A retrospective analysis of substance use among female psychiatric patients in Saudi Arabia.

Objective: This study investigated the prevalence of substance use (SU), and its risk factors, among women attending psychiatric outpatients center in Saudi Arabia. Design: A retrospective cross-sectional design. Materials and methods: We reviewed outpatients' records of 200 female patients with a history of SU from a psychiatric unit in Jeddah, Saudi Arabia from December 2018 to February 2019. The researchers developed the pro forma, and 2 psychiatrists and a family medicine physician validated the form. Results: The most common and widely used were psychoactive substances (58%), followed by central nervous system (CNS) depressants (22%), and finally cannabinols (9.5%). Overall, the highest substance use was the amphetamine-cannabis-nicotine (ACN) representing nearly half of the illicit items (46.6%), followed by heroine-alcohol-benzodiazepine (16.4%), and with the lowest being benzodiazepine-nicotine (1.7%). There was a significant difference between the single substance and multiple substance use in terms of age (p = 0.001), smoking behavior (p = 0.001), patients past history (p = 0.005), and age of the patient at the start of drug use (p = 0.005). Conclusion: Although the prevalence of substance use among women is low in Saudi Arabia, screening of substance use disorders risks and building a rehabilitation program to control drug dependence are needed.

Demographic Characteristics, Comorbidities, and Length of Stay of COVID-19 Patients Admitted Into Intensive Care Units in Saudi Arabia: A Nationwide Retrospective Study.

Background: This study aimed to describe the demographic characteristics and determine the risk factors associated with disease severity and length of hospital and intensive care unit (ICU) stay in a cohort of COVID-19 patients admitted into ICU in Saudi Arabia. Methods: This was a national, multi-center, retrospective cross-sectional study of all COVID-19 cases admitted into different ICUs in Saudi Arabia between March 2020 and September 202l. Demographic, clinical features, comorbidities, and length of stay (LOS) data were retrieved from the national Health Electronic Surveillance Network (HESN) and Taqassi databases at the Saudi Ministry of Health (MOH) for subsequent analyses. We used multiple linear regression models to determine risk factors associated with critical outcomes (including LOS in ICU) among COVID-19 cases. Results: A total of 12,436 COVID-19 patients were included in this study, with a mean age of 59.57 ± 18.30 years and 7,679 (62%) were <65 years old. COVID-19 was more common in males (N = 7,686, 61.9%) and Saudi nationals (N = 8,516, 68.5%). The clinical characteristic findings showed that 36.3% of patients required invasive ventilation whilst 65.4% received tracheostomies for ventilation, and 4% were on dialysis. Our analysis revealed that 2,978 (23.9%) patients had one comorbidity, 4,977 (47.4%) had two or more comorbidities, and diabetes (48.2%) was the most prevalent comorbidity, followed by hypertension (44.2%), and chronic cardiovascular disease (10.5%). Thirteen variables emerged as significant predictors of LOS in ICU using multiple linear regression analyses, with invasive ventilation as the strongest predictor of LOS in the ICU (beta = -0.68, p = 0.001) and hospital admission (beta = -0.65, p = 0.001). Conclusions: COVID-19 continues to affect millions of people around the world, with a mortality rate of about 2-3% of all infected patients. Our analysis revealed that comorbidities such as chronic kidney disease, cardiovascular disease, diabetes, and older age were significant risk factors associated with a poorer prognosis and longer duration of stay in hospitals and ICU.

Predictors of Mental Health Status among Quarantined COVID-19 Patients in Saudi Arabia.

BACKGROUND: The negative psychological impact of COVID-19 in the general population has been well documented. Similar studies among those who were infected and who underwent quarantine remain scarce, particularly in the Arab region. The present study aims to fill this gap. METHODS: In this cross-sectional study, suspected/confirmed COVID-19 individuals who were quarantined in the Ministry of Health (MOH) facilities were invited to participate in an online survey. All consenting participants answered a generalized questionnaire that included demographic characteristics, as well as a five-part questionnaire that assessed the symptoms of depression, anxiety, insomnia, and distress. RESULTS: A total of 335 suspected/confirmed COVID-19 individuals (198 males and 137 females) participated. Being female is associated with increased risk of depression (odds ratio OR 1.8 (confidence interval, CI 1.1-3.1; p = 0.03)) as well as being employed by the government (OR 2.8 (CI 1.1-7.0; p = 0.03)). Level of education (OR 2.3 (CI 1.0-5.4; p = 0.049)) and employment in government (OR 3.0 (CI 1.2-7.8; p = 0.02)) were significantly associated with distress. Increasing age (45 years and above) appeared to be protective against distress (OR 0.2 (CI 0.02-0.69; p = 0.008)), as well anxiety and sleep pattern (OR 0.3 p < 0.05). CONCLUSION: Findings of the present study highlight that infected COVID-19 populations are at higher risk for acute and detrimental psychological well-being during quarantine and/or self-isolation. Identification of the coping mechanisms of older adults during periods of distress may prove beneficial in the pandemic preparedness of younger generations.

Gender Difference in Pain Management Among Adult Cancer Patients in Saudi Arabia: A Cross-Sectional Assessment.

OBJECTIVE: To compare gender differences in pain management among adult cancer patients in Saudi Arabia and to explore the predictors associated with attitudinal barriers of cancer patients to pain management. METHODS: A descriptive cross-sectional study was conducted among 325 cancer patients from tertiary hospitals in Saudi Arabia. RESULT: Of the total participants, 67.4% were women (N = 219) and 32.6% were men (N = 106). The overall mean scores of the attitudinal barriers questionnaire were 49.51 ± 13.73 in men and 54.80 ± 22.53 in women. The analysis shows significant differences in scores in subscales of tolerance (men = 7.48 ± 2.37), (women = 8.41 ± 3.01) (p = 0.003) and fear of distraction in the course of treatment (men = 6.55 ± 1.34), and (women = 7.15 ± 2.63) (p = 0.008). Female patients reported a more moderate to severe level of pain than men (worst pain in last week of 7.07 ± 1.50, worst pain in last week of 5.84 ± 2.65, respectively). Splitting by gender, the significant predictor for physiology effect domains in male cancer patients includes age, marital status, employment status, monthly income, cancer type, and presence of comorbid disease (p < 0.050). Age was a significant predictor of the domains of fatalism, communication, and harmful effects (p < 0.050) among female cancer patients. CONCLUSION: The present study revealed significant differences between men and women with attitudinal barriers to cancer pain management. Managing pain requires the involvement of all methods in a comprehensive manner, thus unalleviated pain influences the patient's psychological or cognitive aspect.

Mental Health Outcomes of Healthcare Providers During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Study.

Objective: In this descriptive cross-sectional study we aimed, to assess the level of depression, anxiety, insomnia and distress symptoms experienced by healthcare providers during the COVID-19 pandemic in Saudi Arabia. Methods: All healthcare providers currently working in different hospitals were invited to participate in this study. Data gathering started in March 2020 to May 2020. The participants answered a five-part questionnaire which includes demographic data, a 9-item Patient Health Questionnaire, a 7-item Generalized Anxiety Disorder, a 7-item Insomnia Severity Index, and a 22-item Impact of Event Scale-Revised, which assess the level of depression, anxiety, insomnia, and distress. Results: Out of 200 healthcare providers, 40% were males. 52% were aged 31-40 years old, 61% were married. The majority of the participants were Saudi nationals (84%), 74% were nurses, 11% were physicians and 15% were other healthcare providers. More than half of the participants worked as front-liners (57%). Overall, 73, 69, 62, and 83% of all healthcare providers reported symptoms of depression, anxiety, insomnia, and distress, respectively. The analysis showed severe symptoms level of depression for physicians and nurses was 35% and 20% (p < 0.05), respectively. Only three of the independent variables made a unique contribution to the model (gender, profession, and working position) (p < 0.05). Conclusion: COVID-19 pandemic has a significant impact on the mental health of healthcare providers in Saudi Arabia. Female nurses and healthcare providers working in the frontline who were directly treating patients with COVID-19 are at increased risk of severe depression, anxiety and distress.

Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross -sectional study.

OBJECTIVE: In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia. METHODS: A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination. RESULTS: The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm2) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants' followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10- 0.96 (p = 0.015). CONCLUSION: This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.

Recommendation of Aspirin-Guide App and Physicians Clinical Decision of Aspirin Use to Prevent CVD Among Diabetic Patients, Is there any Differences?

OBJECTIVE: This study aims to identify the prevalence of aspirin use among type 2 diabetic (T2DM) patients and assess the concordance in aspirin use among these patients as prescribed by physicians and as recommended by the Aspirin-Guide app. METHODS: A total of 301 T2DM patients from King Khalid University Hospital in Riyadh, Saudi Arabia participated in this cross-sectional study. Patient's electronic medical records through eSihi system were reviewed and all data included in the free online and mobile app called Aspirin-Guide were collected in a specially designed data checklist. RESULT: The prevalence of aspirin use was more common in patients who were in the age group of 51 to 59 and male participants' with T2DM. Males were nearly twice more likely to use aspirin compared to females (P = 0.001). Based on recommendations from the Aspirin-Guide app, 26% of the patients who were on aspirin (N = 51) were not eligible for aspirin therapy, while 37.7% (N = 40) of the patients eligible for aspirin therapy had not been put on aspirin by their physicians (P = 0.039). Male sex (P = 0.003), use of statins (P = 0.001), and being advised to use aspirin (P = 0.041), were significantly associated with aspirin use in T2DM patients. CONCLUSION: There was a significant difference in the proportion of patients currently on aspirin as prescribed by their physicians and those eligible for aspirin therapy as per the Aspirin-Guide app. The use of an app to uniformized aspirin use among eligible patients should be based on up-to-date guidelines and account for patient acceptability and willingness to commence treatment.

Assessment of psychological distress among cancer patients undergoing radiotherapy in Saudi Arabia.

BACKGROUND: Cancer patients under psychological distress have reduced compliance with treatment and prolonged hospitalizations. Identifying cancer patients who may be more likely to suffer from psychological distress over the disease trajectory is essential to targeting the proper interventions and providing the best care. In this descriptive cross-sectional study, we aim to assess the levels of emotional and physical distress, depressive symptoms, and social concerns of cancer patients undergoing radiotherapy treatment in Saudi Arabia. METHODS: A total of 148 cancer patients undergoing radiotherapy from five different public tertiary-level hospitals in Saudi Arabia participated in this study. The survey was conducted by a trained researcher from November 2015 through April 2016. The Psycho-Oncology Screening Tool was used to identify levels of distress of cancer patients undergoing radiotherapy. Emotional and physical distress, depressive symptoms, and social concerns in receiving psychosocial services were assessed. RESULTS: The findings show above average levels of physical and emotional distress was (342.07±78.9) and social concerns was (7.27±1.68). Age was a significant predictor of psychological distress and in social concerns (P<0.05). Marital status and employment status emerged as significant predictors of depressive symptoms and social concerns (<0.05), (P<0.001), respectively. The patients' type of cancer was significantly associated with the level of physical distress, emotional distress, and depressive symptoms (P<0.05). CONCLUSION: Cancer patients undergoing radiotherapy displayed above-average levels of distress. This may have significant implications on their adherence for treatment and patient outcomes. Routine screening and support services or psychosocial care for patients are warranted among cancer patients undergoing radiotherapy.

Association of health literacy and self-management practices and psychological factor among patients with type 2 diabetes mellitus in Saudi Arabia.

OBJECTIVES: To determine the association between sociodemographic, clinical, and health literacy and the presence of depressed mood and their relationships  to diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia. METHODS: A total of 352 T2DM patients from 2 public tertiary hospitals in Saudi Arabia participated in this descriptive cross-sectional study between December 2016 and February 2017. All respondents answered a 4-part questionnaire, which includes demographic data, Diabetes Self-Management Questionnaire (DSMQ), 36-item test based Short Test of Functional Health Literacy in Adults, and a 2-item Patient Health Questionnaire (PHQ-2). The Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for self-management among T2DM patients. Results: The analysis showed that majority of the participants had low to marginal functional health literacy. The overall DSM-16 score was good, indicating more effective self-care, while 20% of the participants had a score of 2 or more in the PHQ-2 indicating presence of depressed mood.  No significant association was found between DSM and health literacy among the study participants while age, gender, educational level, employment status, and level of the depressive symptom were significantly associated with differences in the level of functional literacy of the participants. Conclusion: The study shows that nearly half of the T2DM patients that exhibited low level of functional health literacy had low diabetes self-management.  Our findings also show that gender significantly affects diabetes self-management in which odds are a lot higher among females than males with diabetes self-management. This study underscores the importance of proper counselling and education about diabetes control on both patients and family members.

Health promoting lifestyle of university students in Saudi Arabia: a cross-sectional assessment.

BACKGROUND: College is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges in Saudi Arabia. METHODS: A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors. RESULTS: The majority of participants were females (70.4%), 20% of the participants were overweight and 11.3%, were obese. The analysis showed that there was a significant difference between health colleges and non-health colleges with regards to the factor of health responsibility. Students at both schools were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students in both colleges do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Saudi Arabia. CONCLUSION: The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

A Cross-Sectional Assessment of Literacy and Awareness, Attitudes, and Beliefs About Colorectal Cancer and Its Screening in Riyadh Region.

This study aims to explore the association between functional health literacy and awareness for, beliefs, and attitudes of patients with colorectal cancer (CRC) and CRC screening test in Riyadh, Saudi Arabia. A total of 256 participants from two different tertiary level hospitals in Riyadh, Saudi Arabia were recruited in this study. The participants were interviewed by a trained researcher between October and December 2015. All respondents answered a three-part questionnaire which included demographic data, questions related to CRC awareness, attitude, behaviour, and short Test of Functional Health Literacy in Adults (STOFHLA). More than half of the participants had an inadequate awareness of functional health literacy skills (FHLS), 16.4 % had marginal of FHLS awareness and 17.6 % had adequate awareness about FHLS as assessed by the STOFHLA. Overall, the majority of the participants in both marginal and adequate aware groups showed a limited awareness about colorectal cancer screening and testing. A significant association was found on awareness of the patients about frequencies that they should have been tested for colorectal cancer and functional health literacy. No significant association was found between functional health literacy as assessed by STOFHLA and concerns of Faecal Occult Blood Test (FOBT) (p = 0.384) and sigmoidoscopy or colonoscopy might cause embarrassment (p = 0.089), harm (p = 0.917), and pain (p = 0.849). The present study revealed a low level of health literacy among Saudi adults in Riyadh region. Although the level of literacy was low, the bigger concern is that of the poor awareness and beliefs of Saudi adults about CRC and CRC screening.

Assessment of Health-Related Quality of Life Among Caregivers of Patients with Cancer Diagnosis: A Cross-Sectional Study in Saudi Arabia.

A descriptive cross-sectional survey was conducted over 5 months in two tertiary hospitals in Riyadh, Saudi Arabia. The 5-month period was from November 2014 to March 2015. The survey instrument used was a Short-Form Health Survey SF-36 (the RAND 36-item) questionnaire that measure QOL of the caregivers. Our study subjects included 289 randomly selected Saudi caregivers. Almost all the mean scores were increased (higher than 50) with the exception of levels of energy/fatigue. Role functioning/physical scored the highest (81.02 ± 35.33) followed by physical functioning (76.34 ± 29.83). Other domains of QOL scored (71.02 ± 35.33) for the role functioning/emotional; pain (71.15 ± 28.48), emotional well-being (60.58 ± 18.44); social functioning (58.39 ± 25.83), and general health (54.32 ± 17.08). In multivariate regression analysis, the model predicts that the contributions of age, gender, and the cancer type of patients were a statistically significant predictor with the QOL domains of caregivers. Cancer caregivers in Saudi Arabia caring for patients more than 1 year after diagnosis reported favorable QOL. Factors associated with QOL domains included age, gender of the caregivers, and the types of cancer patients. These findings are encouraging as a baseline for providing more information to future studies in QOL of caregivers.

Barriers to Cancer Clinical Trial Participation Among Saudi Nationals: A Cross-Sectional Study.

This study aims to determine the factors that act as barriers to Saudi cancer patients in participating in a clinical trial (CT). A total of 244 patients from two different tertiary level hospitals (King Khalid University Hospital and King Fahad Medical City Hospital) in Riyadh, Saudi Arabia, participated in this cross-sectional study. The participants were interviewed by a trained researcher between September and November 2015. All respondents answered a three-part questionnaire which includes demographics, clinical information, and questions related to awareness of CTs, willingness to participate, and factors affecting participation in CTs. The mean age of the participants was 50.83, and 57 % of the participants were females. Most of the participants (63.5 %) were currently being treated for cancer, and 28 % were diagnosed with breast cancer followed by colorectal cancer. Health status or quality of life was self-reported as acceptable by 27.9 % of the participants, and 25 % of the participants at stage II of cancer. The factors that act as barriers to Saudi cancer patients in participating in a CT can be categorized into patient- and physician-related factors. Patient factors include lack of awareness, misconception and fear in participating in CTs; physician-related factors comprise of lack of encouragement from physician to patients in participating in a CT. The study identified few major barriers to participation in CTs. Increased patient awareness and recruitment strategies are required to increase accrual of patients including training for physicians and disseminating easy-to-read tools to the public.

Ebola outbreak preparedness and preventive measures among healthcare providers in Saudi Arabia.

INTRODUCTION: As medical professionals on the front lines in the outbreaks of infectious disease like Ebola Virus Disease (EVD), healthcare providers must have sufficient knowledge, skills, and best practices to protect themselves and the public from the disease. The purpose of this study is to identify the level of awareness, attitudes and practices among healthcare workers in relation to precautionary measures to EVD. METHODOLOGY: A total of 177 physicians and 545 nurses participated in a descriptive cross-sectional study from a tertiary government hospital in Saudi Arabia. All subjects answered a self-administered questionnaire focusing on their level of awareness, concerns, and clinical practice related to EVD. RESULTS: Majority of the participants were knowledgeable about the etiology, mode of transmission, signs and symptoms, and treatment of EVD. All of the participants had high levels of concern about EVD (p=0.001) and about the implementation of strict standard infection control precautionary measures. The study found that greater infection control measures were taken by the participants including frequent hand washing, use of personal protective equipment, and avoiding normal activities such as going to work, school, travel, etc. if fever symptoms appear. CONCLUSION: A combination of evidence based knowledge about EVD and high levels of concern of healthcare providers in relation to precautionary measures to EVD are the main factors leading to strict compliance with the infection control measures recommended in this study. Additionally, healthcare providers must be trained in infection control and adhere to the universal infection control standard guidelines to facilitate prevention and precaution.

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer.

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.

Awareness, Attitudes, and Practices Related to Coronavirus Pandemic Among Public in Saudi Arabia.

New cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) were reported in Gulf countries in 2014, and to date, it has reportedly infected 837 people and killed 291 globally. Awareness of an individual's knowledge and being able to predict his or her behavior is crucial when evaluating clinical preparedness for pandemics with a highly pathogenic virus. The aim of this study was to identify awareness, attitudes, and practices related to MERS-CoV among the public in Saudi Arabia. A cross-sectional study of 1147 adult subjects recruited from various shopping malls in Riyadh was conducted. All the subjects were interviewed using a questionnaire that tested their knowledge, attitudes, and use of precautionary measures in relation to the MERS-CoV pandemic. The majority of the participants showed high levels of concern and had utilized precautionary measures. After adjusting for other variables, gender was the only significant predictor of the level of concern (P < .001), while knowledge was the significant predictor of both the level of concern and precaution (P < .001). High concern translated into a higher compliance with precautionary recommendations. Frequent communication between health care providers and the public is recommended to help dispel myths about the disease and to empower the public with the information needed to help the Saudi government in containing the disease outbreak.