The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications.

Cardiovascular disease (CVD) is a critical public health issue in Saudi Arabia, where it is the leading cause of death. The economic burden of CVD in the country is expected to triple by 2035, reaching $9.8 billion. This paper provides an overview of CVD in Saudi Arabia and its risk factors, impact on healthcare, and effects on patients' quality of life. The review emphasizes the potential of cardiac rehabilitation (CR) programs in addressing the CVD epidemic. CR programs have been shown to reduce morbidity, mortality, and hospital readmissions while improving patients' cardiovascular health and overall well-being. However, these programs are underutilized and inaccessible in Saudi Arabia. The paper highlights the urgent need for CR programs in the country and suggests key strategies for implementation. These include increasing patient referrals, tailoring programs to individual needs, enhancing patient education, and making CR accessible through home-based options. Fostering multidisciplinary collaboration and developing tailored guidelines for Arab countries can further enhance the impact of CR programs. In conclusion, this review underscores the vital importance of comprehensive CR programs in Saudi Arabia to combat the rising CVD burden, improve patient quality of life, and align with the goals of the Saudi 2030 Vision for a healthier society.

Serum Levels of Proinflammatory Biomarkers in Military Recruits with and without Metabolic Syndrome.

Objectives: Inflammatory mediators are associated with many chronic diseases; however, their role in metabolic syndrome (Met-S) is not well documented. We therefore aimed to compare the serum markers of inflammation including C-reactive protein (CRP), myeloperoxidase (MPO), interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), and TNF-ß in young military recruits with and without Met-S. We hypothesized that any significant change in inflammatory markers between the two groups would indicate the role of inflammation in Met-S that would help in future directions for screening and treatment of Met-S. Design and Methods. A total of 2010 adult men, aged 18-30 years, were divided into two groups: with Met-S (N = 488) and without Met-S (N = 1522), according to the International Diabetes Federation definition. We compared the serum levels of inflammatory biomarkers between the two groups. We also studied the correlations between the inflammatory markers and the components of Met-S to explore the biomarker potential of inflammatory markers for screening of Met-S. Logistic regression analysis was performed to test the association between inflammatory markers and Met-S. Results: A large number of subjects in the Met-S group were suffering from obesity. Out of the 2010 total subjects, only 731 (36.4%) had normal fasting blood sugar (FBS), while the prevalence of prediabetes and diabetes was significantly higher in subjects with Met-S. We observed significant increases in serum levels of CRP, MPO, IL-6, and TNF-ß but not TNF-α in subjects with Met-S as compared to subjects without Met-S. All the markers of inflammation showed significant correlations with Met-S, triglycerides (TG), blood pressure, body mass index (BMI), and age; however, none of these markers were correlated with HDL. Logistic regression analysis showed a significant association between Met-S and inflammatory markers. Conclusions: Serum levels of CRP, MPO, IL-6, and TNF-ß are significantly increased in young adults with Met-S. This is probably the first study reporting TNF-ß levels in Met-S. Since a proinflammatory cascade precedes many years before the onset of cardiovascular disease, these inflammatory biomarkers could help in the monitoring of high-risk individuals with Met-S who will be requiring therapeutic intervention.

A first-principles investigation of the linear thermal expansion coefficients of BeF2: giant thermal expansion.

We present the results of a theoretical investigation of the linear thermal expansion coefficients (TECs) of BeF2, within a direct Grüneisen formalism where symmetry-preserving deformations are employed. The required physical quantities such as the optimized crystal structures, elastic constants, mode Grüneisen parameters, and phonon density of states are calculated from first-principles. BeF2 shows an extensive polymorphism at low pressures, and the lowest energy phases [α-cristobalite with space group (SG) P41212 and its similar phase with SG P43212] are considered in addition to the experimentally observed α-quartz phase. For benchmarking purposes, similar calculations are performed for the rutile phase of ZnF2, where the volumetric TEC (α v), derived from the calculated linear TECs along the a (α a ) and c (α c ) directions, is in very good agreement with experimental data and previous theoretical results. For the considered phases of BeF2, we do not find any negative thermal expansion (NTE). However we observe diverse thermal properties for the distinct phases. The linear TECs are very large, especially α c of the α-cristobalite phase and its similar phase, leading to giant α v (∼175 × 10-6 K-1 at 300 K). The giant α v arises from large Grüneisen parameters of low-frequency phonon modes, and the C 13 elastic constant that is negatively signed and large in magnitude for the α-cristobalite phase. The elastic constants, high-frequency dielectric constants, Born effective charge tensors, and thermal properties of the above phases of BeF2 are reported for the first time and hence serve as predictions.

Prevalence of Caries among School Children in Saudi Arabia: A Meta-Analysis.

Introduction: Children's dental health has become the primary concern, because of the increase in the prevalence of caries amongst school children in Saudi Arabia. Therefore, a meta-analysis was conducted to assess the prevalence and severity of dental caries among school children in Saudi Arabia. Method: A systematic search of Scopus, ISI Web of Science, EMBASE, Saudi digital library, Google Scholar, and MEDLINE via Ovid for cross-sectional studies with healthy participants between 5and -15 years. Two authors independently extracted the prevalence of caries. With 95% confidence intervals (CIs) using a random-effects model, we calculated caries prevalence. Results: Dental caries prevalence data were extracted from 18 cross-sectional studies (n = 56,327 children). The pooled estimate for the caries prevalence among 5-7 years' children was 84% (95% CI: 0.81-0.87%; I2 = 91%) while among 12-15 years' children was 72% (95% CI: 0.63-0.79; I 2 = 96.2%). Discussion. In this systematic review, the summary estimate of the prevalence of dental caries among children of 5-7 years and 12-15 years were 84% and 72%, respectively. Further research is required to identify approaches for preventing and treating dental caries in schoolchildren.

Association between preventable risk factors and metabolic syndrome.

The risk factors associated with metabolic syndrome (Met-S) including hypertension, hyperglycemia, central obesity, and dyslipidemia are preventable, particularly at their early stage. There are limited data available on the association between Met-S and preventable risk factors in young adults. We randomly selected 2,010 Saudis aged 18-30 years, who applied to be recruited in military colleges. All the procedures followed the guidelines of International Diabetes Federation. The results showed that out of 2,010 subjects, 4088 were affected with Met-S. The commonest risk factors were high blood sugar (63.6%), high systolic and diastolic blood pressures (63.3 and 37.3%), and high body mass index (57.5%). The prevalence of prediabetes and diabetes were 55.2 and 8.4%, respectively. Obesity, diabetes, hypertension, and hypertriglyceridemia were significantly associated with Met-S. The frequency of smoking was significantly linked with the development of Met-S. The prevalence of Met-S was found to be significantly higher in individuals with sedentary lifestyle. In conclusion, the results of this study clearly indicate that military recruits, who represent healthy young adults, are also prone to Met-S. The findings of this study will help in designing preventive measures as well as public awareness programs for controlling the high prevalence of Met-S in young adults.

Recent Trends of Metabolic Syndrome and Its Components in Military Recruits from Saudi Arabia.

Metabolic syndrome (Met-S) constitutes the risk factors and abnormalities that markedly increase the probability of developing diabetes and coronary heart disease. An early detection of Met-S, its components and risk factors can be of great help in preventing or controlling its adverse consequences. The aim of the study was to determine the prevalence of cardio-metabolic risk factors in young army recruits from Saudi Arabia. A total of 2010 Saudis aged 18-30 years were randomly selected from groups who had applied to military colleges. In addition to designed questionnaire, anthropometric measurements and blood samples were collected to measure Met-S components according to the International Diabetes Federation (IDF) criteria. Met-S prevalence was 24.3% and it was higher in older subjects than the younger ones. There were significant associations between Met-S and age, education level and marital status. The most common Met-S components were high fasting blood sugar (63.6%) followed by high blood pressure (systolic and diastolic, 63.3% and 37.3% respectively) and high body mass index (57.5%). The prevalence of pre-diabetes and diabetes were found to be 55.2% and 8.4%, respectively. Hypertriglyceridemia was found in 19.3% and low levels of high-density lipoproteins (HDL) in 11.7% of subjects. In conclusion, there is a high prevalence of Met-S in young adults of Saudi Arabia. There is a need for regular monitoring of Met-S in young populations to keep them healthy and fit for nation building. It is also important to design and launch community-based programs for educating people about the importance of physical activity, cessation of smoking and eating healthy diet in prevention of chronic diseases.

Prevalence and factors associated with low bone mineral density in Saudi women: a community based survey.

BACKGROUND: Low bone mineral density (BMD) is a public health issue in Saudi Arabia. This study measured the prevalence and factors associated with low BMD in Saudi women in Riyadh, Saudi Arabia. METHODS: A cross sectional study using two stage cluster sampling technique was conducted in Riyadh, 2009. Thirty clusters, each comprising of 300 houses were randomly chosen and from each cluster 38-40 households were selected to identify 1150 women of >40 years. Women were invited to primary health care center for filling of self-administered questionnaire (n = 1069) comprising of sociodemographic, health, diet and physical activity variables. 1008 women underwent screening for low BMD using the quantitative ultrasound technique. 535 (53%) women with positive screening test were referred to King Khalid Hospital for Dual X-ray Energy absorptiometry (DXA). RESULTS: 362 women underwent DXA and 212 (39.6%) were screened low BMD either at lumbar spine or femur neck. Mean age of women was 55.26(±8.84) years. Multivariate logistic analysis found; being aged 61 to 70 years (OR 2.75, 95% CI: 1.32-1.48), no literacy (OR 2.97, 95% CI:1.44 - 6.12) or primary education (OR 4.12, 95% CI:2.05-8.29), history of fractures (OR 2.20, 95% CI:1.03- 4.69) and not drinking laban(diluted yogurt) (OR 2.81, 95% CI:1.47- 5.37) significantly associated with low BMD. CONCLUSIONS: Women with low level of education, who do not drink laban and had history of fractures were at high risk of low BMD.

Resuscitation volume in paediatric non-haemorrhagic blunt trauma.

INTRODUCTION: Trauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications. METHODS: We examined data from 139 trauma patients 1-17 years of age with an injury severity score ≥ 12 resuscitated at a Trauma-designated Children's Hospital. Patients were separated into discreet groups based on ATLS age-dependent vital functions: toddler/preschooler (1-5 years), school age (6-12 years) and adolescent (13-17 years). RESULTS: The median RV (total fluid intake-maintenance fluid intake) in ml/kg over the first 24h from the time of trauma by age was: 24 (IQR=19-47; 1-5 years); 26 (IQR=15-36; 6-12 years); and 22 (IQR=14-42; 13-17 years). The differences in RV/kg/24h following NH trauma was not significantly different between age groups (p=0.41). Urine output over the 24h ranged from 2.5 (IQR=1.9-3.3; lower age group) to 1.8 (IQR=1.2-2.4; upper age group) ml/kg/h; greater than the ATLS recommended age-dependent targets. Haematocrit was the only significant independent predictor of RV/kg/24h (p<0.001). Fluid-related complications attributable to RV were identified in 12% (n=17/139) of patients, and included ascites (8%; n=11/139) and/or pleural effusion(s) (9%; n=13/139). Patients with fluid-related complications received significantly more RV in ml/kg/24h (42, IQR=27-76) than those without complications (22, IQR=14-36; p=0.001). CONCLUSIONS: The range of median RV administered to paediatric NH blunt trauma patients with ISS ≥ 12 was 22-26 ml/kg/24h. The RV administered was excessive based on high urine outputs and the presence of fluid-related complications. Further evaluation of RV triggers and endpoints used by paediatric traumatologists is required.

Health education resources availability for diabetes and hypertension at primary care settings, aseer region, saudi arabia.

OBJECTIVE: The aim of this study was to evaluate the availability of health materials and means on diabetes and hypertension at PHCCs in Aseer region, Saudi Arabia. MATERIALS AND METHODS: This study was carried out in PHCCs in Aseer region. A questionnaire was distributed to all PHCCs in the region. The questionnaire elicited information on the total population served, the number of diabetic and hypertensive patients, and the availability of health materials for diabetes and hypertension. Data were entered and analyzed by using SPSS. RESULTS: A total of 242 PHCCs out of 245 responded to this questionnaire. There were 20 health educators (8%).Availability of health education materials ranged between 10 to 50%. Health education programs for Diabetes and hypertension were available in more than 90% of PHCCs. CONCLUSION: This study revealed that most of PHCCs in Aseer region lacked essential health education materials and means for diabetes and hypertension and, therefore were in urgent need of these materials from the Health Education Department, private health sectors and drug companies.

Resource availability for care of hypertensives at primary health settings in Southwestern Saudi Arabia.

OBJECTIVE: To assess the availability of resources required for hypertension care at primary health care centers in Aseer region, Southwestern Saudi Arabia. METHODS: This study was carried out at primary health care settings in Aseer region, Kingdom of Saudi Arabia (KSA), during during September 2001 by distributing a questionnaire to all the technical directors of primary health care centers (PHCCs) in Aseer region, KSA. The questionnaire composed of 4 main parts that dealt with profile of these PHCCs and the degree of availability of the essential resources for care of hypertension. Data of the questionnaire was entered and analyzed by using statistical package for social sciences. RESULTS: Ninety-nine percent of PHCCs responded to the questionnaire. The total served population was more than 970,000. The total registered hypertensive patient was 13087 patients. Seventy-five percent of PHCCs have chronic diseases mini-clinics, 90% have appointment system and management protocol for hypertension. Availability of health education materials, diagnostic tools and antihypertensive drugs ranged from 10-81.4%. CONCLUSION: This study found that many essential resources for hypertension care were not adequately available. Urgent provision of these items is considered a priority in order to introduce good health care for hypertensive patients in Aseer region, KSA.

Attitudes to premarital counseling among students of Abha Health Sciences College.

OBJECTIVE: The aim of this study is to explore the attitudes of the students of Health Sciences College in Abha, Kingdom of Saudi Arabia (KSA) towards premarital counseling. METHODS: This study was conducted among the students of Health Sciences Colleges in Abha, KSA, during the 2nd semester of the academic year of 1999-2000. A self-administered questionnaire was distributed to all available students who answered it under the direct supervision of the Heads of Departments. The questionnaire consisted of 3 main parts; the first part was regarding socio-demographic and scientific characteristics, the 2nd part concerned with attitudes towards premarital counseling while the 3rd part explored the preferred items to be included in premarital counseling. Data of the questionnaire were entered and analyzed by statistical package for social sciences. Association between categorical variables were tested by Chi-square test and considered significant if (P-value less than 0.05). RESULTS: One hundred and eighty-six students responded, giving a response rate of 70%. Seventy percent of students showed acceptance of premarital counseling while 13% rejected it. Legalization of premarital counseling was agreed on by 19% compared to 41% who refused it. Family history and blood tests for hemoglobinopathies were the most common 2 items preferred to be included in premarital counseling by the respondents. CONCLUSION: This study showed that most of the students at Health Sciences College in Abha, KSA have good attitudes towards premarital counseling in spite of a few students who justify their refusal by the misunderstanding of Islamic rules. This misunderstanding needs intensification of health education in which religious leaders are involved to clarify and correct this misconception.

Difficulties faced when conducting primary health care programs in rural areas.

OBJECTIVE: The aim of this study is to explore the difficulties that face primary health care teams who work in rural areas in Aseer region, Kingdom of Saudi Arabia. METHODS: This study was carried out in 1999 by distributing a multi-purposes questionnaire to all members of health teams who work in the primary health care centers located in the rural areas of Aseer region, Kingdom of Saudi Arabia. This questionnaire consisted of 3 parts that were concerned with the characteristics of primary health care centers teams and difficulties faced by them while conducting primary health care programs during their daily activities at primary health care centers. Data was entered and analyzed by personal computer which was provided with statistical package for social sciences. RESULTS: A total of 68 primary health care centers were located in the rural areas of Aseer region, Kingdom of Saudi Arabia. Those primary health care centers serve 127,880 individuals who live in 657 villages. Three hundred and four members of the primary health care centers teams answered our questionnaire, 23% were physicians, 45% were nurses and 17% were Saudis. Thirty percent reported that they face some difficulties during conducting primary health care programs and 24% reported difficulties during dealing with clients. Most of the difficulties were the lack of medical facilities, rough roads and languages barriers. CONCLUSION: This study revealed that approximately one 3rd of primary health care teams who work in the rural areas of Aseer region, Kingdom of Saudi Arabia face significant difficulties that will affect the introducing of essential primary health care programs. A multi-sectoral integrated approach is mandatory to overcome these difficulties and introduce good quality care.

Availability of resources of diabetic care in primary health care settings in Aseer region, Saudi Arabia.

OBJECTIVE: The objective of this study is to evaluate the availability of resources of diabetes care in primary health care settings in Aseer region, Southwest, Kingdom of Saudi Arabia. METHODS: This study was conducted during September 2001 by distributing a questionnaire to all technical directors of primary health care centers (PHCCs) in Aseer region. The questionnaire, designed by the authors, contained 6 sections that dealt with the necessary structures of diabetic care in the region in addition to the data base of PHCC such as served population, distance from the hospital, and total working physicians and nurses at the PHCC. The data from the questionnaire was entered and analyzed using Statistical Package for Social Sciences. RESULTS: Two hundred and forty-two PHCC technical directors responded to the questionnaire. Total served population by PHCC was 970,306 individuals. Total working physicians were 391 and nurses were 902. Diabetics represented 2.7% of the total served population. More than 90% of PHCCs have diabetic files, registers, appointment system and protocol for diagnosis and treatment of diabetes. Oral hypoglycemic agents were always available at 55% of PHCCs while metformin was not available at 52% of PHCCs. Diabetic identification cards were available in 80.4% of PHCCs while the health education means were less available, except for health education programs was available at 97.5% of PHCCs. At least, 40% of PHCCs were provided financially or by different means of health education through community health committees. CONCLUSION: This study revealed that resource items for diabetic care are inadequate in particular drugs and laboratory facilities. Establishment of a diabetes committee in Aseer region is a priority in order to manage such shortages and to plan, supervise and coordinate the diabetic care in the region.