Utility of patient information leaflet and perceived impact of its use on medication adherence.

BACKGROUND: Although patients frequently use patient information leaflets (PILs) to obtain information about medicine, their confidence in using it may be diminished after reading it. This study aimed to assess the public perception of PIL's quality and the perceived impact of its use on medication adherence. METHODS: A community-based cross-sectional study of 1,138 adult individuals in Saudi Arabia, April-May 2020, was conducted via Survey Monkey using an anonymous validated e-questionnaire. Data were collected on personal characteristics, PIL readership and preferences, perception towards PIL quality and impact of its use on taking medication, and reasons for not reading PIL. In addition, logistic regression analysis was performed to identify the significant predictors of reading PIL. Significance was considered at p < 0.05. RESULTS: Nearly all participants (91.1%) reported reading PIL. The more read PIL's sections were directions of use (52.7%) and side effects (30.3%). Female gender (OR = 5.64, 95%CI: 3.53,9.02), age over 40 years (OR = 2.80, 95%CI: 1.69,4.64), and secondary education or more (OR = 1.74, 95%CI: 1.06,2.85) were the significant predictors of reading PIL. The majority of PIL readers reported their preference for verbal information (65.8%), hard copy presentation (77%), adding graphics (71.1%), and concise content of PIL (68.8%). In addition, most participants reported PIL always/usually adds to their knowledge of medicines (70.6%) and said that PIL reading positively impacted their medication adherence (64.9%). For only 8.8%, PIL reading negatively impacted their adherence, primarily because of reading information on medicine's side effects and complications (74.4%). More than one-half of participants perceived the PIL quality as good/excellent in terms of; font size (51.3%), language comprehensiveness (64.9%), paper quality (68.0%), and general appearance (64.9%). Getting sufficient information from doctors and pharmacists was the main reason for not reading the PIL (59.2%). Most participants (92.5%) agreed on standardizing how information is displayed in the PIL among all PILs of all companies. CONCLUSION: PIL is read by nearly all the study sample, especially females, older, and educated subjects. It was perceived as beneficial in upgrading medication adherence. Effective designing of PILs should focus on patients' literacy level and age. Standardization of the PIL structure in all pharmaceutical companies is recommended.

Clinical characteristics and outcome of Covid-19 illness and predictors of in-hospital mortality in Saudi Arabia.

BACKGROUND: Patients' race and ethnicity may play a role in mortality from Covid-19. Studies in China, the US, and Europe have been conducted on the predictors of Covid-19 mortality, yet in the EMR countries, such studies are scarce. Therefore, we aimed to describe the hospitalization rate, ICU-admission, and in-hospital mortality of Covid-19 and predictors of in-hospital mortality in Saudi Arabia. METHODS: E-medical records were examined for all Covid-19 patients diagnosed in five tertiary hospitals affiliated with the Saudi-National Guard-Health Affairs during March 21, 2020, and September 12, 2021, based on a positive SARS-CoV-2 RT-PCR test, (n = 35,284). Data were collected on patients' characteristics, comorbidities, laboratory findings, hospitalization, ICU admission, and in-hospital and overall mortality. Logestic regressions were used to identify the independent predictors of in-hospital mortality. The best laboratory parameters cut-off values to predict in-hospital mortality were identified using the area under the receiver operating characteristic curve (AUC). Significance was considered at p < 0.05. RESULTS: Of all 35,284 Covid-19 patients, 81.8% were adults and 21.7% were hospitalized. Compared to non-hospitalized patients, hospitalized patients were more of female gender (52.1% versus 47.3%, p < 0.001) and had higher mean age (p < 0.001), higher mean BMI (p < 0.001), and higher rates of: diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), cancer (p < 0.001), COPD (p < 0.001) and asthma (p = 0.011). The study showed 3.1% overall case-fatality, 20.3% ICU admission rate, and 9.7% in-hospital mortality. Predictors of in-hospital mortality among adult patients were; patients' age ≥ 70 years (OR = 6.93, 95% CI 1.94-24.79), ischemic heart disease (OR = 1.80, 95% CI 1.05-3.09), ICU admission (OR = 24.38, 95% CI 15.64-38.01), abnormal C-reactive protein "CRP" (OR = 1.85, 95% CI 1.08-3.16), abnormal D-dimer (OR = 1.96, 95% CI 1.15-3.36), lymphopenia (OR = 2.76, 95% CI 2.03-3.3.76), high neutrophil count (OR = 2.10, 95% CI 1.54-2.87), and abnormal procalcitonin (OR = 3.33, 95% CI 1.88-5.90). The best laboratory parameters cut-off values to predict in-hospital mortality were CRP > 72.25 mg/L (AUC = 0.64), D-dimer > 1125 µg/L (AUC = 0.75), neutrophils count > 5,745 × 10^9/L (AUC = 0.70), lymphocytic count < 1.10 × 10^9/L (AUC = 0.72), and procalcitonin > 0.18 ng/mL (AUC = 0.76). CONCLUSIONS: Rates of hospitalization, ICU-admission, in-hospital mortality and overall case fatality were nearly comparable to the rates in western countries. Early interventions are necessary for high-risk Covid-19 patients, especially elderly patients and those with cardiac diseases.

Perception and attitude of healthcare workers in Saudi Arabia with regard to Covid-19 pandemic and potential associated predictors.

BACKGROUND: Healthcare workers (HCWs) face considerable mental and physical stress caring for patients with Covid-19. They are at higher risk of acquiring and transmitting this virus. This study aims to assess perception and attitude of HCWs in Saudi Arabia with regard to Covid-19, and to identify potential associated predictors. METHODS: In a cross-sectional study, HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email with an anonymous link, by a concern scale about Covid-19 pandemic during 15-30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern statements in five distinct domains. Multiple regression analysis was used to identify predictors of high concern scores. RESULTS: A total of 844 HCW responded to the survey. Their average age was 40.4 ± 9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with others. The majority of participants (72.1%) had overall concern scores of 55 or less out of a maximum score of 96 points, with an overall mean score of 48.5 ± 12.8 reflecting moderate level of concern. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions available. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to and/or from areas affected by Covid-19 (94.7%) and felt safe the government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p < 0.001), younger age (p = 0.003), undergraduate education (p = 0.044), living with others (p = 0.003) working in the western region (p = 0.003) and direct contact with patients (p = 0.018). CONCLUSIONS: This study highlights the high concern among HCWs about Covid-19 and identifies the predictors of those with highest concern levels. To minimize the potential negative impact of those concerns on the performance of HCWs during pandemics, measures are necessary to enhance their protection and to minimize the psychological effect of the perceived risk of infection.

Prevalence, pattern and factors of intimate partner violence against Saudi women.

BACKGROUND: This study aimed to assess the prevalence of intimate partner violence (IPV) and its correlates, amongst currently married Saudi women. METHODS: A total of 400 currently married females aged 19-65 years old who attended the outpatient clinics of PHC centres in Riyadh, from 1 November 2015 to 1 February 2016, were screened for the current and previous experiences with IPV, and its correlates, using the previously validated Arabic version of the WHO multi-country instrument on violence against women. Logistic regression analyses were applied to identify the correlates of IPV. RESULTS: The lifetime overall prevalence of IPV was 44.8%, in the form of; physical (18.5%), emotional (25.5%), sexual (19.2%) and economic (25.3%) violence. Wife's experience of child abuse was significantly associated with physical [OR = 3.63, P < 0.001], emotional [OR = 2.2, P = 0.004], sexual [OR = 2.42, P = 0.006], economic [OR = 2.24, P = 0.006] and overall IPV [OR = 2.76, P < 0.001], whilst husband's experience was significantly associated with only the emotional violence [OR = 2.4, P = 0.004]. Physical violence was significantly more prevalent when the woman lived with other wife in same house. CONCLUSION: IPV with its all forms was prevalent amongst Saudi women. Child abuse experience and polygamy were significantly associated with IPV. Designing tailored IPV national prevention programmes is a necessity.

Efficacy of scopolamine transdermal patch in children with sialorrhea in a pediatric tertiary care hospital.

BACKGROUND: Drooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, although it is not approved for this indication and there are limited clinical studies about its effectiveness. This study aimed (1) to assess the impact of STP use on the severity of drooling and on the frequency of emergency department (ED) and hospital readmission (RA) visits related to drooling, and (2) to determine the level of family satisfaction with STP when used in children with neurological disorders. METHODS: This is a retrospective cohort study of all pediatric patients aged 3-14 years, with non-progressive neurodevelopmental disability, who used STP for more than one year during the period between April 2015 and July 2018 (n = 44). Data on demographics, clinical status, comorbidities, STP dose and duration, other medications, ED and RA visits were collected. Follow-up phone-call interviews with parents/caregivers were performed using a parent-reported frequency and severity rating scale of sialorrhea. Absolute and relative risk reductions were calculated to assess the impact of STP on ED and RA visits. Significance was considered at p-value of ≤ 0.05. RESULTS: STP use showed significant reduction in severity of drooling (p < 0.001), wiping of the child's mouth (p < 0.001), bibs or clothing changes (p < 0.001), choking and aspiration of saliva (p = 0.001). The Relative Risk Reduction of the drooling-related ED and RA visits were 86% and 67% respectively. Nearly two-thirds (60%) of caregivers were satisfied with using STP. CONCLUSIONS: This is the first study of its kind done in Saudi Arabia demonstrating favorable impact of STP use by children on the consequences associated with drooling and with the frequency of ER and RA visits due to drooling. Development of a medication use protocol is recommended to standardize STP treatment in order to optimize its effectiveness. This study serves as baseline information for future prospective interventional studies.

Level of awareness of Saudi medical students of the internet-based health-related information seeking and developing to support health services.

BACKGROUND: Many studies are available in the literature about e-health in Saudi Arabia, however, data is limited to a few organizations and does not necessarily reflect the current and potential use of e-health for health care organizations in the country. This study aimed to determine the level of awareness of Saudi medical students of the internet-based health-related information seeking and developing to support health services and significant predictors of their practice. METHODS: A cross-sectional survey of 440 medical students in Riyadh, Saudi Arabia, was conducted, during October/November 2019, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude, and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p < 0.05. RESULTS: Of 440 medical students, the majority were females (55.7%) and from families whose monthly income was more than 10,000SR (82.8%). Overall knowledge about e-health was unsatisfactory (percentage mean score, PMS = 71.6%), with only 43.6% of students reporting a satisfactory level. However, this level was satisfactory for fields of application (Percentage mean score-PMS = 76.6%) and unsatisfactory for the definition of e-health (PMS = 70.7%) and methods of its use (PMS = 65.7%) domains. The overall attitude towards e-health use was positive (PMS = 82.3%), with nearly three-quarters of students (73.4%) reporting a positive attitude. Generally, a good level of practice of e-health was reported by students (PMS = 84.3%), with more than three-quarters of students (78.4%) reporting good practice. Adjusting for age, gender, stream, educational grade, and family monthly income, good practice was significantly predicted with higher knowledge (t = 2.22, p = 0.03) and attitude (t = 2.11, p = 0.04) scores. CONCLUSION: This study provides basic information regarding medical students' level of awareness of internet-based health-related information seeking and developing to support health services. More resources should be directed to elevate medical students' knowledge and to motivate them to practice e-health using the available tools.

Use of smartphone and perception towards the usefulness and practicality of its medical applications among healthcare workers in Saudi Arabia.

BACKGROUND: In Saudi Arabia, healthcare industry is undergoing major expansions to meet the demand of rapidly growing healthcare needs. The aims of this study were; (1) to assess the pattern of smartphone use in healthcare facilities, and (2) to determine perception towards its use among healthcare workers. METHOD: A cross-sectional survey of 351 healthcare workers (HCWs) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia was conducted, from October to November 2016, using a previously validated perception domain to measure perception towards usefulness (5 statements) and practicality (5 statements) of smartphones in clinical settings. Pattern of use of smartphones and health-related applications in healthcare facilities was also investigated. Logestic regression models were applied to identify the predictors of smartphone use and installation of health-related applications for use in healthcare facilities. Significance was considered at p-value of < 0.05. RESULTS: Utilization rate of smartphone was 42.3%, and only 6.1% of all healthcare providers reported always using applications in their practice. Reasons for use were: as a source of drug information (69.8%), for disease diagnosis (56.4%), to access medical websites (42.5%), to review guidelines and protocols related to healthcare (34.1%), for procedure documentation (23.5%), and as a source of patients education materials (22.3%). Perceptions of HCWs towards smartphone use was less than satisfactory (Overall percentage mean score = 60.4 ± 18.7), with only 11.6% reporting positive perception. After adjusting for possible confounders, the total perception mean score was a significant predictor of both smartphone use (ß = 0.033, p < 0.001) and medical applications installation (ß = 0.033, p < 0.001). Installation of medical applications was also predicted by being a physician (ß = 0.008, p = 0.024). CONCLUSION: Smartphone utilization in healthcare facilities by HCWs in Saudi Arabia is low. This could be attributed to their less than satisfactory level of perception towards its use. Smartphone use and installation of medical applications for use in health facilities were predicted by perceived usefulness and practicality of its use. Intervention from higher health authorities is necessary to enforce the importance of smartphone use in clinical practice. Conduction of further studies on the impact of smart phone use on the healthcare quality in Saudi Arabia is recommended.

Prospective study of early and late outcomes of extremely low birthweight in Central Saudi Arabia.

BACKGROUND: Survival of preterm neonates has steadily improved over the past five decades, due to changes in the neonatal intensive care. However, in Saudi Arabia, there are no written guidelines on the definition of the lower limit of viability, and there has been a call for such a limit. The aims of this study were: (1) to determine lower limits of viability and survival in extremely low birthweight (ELBW) infants, and (2) to determine incidence of neurodevelopmental and cognitive abnormalities within 3-6 years after birth. METHODS: Prospective study of all live inborn ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, within 3 years [between January 1st, 2005 and December 31st, 2007] was conducted (n = 117). Data were collected on demographic and birth data, neonatal complications & interventions and death on discharge. Prospective follow up of all survivors was done, within 6 years after birth, to assess the outcome in terms of neurodevelopmental and cognitive abnormalities. Predictors of survival were determined using logistic regression model. Significance was considered at p-value ≤0.05. RESULTS: Of all ELBW infants, 41% died before discharge. Survival rate was directly correlated with gestational age (GA) and birthweight (p < 0.05). The 50% limits of viability were those at 25 weeks' gestation or with > 600 g. After adjusting for possible confounders, significant predictors of survival were birthweight (p = 0.001) and Apgar score (p < 0.001). The following impairments were reported during follow up of survivors: developmental delay (39.2%), cerebral palsy (36.2%), speech problems (33.3%), wasting (12.5%), intellectual disability (10%), visual problems (6.6%) and hyperactivity (5.6%). CONCLUSION: More than one-third of ELBW died before discharge from NICU, and two-thirds of survivors had one or more neurodevelopmental and/or cognitive abnormalities during their first 6 years of life. The 50% limits of viability of ELBW infants were those at week 25 of gestation or with a birthweight of more than 600 g. Birthweight could be considered as more valid than gestational age in the prediction of viability of ELBW infants. The process of care of ELBW infants in Saudi Arabia may need to be revisited taking these findings into consideration.

An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia.

BACKGROUND: Middle East Respiratory Syndrome (MERS) is caused by MERS coronavirus (MERS-CoV). More than 80% of reported cases have occurred in Saudi Arabia, with a mortality exceeding 50%. Health-care workers (HCWs) are at risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding MERS were evaluated. METHODS: An anonymous, self-administered, previously validated questionnaire was given to 1031 HCWs at three tertiary hospitals in Saudi Arabia from October to December, 2014. Concerns regarding the disease, its severity and governmental efforts to contain it, as well as disease outcomes were assessed using 31 concern statements in five distinct domains. A total concern score was calculated for each HCW. Multiple regression analyses were used to identify predictors of high concern scores. RESULTS: The average age of participants was 37.1 ± 9.0 years, 65.8% were married and 59.1% were nurses. The majority of respondents (70.4%) felt at risk of contracting a MERS-CoV infection at work, 69.1% felt threatened if a colleague contracted MERS-CoV, 60.9% felt obliged to care for patients infected with MERS-CoV and 87.8% did not feel safe at work using standard precautions. In addition, 87.7% believed that the government should isolate patients with MERS in specialized hospitals, 73.7% agreed with travel restriction to and from areas affected by MERS and 65.3% agreed with avoiding inviting expatriates from such areas. After adjustment for covariates, high concern scores were significantly associated with being a Saudi national (p < 0.001), a non-physician (p < 0.001) and working in the central region (p < 0.001). CONCLUSIONS: The majority of respondents reported concern regarding MERS-CoV infection from exposure at work. The overall level of concern may be influenced by previous experience of MERS outbreaks and related cultural issues. The concerns of HCWs may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.

Impact of basic life-support training on the attitudes of health-care workers toward cardiopulmonary resuscitation and defibrillation.

BACKGROUND: Cardiopulmonary resuscitation (CPR) increases the probability of survival of a person with cardiac arrest. Repeating training helps staff retain knowledge in CPR and in use of automated external defibrillators (AEDs). Retention of knowledge and skills during and after training in CPR is difficult and requires systematic training with appropriate methodology. The aim of this study was to determine the effect of basic life-support (BLS) training on the attitudes of health-care providers toward initiating CPR and on use of AEDs, and to investigate the factors that influence these attitudes. METHODS: A quasi-experimental study was conducted in two groups: health-care providers who had just attended a BLS-AED course (post-BLS group, n = 321), and those who had not (pre-BLS group, n = 421). All participants had previously received BLS training. Both groups were given a validated questionnaire to evaluate the status of life-support education and certification, attitudes toward use of CPR and AED and concerns regarding use of CPR and AED. Multiple linear regression analyses were applied to identify significant predictors of the attitude and concern scores. RESULTS: Overall positive attitudes were seen in 53.4% of pre-BLS respondents and 64.8% of post-BLS respondents (χ2 = 9.66, p = 0.002). Positive attitude was significantly predicted by the recent completion of BLS training (ß = 5.15, p < 0.001), the number of previous BLS training courses (ß = 2.10, p = 0.008) and previous exposure to cardiac-arrest cases (ß = 3.44, p = 0.018), as well as by low concern scores, (ß = -0.09, p < 0.001). Physicians had significantly lower concern scores than nurses (ß = -10.45, p = 0.001). Concern scores decreased as the duration of work experience increased (t = 2.19, p = 0.029). CONCLUSIONS: Repeated educational programs can improve attitudes toward CPR performance and the use of AEDs. Training that addressed the concerns of health-care workers could further improve these attitudes.

Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study.

AIM: This study aimed to (i) assess the level of patient satisfaction and its association with different sociodemographic and healthcare characteristics in an emergency care centre (ECC) in Saudi Arabia and (ii) to identify the predictors of patients' satisfaction. METHODS: A prospective cohort study of 390 adult patients with Canadian triage category III and IV who visited ECC at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 1 July and end of September 2011 was conducted. All patients were followed up from the time of arrival at the front desk of ECC until being seen by a doctor, and were then interviewed. Patient satisfaction was measured using a previously validated interview-questionnaire, within two domains: clarity of medical information and relationship with staff. Patient perception of health status after as compared with before the visit, and overall life satisfaction were also measured. Data on patient characteristics and healthcare characteristics were collected. Multiple linear regression analysis was used, and significance was considered at p≤0.05. RESULTS: One-third (32.8%) of patients showed high level of overall satisfaction and 26.7% were unsatisfied, with percentage mean score of 70.36% (17.40), reflecting moderate satisfaction. After adjusting for all potential confounders, lower satisfaction with the ED visit was significantly associated with male gender (p<0.001), long waiting time (p=0.032) and low perceived health status compared with status at admission (p<0.001). Overall life satisfaction was not a significant predictor of patient satisfaction. CONCLUSIONS: An appreciation of waiting time as the only significant modifiable risk factor of patient satisfaction is essential to improve the healthcare services, especially at emergency settings.

Using the health belief model to predict breast self examination among Saudi women.

BACKGROUND: In the Kingdom of Saudi Arabia, breast cancer (BC) usually presents at advanced stages and more frequently in young pre-menopausal women in comparison to western countries. There is controversy surrounding the efficacy of breast self examination (BSE) for early detection of BC in countries where other methods are available. This study aims to explore the perception towards breast cancer and towards BSE among Saudi women, using the Health Belief Model (HBM). METHODS: A convenient sample of adult Saudi female employees, working at King Abdulaziz Medical City, Riyadh, Saudi Arabia (n = 225), and their non-working adult female family members (n = 208), were subjected to the Arabic version of revised Champion's Health Belief Model Scale (CHBMS) and the Arabic version of Breast Cancer Awareness Measure (CAM), to assess their knowledge and attitude on BC respectively. Percentage mean score (PMS) for each HBM domain was calculated. Significant predictors of BSE practice were identified using logistic regression analysis and significance was considered at p < 0.05. RESULTS: The majority of women heard about BSE (91.2 %), only 41.6 % reported ever practicing BSE and 21 % performed it regularly. Reported reasons for not doing BSE were: not knowing how to examine their breast (54.9 %), or untrusting themselves able to do it (24.5 %). Women were less knowledgeable about BC in general, its risk factors, warning signs, nature and screening measures (PMS:54.2 %, 44.5 %, 61.4 %, 53.2 %, 57.6 % respectively). They reported low scores of; perceived susceptibility, seriousness, confidence and barriers (PMS: 44.8 %, 55.6 %, 56.5 % & 41.7 % respectively), and high scores of perceived benefits and motivation (PMS: 73 % & 73.2 % respectively) to perform BSE. Significant predictors of BSE performance were: levels of perceived barriers (p = 0.046) and perceived confidence (p = 0.001) to BSE, overall knowledge on BC (p < 0.001), work status (p = 0.032) and family history of BC (p = 0.011). CONCLUSIONS: Saudi women had poor knowledge on BC, reported negative attitude towards BSE and their practice was poor. Working women and those with family history of BC, higher perceived confidence and lower perceived barriers on HBM, and those with high level of knowledge on BC were more likely to perform BSE. Breast awareness as an alternative to BSE needs further investigations. HBM was shown as a valid tool to predict BSE practice among Saudi women.

Prevalence, consequences and predictors of low back pain among nurses in a tertiary care setting.

PURPOSE: Nursing is a profession with high incidence and prevalence of low back pain (LBP), with its medical and professional consequences. These prevalence rates vary among countries, and with various measurements have been used to determine LBP. Individual and work-related factors are regarded as causal factors for many back injuries. The aims of study this were: (1) to estimate the prevalence of LBP using different measures, (2) to determine medical and professional consequences of LBP, and (3) to determine the associated factors and significant predictors of LBP. METHODS: A cross-sectional study was conducted among 254 nurses from different departments/wards at Hamad General Hospital (HGH), Doha, Qatar over two months (February and March, 2015). A self-administered modified Nordic questionnaire was used to collect data regarding five different measures of LBP, its medical and occupational consequences and individual/lifestyle and work-related risk factors of LBP. Descriptive and analytic statistical analyses were done using chi-square and multivariate logistic regression techniques. Significance was considered at p ≤ 0.05. RESULTS: The findings of this study broadly confirm the high levels of back pain in nursing, with a one-year prevalence of LBP of 54.3 % for LBP of at least one day, 26.8 % for chronic LBP, 18.1 % for sick leave seeking LBP, and 34.3 % for medical treatment seeking LBP. Difficult or impossible activities of daily living were reported due to LBP in climbing stairs (50.7 %), walking (42.8 %), standing up (39.9 %), sleeping (33.3 %), getting out of bed (30.4 %) and wearing clothes (20.3 %). Work stop due to LBP was reported by 76.8 % of nurses, with 2.03 ± 3.09 days within the last year. Treatment was sought in 58.7 % by medical care, and 15.9 % by physiotherapy, while seeking rest days and/or sick leave was sought in 50.8 % of nurses with LBP. Sports practice (p = 0.003), office work (p < 0.001) and exposure to physical stress (p = 0.002) were the only significant predictors of LBP among nurses, when logistic regression analysis was conducted. CONCLUSION: The prevalence of LBP among nurses at HGH is high and should be actively addressed, however, it was not a major cause of sick leave. Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programs to teach the proper use of body mechanics and sports activity programs.

Cesarean section in a high-parity community in Saudi Arabia: clinical indications and obstetric outcomes.

BACKGROUND: The study of the indications for cesarean section (CS) and its outcomes are useful for hospitals, clinicians, and researchers in determining strategies to lower the primary and repeat CS rate. The aim of this study was to identify the indications for CS and the incidence of adverse maternal/fetal outcomes in a tertiary care setting. METHODS: A retrospective cohort study of women (n = 4305) who gave birth by CS at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia (June 2008 to February 2011), was performed. All of the women's medical records were reviewed by two consulting physicians to obtain the primary indications for CS and determine the maternal characteristics, type of CS (emergency or elective), and birth weight. All adverse maternal and fetal outcomes were recorded. The point and interval estimates of the odds ratios were calculated using a logistic regression model to identify the significant predictors of adverse maternal and/or fetal outcomes. RESULTS: Of a total of 22,595 deliveries from 2008 to 2011, 4,305 deliveries were CS deliveries (19.05%). Two-thirds (67%) of all CS deliveries were emergency CSs, and the remaining deliveries were elective CSs (33%). Difficult labor (35.9%), fetal distress (21.9%) and breech presentation (11.6%) were the most frequent indications of emergency CS, while previous CS (54.3%), breech presentation (20.4%) and maternal request (10.1%) ranked first for elective CS. Adverse maternal and fetal outcomes were diagnosed in 5.09% and 5.06% of deliveries, respectively, with a significantly higher incidence in the emergency (6.06% & 5.51% respectively) than in elective CS (3.10 & 4.16% respectively). Blood transfusion was the most frequent adverse maternal outcome (3.72%), followed by ICU admission (0.63%), HELLP (0.51%), and hysterectomy (0.30%), while IUGR (3.25%) was the most frequent adverse fetal outcome, followed by IUFD and the need for ICU admission (0.58% each). Adverse maternal outcomes were significantly predicted by high gravidity (OR = 2.84, 95% CI:1.26-6.39, p = 0.011) and preeclampsia (OR = 2.84, 95%CI:1.83-4.39, p < 0.001), while adverse fetal outcomes were predicted by: twinning (OR = 1.81, p = 0.002), hydramnios (OR = 6.70, p < 0.001), and preeclampsia (OR = 2.74, p < 0.001). Preterm delivery was a significant predictor for both adverse maternal and fetal outcomes (OR = 2.39, p < 0.001 & OR = 4.57, p < 0.001, respectively). CONCLUSIONS: Difficult labor and previous CS were the main indications for CS in Saudi Arabia. High gravidity was a significant predictor of adverse maternal outcomes. Encouraging Saudi women to consider embarking on fewer pregnancies could act as a safeguard against mandatory CSs for subsequent births in multigravida and grand-multigravida Saudi females. Future prospective study that addresses women with repeat CSs and their association with adverse maternal and fetal outcomes is recommended.

Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers.

Background: This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods: In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results: One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion: Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.

Awareness and Predictors of the Use of Bioinformatics in Genome Research in Saudi Arabia.

Background: With the advances in genomics research, many countries still need more bioinformatics skills. This study aimed to assess the levels of awareness of bioinformatics and predictors of its use in genomics research among scientists in Saudi Arabia. Methods: In a cross-sectional survey, 309 scientists of different biological and biomedical specialties were subjected to a previously validated e-questionnaire to collect data on (1) Knowledge about bioinformatics programming languages and tools, (2) Attitude toward acceptance of bioinformatics resources in genome-related research, and (3) The pattern of information-seeking to online bioinformatics resources. Logistic regression analysis was applied to identify the predictors of using bioinformatics in research. Significance was set at p<0.05. Results: More than one-half (248, 56.4%) of all scientists reported a lack of bioinformatics knowledge. Most participants had a neutral attitude toward bioinformatics (295, 95.4%). The barriers facing acceptance of bioinformatics tools reported were; lack of training (210, 67.9%), insufficient support (180, 58.2%), and complexity of software (138, 44.6%). The limited experience was reported in; having one or more bioinformatics tools (98, 31.7%), using a supercomputer in their research inside (44, 14.2%) and outside Saudi Arabia (55, 17.8%), the need for developing a program to solve a biological problem (129, 41.7%), working in one or more fields of bioinformatics (93, 30.1%), using web applications (112, 36.2%), and using programming languages (102, 33.0%). Significant predictors of conducting genomics research were; younger scientists (p=0.039), Ph.D. education (p=0.003), more than five years of experience (p<0.05), previous training (p<0.001), and higher bioinformatics knowledge scores (p<0.001). Conclusion: The study revealed a short knowledge, a neutral attitude, a lack of resources, and limited use of bioinformatics resources in genomics research. Education and training during each education level and during the job is recommended. Cloud-based resources may help scientists do research using publicly available Omics data. Further studies are necessary to evaluate collaboration among bioinformatics software developers and biologists.

The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure.

Background: Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods: In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results: Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01‒1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33‒18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion: The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.

Impact of Patient-Centered and Self-Care Education on Diabetes Control in a Family Practice Setting in Saudi Arabia.

Background: Diabetes mellitus is a chronic and complex medical disease that leads to significant morbidity and mortality. Patient-centered diabetes education that emphasizes active patient involvement, self, and shared care constitutes a substantial and essential component of the comprehensive diabetes management approach. Objectives: To assess the impact of patient-centered diabetes education sessions on the prescribed treatment plan in controlling diabetes and other related cardiovascular risk factors. Methods: In a pre-experimental pretest-posttest one group study design, all referred patients with type 2 diabetes (T2DM) to the diabetes educator clinic (n = 130 patients) during the period of 6 months from January to July 2021 were subjected to multiple and consecutive patient-centered diabetes education sessions, based on the framework published by the Association of Diabetes Care and Education Specialties (ADCES), in addition to their usual treatment plan. Demographic, social, and biological data were obtained at the baseline, three months, and six months after the intervention. Nonparametric Friedman and Cochran's Q tests for related samples were applied to examine the impact of this educational intervention on glycosylated hemoglobin (HbA1c) and other associated cardiovascular risks. The results of 130 patients with T2DM showed a significant reduction of mean systolic blood pressure "SBP" (p = 0.015), glycosylated hemoglobin (HbA1c) (p < 0.001), fasting blood sugar "FBS" (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride (p < 0.001), and significant rise of mean high-density lipoprotein (p = 0.011). At three and six months after the intervention, 43% and 58% of patients showed improved HbA1c levels. The mean HbA1c was reduced from 10.2% at the beginning of the study to 8.7% (p < 0.001) after six months. Moreover, a significant reduction in the prevalence of obesity (p = 0.018), high FBS (p = 0.011), and high SBP (p = 0.022) was detected. Conclusions: This study showed a considerable positive impact of diabetes education and patient-centered care on optimizing glycemic and other cardiovascular risk control. The needs of certain patients with T2DM should be addressed individually to achieve the best possible outcomes. Further research is needed to explore the long-term benefits of this intervention.

Impact of a Video-Based Educational Intervention on the Levels of Knowledge and Concerns about COVID-19 Vaccination.

BACKGROUND: The hesitancy to receive the COVID-19 vaccine plays a role in delaying the current global and national COVID-19 management strategies. Evidence has highlighted the importance of examining the public's concerns and knowledge about COVID-19 vaccines in sustaining public prevention of the further spread of the virus worldwide. This study aimed to assess the impact of a video-based educational session on the Saudi public's levels of knowledge and concerns about the COVID-19 vaccination. METHODS: In a double-blind, randomized posttest-only control group study design, 508 Saudis were randomized to an experimental group (n = 253) and a control group (n = 255). The experimental group was exposed to a video-based educational session, while the control group was not. Then both groups were subjected to a validated questionnaire to assess their level of knowledge and concerns about the vaccine. RESULTS: In comparison to the control group, the experimental group showed a significantly lower proportion of overall high concern (0.4% vs. 5.5%, p < 0.001) and a higher proportion of overall good knowledge (74.2% vs. 55.7%, p < 0.001). After adjustment for possible confounders, the experimental group showed a significantly lower percent mean score of overall concern (45.0% vs. 65.0%, p < 0.001) and a higher percent mean score of overall knowledge (74.2% vs. 55.7%, p < 0.001) than the control group. CONCLUSIONS: The video-based educational intervention positively impacted the levels of knowledge and concerns about COVID-19 vaccination among the experimental group. These interventions safeguard against the rumors and misconceptions about COVID-19 vaccinations. Further studies on the impacts of such interventions on vaccine uptake are recommended.

Epidemiology of postoperative spinal wound infection in the Middle East and North Africa (MENA) region.

Background: Despite the extensive literature on postoperative spinal wound infection, yet to our knowledge, there is no previous study containing combined data from several sites in the Middle East and North Africa (MENA) region. This study aimed to estimate the incidence of surgical site infection (SSI) following spine surgeries, its associated factors, and management. Methods: In a retrospective cohort study, medical records of all patients ≥18 years of age who underwent spine surgery at 6 tertiary referral centers in the MENA region between January 2014 to December 2019 (n=5,872) were examined to collect data on the following: (1) Patient's characteristics, (2) Disease characteristics, (3) Spine surgery approach, and (4) Characteristics of Postoperative SSI. The determinants of postoperative SSI were identified using logistic regression analysis. Receiver operating characteristic (ROC) curve was applied to identify the cut-off of the length of stay in the hospital postoperatively till the infection is likely to occur. Significance was set at p<.05. Results: The overall incidence of SSI was 4.2% (95% CI: 3.72-4.77), in the form of deep (46.4%), superficial (43.1%), dehiscence (9.3%), and organ space (1.2%) infections. After adjusting for all possible confounders, significant predictors of postoperative SSI were; diabetes (OR=2.12, p<.001), smoking (OR=1.66, p=.002), revision surgery (OR=2.20, p<.001), open surgery (OR=2.73, p<.001), perioperative blood transfusion (OR=1.45, p=.033), ASA class III(OR=2.08, p=.002), and ≥4 days length of stay "LOS" (OR= 1.71, p=.001). A cut-off of 4 days was the optimum LOS above which postoperative SSI is more likely to occur, with 0.70 sensitivity, 0.47 specificity, and 0.61 area under the curve. Conclusions: This is the first study that highlighted the incidence of postoperative SSI in spine surgery in the MENA region. Incidence figures are comparable to figures in different areas of the world. Identifying predictors of SSI might help high­risk patients benefit from more intensive wound management.