Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region.

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

Impact of Rural vs. Urban Residence on Survival Rates of Patients with Glioblastoma: A Tertiary Care Center Experience.

Purpose: Although the association between residential location and survival in patients with different cancer types has been established, the conclusions are contentious, and the underlying mechanisms remain unknown. Here, we reviewed the impact of residence on the survival of patients with glioblastoma (GBM). Methods: We conducted a retrospective study to compare the impact of rural and urban residence on the survival rates of patients with GBM diagnosed in Riyadh City and outside Riyadh. All patients in this study were treated in a tertiary care hospital, and their survival rates were analyzed in relation to their residence and other related factors, namely radiotherapy timing. Results: Overall, 125 patients were included: 61 from Riyadh City and 64 from outside. The majority of patients in both groups were aged >50 years (p = 0.814). There was no statistically significant difference between the groups in the Eastern Cooperative Oncology Group Performance Status (p = 0.430), seizure (p = 0.858), or initiation timing of radiotherapy (p = 0.781). Furthermore, the median survival rate in the Riyadh group versus the other group was 14.4 months and 12.2 months, respectively, with no statistical significance (p = 0.187). Conclusions: Our study showed that residential location had no significant effect on GBM prognosis. However, further studies with a larger sample size are required to delineate the other factors of referral within the healthcare system to facilitate the management of these patients within a specific timeframe.

Effect of Altitude on Hemoglobin and Red Blood Cell Indices in Adults in Different Regions of Saudi Arabia.

Purpose: Complete blood count (CBC) is a commonly used blood test for health checks. This study was conducted to compare CBC from two different altitudes and from sea-level populations in order to suggest correction factor for altitude-related increment on the hemoglobin and red blood cell indices. Patients and Methods: In this retrospective lab records study, large datasets of CBCs over 5-year period were screened from three different regions of Saudi Arabia, Jeddah (a coastal city), Taif City located at 1879 m above sea level, and Abha City at located 2270 m above sea level. Descriptive analysis and significance testing of the CBC variables at different altitude were compared. Results: A total of 57,059 participants were included for final analysis. Mean hemoglobin (Hb) concentration (g/dL) was 14.81 for men and 13.77 for women at sea level, whereas Hb concentrations were 15.35 and 14.19 for men and women residing at Taif City, respectively, and 15.40 and 14.71 for men and women at Abha City, respectively. Hemoglobin and other red cell indices were significantly different among men and women across different altitude, except for mean corpuscular volume (MCV). The MCV 95th percentile range was lower at sea level and both altitudes as compared to current reference range (76-91 fL vs 81-98 fL). Conclusion: Although altitude-associated increment in Hb concentration was evident in both men and women, it was lower than as suggested by World Health Organization and Centers for Disease and Control. Results of this study can also be used to derive new CBC reference intervals for Saudi residents living at high altitude. A correction factor (ΔHb) of 0.30 g/dL per 1000 m altitude is suggested to be used in adult population living at high altitudes in Saudi Arabia which should help better define anemia and polycythemia at altitude.

The possible effects of α-tocopherol against amiodarone-treated lungs in rats: vimentin detection, lipid peroxidation assay, and histological and ultrastructural evaluations.

The purpose of this study was to learn more about the pathogenesis of amiodarone (AD) on alveoli and also the possible preventive effect of α-tocopherol (α-T) against these hazards. Rats were divided into 4 groups, one of which acted as a control, the second received α-T, the third AD, and the fourth AD and α-T for 2 weeks. Light microscopy (LM), immunohistochemistry, transmission electron microscopy (TEM), and malondialdehyde (MDA) activity were analyzed in sections of lung tissue. Alveoli of lung tissue AD examined with LM showed dilatation of alveolar spaces, aggregation of red blood cells, and narrowing of alveolar septa. When stained with vimentin (VIM), alveoli showed a positive reaction in the majority and a moderate reaction in others. In the pneumocytes of the type II, some cytoplasmic vesicles had been deflated, whereas others contained lamellar bodies, a damaged nucleus, and vesicles in their heterochromatin. In the interstitial space, collagen fibers with aggregation of red blood cells and a disrupted blood-air barrier were detected. In rat lung alveoli treated with AD and α-T, the alveolar septum thickened and the alveolar spaces expanded as estimated. The alveoli of this group had more or less intact type I and II pneumocytes and a better appearance of the blood-air barrier. In the cells of the alveolar lining, the VIM staining leads to a diffuse positive response. Finally, lung parenchyma also improved, suggesting that α-T may help minimize the effects of AD.

Knowledge, Attitudes, and Practices towards Food Poisoning among Parents in Aseer Region, Southwestern Saudi Arabia.

Background: Food poisoning is caused by eating contaminated food. Improper food safety knowledge, poor food handling, and inadequate personal hygiene may allow microbes to grow in sufficient numbers to cause a food-borne illness. The aim of this paper was to assess the knowledge, attitudes, and practices regarding food poisoning and its determinants of parents in the Aseer region of Saudi Arabia. Methodology: This is a descriptive cross-sectional study conducted on 3011 parents in the Aseer region in the southwest region of Saudi Arabia. An online questionnaire was used to collect the data. The level of knowledge of the participants was scored as a percentage and further classified as "good" or "poor". Attitudes were classified as "positive", "neutral", or "negative" based on a calculated composite mean score. The participants were asked about standard food hygiene practices, and the practices were recorded based on how often they were performed, with the results recorded as "usually", "sometimes", or "never". Results: The age range of the parents was between 18 and 65 years old, with a mean age of 28.9 ± 10.4 years. Among the participants, 96.2% were Saudi, and 81.8% were female. Almost 53% of the fathers and 41% of the mothers were university graduates. About 55% of the mothers were housewives. Almost equal proportions of the parents had "good" and "poor" levels of knowledge on food poisoning. Around 41% of the parents had positive attitudes towards safe food consumption. Older parents (defined as above 30 years of age), males, university graduates, and urban residents had significantly higher levels of knowledge regarding food poisoning. Conclusions: This study provided much needed information on the knowledge, attitudes, and practices related to food poisoning among parents in the Aseer region of Saudi Arabia. Although most respondents reported satisfactory practices, gaps were identified in knowledge and attitudes. This suggests a need for further investigation focused on the observed practices and strengthening health education activities for the community.

Awareness and Perception of Parents Regarding Well Baby Clinic in Primary Health Care Centres in Abha City, Southwestern Saudi Arabia.

BACKGROUND: Well-baby clinic (WBC) service is implemented in all primary health care centers and is provided based on international standards to all children under 5 years in Saudi Arabia. It is a comprehensive package of health promotion and curative care to improve and maintain the health status and well-being of this age group. AIM: The main aim is to assess parents' awareness and perception regarding WBC in primary health care centers in Abha sector, Kingdom of Saudi Arabia (KSA). METHODOLOGY: A descriptive cross-sectional approach was used in the current study. The study targeted all babies' caregivers attending WBCs in primary health care centers in Abha city. The children's parents were included using three stages cluster sample technique. The questionnaire included participants' demographic data such as age, gender, relation to the baby, educational level, work, and monthly income. Awareness regarding the WBC was assessed using two main items covering hearing about the clinic provided services. RESULTS: The study included 1593 participants whose ages ranged from 19 to 55 years old with a mean age of 34.6 ± 11.8 years. About 64% of the respondents knew about the WBC, which was significantly higher among the females than males (P = .003). Also, 71.2% of respondents aged 25-34 years knew about well-baby clinic (WBC) compared to 35% of parents aged less than 25 years (P = .001). Exact 57.1% of the respondents went to the nearest governmental health office at vaccination times. About 46% of the respondents reported that the clinic nurse was the main person who dealt with them. Regarding services provided by a nurse at the vaccination clinic, registering child vaccination was the most reported (66.2%), followed by helping the mother make the child calm (56.8%). CONCLUSIONS: In conclusion, the study revealed that proper care is vital for a child's survival as well as optimal physical and mental development. Adequately cared child has proper well-being and happiness. Mothers and children caregivers had adequate awareness and acceptable attitude towards WBCs and provided services. Some barriers were declared including lack of available WBCs within the residence range, not all WBCs usually working, and more information should be provided about WBCs.

Prevalence and factors associated with gastroesophageal reflux disease among primary health care attendants at Abha city, southwestern Saudi Arabia.

BACKGROUND: Gastroesophageal reflux disease (GERD) is an abnormal reflux of the gastric content into the esophagus. In Saudi Arabia the GERD prevalence is not recently well studied. OBJECTIVE: To investigate the prevalence of gastroesophageal reflux disease and associated factors among attendants of primary health care centers (PHCCs) at Abha city, Saudi Arabia. METHOD: A descriptive cross- sectional study was performed using GerdQ as diagnostic tool for the GERD. The GerdQ consisted of six questions. Four questions were about the positive GERD predictors. The other two questions were about the negative GERD predictors. The scoring of GerdQ relies on the frequency of GERD symptoms during the last seven days. Using stratified random sample technique a representative sample was slected from the study PHCCs taking into conmsideration the relative catchment population in each center among adult males and females attending the selected PHCCs for any reason. RESULTS: The present study included 320 persons. The study showed a prevalence of GERD of 67.8%. The prevalence of GERD with high impact on daily life (HIDL) was found to be 50%. By multiple logistic regression (enter method) only four significant independent factors associated with GERD were identified; being unmarried (aOR = 1.85, 95% CI:1.02-3.23); smoking (aOR = 2.11, 95% CI: 1.41-5.98), fast food intake (OR = 1.28, 95% CI:1.01-1.71), and subjective perception of stress (OR = 3.0, 95% CI:1.68-5.26). CONCLUSIONS: GERD is a public health problem among adults in the region. Community level awareness programs are recommended. Healthcare providers must be aware of community perceptions and practices.

Demographic characteristics and types of stroke in Southwestern Saudi Arabia, and the potential demand of neuro endovascular specialists.

OBJECTIVES: To identify demographic characteristics, and types of stroke in Southwestern (Aseer) Region, Saudi Arabia. METHODS: This study is a retrospective and hospital-based. The data of all stroke patients (n=562) admitted to the tertiary care hospital in the province, Aseer Central Hospital (ACH) within the period from January 2016 until December 2017 are included. RESULTS: The mean ± SD of stoke patients' age was 62.6 ± 17.0 years. Male patients were more than female patients (62.6% and 37.4%, respectively). The majority (93.2%) were Saudi, while 91.5% had below university education and 6.4% were smokers. Interestingly, only 2% of patients had a family history of stroke, while 68.1% were diabetic, 80.4% were hypertensive, 91.6% had high serum cholesterol level, and 10.7% had history of transient ischemic attacks (TIA). Despite the lack of awareness, and leading to delay in reaching health care facility, 58.1% of stroke patients, were arriving to emergency department (ED) in less than 24 hours (potential endovascular therapeutic window). CONCLUSIONS: In Aseer Region, Saudi Arabia, stroke affects mainly those who are older, less educated, diabetic, hypertensive, with hypercholesterolemia and previous history of TIA. Associated factors for stroke differ significantly according to their nationality.

Prevalence of Depression, Anxiety, and Stress among the General Population in Saudi Arabia during Covid-19 Pandemic.

Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health. Our objective was to assess prevalence of depression, anxiety, and stress among the general population in Saudi Arabia during this pandemic. A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. Psychological impact was assessed using the Arabic version of Depression, Anxiety, and Stress Scale (DASS-21). A total of 1597 participants completed the survey. In total, 17.1% reported moderate to severe depressive symptoms; 10% reported moderate to severe anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, anxiety, and stress were significantly higher among females, younger respondents, and health care providers. Depression was higher among smokers, singles, and non-working respondents. Anxiety was higher among those reporting contacts with COVID-19 positive cases, previously quarantined and those with chronic health problems. Our findings reaffirm the importance of providing appropriate knowledge and specialized interventions to promote the mental well-being of the Saudi population, paying particular attention to high-risk groups.

The pattern of iron deficiency with and without anemia among medical college girl students in high altitude southern Saudi Arabia.

INTRODUCTION: The prevalence of iron deficiency, latent and symptomatic, is heterogeneous worldwide. In this study, we aim to explore the prevalence of iron deficiency, with and without anemia, among medical college females at the high Altitude Aseer region of Southwestern Saudi Arabia. METHODOLOGY: 200 female medical students were randomly sampled, between the ages of 19 and 27 years. Blood samples were collected for complete blood count (CBC) values and serum ferritin determination. Questionnaires were completed in order to collect demographics, medical history, and socioeconomic information of the participants. RESULTS: Prevalence of overall iron deficiency was high (63%, serum ferritin <20 µg/L, 52.5%, ferritin <15 µg/L). Anemia, adjusted for high altitude (defined as less than 13 g/dL was present in 41 participants (20.5%) and 12 (6.5%) have Hb <12 g/dL. Iron-deficiency anemia (Hb <13 g/dL and serum ferritin <15 µg/L) was present in 35 (17.5%). Personal and family history of anemia and poor animal product containing meals were positively correlated with the presence of iron deficiency state. Neither symptoms of anemia, nor the presence of menorrhagia correlate with the presence of iron deficiency anemia. CONCLUSION: Iron deficiency with and without anemia is a very common and condition in young females' population at high altitude. Implementing a lab method to screen for anemia on vulnerable populations is needed. Frequently asymptomatic, the primary care providers should maintain a high degree of suspicion in order to initiate screening for iron status.

Sleep hygiene, sleep-related problems, and their relations with quality of life in a primary-care population in southwest Saudi Arabia.

BACKGROUND: Little is recognized about factors affecting poor sleep hygiene and relations of sleep problems with the quality of life among adults. AIMS: To evaluate sleep hygiene, explore its associated factors, assess the prevalence of excessive daytime sleepiness (EDS) and insomnia, and their relations with sleep hygiene. Besides, correlate sleep problems with life quality. METHODS: A representative sample of primary healthcare population was surveyed using questionnaires comprising sociodemographic characters, personal lifestyles, validated Arabic versions of Epworth sleepiness scales, Athens insomnia scale, short-form health survey questionnaire (SF-12), and developed Arabic sleep hygiene index (SHI). RESULTS: A total of 401 adults participated in the study. The average SHI score was 17.25 ± 7.33. Poorer sleep hygiene was significantly detected in younger age, unmarried, unemployed, smokers, and energy drinks consumers (P < 0.05). Positive significant correlations were correlated with cellphone and video-gaming duration. About 56.61% and 39.90% of participants suffered insomnia symptoms and EDS, respectively. Significant poorer SHI was detected among insomnia and EDS sufferers. Negative significant correlations were observed between scores of both components of SF-12 and EDS, insomnia, and SHI. CONCLUSION: Significant negative associations were detected between SHI, EDS, insomnia, and both components of life quality. The role of sleep hygiene education programs in the promotion of sleep and quality of life need to be considered.

Prevalence and determinants of unconscious stereotyping among primary care physicians. An analytical cross-section study.

OBJECTIVES: To explore implicit stereotyping among primary healthcare (PHC) physicians and to identify determinants of physicians' stereotyping of patients based on the patients' characteristics and appearance. METHODS: This study followed an analytical cross-sectional design conducted between October 2019 and December 2019, and included 250 primary healthcare (PHC) physicians in Aseer Region, Kingdom of Saudi Arabia. Data was collected using a self-administered questionnaire, which included items concerning physicians' sociodemographic characteristics, and their attitudes toward patient characteristics and patient appearance. RESULTS: Prevalence of stereotyping among PHC physicians was 63.6% with respect to patient characteristics and 57.6% with respect to patient appearance. Stereotyping based on patient characteristics was higher among younger participants, females, those with bachelor's degrees, those in general practitioner positions, and those with less experience in PHC. CONCLUSION: Most PHC physicians in Aseer Region, Kingdom of Saudi Arabia, are liable to implicit stereotyping based on patient characteristics (namely, gender and educational level) and patient appearance (namely, clothing). Therefore, it is recommended to train PHC physicians in cultural competency to reduce unintentional acts of discrimination toward their patients.

Schoolteachers' Knowledge of Attention-Deficit/Hyperactivity Disorder-Current Status and Effectiveness of Knowledge Improvement Program: A Randomized Controlled Trial.

BACKGROUND: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school. OBJECTIVES: To assess the schoolteachers' knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program. METHODS: A randomized controlled trial study design was followed on 100 primary school teachers from Abha City, Saudi Arabia. Teachers were randomly selected and allocated into trial and control groups. A self-administered questionnaire was used to evaluate teachers' knowledge about ADHD. After the baseline assessment, participants in the trial group received a two-day ADHD knowledge improvement program. Teachers' knowledge about ADHD was reassessed using the same questionnaire immediately after finishing the intervention program and after three months in both groups. RESULTS: Only 16% and 22% of trial and control groups, respectively, showed adequate baseline knowledge about ADHD. Teachers' main sources of information about ADHD were the internet (67%), friends (47%), TV (34%), and reading books (23%). Knowledge of teachers in the trial group significantly improved immediately after the intervention. After three months, these knowledge benefits slightly declined but remained more adequate than those of teachers in the control group. The logistic regression model revealed that being a participant in the trial group and of higher qualification were associated with significant improvement in teachers' retained knowledge on ADHD (p < 0.001 and p = 0.050, respectively). CONCLUSIONS: The majority of male primary school teachers in Abha City, Saudi Arabia, have inadequate knowledge about ADHD. Applying a knowledge improvement program can substantially improve their knowledge of ADHD. Consideration should be given to the integration of ADHD knowledge improvement program into teachers' educational programs.

Updating indicators for scaling the socioeconomic level of families for health research.

BACKGROUND: Socioeconomic position is a community-used concept in health research. The social level is related to numerous exposures, resources, and susceptibilities that may affect health. AIM: To update and validate a tool for scaling the socioeconomic level of families for health research. PARTICIPANTS AND METHODS: A multistage stratified cluster sampling technique was used to select 900 families (one index person per family) from urban and rural areas in the Alexandria governorate using the proportional allocation method. Ten variables reflecting parental education, parental occupation, family characteristics, financial status as well as home sanitation were reduced to a single socioeconomic status (SES) index using two methods: the Sigma scoring method and factor analysis. Reliability and validity were assessed for the developed scale. Factor scores were classified into three categories (low, medium, high) using cluster analysis, and then different cut-off points for the Sigma scoring method were used and compared with the cluster solution using the κ statistic. RESULTS: Results showed that the developed scale was both reliable (Cronbach's α coefficient α=0.79) and valid [8 out of the 10 items had high loading (>0.5) for SES]. The best cut-off points for SES classification using the proposed scoring system that yielded the highest agreement with the cluster solution (κ=0.77) were less than 40%, 40 to <70%, and at 70% or more, with an overall correct classification of 84.7%. CONCLUSION AND RECOMMENDATION: The new scale proved to be valid and reliable. This scale is recommended for use for scaling the socioeconomic level of families for health research.

Risk factors of perinatal and neonatal mortality in Alexandria, Egypt.

BACKGROUND: Egypt has already achieved the goal of reducing the under-five mortality rate (U5MR) by two-thirds. However, one of the challenges that Egypt currently faces is how to reduce the perinatal and neonatal mortality (PM, NM). This study aimed to identify the social and biomedical risk factors contributing toward PM and NM in Alexandria, Egypt. PARTICIPANTS AND METHODS: A case-control design was used. Cases were 150 mothers whose index pregnancy terminated in perinatal (from the 28th week of pregnancy to less than 7 days after birth) and neonatal deaths (from the seventh day to less than the 28th day after birth). They were selected from the antenatal clinic and neonatal care unit of ElShatby University hospital for Obstetrics and gynecology. Controls were 150 mothers with live births ranging in age from 28 days up to 2 months selected from the outpatient clinics of ElShatby University Hospital for Pediatrics. RESULTS: Stepwise logistic regression analysis indicated a higher risk of PM/NM among very young or very old mothers (OR=4.1 and 6.46, respectively), those who had previous PM/NM [odds ratio (OR)=12.7; 95% confidence interval (CI): 5.04-29.54], grand multiparous (OR=2.23; 95% CI: 1.50-5.42), those with infrequent antenatal visits (OR=3.88; 95% CI: 2.26-6.65), and mothers with complications during the index pregnancy (OR=9.21; 95% CI: 3.40-24.95). CONCLUSION: This study confirms the evidence of a positive association between PM/NM and maternal age, obstetric history, and utilization of healthcare services. Appropriate age at marriage and pregnancy, spacing of and limiting the number of births, and improving antenatal, natal, and postnatal care are priority actions that can reduce PM/NM in Alexandria.