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Public Health master students at QU defend their theses | Qatar University

Public Health master students at QU defend their theses

2022-05-12
QU

The Department of Public Health, at Qatar University’s (QU) College of Health Sciences organized thesis oral defenses for seven candidates in the Master of Public Health (MPH).

In addition to faculty examiners from the department, the examinations committee consisted of assessors from the QU’s College of Health Sciences, College of Pharmacy, College of Medicine, College of Dental Medicine, College of Arts and Sciences, the Social and Economic Survey Research Institute; Weill Cornell Medicine - Qatar, as well as external examiners from the UK, Australia, Lebanon and UAE.

Under the supervision of Dr. Karam Adawi, MPH student Hana Abukhadijah presented her thesis entitled “Usability Testing of the International Cardiac Rehabilitation Registry (ICRR).” This was a mixed-methods study using the Think-Aloud method to elicit feedback on the ICRR while end-users were entering patient data, followed by semi-structured interviews. Results of this study proved that ICRR is relevant, user-friendly with high end-user satisfaction, and showed high perceived usefulness to support CR service quality. The usability of the ICRR was enhanced based on participants’ feedback. The ICRR is ready for the next stage, which is the pilot testing before the final launch.

Malik Smadi, under the supervision of Dr. Mujahed Shraim and co-supervisor Dr. Ghadir Al Jayyousi delivered his thesis “Depression Screening Rates and Patterns of Management in Primary Care in Qatar: A Cross-Sectional Study.” The results of his study showed that depression screening rates were 6 per 1000 people in 2017 and in 2019. The proportion of persons prescribed antidepressants increased between 2017 and 2019 from 19.4% to 28.2%. The overall referral to any psychiatric clinic increased from 2.5% in 2017 to 8.0% in 2019. Younger age, female, gender, and those screened in 2019 had higher severity of depression symptoms. Older age and those screened in 2019 were more likely to receive antidepressant prescriptions. Older age, female gender, Qatari nationality, and those who were screened in 2019 were more likely to be referred to support and psychiatry clinics. The study concluded that more research is needed to understand factors associated with screening for depression and related management in primary care and potential underlying mechanisms.

MPH student Rwedah Anwar Ali, under the supervision of Dr. Mohammed Fasihul Alam, and co-supervisor Dr. Susu Zughaier presented her thesis “The Association between Prior Antibiotic Exposure and Antibiotic Resistant Urinary Tract Infection in Primary Care: A Systematic Review and Meta-Analysis.” The study aimed to update the literature in terms of quantifying the association between recent antibiotics exposure and subsequent resistance to urinary tract infections in primary care setting. It found that the overall pooled OR of the association between the resistance developed by patients with UTI and recent antibiotics exposure in primary care was 2.289 [95% CI; 2.006-2.612]. Subgroup analysis indicated a strong association between prior exposure of 1 months and subsequent resistance. It also indicated a strong association between prior exposure and 3 or more courses of antibiotics, OR=3.315[95%CI; 3.32-8.12]. Quinolones had the highest odds of resistance associated with prior exposure to quinolones among the investigated relationships (trimethoprim-Quinolone, Quinolone-trimethoprim, trimethoprim-trimethoprim), estimated as OR=5.49 [95% CI; 3.99-7.56]. The study concluded that efforts in implementing stewardship programs that focus on prescribing behaviors in primary care can play a significant role in reducing antibiotic exposure and thus reducing the likelihood of resistance developed against urinary tract infection treatments.

Under the supervision of Dr. Karam Adawi, and co-supervisors Prof. Laith Abu-Raddad and Dr. Gheyath Nasrallah, student Rasha Abu-El-Ruz delivered her thesis “Epidemiology of Chlamydia trachomatis in Latin America and the Caribbean: Systematic Review, Meta-Analyses, and Meta-Regressions.” The study aimed to provide a comprehensive epidemiological assessment of CT in Latin America and the Caribbean (LAC). Urogenital CT prevalence appears to decrease with age, to be higher in women compared to men, and to increase by 1% yearly. Anorectal CT appears to be higher in men compared to women but shows no temporal trend. The study concluded that LAC is burdened by CT infection. Public health response in LAC region is required to effectively tackle CT infection.

Dr. Hanan Abdul Rahim supervised the MPH student Nadeen Batta who presented her thesis “Fluoride Varnish Application as an Oral Health Intervention in Well-baby Clinic for Children Aged 1-5 Years in Qatar University Health Center: A Feasibility Study.” The study aimed to test the feasibility of providing Fluoride Varnish (FV) application for children who are at risk of dental caries during their regular vaccination visits. The results showed that the intervention was acceptable to parents and their children. Despite a high level of acceptability, implementation rates were lower than expected. In terms of practicality of the intervention, the time utilized for completing the dental caries risk assessment was 1.09 ± 0.33 minutes, whereas 1.37 ± 0.62 minutes was the average time for completing one FV application. The direct cost for providing fluoride varnish to children in the well-baby clinic in Qatar University Health Center was 15QR per application. The most frequently perceived barriers to implementing the intervention were: unavailability of instruments, insufficient supportive staff, lack of physical space, and providing the FV for those who rarely visit the health center. This study concluded that integrating the FV application as a simple, cost-effective strategy for the primary prevention of dental caries in children less than five years old during their regular vaccination visits in a primary health care setting in Qatar is feasible. Increasing the appointment time by a minimum of 3 minutes, providing more structured mandatory oral health education and training to the providers, application of strategies to increase nurses’ adherence, and affording enough staff all are limitations to be addressed by management before introducing the FV application in the well-baby clinic for children at risk of having dental caries.

Under the supervision of Prof. Manar Elhassan and co-supervisor Prof. Ahmed Awaisu, MPH student Dalia Ahmed who presented her thesis “Prevalence of Polypharmacy and Inappropriate Prescribing among Patients Exposed to Polypharmacy and Associated Factors in Elderly Patients with Cardiac Conditions in Qatar.” This study aimed to conduct a systematic review on the prevalence of polypharmacy in the MENA region and to determine the prevalence of polypharmacy and PIP and its associated factors among elderly patients with CVDs during hospital discharge at the Heart Hospital in Qatar. The prevalence of polypharmacy ranged from 17.2% to 88.6% among the elderly in the MENA region, and was 90.5% (95%CI 87.2-93.1) among elderly patients discharged from the Heart Hospital in Qatar. Among those exposed to polypharmacy, PIP was prevalent in 64.9% (95% CI: 59.7-69.8); the mean number of medications per patient upon discharge was 11.8 (SD 4.4). Key factors associated with having PIP were age (aPR = 1.04; 95%CI 1.03-1.05; p-value <0.001) and number of medications upon discharge (aPR= 1.04; 95%CI 1.03-1.05; p-value <0.001). Clinical pharmacists’ revision of the prescriptions was associated with reduced prevalence of PIP (aPR= 0.78; 95%CI 0.64-0.96; P value=0.018). The study concluded that polypharmacy and PIP are major issues in the MENA region and Qatar, emphasizing the need for further research on the feasibility of interventions that minimize PIP especially among elderly with CVDs and an increasing number of medications. It suggested holding educational sessions on the use of evidence-based tools for the management of PIP such as BEERS criteria to familiarize the doctors and the pharmacist at the Heart Hospital with use of these tools and to have policies in place to enforce their integration during the discharge process.

Finally, MPH student Khadiga Abdulrashid, supervised by Dr. Mohammed Fasihul Alam and co-supervisors Prof. Manar Elhassan and Prof. Tim Harris, delivered her thesis “The Effectiveness, Health Care Resource Utilization and Cost-effectiveness of Intravenous Paracetamol Versus Alternative Analgesics Used Among Patients with Acute Pain in Emergency Departments: Systematic Reviews and A Meta-Analysis.” This study evaluated the level of analgesia provided by IVP alone as compared to NSAIDs, opioids alone, or in combination in adults attending the ED with acute pain. Additionally, it assessed systematic economic evaluation evidence to determine health care resource utilization and costs associated with drug administration for the management of acute pain.

The study found that at 30 minutes IVP provided equivalent levels of analgesia compared to opioids, NSAIDs alone or in combination; pooled mean difference=0.09 [95%CI: -0.85, 1.05]. Patients treated with IVP, and opioids required similar quantities of rescue analgesia, but this was lower in those who received NSAIDs. Adverse events were 50% lower in patients receiving IVP (RR: 0.50; 95%CI: 0.40, 0.62) as compared to opioids and 30% higher in IVP than NSAIDs (RR: 1.30; 95%CI: 0.78, 2.17). The economic evaluation suggested that ED acute pain management treatments vary across healthcare systems which lead to differential costs and healthcare resource use. Based on the available evidence, the study found that IVP is an equally effective analgesic as opioids or NSAIDs or combined at initial 30 minutes in patients with acute pain. However, the use of IV opioids inflicts an economic burden on the healthcare system.