Middle Eastern Arab Countries Research Articles

Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases.

Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treatingEPA. An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. There were 156 EPA cases diagnosed over six years, with a mean age of 33years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.

Epidemiology of scorpion stings in the West Bank, occupied Palestinian territory.

Scorpionism (scorpion sting envenoming) is an endemic public health concern in many Arab Middle Eastern countries. However, our knowledge of the epidemiology of scorpion stings in the West Bank is limited. To investigate the epidemiology of scorpion stings in 4 districts of the West Bank over a specified period. We obtained scorpion sting records from the main hospitals in 4 districts of the West Bank for 2012 and 2014-2020. A total of 2175 cases were analyzed retrospectively using SPSS version 17. The average age and standard deviation (±SD) for both sexes was 24.7±17.5 years (22.7±16.5 and 27.1±18.4 years for males and females, respectively). The median age was 20 years and 47.2% were children under 18 years. Most cases were reported during the summer months, between June and October, with a peak in July-August. By anatomic site, the right hand was the most commonly stung in both sexes, followed by the right foot. The chest, buttocks and scrotum were the least affected body parts. Clinical data were available for 405 cases, in which pain, vomiting and sweating were the most common symptoms. The overall incidence of stings was 26.32 per 100 000 inhabitants per year over the study period of 8 years (59.21-171.67, 95% CI). Scorpion stings are commonly encountered by adults and children in the West Bank. There is a need for awareness among the West Bank populations on how to avoid being stung, to train medical staff to better manage sting cases, and to evaluate the antivenom currently being used by physicians for scorpion stings.

What is the best referral strategy for axial spondyloarthritis? A prospective multicenter study in patients with suspicious chronic low back pain.

To assess the value of referral strategies for axial spondyloarthritis (axSpA) in patients with suspicious chronic inflammatory low back pain (LBP), to estimate the value of inflammatory back pain (IBP) for referral, and to identify the predictive factors of the final diagnosis of axSpA in Middle Eastern Arab countries. The study was multicentric, prospective, and conducted in LBP first-line clinics (rheumatology, internal, family medicine, orthopedic surgery, neurosurgery, and neurology). Consecutive adult patients aged under 45years were included in case of LBP suspicious of inflammatory nature according to the first-line physician. The rheumatologist's final diagnosis was the gold standard. The diagnostic properties of ten referral strategies (Brandt I, II, III, Hermann, RADAR, RADAR 2/3, MASTER, Braun, CAFASPA, and ASAS) and of IBP were calculated. A multivariable logistic regression identified the clinical predictive factors of axSpA. In 515 referred patients, axSpA was confirmed in 48%, refuted in 43%, and diagnosis remained inconclusive in 9%. The optimal referral strategy was the MASTER (PLR 3.3), which comprises IBP, good response to NSAIDs, positive HLA-B27, and SpA family history. Considering strategies without HLA-B27, the RADAR 2/3 had a PLR of 2.9 (IBP, good response to NSAIDs, any extra-musculoskeletal manifestation). The predictive factors for axSpA were MRI sacroiliitis, positive HLA-B27, high CRP, psoriasis, IBP, and longer symptom duration. Of all patients, 35% were self-referred, 16% were referred by primary care physicians, and 15% by neuro/orthopedic surgeons. Optimizing physicians' awareness of these clinical features may enhance referral in axSpA.

Patterns, mechanism of injury and outcome of pediatric trauma at a level 1 trauma centre: a descriptive retrospective analysis.

There is a gap in knowledge on the epidemiology of pediatric trauma in the developing countries. We aimed to describe the injury pattern, mechanism of injury (MOI), and outcomes of pediatric trauma in a level 1 trauma centre in one of the Arab Middle Eastern countries. A retrospective analysis of pediatric injury data was conducted. All trauma patients (<18 years old) requiring hospitalization between 2012 and 2021 were included. Patients were categorized and compared based on the MOI, age-group and injury severity. A 3,058 pediatric patients (20% of the total trauma admissions) were included in the study. The incidence rate in 2020 was 86 cases per 100,000 pediatric population in Qatar. The majority were male (78%) and the mean age was 9.3 ± 5.7 years. Nearly 40% had head injuries. The in-hospital mortality rate was 3.8%. The median injury severity score (ISS) (interquartile range; IQR) was 9 (4-14) and Glasgow coma scale (GCS) was 15 (IQR 15-15). Almost 18% required Intensive Care admission. Road Traffic Injuries (RTI) were more frequent in 15-18 years old whereas ≤4 years group was mostly injured by falling objects. The case fatality rate was higher among females (5.0%), and in 15-18 years (4.6%) and <4 years (4.4%) group. Pedestrian injuries were more lethal among the MOI. One fifth had severe injury with a mean age of 11 ± 6 and 9.5% had ISS of ≥25. Predictors of severe injury were age (10 years old and above) and RTI. Almost one-fifth of the trauma admissions at the level 1 trauma centre in Qatar is due to traumatic injuries among the pediatric population. Developing strategies that are based on understanding the age- and mechanism-specific patterns of traumatic injuries among the pediatric population remains crucial.

Community pharmacy services in Middle Eastern Arab countries: consumers’ perspective

Over the past few decades, the role of pharmacists has been shifted from medicines to patients’ care. This article is a literature review of the several published works concerning consumers’ perceptions toward community pharmacy services (CPS) from different Middle Eastern Arab countries (MEACs). To identify consumers’ perspectives toward CPS in the MEACs. Standard search strategies were adopted using PubMed, ScienceDirect and Google Scholar for the published literatures (n=22) related to CPS in MEACs in the period between 2000 and 2022. All articles assessing customers’ perception towards CPS in the MEAC. Three themes were identified from the review articles: consumers’ perception toward community pharmacy practice, consumers’ perception toward the role of community pharmacists (CPs) and indicators to develop community pharmacy practice. Consumers showed varied perception toward different aspects of community pharmacy practice. The public showed good understanding toward the traditional role of CPs. Moreover, public is interested to extend the role of CPs. Several barriers were identified that limit the public from seeking medical advice from CPs.

Challenges and Construction Applications of Solid Waste Management in Middle East Arab Countries

Over the past few decades, solid waste production, specifically construction waste, in Middle Eastern Arab countries has dramatically increased. This is characterized by several factors, including rapid urbanization, common food wasting habits, diverse culture, lack of proper planning of solid waste processes, insufficient equipment, as well as lack of proper funding. The exponential growth in solid waste generation rates has led to hazards to health and the environment, causing issues related to air and water pollution under the already increasing pressure of climate change. In this review, we analyze the current solid waste challenges in 13 Arab countries, common diseases, and actual projects applied. The selection of Arab countries was mainly based on the countries with the highest population as well as the availability of data in the field of study. This review also highlights the efforts of the Arab governments that implemented several pilot projects that are not sustainable or effective in the long term. We discuss the main issues facing each Arab country and the main challenges they have in common, as well as the potential to use the great amounts of construction waste in these countries. It is recommended that proper disposal and collection plans should be prioritized in the municipalities’ agendas since air and water pollution represent the main challenge in all Arab countries. Adequate treatment, recycling, and compost production facilities should be initiated and monitored regularly to take advantage of the relatively high percentage of organic matter in most Arab countries. Proper cooperation between the informal sector, private companies, and governments should be ensured in order to achieve long-term goals in the solid waste management (SWM) sector in MENA (Middle East and Northern Africa) Arab countries. This review provides a comprehensive study of the construction waste in MENA Arab countries that will help reach the goal of achieving sustainable countries.

Pharmacy practice and clinical pharmacy research in the Middle East: a scoping review of studies from Bahrain, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, United Arab Emirates, and Yemen.

BackgroundPharmacy practice research publications has increased significantly in the last decade. This is also true for Middle Eastern countries.AimsThe aim of this study was to document and review pharmacy practice literature in the Middle Eastern Arab countries.Materials and methodsA scoping review was conducted using PRISMA-ScR guidelines. Medline/PubMed and Scopus were used to screen the articles. All published original research articles concerning any facet of pharmacy practice in 12 Arabic Middle Eastern countries during 2009–2019 were included. A thematic analysis was performed to classify the articles.ResultsNine hundred and eighty-one articles were included in this study. Eight themes emerged from the selected articles. Medication use was the predominant theme 30.78% (302), followed by pharmacy practice and pharmacist services 22.94% (225), and then pharmacy education and professional development 16.31% (160). The KSA, Jordan, Qatar, and the UAE were the leading countries to publish pharmacy practice research.ConclusionsPharmacy practice research is growing and significantly adding to enhance pharmaceutical health services in the Middle East Region. There is a need to develop a research agenda. This will help in enriching the practice, as well as to avoid repetitive ideas.

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study.

BackgroundPublic acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries.MethodsAn online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants’ demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values.ResultsA total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants’ country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores.ConclusionThe political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.

Entrepreneurship, gender and success in Lebanon

PurposeThe aim of this paper is to explore how men entrepreneurs construe their success and the influence of the socio-cultural context and political and economic turbulence on their construals of success in the context of the Arab country of Lebanon.Design/methodology/approachTo achieve the objective, the author draw on intersectionality theory and capitalise on twenty in-depth, semi-structured interviews with men entrepreneurs.FindingsThe findings reveal how construals of success by men entrepreneurs occur at the nexus between patriarchy, gendered expectations and adverse economic and political conditions. As a result, success is construed through the perseverance and legitimacy of their business and their compliance with expected family roles. These construals unfold as the men hold themselves accountable for and do gender and success per the ideal expectations indoctrinated by patriarchy.Originality/valueThe originality of this study lies in its theoretical contributions. First, it is the first study to explore the construals of success by men entrepreneurs in an Arab Middle Eastern country. Second, it contributes to a growing body of work that explores gender as a situated practice and demonstrates how it is performed by men entrepreneurs while construing their success. Third, it contributes to research on intersectionality in entrepreneurship and sheds light on the interconnections of gender, patriarchal socio-cultural values, economic and political conditions and entrepreneurship in Arab countries.

Perceptions of patients with rheumatoid arthritis about self-assessment of disease activity after watching an educational video: a qualitative pilot study from the AUTO-DAS in Middle Eastern Arab countries project.

To evaluate the perceptions of patients with rheumatoid arthritis (RA) about self-assessment of their disease activity after watching an educational video. Consecutive patients with RA consulting their rheumatologist in six Middle Eastern Countries were invited to watch an educational video developed to teach self-assessment using Disease Activity Score (DAS-28). Then, a rheumatology nurse conducted a semi-structured interview and collected the patients’ perception about the understanding of the video, feasibility, capability and confidence in performing self-assessment using Likert-type items. The degree of confidence with self-assessment was correlated to the patients’ socio-demographic characteristics. Sixty-two patients were included and had an overall positive reaction to the video. It was easy to understand in 96% and helped facilitate self-assessment in 92% of cases. Self-assessment was considered totally feasible in 74%, and 66% of patients were capable of always doing it, with a confidence of 60% (always) to 34% (sometimes). Confidence was associated with a higher educational level. Nevertheless, 77% of patients felt that the self-assessment would not fully replace the physician’s visit. Open-ended questions identified five themes: better understanding of the disease, easier communication with the rheumatologist, less consultation time, difficulty with the scoring part and importance of practice. Patients with RA felt that self-assessment was feasible and helpful in understanding RA, improving communication with the rheumatologist and shortening the visit time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00296-021-04799-2.

Development of an Educational Video for Self-Assessment of Patients with RA: Steps, Challenges, and Responses.

Objectives:The primary objective was to develop an educational video to teach patients with rheumatoid arthritis (RA) self-assessment of their disease activity. Secondary objectives were to validate the video, identify the challenges in producing it, and the responses to these challenges.Methods:Rheumatologists from 7 Middle Eastern Arab countries (MEAC) discussed unmet needs in the education of patients with RA. They reviewed pre-existing educational audiovisual material and drafted the script for a new video in Arabic. The video was produced in collaboration with a technical team, then validated by patients using a standardized interview. At each step of production, challenges were identified.Results:Twenty-three rheumatologists from MEAC identified unmet needs in patients’ education. A video was produced, explaining the concepts of treat-to-target and showing a patient performing self-assessment using DAS-28. Sixty-two patients were interviewed for validation and found the video to be useful and easy to understand, albeit not replacing the physician’s visit. Most common challenges encountered included acceptance of patient empowerment, agreement on DAS-28 as composite measure, production of a comprehensible written Arabic text, and addressing the population cultural mix.Conclusion:Despite challenges, the video was well accepted among patients and can be used for clinical and research purposes. It is particularly useful in pandemic periods where social distancing is recommended.

Reliability and validity of Arabic version of revised general nutrition knowledge questionnaire on university students.

The current study evaluated the reliability and validity of the Arabic version of the revised general nutrition knowledge questionnaire (GNKQ-R) for adults. The eighty-eight-item English GNKQ-R was adapted into an eighty-six-item Arabic version. Four validation studies were conducted for internal (n 805) and external (n 106) reliability, construct validity between participants with (n 84) and without (n 88) nutrition background, convergent validity for associations between nutrition knowledge and demographic characteristics (n 750) and responsiveness to online nutrition information (n 55). United Arab Emirates University in United Arab Emirates and Hashemite University in Jordan. Undergraduate students aged 18 years and above, enrolled in any programme at the two universities, were recruited. Overall, internal reliability (Cronbach's α = 0·91) and external reliability (P = 0·350; intra-class correlation coefficient = 0·84) were high. Significantly higher GNKQ-R scores of students with (66·0 (10·6)) v. without (38·0 (10·7), P < 0·001; d = 2·6) nutrition background indicated high construct validity. Significantly higher GNKQ-R scores among females v. males, older and senior students v. younger and junior students and students in health discipline v. non-health discipline reflected good convergent validity. Significant differences in GNKQ-R scores with nutrition information (time 1 = 37·8 (10·5) and time 2 = 47·7 (9·1), P < 0·001; d = 1·0) indicated high responsiveness to nutrition intervention. The Arabic GNKQ-R showed high reliability and validity in the young adult Arab population. Besides the reliability of the overall questionnaire, each section demonstrated adequate reliability. Further studies are warranted to establish the generalisability and applicability of the Arabic GNKQ-R in older adults and in different middle-eastern Arab countries.

Community Health and Wellness Fair: A strategy for Assessment of Social Determinants of Health, Inclusion and Engagement of Newcomers.

Community health fair has been used informally as a way of offering health promotion, education, and screening services onsite to underserved and hard to reach populations such as the newcomers. To utilize an annual health fair for the assessment of the overall perception of health status of newcomers in relation to the determinants of health; and to evaluate its effectiveness as an intervention to engage attendees in their community. The 3rd Annual refugees and immigrant's health and wellness resources fair in Allegheny County. A cross sectional study was designed using questionnaires focused on the health and social determinants of health, with few open-ended questions related to engagement and networking. A total of 107 individuals participated in the study. The age ranged between 18-75years, 46.9% males and 53% females. The largest representations from Bhutan, Arab Middle Eastern countries, and Ghana. Perception of health was examined in relation to other determinants such as language, regular checkups, employment, income, education, access to health, and psychosocial needs. Results revealed that health perception varied by ethnicity, was influenced by English proficiency, access to health, employment, and regular checkups, while education, and income did not show an impact. A qualitative analysis to the narrative responses revealed that the health fair was very effective in breaking the structural barriers with providers as well as for community engagement. The annual health fair was a successful strategy in the assessment of the health determinants and for community engagement of the newcomers.

Poland’s Cultural Relations with Middle-Eastern Arab Countries

Poland’s Cultural Relations with Middle-Eastern Arab Countries

Chinese ‘Soft Power Pipelines Diffusion’ (SPPD) to the Middle Eastern Arab Countries 2000-2018: A Discursive-Institutional Study

ABSTRACT The article examines China’s ‘soft power’ invested in Middle Eastern countries from 2000 to 2018 by offering three main ‘Soft Power Pipelines Diffusion’ (SPPD): the media, popular culture and education. The paper focuses not only on China’s soft presence but also on the response and reception of its power in Middle Eastern Arab countries. China’s soft power presence and efforts were found to be efficient and to contribute to China’s image in the region and to its transformation into an attractive destination for cooperation in many soft areas.

Fitting in: Different Types of Person-Environment Fit as Drivers of Career Self-management in Kuwait

Contributing to emerging efforts to integrate the understudied career self-management (CSM) with person- environment fit research, this study aims to assess the unique effects of person-organization, person-coworkers and needs-supplies fits on employees&amp;rsquo; deployment of career advancement strategies. A questionnaire was completed by 548 highly educated young Kuwaitis and self-initiated expatriates (Arab and South Asian) working in medium and large Kuwaiti organizations. The simultaneous effects of the three types of fits is assessed and the findings demonstrate that an increase in person-coworkers fit and decrease in person-organization and needs-supplies fits consistently encourage the deployment of career advancement strategies concerning accessing influential networks, self-promotion, competence building and psychological boundaryless. A relatively more robust effect of person-coworker fit has been detected. It is attributed to the Arab collectivistic culture and to the construct being a career competency and a contextual factor as per the &amp;ldquo;intelligent career&amp;rdquo; theory. Interventions should be mindful of the differential effects of different types of fit on CSM. Developing organizational &amp;lsquo;standards of fit&amp;rsquo; and CSM skills are essential for individual career development and organizational success. The study provides unique information about the understudied constructs of CSM and person-environment fit in a traditional and high inequality Arab Middle Eastern country, and infers the causes of the inconsistent effects of contextual factors reported by previous studies.&amp;nbsp;

Email is evil!

PurposeThis study aims to assess consumers’ beliefs in three Middle Eastern Arab countries regarding attitudinal and behavioural responses towards permission-based direct email marketing (hereafter DEM) and the moderating role of gender in the hypothesised path model.Design/methodology/approachStructural equation modelling was used to test the hypothesised path model by using data collected from 829 respondents.FindingsThe findings show that attitude was found to fully mediate the relationship between beliefs and behavioural responses towards permission-based DEM. Gender moderates the relationship between beliefs and attitudes and responses to permission-based DEM. Notably, female respondents were found to react more actively when exposed to permission-based DEM.Research limitations/implicationsFurther qualitative research is needed to learn more about how and why individuals develop behavioural intentions in certain ways towards opt-in DEM. In addition, neuropsychology approaches such as eye-tracking are endorsed for future research to gain more insights and conquer biases associated with self-reporting procedures in countries where such technologies are deemed as legal and ethical to be used with human subjects.Practical implicationsAdvertisers promoting products and services in the Middle Eastern Arab context should take further steps to enhance the quality of information (including cultural sensitiveness) and the perceived entertainment value that could be delivered to consumers through permission-based DEM, especially for female internet users. Additionally, this study highly recommends the double opt-in approach to permission-based DEM.Originality/valueTo the best of the authors’ knowledge, this is the first attempt to address the gender role as a moderator of the path depicting the effectiveness of permission-based DEM approach in the Middle East (Arab counties) from beliefs to behavioural responses via attitudes.

Epilepsy stigma in Saudi Arabia: The roles of mind–body dualism, supernatural beliefs, and religiosity

IntroductionThe stigma of epilepsy continues to negatively impact people with epilepsy (PWE) in many Arab Middle Eastern countries, including Saudi Arabia. Socioreligious, cultural, and philosophical ideas prevalent in the region may contribute to the underpinnings of stigma toward PWE, but this has not been sufficiently studied. Materials and methodsThis study recruited a convenience sample of people without epilepsy from clinic waiting rooms and through social media. Participants completed a questionnaire with questions about demographics, mind–body dualism (MBD), supernatural beliefs (SB), attitudes toward epilepsy (ATE), and religiosity. ResultsA total of 210 participants were recruited. Analysis of variance (ANOVA) showed a significant difference in the mean total ATE scores, indicating better ATE with higher education (p < 0.001). Despite the relatively high level of education and a high proportion of participants with medical training, only slightly more than half rejected the possibility that demonic possession may be a cause of epilepsy. Attitudes toward epilepsy were correlated with MDB and SB but not with religiosity. Mind–body dualism and religiosity correlated significantly with negative attitudes toward PWE (p < 0.05). A linear regression model using ATE as the dependent variable and MDB, SB, and educational level as independent variables significantly predicted ATE (F = 15.6, p < 0.001, R2 = 0.24), although SB dropped out as a predictor of ATE in that model. Another regression used SB as the dependent variable, and MBD, religiosity, and educational level as independent variables were also significant with all three variables predicting SB (F = 64.0, p < 0.001). ConclusionsMind–body dualism was related to the cognitive process leading to supernatural misconceptions about epilepsy and negative attitudes toward PWE in Saudi Arabia. Although misconceptions that supernatural possession was the cause of epilepsy (justifying treatment by religious healing) and was likely derived from prevalent religious beliefs of the region, religiosity was not associated with negative attitudes toward PWE. The merits and efficacy of an intervention focused on reducing the negative effects of MBD and SB on ATE warrants further investigation.

The nature of well-being objective function in tax-free regime of ethico-economics

PurposeThe purpose of this study is to explain the effect of a tax-free regime of socioeconomics in the social well-being function. This paper carries on the message that has been recognized in the economic theory and by many for a long time now. This is that the incidence of all forms of taxes – direct and indirect taxes – proves to cause inequitable distribution of wealth. The rich still comprises the top 1 per cent of the income earners despite the existence of heavy tax burden. This paper goes beyond this observation and its explanation to make the case that the tax regime also causes distortionary effects in the generalized system of social and economic relations.Design/methodology/approachIn the midst of the generalized system of simulating the well-being function, subject to what is called the circular causation system of the endogenous variables is explained by the critical parameter of the epistemic nature in the unity of knowledge by complementarities between the variables signifying the good choices.FindingsThis paper also contrarily establishes and explains the nature of equitable production and distribution of income in society at large. The tax-free regime is explained to generate and sustain balanced inter-causality between the critical variables in the generalized system of equations for simulating the well-being function. Some of the special properties of the evolutionary learning kind of the well-being simulation problem in the tax-free regime are brought out.Research limitations/implicationsEmpirical work could follow.Practical implicationsOf special interest are the Arab Middle Eastern countries, most of which do not levy tax on households; with a small rate on businesses.Social implicationsThis paper goes beyond this observation and its explanation to make the case that the tax regime also causes distortionary effects in the generalized system of social and economic relations. Most importantly, the presence of tax regime disturbs the balanced forms of inter-causality between the critical variables of the social and economic type. The social well-being is thus eroded in the midst of a tax regime.Originality/valueThis paper is a rare one of its kind to bring out the question surrounding the tax-free regimes usually practiced in Islamic fiscal theory and today adopted by many Muslim countries in the Middle East.

Alcohol Screening in a National Referral Hospital: An Observational Study from Qatar.

BackgroundAlcohol consumption is a high-risk factor for several medical disorders and traffic accidents and poses a burden on outpatient clinics and emergency units. We aimed to assess the pattern of alcohol screening among patients in a multicultural setting in a national referral hospital in an Arab Middle-Eastern country.Material/MethodsA retrospective analysis was conducted for patients who were screened with blood alcohol concentration (BAC) in the Emergency Department (ED) in the period from January 2009 to December 2012. BAC positive and negative patients were compared, and BAC positive patients were classified into mmol/L (Group 1: BAC 0.1–10.8 (less intoxicated); Group 2: BAC 10.9–21.7 (intoxicated), and Group 3: >21.7 mmol/L (intoxicated at CNS depression level).ResultsA total of 9417 patient visits were screened for BAC during the study period (an average of 4.87 per 1000 ED visits); 38% of these tested positive. Most screened persons were males (97%) with a mean age of 37.5±11.6 years. There was a steady increase in BAC screening initially (3.18 per 1000 ED visits in 2009 and 7.47 in 2012). However, the proportion of BAC-positives per total screened decreased steadily over the years, from 50% in 2008 to 33% in 2012. There were more BAC positives (92% vs. 81%, p<0.05) in patients seeking medical vs. non-medical assessment. Among BAC positives, Group 3 patients had higher HLOS (p=0.001), but the ICU-LOS was comparable.ConclusionsDespite the absence of a clinical protocol for alcohol screening, this study shows that alcohol consumption has a serious impact in ED visits and hospitalizations, even in a country that partially prohibits alcohol drinking. Implementing a protocol for the screening of alcohol misuse among select hospitalized patients should be considered in the ED.