Do routinely measured risk factors for obesity explain the sex gap in its prevalence? Observations from Saudi Arabia.

BACKGROUND: The prevalence of adult obesity is higher in women than men in most countries. However, the pathways that link female sex with excess obesity are still not fully understood. We examine whether socioeconomic and behavioural factors may mediate the association between sex and obesity in the Saudi Arabian setting where there is female excess in obesity. METHODS: We performed a mediation analysis using a cross-sectional, national household survey from Saudi Arabia with 4758 participants (51% female). A series of multivariable regression models were fitted to test if socioeconomic position, physical activity, sedentary behaviour, diet, and smoking mediate the association between sex and obesity (BMI >=30). The findings were confirmed using causal mediation analysis. RESULTS: Women in this sample were roughly twice as likely as men to be obese (crude OR 1.9; 95% CI 1.6-2.3). The odds ratio remained significantly higher for women compared to men in models testing for mediation (OR range 1.95-2.06). Our data suggest that indicators of socio-economic position, physical activity, sedentary behaviour, diet, and smoking do not mediate the sex differences in obesity. CONCLUSIONS: Our analysis shows that most commonly measured risk factors for obesity do not explain the sex differences in its prevalence in the Saudi context. Further research is needed to understand what might explain the female excess in obesity prevalence. We discuss how data related to the lived experience of Saudi men and women may tap into underlying mechanisms by which the sex difference in obesity prevalence are produced.

Role and challenges of simulation in undergraduate curriculum.

RATIONALE: Medical simulation is relatively a novel technology widely utilized for teaching and assessing students clinical skills. Students and faculty face many challenges when simulation sessions are introduced into undergraduate curriculum. OBJECTIVES: The aim of this study is to obtain the opinion of undergraduate medical students and our faculty regarding the role of simulation in undergraduate curriculum, the simulation modalities used, and the perceived barriers in implementing simulation sessions. METHODS: A self-administered pilot tested questionnaire with 18 items using a 5-point Likert scale was distributed to undergraduate male (n = 125) and female students (n = 70) as well as to the faculty members (n = 14) at King Fahad Medical City, King Saud Bin Abdul Aziz University of Health Sciences, Saudi Arabia, to respond. Survey elements addressed the role of simulation, simulation modalities used, and perceived challenges to implementation of simulation sessions. RESULT: Various learning outcomes are achieved and improved through the technology enhanced simulation sessions such as communication skills, diagnostic skills, procedural skills, self-confidence, and integration of basic and clinical sciences. The use of high fidelity simulators, simulated patients and task trainers was more desirable by our students and faculty for teaching and learning as well as an evaluation tool. According to most of the students', institutional support in terms of resources, staff and duration of sessions was adequate. However, motivation to participate in the sessions and provision of adequate feedback by the staff was a constraint. CONCLUSION: The use of simulation laboratory is of great benefit to the students and a great teaching tool for the staff to ensure students learn various skills.

Academic and socio-demographic factors influencing students' performance in a new Saudi medical school.

OBJECTIVE: The objective of this study is to examine factors such as the students' demographic data, motivation, educational factors and socio-cultural factors, and identify whether these factors affect the academic performance of undergraduate medical students. METHODS: A cross-sectional study design utilising grade point averages (GPAs) of two cohorts of students in both levels of the pre-clinical phase. In addition, self-administered questionnaire was used to evaluate the effect of these factors on students with poor and good cumulative GPA. RESULTS: Academic performance was significantly affected with factors such as gender, marital status, interest and motivation, and the transportation used to reach the faculty. Students with a cumulative GPA of 3.0 or greater significantly differed than those with a GPA of less than 3.0 being higher in female students, in married students, students have interest to study medicine and type of transportation used to reach the college. Factors including age, motivation, learning resources, study time and type of transportation used have shown to create a significant difference in GPA between male and females. CONCLUSION: Factors such as age, gender, marital status, interest and motivation to enter medical school, learning resources, study time and the transportation used have been shown to significantly affect medical student's cumulative GPA as a whole batch as well as when they are tested for gender.

Gender differences in learning styles and academic performance of medical students in Saudi Arabia.

RATIONALE: Teachers at medical school are often faced with challenges of improving student satisfaction with the learning environment. On the other hand, education in the medical field is very competitive and medical students are exposed to diverse methods of teaching. Students adapt specific learning styles to keep pace with the information delivered to them in their institutions. OBJECTIVE: The aim of this study is to know the differences in learning styles between male and female students, and the effect it has on academic performance. METHOD: The VARK Questionnaire version 7.0 (Visual, Aural, Read/Write and Kinesthetic) was administered to the fourth year and fifth year medical students at King Saud Bin Abdul Aziz University for Health Sciences, Faculty of Medicine at King Fahad Medical City, Saudi Arabia for determining the preferred learning methods of students participating in this study. The learning styles were then compared to cumulative grade point average (GPA) obtained by the students. RESULT: The dominant learning style preference of students was multimodal. Among students who preferred unimodal preference, aural and kinesthetic preference was predominant for males and females. Moreover, Females had more diverse preferences than male students. Multimodal learners have higher cumulative GPAs when compared with the unimodal learners. CONCLUSION: This study revealed variation in learning style preferences among genders, and its implications on academic performance of medical students.

At-risk marriages after compulsory premarital testing and counseling for ß-thalassemia and sickle cell disease in Saudi Arabia, 2005-2006.

Results from a screening program for sickle cell disease and ß-thalassemia suggest about 90% of couples in Saudi Arabia at risk of having affected children still decide to marry. This study determined the rate of at-risk marriages and identified several factors that may prevent at risk couples from marrying. The marriage status of 934 at-risk couples was determined from original screening program records in the Ministry of Health. Of 934 couples, 824 married (88.2%) and 110 (11.8%) did not. A case-controlled study was conducted on 104 couples who did not marry (cases) and 478 couples who did marry (controls) in order to assess relationships between various cultural and social factors and marriage decisions. In the case-controled study, 28.8% of couples (30/104) who did not marry (cases) knew their disease or carrier status before screening compared to 18% (86/478) of those who married (controls). Reasons couples gave for proceeding with marriage included: wedding plans could not be canceled, and fear of social stigma. Couples who did not marry reported being influenced by prior knowledge of their disease or carrier status and whether they or family members were affected. Approximately half of the cases and controls (n = 270, 46.4%) thought it best to undergo screening before proceeding with the engagement and wedding plans. Most couples received no advice to participate in genetic counseling services. Marriage decisions for the small number who received genetic counseling (n = 168, 27.6%) did not differ significantly from those that received no counseling. Recommendations are made for improving the effectiveness of this screening program.

Cancer survival in Africa, Asia, and Central America: a population-based study.

BACKGROUND: Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions. METHODS: Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined. FINDINGS: For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services. INTERPRETATION: The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources. FUNDING: Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA).

The incidence of lung cancer in the Gulf Cooperation Council countries.

BACKGROUND: Lung cancer is the most common cancer in the world, with an estimated number of 1.3 million new cases as of 2002. This is the first report from the countries that comprise the Gulf Cooperation Council (GCC). PATIENTS AND METHODS: All the primary lung cancer cases registered in the Gulf Center for Cancer Registration during 1998 to 2001 were used to calculate the age-standardized incidence rate (ASR) per 100,000 person-years by the direct standardization method. RESULTS: Overall, there were 1607 (1261 males, 346 females) primary lung cancer cases registered during this period with the male to female ratio of 3.6:1. The highest ASR was in Bahrain (34.3 for males, 12.1 for females) followed by Qatar (18.5 for males, 5.5 for females) and Kuwait (13.8 for males, 4.0 for females); the lowest rate was in Saudi Arabia (4.8 for males, 1.3 for females). The mean age at diagnosis for males ranged from 68.7 years in Bahrain to 59.2 years in Oman. For females it ranged from 68.2 years in Bahrain to 58.0 years in Oman. Squamous cell carcinoma in males (except in Qatar) and adenocarcinoma in females were the predominant histological type. CONCLUSIONS: Cancer of the lung is one of the common cancers among males in all the GCC countries and ranks second among Bahraini females. Adenocarcinomas were more common in women than men.

Isolated Diastolic Hypertension among Adults in Saudi Arabia: Prevalence, Risk Factors, Predictors and Treatment. Results of a National Survey.

BACKGROUND: In the past, diastolic hypertension was the main criterion for treatment, but currently, systolic pressure is the main criterion because it was thought that Isolated Diastolic Hypertension (IDH) is not associated with complications. Studies later revealed that IDH carries significant risks. Quantifying the magnitude and risk factors of IDH in the community is essential for all intervention strategies. AIMS: This study aims to determine the prevalence, risk factors, predictors, treatment modalities and lifestyle practices of IDH adult patients in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: Cross-sectional study. METHODS: A community-based cross-sectional study using STEPwise approach among adults using a multistage, stratified, cluster random sample was carried out. Data were collected using questionnaires which included socio-demographics, blood pressure, biochemical, anthropometric measurements and lifestyle practices. Statistical analysis included calculating means and standard deviations, proportions, univariate and multiple logistic regression analysis. RESULTS: Of a total 4562 subjects, 180 (3.95%) suffered from IDH, which was significantly related to age, gender, employment, smoking, diabetes mellitus, obesity and hypercholesterolemia. More than 93% were using some form of treatment, with 77.2% on prescribed drugs, 63% using diet, and 23% using exercise. Significant predictors of IDH were retirement and hypercholesterolemia. CONCLUSION: IDH is associated with some sociodemographic characteristics and co-morbidity. Given the risk of cardiovascular disease associated with IDH, the findings of this study emphasize the need for diagnosing the disease in middle-aged persons focusing on the modifiable risk factors of IDH.

Perceived stress and associated factors among medical students.

BACKGROUND: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. OBJECTIVES: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. RESULTS: Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students' stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. CONCLUSION: Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

The Risk of Nosocomial Transmission of Rift Valley Fever.

In 2000, we investigated the Rift Valley fever (RVF) outbreak on the Arabian Peninsula-the first outside Africa-and the risk of nosocomial transmission. In a cross-sectional design, during the peak of the epidemic at its epicenter, we found four (0.6%) of 703 healthcare workers (HCWs) IgM seropositive but all with only community-associated exposures. Standard precautions are sufficient for HCWs exposed to known RVF patients, in contrast to other viral hemorrhagic fevers (VHF) such as Ebola virus disease (EVD) in which the route of transmission differs. Suspected VHF in which the etiology is uncertain should be initially managed with the most cautious infection control measures.

Completeness and validity of cancer registration in a major public referral hospital in Saudi Arabia.

BACKGROUND: The 1994 Saudi National Cancer Registry (NCR), a population-based registry, showed a crude incidence rate (CIR) of 39/100,000 for all cancers in the Saudi population. The low CIR suggested possible under-reporting, especially during the early years of operation. This study as aimed at estimating the number of missed cases due to under-reporting, and to assess the validity of reported data from a major public referral hospital in Riyadh city. MATERIALS AND METHODS: We compared cancer cases from the three data sources: medical records (MR), which were the original source of NCR cases; pathology reports (PR); and death certificates (DC). We estimated the missing cancer cases using the capture-recapture method with log-linear models of Fienberg to correct for interdependency between the three data sources. To assess the validity of the data, we reabstracted records of about 8% (39/4760 of previously reported cases from the same hospital. RESULTS: A total of 811 cancer cases were reported through the three sources, i.e., MR 611 (75.3%), PR 639 (78.8%) and DC 204 (25.2%). After fitting a series of log-linear models to the three sources of data, the three sources were found to be statistically dependent. Capture-repcapture method indicated that 384 cases were missed, giving an estimation of 1195 cancer cases to be reported. Using these 1195 estimated cases; the estimated ascertainment rates were 51% for medical records, 53% for pathology reports, 17% for death certificates, and 68% for the aggregated registry. In the validity assessment, major disagreement between the abstracted and reabstracted data was found to be highest for stage of disease (44%), followed by histology code and behavior (25.6%). Minor disagreements were most common for date of diagnosis (36%) and grade (36%). Overall, agreements were highest for laterality (95%), followed by primary site codes (90%) and basis of diagnosis (85%). Agreement of tumor description variables (site, histology, behavior, and stage) was 57%. CONCLUSION: Cancer registration will require substantial improvements in both completeness of reporting and data quality at the hospital level. Use of multiple data sources and estimation of missed cases will help ensure completeness of case registration.

Anthropometric risk factors and predictors of hypertension among Saudi adult population - a national survey.

UNLABELLED: This cross-sectional study aimed at determining the anthropometric predictors of hypertension among adults in Saudi Arabia. Multi-stage stratified sampling was used to select 4758 adult participants. The average of three blood pressure measurements using an automatic sphygmomanometer was considered the real blood pressure. Anthropometric measurements and socio-demographics were obtained from participants. The overall prevalence of hypertension was 25.5%. Hypertension was significantly positively associated with selected anthropometric measurements. Selected anthropometric measures were significant predictors of systolic and diastolic blood pressures except for hip measurements. Waist for height ratio was a significant predictor for isolated diastolic hypertension and combined systolic and diastolic hypertension. Waist circumference was the significant predictor for isolated systolic hypertension. Body mass index was a significant predictor for the combined systolic diastolic type. Waist for Hip Ratio was not a significant predictor for any of the hypertension subtypes. CONCLUSION: Waist for height ratio is the most important predictor for blood pressure level and hypertension disease.

Comparative study of physical activity of hypertensives and normotensives: A cross-sectional study of adults in Saudi Arabia.

BACKGROUND: To formulate all intervention strategies for hypertension in the community, it is essential to quantify the magnitude of the disease and its risk factors. The patterns of physical activity have not been studied in terms of their being a risk factor or a predictor of hypertension in Saudi Arabia. MATERIALS AND METHODS: This was a community-based cross-sectional study using the STEP-wise approach of adults and a multistage, stratified, cluster random sample. Data were collected using a questionnaire which included sociodemographics, blood pressure, patterns, levels and duration of physical activity. RESULTS: Of a total of 4758, 1213 (25.5%) were hypertensives. Hypertension was significantly negatively associated with total levels and duration of physical activity in leisure, transport, and work. Significant predictors of hypertension included lower levels of work involving a moderate physical activity for 10 min, walking/cycling for 10 min continuously, and vigorous activity during leisure time. CONCLUSIONS: Hypertension is prevalent among adults; physical inactivity is a significant risk factor and predictor. Targeting this modifiable risk factor can help in prevention, early diagnosis, and control.

Knowledge, attitude, and behavior among Saudis toward cancer preventive practice.

OBJECTIVE: To examine self-reported knowledge, attitude, and preventive practices on cancer among Saudis. MATERIALS AND METHODS: Data was collected from Saudis aged 15 years or more, who attended one of the randomly selected 20 Primary Health Centers (PHC) or the four major private hospitals located in the Riyadh region, either as patients or their escorts. The association between the variables was evaluated by the Chi square test. RESULTS: The study population consisted of 618 males and 719 females. Among the female respondents 23.1% reported that they practiced breast self-examination (BSE); 14.2 and 8.1%, respectively, had clinical breast examination (CBE) and mammography. However, 10.0 and 16.1% of the females, aged 40 years and older, reported having had mammograms and CBE, respectively. The BSE performers were more educated, knew someone with cancer, and had heard of the cancer warning signal. Both educational level and 'heard of cancer warning signal' were significantly related to CBE. Cancer information was received from television / radio by 65.1% and from the physician by 29.4%. Even though 69.4% believed that cancer could be detected early, a vast majority (95.8%) felt early detection of cancer was extremely desirable and 55.1% said their participation was definite in any screening program. A majority of the respondents (92.6%) insisted on the need for physician recommendation to participate and 78.1% expected that any such program should be conducted in the existing hospitals / clinics. CONCLUSION: Culturally sensitive health education messages should be tailored to fulfill the knowledge gap among all population strata. Saudis will benefit from partnerships between public health educators and media to speed up the dissemination of cancer information.

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey.

This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension.

Public knowledge on cancer and its determinants among Saudis in the Riyadh Region of Saudi Arabia.

BACKGROUND: Earlier studies on cancer knowledge/awareness from Saudi Arabia have been few and mostly limited to knowledge of and attitude towards breast cancer. The objectives of the present cross sectional study were to determine the levels of knowledge concerning cancer and to identify associated factors. METHODS: This study was carried out among 1,407 Saudis who were either patients or their escorts, attending selected hospitals in Riyadh region and aged 15 years or more. Required information was obtained by interview using a piloted Arabic questionnaire. Associations between different variables and respondents knowledge were evaluated by Chi square test. Multiple logistic regression analyses were performed to examine the potential impact of the variables. RESULTS: This study population consisted of 688 males and 719 females. Approximately two thirds of participants (67.6%) had never heard of any cancer warning signals, but 80.7% believed some cancers can be cured if detected early, 27.1% believed cancer means end of life and 74.2% believed cancer will appear overnight. The majority of the respondents (65.1%) received information about cancer from television/radio. Although 1,159 had high level knowledge (scored 50.0% and more), only 233 individuals scored 75.0% and more. Significant differences in the knowledge level across age groups, educational levels and marital status were observed. Females had higher level knowledge than males. Odds of having high level knowledge about cancer was 5.27 times higher among those who had undergone any of the tests (breast self examination, mammography, occult blood, Papanicolau smear) compared to those who had none of those tests (95% CI: 1.87-14.8). Those who had heard about any cancer warning signal were more knowledgeable (OR=1.55; 95% CI: 1.10-2.19) than those who hadn't. The other most important determinants of knowledge level included age, and attending a primary health care centre. CONCLUSIONS: Our results suggest that the knowledge of cancer is poor among the public and greater attempts should be made to increase public awareness.

Plague from eating raw camel liver.

We investigated a cluster of 5 plague cases; the patients included 4 with severe pharyngitis and submandibular lymphadenitis. These 4 case-patients had eaten raw camel liver. Yersinia pestis was isolated from bone marrow of the camel and from jirds (Meriones libycus) and fleas (Xenopsylla cheopis) captured at the camel corral.

Outbreak of W135 meningococcal disease in 2000: not emergence of a new W135 strain but clonal expansion within the electophoretic type-37 complex.

In 2000, >400 cases of disease caused by Neisseria meningitidis serogroup W135 (MenW135), the largest MenW135 outbreak reported to date, occurred worldwide among Hajj pilgrims and their contacts. To elucidate the origin of the outbreak strains and to investigate their relatedness to major clonal groups, genotypic and phenotypic subtyping was performed on 26 MenW135 outbreak-associated isolates and 50 MenW135 isolates collected worldwide from 1970 through 2000. All outbreak-associated isolates were members of a single clone of the hypervirulent electrophoretic type (ET)-37 complex, designated the "(W)ET-37 clone"; 19 additional MenW135 strains were also members of this clone, and the remaining 31 MenW135 strains were clearly distinct. The 2000 MenW135 outbreak was not caused by emergence of a new MenW135 strain but rather by expansion of the (W)ET-37 clone that has been in circulation at least since 1970; the strains most closely related to those causing the 2000 outbreak have been isolated in Algeria, Mali, and The Gambia in the 1990s.