. Forty-one randomly selected HD facilities, treating >23 HD patients each, were sampled and represent care for >95% of GCC HD patients. Descriptive results for the GCC countries based on a random sample of 20-30 HD patients in each study facility. Initial results for the GCC are from 931 HD patients treated at 41 dialysis units (ranging from 1 unit in Bahrain to 21 in Saudi Arabia). Results are presented as weighted estimates, accounting for the sampling fraction in each unit. Baseline descriptive statistics (e.g., mean, median, or percentage), weighted by facility sampling fraction were calculated for the study sample. For analyses examining the percent of facility patients having (a) serum phosphorus >6.0 mg/dL or (b) parathyroid hormone (PTH) >600 pg/mL, analyses were restricted to facilities having at least 10 HD patients with a reported serum phosphorus or PTH measurement, respectively. Logistic regression analyses of the indicated binary outcomes were based on the use of generalized estimating equations and were adjusted for GCC country, patient age category (<45 years, 45-65 years, and >65 years old), sex, and whether the patient was diagnosed with diabetes mellitus. Logistic models accounted for clustering of patients within facilities, assuming an exchangeable working correlation matrix. Mean age of HD patients in the GCC countries was 53 years vs. 61-64 years in the three other DOPPS regions. MBD markers showed slightly lower mean serum Calcium in the GCC countries, similar mean serum phosphorus, and intermediate median PTH levels compared with the three other DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P <0.001 for each). History of parathyroidectomy was lower in the GCC countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24%) and phosphorus binder use (81%), whereas intravenous Vitamin D use (24%) was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43%) versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variability was seen across countries and facilities in the GCC. Mean serum calcium was lower in the GCC despite the much greater use of dialysate Ca of ~3.5 mEq/L which may be due to the relatively low use of vitamin D and higher cinacalcet use, meriting further study. Future work will focus on GCC facility HD practices and patient characteristics most strongly related to the achievement of MBD target levels and associated outcomes.

BackgroundAsthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies.MethodsTo review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists.ResultsWe identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria.ConclusionsAsthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Perspectives of Physicians in Gulf Cooperation Council Countries on Sickle Cell Disease

PurposeThis study aims to compare recent topics on value-added tax (VAT) in the European Union (EU) and Gulf Cooperation Council (GCC), understand the differences in VAT discourses between the two regions and explore the connection between research agendas, institutional legacies and semantic output in the field of VAT in each territory.Design/methodology/approachA bibliometric study was conducted using R programming. The data were gathered from the Scopus database, which contains 99 English-language publications with publication dates ranging from 1996 to 2022 (87 of which are from the EU and 12 from the GCC). Information about publications, journals, authors and citations is gathered, validated, cross-referenced and analyzed using bibliometric metrics.FindingsThe results highlight two ideal research contexts for studying VAT: the EU countries approach VAT research with a centralized, pluralistic and quantitative focus, while the GCC countries adopt a centralized, qualitative and practically oriented approach, highlighting distinct research goals, collaboration styles and institutional legacies. The authors extend their result findings to broader discussions on competing knowledge systems in VAT, the significance of the state and the level of autonomy within tax governance after identifying the most popular issues among scholars working in GCC and EU countries.Research limitations/implicationsAlthough the focus of this analysis is restricted to the GCC and EU, it includes theoretical recommendations for broadening its application to other nations. Researchers from the GCC and the EU may benefit from this study by gaining more about VAT and being encouraged to share their research with young researchers. The study’s findings are relevant and important for comprehending the comparative state of research on VAT in GCC and EU countries, tax fields, publications and institutions.Originality/valueThis study analyzes the VAT systems of the GCC and the EU while identifying the intellectual structure of the field from each author’s point of view, revealing the scientometrics and informetrics intellectual structures in detail.

Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.

Purpose This study aims to analyze the impact of Arab Revolution on the Arabian Gulf security by applying on Yemeni Revolution. This can be achieved by analyzing the threat of Arab Spring Revolutions to the national security of the Gulf Cooperation Council (GCC) countries after the breakout of demonstrations and protests in some of the member states. In addition to its analysis of threat of the Regional Security of the Gulf as a result of Yemeni Revolution and Civil War and Iranian intervention to support Houthis within light of regional anarchy and security competition according to the Neorealism and how the GCC Countries face such threats. Design/methodology/approach The study depended on the historical methodology to track the developments of some events related to the Gulf Security and crisis in Yemen. Moreover, it used the analytical approach to analyze the impact of Arab Revolutions and Yemeni Civil War on the Arab Gulf Security. In addition, it depended on the realistic approach to explain the security state at the national and regional level of the Arab Gulf countries within light of regional anarchy, security competition and Iranian support to Houthis “Non-State Actors” (Kenneth Waltz), as well as the offensive realism (John Mearsheimer). Findings The Arab Revolutions had an effect on the national security of GCC countries according to the Neorealism due to the breakout of demonstrations and protests in Saudi Arabia, Kuwait and Sultanate of Oman which reached to the degree of threatening the existence of the state as in Bahrain. The Gulf Regional Security is influenced by Revolution and Civil War in Yemen as a result of that Iranian support to Houthis within light of security competition between Iran and Saudi Arabia, leading to the threat of the Arabian Gulf Security as Yemen is the southern gate to the GCC Countries and having joint borders with Saudi Arabia and Sultanate of Oman. Moreover, the GCC countries dealt with that threat individually, such as, performing internal reforms, or collectively through using military force, such as Bahrain and Yemen (Offensive Realism). Originality/value This study is an introduction to explain the Arab Spring Revolutions, conflict in Yemen and its threat to the Arab Gulf Security according to the Neorealism based on that the GCC countries sought to keep its existence and sovereignty in confrontation to the demonstrations and internal protests and to keep the regional security in confrontation to the threats of neighboring countries such as the Civil War in Yemen and the Iranian Support to Houthis in light of the regional anarchy.

In the GCC countries, date-palm sector is strategically important for the economic, social and environmental development. Therefore, markets globalization has had a huge impact on the comparative advantages of date exports from the GCC countries, highlighting a new range of necessary determinants for competitiveness of these countries on the international date palm date market. The current study is conducted in the framework of the “Development of sustainable date palm production systems in the GCC countries of the Arabian Peninsula” project funded by the Gulf Cooperation Council (GCC) and led by the International Center for Agricultural Research in the Dry Areas (ICARDA), and aims to provide updated estimates of competitiveness indicators of the GCC countries on the international market of date palm.The study starts by a summary description of updated figures concerning date’s production, yields, and consumption trends of the different GCC countries. This first part of the research paper also includes a presentation of the date trade matrix (destinations of exports and imports) of the considered countries. In a second part of this section, a set of competitiveness indicators were calculated to better reflect on the date trade balances performances of each of the GCC countries. The measures of competitiveness indicators conducted in this paper include: i) the Market Share (MS); ii) the Revealed Comparative Advantage (RCA); and iii) the Trade Balance Index (TBI). The Market share indicator was used to identify size advantages and the degree of specialization of a given country on the international market of a given commodity. The RCA has been defined as a measure of performance of international trade competitiveness of a given country for a given commodity. The TBI is used to analyze whether a country has specialization in export (as net-exporter) or in import (as net-importer) for a specific group of products. Data from both FAOSTAT and UN COMTRADE sources was used for the calculation of these indicators. Empirical findings show that GCC and North African countries are holding more than 70% of the international market of dates. The sum of market shares of the 6 GCC countries was about 30% of the international date market during 2015. This is showing that these countries together have strong potential for dominating the international date market. In terms of growth, it was clear that all GCC countries, including the least present on the international market are progressing quite positively with increasing shares from one year to another. In terms of RCA, the highest RCA value was recorded for Saudi Arabia (KSA). It was for about 43.5 in 2013, indicating that the country date export share for 2013 is 43.5% higher than its share in total world export of agricultural goods. Finally, TBI results show the existence of structural differences between KSA and UAE in terms of dates export and import patterns. These two countries are both the main players in date export in the GCC area. However, even though UAE is a net exporter of date palm, which its TBI is much lower than the TBI of KSA, showing that UAE is also importing a higher proportion of its exported dates compared to KSA. The date trade patterns among the GCC countries shows that there is a wide scope of coordination between the different trade strategies of these countries, through specialization and division of tasks. This can generate important opportunities for gaining more weight on the world market of dates.

BackgroundThe World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was developed to assist nations in reducing the demand and supply of tobacco. As of 2020, 182 nations joined the FCTC, agreeing to implement the recommended tobacco control measures. The Gulf Cooperation Council (GCC) countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE) ratified the WHO FCTC by August 2006. Given the unique political, cultural, and religious context – and known tobacco industry efforts to influence tobacco use- in these nations, a careful examination of the translation of FCTC measures into policy is needed. This study aimed to assess the implementation of FCTC tobacco control measures at the national level within the six GCC countries.MethodWe collected and coded the FCTC measures that were implemented in the GCC countries. We examined trends and variations of the implementation between 2008 and 2020.ResultsGCC countries implemented most FCTC measures targeting the demand for and supply of tobacco, with some variation among countries. Bahrain and Qatar were more comprehensively implementing FCTC measures while Kuwait and Oman implemented the least number of the FCTC measures. Implementing measures related to tobacco prices and eliminating the illicit tobacco trade has slowly progressed in GCC countries. All GCC countries entirely banned smoking in workplaces while three countries implemented a partial ban in restaurants. Only Oman has restrictions on tobacco ads shown in media. There is progress in implementing FCTC measures related to tobacco packaging, cessation, and sale to minors in most GCC countries.ConclusionsGiven the influence of the tobacco industry in the Gulf region, the findings suggest a need for ongoing surveillance to monitor the proliferation of tobacco control measures and evaluate their effectiveness. Efforts required to address tobacco use should correspond to the unique political and cultural background of the GCC countries.

In general, foreign direct investments (FDIs) play a crucial role in driving a country's economic development, promoting diversification, and enhancing competitiveness. The Gulf Cooperation Council (GCC) countries, which heavily rely on the oil and gas sectors, are particularly vulnerable to fluctuations in commodity prices. However, these countries have recognized the imperative of economic diversification and have increasingly turned to inward FDIs to achieve it. By attracting capital, advanced technology, and expertise from foreign investors, FDIs enable the GCC countries to expand their economic base beyond the oil and gas sectors. This diversification not only creates employment opportunities but also fosters resilient economic growth, ultimately leading to an improvement in the living standards of the local population. This study investigates the macroeconomic and environmental factors that potentially attract foreign direct investment (FDI) inflows into the Gulf Cooperation Council (GCC) countries in the long run. Additionally, the study explores the causal relationship between these factors and FDI inflows. The panel autoregressive distributed lag (ARDL) approach to co-integration is the primary analytical technique used, utilizing long time-series data from six GCC countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) during the period 1990-2019. The empirical results indicate that, in the long run, almost all independent variables significantly influence FDI in GCC countries. Variables such as GDP growth (GDPG), inflation (INFL), carbon dioxide emissions (CO2), and urbanization (URB) are found to be highly significant (p≤0.01) in their impact on FDI. Moreover, unemployment (UNEMP) also positively and significantly influences FDI in these countries in the long run. Based on the key findings, strategies aimed at reducing persistently high unemployment rates, maintaining population growth, viewing FDI as a driver for GDP growth, and continuing with infrastructure development and urbanization are expected to attract more FDI inflows into GCC countries in the long run. Additionally, fostering both long-term economic incentives and creating a conducive business infrastructure for investors are vital for attracting inward FDI into any nation, including those in the GCC. This research would benefit various stakeholders, including governments, local businesses, investors, academia, and the local society, by providing valuable knowledge and informing decision-making processes related to economic development, diversification, and investment promotion.

This paper provides estimates of the exchange rate pass-through to the quarterly Consumer Price Index (CPI) in five Gulf Co-operation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, and Saudi Arabia) during the period 1999q1 to 2009q4. The degree of pass-through varies significantly across the five GCC countries. Consumer prices in Qatar, Saudi Arabia, and Bahrain show higher and faster response to exchange rate fluctuations as opposed to the findings of Kuwait and Oman. In all cases, over a one-and-half year span, the pass-through is complete for Qatar only. More interestingly, and despite the fact that the euro area is the major import partner to GCC countries, the empirical results revealed that the Japanese Yen/US dollar exchange rate matters more for CPI inflation in GCC countries than Sterling Pound/US dollar or Euro/US dollar. Variations in estimated pass-through are related to nominal exchange rate volatility, import openness, retail distribution channels, and subsidization programs by respective governments. These results have important policy implications given the GCC countries’ movement toward a common market and their efforts to achieve greater monetary policy coordination. In addition, the paper has policy implications for firms exporting to the GCC region.

The six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) are demographically unique in several ways. Non-nationals now comprise 47% of the total GCC population; nationals are a minority in all countries, except Oman and Saudi Arabia. Thus, aggregated data including both nationals and non-nationals provide a highly misleading picture of the evolving demographic situation. This paper describes socio-demographic changes among GCC nationals from the 1970s to the present, and outlines the trends in outflows from the six major sending countries. It then discusses the implications of the socio-demographic transitions among nationals for future migration to GCC countries from Asian countries, taking cognizance of the existing labor force patterns of the indigenous population, as well as the migration policies of the sending as well as receiving countries. GCC countries have among the lowest crude death rates, and infant mortality rates are generally less than 10 per 1000 live births. Fertility has declined but still hovers around 3-4 children per woman, resulting in very high rates of population growth and young populations. About 36-38% of the population in most countries are aged less than 15. These trends have several implications for unemployment rates and actions to replace foreign workers with nationals.

Studies on the assessment of indoor air pollutants in terms of concentration and characterization in the Gulf Cooperation Council (GCC) countries have been recently carried out. This review assesses the health effects associated with indoor air pollution exposures in GCC, including other air pollutants (siloxanes, flame retardants, synthetic phenolic antioxidants) which were not explored in a previous study. In addition, the influence of ventilation conditions due to different indoor environments was also investigated. It was revealed that there is a lack of human health assessment studies on most indoor air pollutants in almost all GCC countries, except the United Arab Emirates, Kingdom of Saudi Arabia and Kuwait, where few attempts were made for some specific pollutants. Commonly reported plausible health effects potentially associated with indoor air pollution were related to respiratory symptoms and sick building syndrome (SBS). Many of the current health assessment studies in GCC countries were based on predictions and/or estimates of exposures rather than clinically based observational studies. Measured ventilation levels and indoor air velocities in most buildings failed to meet the American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE) threshold limits of 8 L/s/p and 0.18-0.25 m/s, respectively. Additionally, limited studies have investigated respiratory symptoms and SBS potentially attributable to poor ventilation in the region. It is highly recommended that future indoor air quality (IAQ) studies in GCC should focus more on epidemiologic and intervention studies.