Proportion of Navy Recruits Diagnosed With Symptomatic Stress Fractures During Training and Monetary Impact of These Injuries.

BACKGROUND: Lower extremity stress fractures result in lost time from work and sport and incur costs in the military when they occur in service members. Hypovitaminosis D has been identified as key risk factor in these injuries. An estimated 33% to 90% of collegiate and professional athletes have deficient vitamin D levels. Other branches of the United States military have evaluated the risk factors for stress fractures during basic training, including vitamin D deficiency. To the best of our knowledge, a study evaluating the correlation between these injuries and vitamin D deficiency in US Navy recruits and a cost analysis of these injuries has not been performed. Cutbacks in military medical staffing mean more active-duty personnel are being deferred for care to civilian providers. Consequently, data that previously were only pertinent to military medical providers have now expanded to the nonmilitary medical community. QUESTIONS/PURPOSES: We therefore asked: (1) What proportion of US Navy recruits experience symptomatic lower extremity stress fractures, and what proportion of those recruits had hypovitaminosis vitamin D on laboratory testing? (2) What are the rehabilitation costs involved in the treatment of lower extremity stress fractures, including the associated costs of lost training time? (3) Is there a cost difference in the treatment of stress fractures between recruits with lower extremity stress fractures who have vitamin D deficiency and those without vitamin D deficiency? METHODS: We retrospectively evaluated the electronic medical record at Naval Recruit Training Command in Great Lakes, IL, USA, of all active-duty males and females trained from 2009 until 2015. We used ICD-9 and ICD-10 diagnosis codes to identify those diagnosed with symptomatic lower extremity stress fractures. Data collected included geographic region of birth, preexisting vitamin D deficiency, vitamin D level at the time of diagnosis, medical history, BMI, age, sex, self-reported race or ethnicity, hospitalization days, days lost from training, and the number of physical therapy, primary care, and specialty visits. To ascertain the proportion of recruits who developed symptomatic stress fractures, we divided the number of recruits who were diagnosed with a stress fracture by the total number who trained over that span of time, which was 204,774 individuals. During the span of this study, 45% (494 of 1098) of recruits diagnosed with a symptomatic stress fracture were female and 55% (604 of 1098) were male, with a mean ± SD age of 24 ± 4 years. We defined hypovitaminosis D as a vitamin D level lower than 40 ng/mL. Levels less than 40 ng/mL were defined as low normal and levels less than 30 ng/mL as deficient. Vitamin D levels were obtained at the discretion of the individual treating provider without standardization of protocol. Cost was defined as physical therapy visits, primary care visits, orthopaedic visits, diagnostic imaging costs, laboratory costs, hospitalizations, if applicable, and days lost from training. Diagnostic studies and laboratory tests were incorporated as indirect costs into initial and follow-up physical therapy visits. Evaluation and management code fee schedules for initial visits and follow-up visits were used as direct costs. We obtained these data from the Centers for Medicare & Medicaid Services website. Per capita cost was calculated by taking the total cost and dividing it by the study population. Days lost from training is based on a standardized government military salary of recruits to include room and board. RESULTS: We found that 0.5% (1098 of 204,774) of recruits developed a symptomatic lower extremity stress fracture. Of the recruits who had vitamin D levels drawn at the time of stress fracture, 95% (416 of 437 [95% confidence interval (CI) 94% to 98%]; p > 0.99) had hypovitaminosis D (≤ 40 ng/mL) and 82% (360 of 437 [95% CI 79% to 86%]; p > 0.99) had deficient levels (≤ 30 ng/mL) on laboratory testing, when evaluated. The total treatment cost was USD 9506 per recruit. Days lost in training was a median of 56 days (4 to 108) for a per capita cost of USD 5447 per recruit. Recruits with deficient vitamin D levels (levels ≤ 30 ng/mL) incurred more physical therapy treatment costs than did those with low-normal vitamin D levels (levels 31 to 40 ng/mL) (mean difference USD 965 [95% CI 2 to 1928]; p = 0.049). CONCLUSION: The cost of lost training and rehabilitation associated with symptomatic lower extremity stress fractures represents a major financial burden. Screening for and treatment of vitamin D deficiencies before recruit training could offer a cost-effective solution to decreasing the stress fracture risk. Recognition and treatment of these deficiencies has a role beyond the military, as hypovitaminosis and stress fractures are common in collegiate or professional athletes. LEVEL OF EVIDENCE: Level III, prognostic study.

Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis.

BACKGROUND: The peritonitis rate among children treated with peritoneal dialysis (PD) has not been widely reported in Saudi Arabia. The study aim was to estimate the peritonitis rate per patient-year and investigate the factors associated with higher peritonitis rates in a sample of PD children at King Abdullah Specialist Children's Hospital-Riyadh (KASCH-R), Saudi Arabia. METHODS: This retrospective cohort study included 27 PD children treated between September 2007 and December 2017 at KASCH-R. We recorded the children's demographic and clinical data, and the frequency of peritonitis. RESULTS: The 27 PD children reviewed (63% girls; mean age = 7.32 years old; range, 1-14 years), resulted in 86 peritonitis diagnoses in which the overall recurrence rate (in at least one episode) was 58/86 (67.4%) with a 95% confidence interval (CI), 56.5 to 77.2%. The rate of peritonitis episodes per patient-year was 0.76 (1 episode per 1.31 patient-year). The generalized Poisson model identified older children (age >  10 years) (adjusted rate ratios [aRR] = 7.273, 95% CI: 1.562-33.860), congenital nephrosis (aRR = 4.677, 95% CI: 1.443-15.155), height below 3rd percentile (aRR = 4.689, 95% CI: 1.874-11.735), weight below 3rd percentile (aRR = 5.388, 95% CI: 1.678-17.302), low albumin level (aRR = 4.041, 95% CI: 2.053-7.956), two-week duration of antibiotic therapy (aRR = 2.947, 95% CI: 1.163-7.468), which were independently associated with a high peritonitis rate. CONCLUSIONS: This study showed a high peritonitis rate in our center. Older children, congenital nephrosis, height and weight below the 3rd percentile, low albumin level, and long duration of antibiotic therapy were associated with a higher rate of peritonitis. An optimal peritonitis prevention strategy or best-practice guideline is needed to reduce and prevent peritonitis occurrence in our center.

Tuberculosis mortality and associated factors at King Abdulaziz Medical City Hospital.

BACKGROUND: Tuberculosis (TB) continues to be a public health challenge in Saudi Arabia, particularly for the elderly. This study was conducted to estimate mortality per 1000 person-year among TB and resistant TB cases and to identifying factors associated with mortality. METHODS: This is a retrospective cohort study of 713 new TB cases at King Abdulaziz Medical City in Riyadh diagnosed between January 1, 2000, and December 31, 2016. Patient medical records and microbiology lab databases were used to identify TB cases. Through reviews were conducted of patients' medical records, including physician notes, physical examinations, radiology (scans and imaging), laboratory tests, and follow-up notes. Collected data include demographic information, clinical features, diagnoses, comorbidities, and death rates. RESULTS: Of the 713 TB patients included in this study, 110 died, giving an average mortality rate of 22 per 1000 person-years (PY; 95% CI: 18.2-26.4). Elderly patients (≥ 60 years) had a higher mortality rate of 36.5 per 1000 PY (95% CI: 28.9-45.5). As age increases by one year, the hazard of mortality increase by 2.4% (aHR: 1.024 [95% CI: 1.009-1.039, P = 0.002]). Higher hazard of mortality was found among males (aHR: 2.014 [95% CI: 1.186-3.418, P = 0.010]). Patients with respiratory and other types of comorbidities and cancer had a higher mortality hazard (aHR: 1.898 [95% CI: 1.005-3.582, P = 0.048]; aHR: 2.346 [95% CI: 1.313-4.192, P = 0.004]; aHR: 3.292 [95% CI: 1.804-6.006, P = 0.001]), respectively. Multidrug-resistant TB (MDR-TB) was found in 2 cases (0.28%) (95% CI: 0.08-1.02), 1.68% were resistant to only one antibiotic, 0.14% had rifampicine-resistant TB (RR-TB), 0.28% had MDR-TB, and 0.14% had extensively drug-resistant TB (XDR-TB). CONCLUSIONS: The mortality rate among TB patients was found to be 22 per 1000 person-year at our center. TB was associated with high mortality rates among males, the elderly, and patients with cancer, respiratory illness, and other comorbidities. Future clinical practice should include establishing an efficient TB diagnostic program and continued hazard assessment of TB treatment options.

Rate and factors for scabies recurrence in children in Saudi Arabia: a retrospective study.

BACKGROUND: Despite the fact that several scabies outbreaks emerged in schools in Saudi Arabia in 2018, no study has investigated the risk of scabies recurrence among children in Saudi Arabia. This study aimed to estimate the rate of scabies recurrence and identify factors that were associated with an increased risk of recurrence among children. METHODS: This is a multi-center retrospective study of children (age < 14 years) who were diagnosed between May 20, 2015 and September 12, 2018 with one or multiple recurrent scabies at the Ministry of National Guard Health Affairs (MNGHA) hospitals and clinics in Saudi Arabia. Data were obtained from an electronic health system, BestCare database. RESULTS: A sample of 264 children analyzed (mean age of 6.7 years) resulted in a cumulative number of 316 scabies diagnoses in which 86 (27.2%) experienced scabies recurrence (at least once). Independent factors associated with a high risk of scabies recurrence: older children (adjusted hazard ratio [aHR], 1.036; 95% CI, 1.002-1.072; P = 0.039), female gender (aHR, 1.734; 95% CI, 1.329-2.262; P = 0.001), Western region of Saudi Arabia (aHR, 1.548; 95% CI, 1.115-2.151; P = 0.009), and 2nd tertile season [May to August] (aHR, 2.368; 95% CI, 1.706-3.288; P = 0.001). CONCLUSIONS: The study demonstrated that the recurrence rate of scabies among children is high. Older children, the female gender, the Western region of Saudi Arabia, and the seasonality were independently associated with an increased risk of scabies recurrence. High temperature and low humidity should be explored as leading factors for scabies infestations in Saudi Arabia. Findings derived from this study may be useful for clinicians and governments in optimizing clinical management of scabies cases and contacts.

Motives for - and prevalence of - cesarean delivery on maternal request: A survey in Saudi Arabia.

Background: Although cesarean delivery on maternal request (CDMR) has been associated with an increase in the frequency of cesarean sections (CSs), there is a lack of studies reporting the frequency of CDMR in Saudi Arabia. This study was conducted to estimate the prevalence of and the motives for CDMR and identify its associated factors. Methods: This cross-sectional study was conducted between March and June 2017 on 364 pregnant women who planned a CS at King Abdulaziz Medical City in Riyadh. The characteristics of the women and their motives for undergoing a CS for the current pregnancy term were collected. Results: The prevalence of CDMR was found to be 13.7% (50/364) [95% confidence interval (CI): 10.370%-17.706%]. Older maternal age ( ≥ 40 years) [adjusted odds ratio (aOR) = 3.9; p = 0.019], family history of CS (aOR = 2.9; p = 0.038), non-Saudi nationality (aOR = 5.0; p = 0.050), and receiving education or medical information about the possibility of delivering by CS (aOR = 13.7; p = 0.030) were significantly associated with a higher prevalence of CDMR. As the number of previous CSs increased by one (aOR = 0.6; p = 0.011), the odds of CDMR decreased by 40%. The most common motives for demanding a CS in the absence of medical indications were avoiding labor or possible complications from vaginal birth (60%) and fear of pain on vaginal delivery (46%). Conclusions: A high prevalence of CDMR was documented at King Abdulaziz Medical City, especially among women of older maternal age, having a family history of CS, of non-Saudi nationality, and who received education or medical information about the possibility of delivering by CS. Counseling programs might be helpful for pregnant women who fear pain in vaginal delivery or have had a previous traumatic birth experience.

Impact of age on postoperative complications following bariatric surgery.

Background: The impact of age on complications following bariatric surgery remains unclear. Research is therefore warranted among previously unstudied populations of bariatric surgery patients. The aim of the current study was to assess the impact of age on postoperative complications following bariatric surgery in Saudi Arabia. Methods: This retrospective study included 301 patients who underwent bariatric surgery between January 2011 and July 2016. Patients were classified into three groups according to age: < 25 years; 25-36 years; and >36 years. Primary outcomes were determined by identifying the number of complications reported during a period of 180 days. The negative binomial model was used to assess the relationship between age and the high rate of postoperative complications following adjustment for confounding variables. Results: The incidence of overall complications was 10.1% in the < 25-year age group, 15% in the 25-36-year age group, and 24.2% in the >36-year age group. After adjusting for confounding variables, it was discovered that the risk of postoperative complications increases with age. The risk was higher in the >36-year age group than in the >25-year age group [adjusted relative rate (aRR) = 2.35; 95% confidence interval (CI) = 1.046-5.290; p = 0.039]. Diabetes (aRR = 3.27), adjustable gastric bands (aRR = 3.40), and a more lengthy hospital stay (aRR = 1.23) were associated with increased rates of postoperative complications. Conclusion: Age is independently associated with a high rate of postoperative complications following bariatric surgery. The results showed that patients with diabetes, those using adjustable gastric bands, and those with longer length of hospital stay had significantly higher incidence of postoperative complications. These findings indicate the need for risk stratification tools to evaluate patients as candidates for bariatric surgery and to use as a guide for identifying optimal preoperative factors.

Estimating survival rates in MERS-CoV patients 14 and 45 days after experiencing symptoms and determining the differences in survival rates by demographic data, disease characteristics and regions: a worldwide study.

Although Middle East respiratory syndrome coronavirus (MERS-CoV) has a recorded 5 years of circulation in 27 countries worldwide, there is no international study to assess whether there is variation in mortality by region. Neither has there been a comprehensive study detailing how the disease characteristics of MERS-CoV influence mortality in patients presenting symptoms. This study aimed to assess how region, patient and disease characteristics influence 14- and 45-day mortality in MERS patients. The author utilised publically available data on MERS-CoV. The study included 883 MERS patients reported between 5 January 2015 and 10 March 2017. Data on patient and disease characteristics were collected. The mean age at MERS-CoV diagnosis was 54.3 years: 69.1% were male, and 86.7% of the cases were reported from Saudi Arabia. About 40% of MERS patients studied were over the age of 60. The study estimated 14- and 45-day survival rates after initial onset of symptoms: 83.67% and 65.9%, respectively. Saudi Arabian MERS patients exhibited 4.1 and 5.0 times higher 14-day (adjusted hazard risk (aHR) = 4.1; 95% confidence interval (CI) 1.012-16.921) and 45-day (aHR = 5.0; 95% CI 1.856-13.581) mortality risk compared with MERS patients in the Republic of Korea or other countries. Similarly, Middle Eastern MERS patients showed 5.3 and 4.1 times higher 14-day (aHR = 5.3; 95% CI 1.070-25.902) and 45-day (aHR = 4.1; 95% CI 1.288-113.076) mortality risk compared with MERS patients in the Republic of Korea or other countries. The results demonstrated a link between mortality and geography, disease and patient factors such as regions, symptoms, source of infections, underlying medical conditions, modes of transmission, non-healthcare workers and those of older age. Educational programmes, access to healthcare and early diagnosis could be implemented as modifiable factors to reduce the higher mortality rates in MERS patients.

Underlying trend, seasonality, prediction, forecasting and the contribution of risk factors: an analysis of globally reported cases of Middle East Respiratory Syndrome Coronavirus.

This study set out to identify and analyse trends and seasonal variations of monthly global reported cases of the Middle East respiratory syndrome coronavirus (MERS-CoV). It also made a prediction based on the reported and extrapolated into the future by forecasting the trend. Finally, the study assessed contributions of various risk factors in the reported cases. The motivation for this study is that MERS-CoV remains among the list of blueprint priority and potential pandemic diseases globally. Yet, there is a paucity of empirical literature examining trends and seasonality as the available evidence is generally descriptive and anecdotal. The study is a time series analysis using monthly global reported cases of MERS-CoV by the World Health Organisation between January 2015 and January 2018. We decomposed the series into seasonal, irregular and trend components and identified patterns, smoothened series, generated predictions and employed forecasting techniques based on linear regression. We assessed contributions of various risk factors in MERS-CoV cases over time. Successive months of the MERS-CoV cases suggest a significant decreasing trend (P = 0.026 for monthly series and P = 0.047 for Quarterly series). The MERS-CoV cases are forecast to wane by end 2018. Seasonality component of the cases oscillated below or above the baseline (the centred moving average), but no association with the series over time was noted. The results revealed contributions of risk factors such as camel contact, male, old age and being from Saudi Arabia and Middle East regions to the overall reported cases of MERS-CoV. The trend component and several risk factors for global MERS-CoV cases, including camel contact, male, age and geography/region significantly affected the series. Our statistical models appear to suggest significant predictive capacity and the findings may well inform healthcare practitioners and policymakers about the underlying dynamics that produced the globally reported MERS-CoV cases.

Emergency department 72-hour revisits among children with chronic diseases: a Saudi Arabian study.

BACKGROUND: Emergency Department (ED) revisits have often been used as an indicator of medical care quality. This study aimed to quantify the frequency of ED revisits within 72 h of discharge and identify its factors among children with chronic diseases. METHODS: We designed a retrospective cohort study of children with at least one chronic disease who were also under 18 years of age and had attended and were discharged from the ED at King Abdullah Specialist Children's Hospital (KASCH-RD), Riyadh, Saudi Arabia between April 19, 2015 and July 29, 2017. The outcome measure was the frequency of ED revisits during a period of 72 h after discharge. RESULTS: The study included 11,057 ED discharges of children with at least one chronic disease. Their revisit rate was 1211 (11%), with 83 (6.9%) having had a second ED revisit within 72 h of ED discharge. According to ICD-10 codes, the most common causes of ED revisits were respiratory, digestive, genitourinary, symptoms, and external causes. Factors of frequent ED revisits within 72 h were young age, institutional health insurance coverage, year of new health information system (2015), external causes, and genitourinary. CONCLUSION: The rate of 72-h ED revisits after discharge of children with chronic diseases treated at KASCH-RD was relatively high, and was associated with young age, institutional health insurance coverage, year of a new health information system implementation, and external causes of ED visit. These study findings amplify the need for intervention to reduce the rate of early ED revisits among children with chronic diseases.

Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia.

Research on Saudi Arabian cancer patients is a priority at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Because there is limited research on the quality of life (QoL) of Saudi Arabian cancer patients, the aim of this study was to identify the predictors of the QoL in a sample of Saudis with cancer. In August 2016, a cross-sectional study was conducted on 438 patients with a variety of cancer types (145 breast, 109 colorectal, 38 leukemia, 45 lymphoma, and 99 other types) who attended the Oncology Outpatient Clinics at KAMC. Sociodemographics, clinical symptoms, and cancer treatments were collected for each patient. We used the SF-36 instrument to assess QoL. Of the cancer patients studied, 28.4% had a family history of cancer, and, according to subgroup analyses, the elderly, those lacking formal education, the unemployed, those diagnosed with Stage III/IV, and those with metastasis had significantly worse physical functions than the other cancer patients. According to multiple linear regression analyses, cancer patients who exercised regularly tended to have better physical function, emotional role function, vitality, social function, and general health (increase in SF-36 scores of 8.82, 9.75, 5.54, 6.66, and 4.97, respectively). Patients with first-year-after-cancer diagnosis tended to have poor emotional wellbeing, social function, and general health (decrease in SF-36 scores of 5.20, 7.34, and 6.12, respectively). Newly diagnosed cancer patients and patients who did not exercise tended to experience significantly poor QoL in several domains; thus, the effectiveness of exercise must be assessed in Saudi cancer patients as an intervention to improve QoL.

The predictors of 3- and 30-day mortality in 660 MERS-CoV patients.

BACKGROUND: The mortality rate of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) patients is a major challenge in all healthcare systems worldwide. Because the MERS-CoV risk-standardized mortality rates are currently unavailable in the literature, the author concentrated on developing a method to estimate the risk-standardized mortality rates using MERS-CoV 3- and 30-day mortality measures. METHODS: MERS-CoV data in Saudi Arabia is publicly reported and made available through the Saudi Ministry of Health (SMOH) website. The author studied 660 MERS-CoV patients who were reported by the SMOH between December 2, 2014 and November 12, 2016. The data gathered contained basic demographic information (age, gender, and nationality), healthcare worker, source of infection, pre-existing illness, symptomatic, severity of illness, and regions in Saudi Arabia. The status and date of mortality were also reported. Cox-proportional hazard (CPH) models were applied to estimate the hazard ratios for the predictors of 3- and 30-day mortality. RESULTS: 3-day, 30-day, and overall mortality were found to be 13.8%, 28.3%, and 29.8%, respectively. According to CPH, multivariate predictors of 3-day mortality were elderly, non-healthcare workers, illness severity, and hospital-acquired infections (adjusted hazard ratio (aHR) =1.7; 8.8; 6.5; and 2.8, respectively). Multivariate predictors of 30-day mortality were elderly, non-healthcare workers, pre-existing illness, severity of illness, and hospital-acquired infections (aHR =1.7; 19.2; 2.1; 3.7; and 2.9, respectively). CONCLUSIONS: Several factors were identified that could influence mortality outcomes at 3 days and 30 days, including age (elderly), non-healthcare workers, severity of illness, and hospital-acquired infections. The findings can serve as a guide for healthcare practitioners by appropriately identifying and managing potential patients at high risk of death.

The effects of age and gender on the prevalence of insomnia in a sample of the Saudi population.

OBJECTIVES: The aim of this study was to determine the prevalence of insomnia among the Saudi adult population. STUDY DESIGN: A cross-sectional insomnia survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. The presence of insomnia was defined by difficulty initiating sleep, early morning awakening, or frequent awakening, in addition to the second-day effect in the form of fatigue, tiredness, or changes in the mode because of lack of sleep. RESULTS: The crude prevalence of insomnia was 77.7% (95% CI = 75.9-79.5%). The gender-adjusted prevalence of insomnia was higher for females, 88.7% (95% CI = 86.4-90.7%) than for males, 70.4% (95% CI = 67.8-72.9%), p-value = .001. The age-adjusted prevalence of insomnia was higher for the elderly, 93.7% (95% CI = 90.6-96.0%) than for the middle aged, 79.8% (95% CI = 77.4-82.1%), or for the young group, 64.2% (95% CI = 59.9-68.4%), p-value = .001. The Chi-square analyses revealed that (1) being elderly, widowed/divorced, females, or housewives, (2) having a lack of education, and (3) excessive tea consumption were significantly associated with elevated risks for insomnia (p-values < .05). CONCLUSIONS: Insomnia is most prevalent among Saudi females and the elderly Saudi population.

Association between omeprazole use and Clostridium difficile infection among hospitalized patients: A case-control study of the Saudi population.

Background: While few international studies have assessed the association between omeprazole use and the risk of Clostridium difficile infection (CDI), research into this is lacking in Saudi Arabia and the Middle East region. The aim of this study was to determine whether exposure to omeprazole is associated with the risk of Clostridium difficile infection in a sample of hospitalized Saudi patients. Methodology: A retrospective matched case-control study was conducted at the King Abdulaziz Medical City in Riyadh, Saudi Arabia, from 1 August 2010 through 31 July 2015. The analysis included a total of 200 patients: 100 CDI cases and 100 matched controls. Results: The majority (60%, 120 out of 200) of patients had received proton pump inhibitors (PPIs), and a minority (18.5%, 37 out of 200) had received omeprazole. The PPI use was insignificantly higher in CDI cases than in controls. However, the use of omeprazole was significantly higher in CDI cases compared with controls. Specifically, patients receiving omeprazole were two times more likely to develop CDI compared with controls (aOR = 2.1, 95% confidence interval (CI) = (1.007-4.437)). After adjusting for potential predictors of CDI, watery diarrhea (aOR = 59.1, 95% CI = 19.831-175.974) and abdominal pain (aOR = 7.5, 95% CI = 2.184-25.445) were found to be independent predictors of CDI. Conclusions: The data suggests that PPIs were commonly used in patients admitted to King Abdulaziz Medical City in Riyadh: six out of ten patients received PPIs. The findings support a possible association between the use of omeprazole and a high risk of CDI. To confirm causality, the link between omeprazole and CDI should be assessed in a large interventional study.

Factors associated with No-Shows and rescheduling MRI appointments.

BACKGROUND: One of the major challenges facing global radiology services comes from delays connected to long waiting lists for magnetic resonance imaging (MRI) procedures. Such delays in diagnostic procedures could lead to poorer patient care outcomes. This study intended to estimate the rate of "No-Shows" or "Reschedule" MRI appointments. We also investigated the factors correlating No-Shows and Reschedule MRI appointments. METHODS: A cross-sectional study was conducted in Saudi Arabia using data obtained via MRI schedule reviews and self-administrated questionnaires. Clinical and demographic data were also collected from the study participants. Stepwise binary logistic regression was used to analyze the data. RESULTS: A total of 904 outpatients were asked to participate in the study, and we enrolled 121 outpatients who agreed to complete the study questionnaire. Of the 904 outpatients, the rate of No-Shows or Reschedule was 34.8% (95% Confidence Interval: 31.7-38.1%). Of the 121 outpatients studied, the rate of No-Shows or Reschedule was 49.6% (95% CI: 40.4-58.8%). Those of the female gender (OR = 6.238; 95% CI: 2.674-14.551, p-value = 0.001) and lack of education (OR = 2.799; 95% CI: 1.121-6.986, p-value = 0.027) were highly associated with No-Shows for the MRI appointments. There was no clarification of the MRI instructions (OR = 31.396; 95% CI: 3.427-287.644; p-value = 0.002), and family member drivers (OR = 15.530; 95% CI: 2.637-91.446, p-value = 0.002) were highly associated with rescheduling the MRI appointments. CONCLUSIONS: We noted higher rates of No-Shows and Rescheduling of MRI appointments in females, those with a lack of formal education, those who had not received the procedure instructions, and those who lacked transportation. We recommend setting targets and developing strategies and policies to improve more timely access to MRI, and thus reduce the waiting time.

Saudi SCD patients' symptoms and quality of life relative to the number of ED visits.

BACKGROUND: Individuals living with sickle cell disease (SCD) have significantly increased emergency department (ED) use compared to the general population. In Saudi Arabia, health care is free for all individuals and therefore has no bearing on increased ED visits. However, little is known about the relationship between quality of life (QoL) and frequency of acute care utilization in this patient population. METHODS: A cross-sectional study was conducted on 366 patients with SCD who attended the outpatient department at King Fahad Hospital, Hofuf, Saudi Arabia. Data were collected through self-administered surveys, which included: demographics, SCD-related ED visits, clinical issues, and QoL levels. We assessed the ED use by asking for the number of SCD-related ED visits within a 6-month period. RESULTS: The self-report survey of ED visits was completed by 308 SCD patients. The median number of SCD-related ED visits within a 6-month time period (IQR) was four (2-7 visits). According to the unadjusted negative binomial model, the rate of SCD-related ED visits increased by (46, 39.3, 40, and 53.5 %) for patients with fever, skin redness with itching, swelling, and blood transfusion, respectively. Poor QoL tends to increase the rate of SCD-related ED visits. Well education and poor general health positively influenced the rate of SCD-related ED visits. Well education tends to increase the rate of SCD-related ED visits by 50.2 %. The rate of SCD-related ED visits decreased by 1.4 % for every point increase in general health. CONCLUSION: Saudi patients with sickle cell disease reported a wide range of SCD-related ED visits. It was estimated that six of 10 SCD patients had at least three ED visits within a 6-month period. Well education and poor general health resulted in an increase in the rate of SCD-related ED visits.

Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia.

INTRODUCTION: In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA). METHODS: A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals. RESULTS: Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion. CONCLUSION: The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders.

Health-related quality of life in patients with sickle cell disease in Saudi Arabia.

BACKGROUND: There is a lack of research concerning health-related quality of life (HRQoL) in Saudi patients with sickle cell disease (SCD), particularly among adult populations. The aim of the current study was to describe the characteristics of SCD patients and their impact on their quality of life (QoL). METHODS: Six hundred twenty-nine adult SCD patients who attended King Fahad Hospital in Hofuf and King Fahad Central Hospital in Jazan were included in the analysis. Demographic/clinical data were collected and an Arabic version of the Medical Outcomes 36-Item Short-Form Health Survey (SF-36) questionnaire was used to assess QoL. RESULTS: SCD patients who hold a university degree reported positive impacts on the following domains of SF-36: physical role function, vitality, emotional well being, social function, pain reduction, and general health (P = .002, P = .001, P = .001, P = .003, P = .004, and P = .001, respectively). In general, patients with fever, skin redness, swelling, or history of blood transfusion tended to impair the health status of the SF-36. A multivariate analysis revealed that patients with a university degree tended to report high scores of physical role functions, emotional role function, and vitality. Patients with regular exercise tend to increase vitality, social function, general health, and reduce pain. Unemployment tends to lessen vitality and worsen pain. On average, pain, social function, and physical function scores tended to worsen in patients with swelling or history of blood transfusion. CONCLUSIONS: This study highlighted that poor education, fever, skin redness, and swelling were negatively associated with specific components of SF-36. SCD patients with a history of blood transfusion found their QoL poorer, whereas regular exercise tended to improve QoL.

Correlation of Dental and Skeletal Malocclusions in Sagittal Plane among Saudi Orthodontic Patients.

AIM: Whether or not the dental relationship correlates with skeletal relationship in the sagittal plane is an area of interest for orthodontic diagnosis and treatment planning. Thus, the aim of this study was to investigate the correlation of the dental malocclusion and the skeletal malocclusion in the sagittal plane among Saudi orthodontic patients. MATERIALS AND METHODS: Orthodontic dental casts and cephalometric radiographs of 124 patients were investigated and analyzed. The dental casts were classified in relation to the molar relationship according to Angle's classification and to the incisal relationship according to the British Standards Institution (BSI) classification. The sagittal relation in the cephalometric radiographs was analyzed according to ANB angle and WITS appraisal. RESULTS: The results show that the incisal relation had a very high significant association with WITS appraisal (p = 0.0045), whereas with ANB, the association was marginally significant (p =0.0528). No significant associations were found with molar relation neither at ANB (p = 0.2075) nor at the WITS (p = 0.4794) appraisal. Significant positive correlations between ANB and WITS appraisal were found at the three incisal classification classes (class I, r = 0.73; class II, r = 0.64; class III, r = 0.75) and no significant correlation was observed in all classes with the Angle's (molar) classification. CONCLUSIONS: The incisal classification had a significant association with WITS appraisal, whereas with ANB the association was marginally significant. No correlation was found between Angle's (molar) classification and ANB or WITS appraisal. CLINICAL SIGNIFICANCE: The incisal relation could be considered as a good indicator of the skeletal malocclusion in the sagittal plane in the orthodontic practice.

The prevalence of psychological impact on caregivers of hospitalized patients: The forgotten part of the equation.

INTRODUCTION: Despite the large number of caregivers suffering from various psychiatric disorders, research on psychological symptoms among caregivers of hospitalized patients is lacking in Saudi populations. OBJECTIVES: The objective of this study is to determine the prevalence of depression, anxiety and stress among caregivers of hospitalized Saudi patients. METHODS: A cross-sectional study of depression, anxiety and stress among caregivers of hospitalized patients was conducted. Arabic speaking caregivers (n = 353) between the ages of 14 and 80 years were included in the study. The Depression Anxiety Stress Scales (DASS-21) test (Arabic version) was used to measure the three psychological symptoms. RESULTS: The study has shown high rates of depression, anxiety and stress among caregivers (72.8%, 76.5%, and 61.5%, respectively). Depression was found to be associated with long-term hospital stay (81.4% vs. 69.3%; p-value = 0.021) and family caregivers (75.4% vs. 46.9%, p-value = 0.001). Anxiety was found to be associated with family caregivers (78.8% vs. 53.1%; p-value = 0.001). The three psychological symptoms were higher among those with an age above 20 years old (p-value < 0.05). Multivariate logistic models show the risk of the psychological symptoms increased with low-income, higher education, immediate relation to the patient, and older caregivers. CONCLUSIONS: The findings suggest that the prevalence of depression, anxiety and stress symptoms were very common among caregivers. The results showed that approximately 8 out of 10 caregivers suffer from at least one psychiatric disorder. Older, low socioeconomic status, and well-educated caregivers were identified as being at higher risk of developing psychiatric symptoms.