Prevalence and Factors Associated With Using Complementary Medicine Among Adults With Type 2 Diabetes in Primary Healthcare Centers of Al-Ahsa, Eastern Saudi Arabia.

Background and aim Type 2 diabetes mellitus (T2DM) is a major health problem in Saudi Arabia. The use of complementary and alternative medicine (CAM) for the management of T2DM is increasing, but there is limited research on its safety and efficacy. This study aimed to investigate the prevalence and factors associated with CAM use among patients with T2DM attending primary healthcare centers in Al-Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted between January and March 2024 to assess CAM use among T2DM patients in Al-Ahsa. Data were collected through telephone interviews using a validated questionnaire covering demographics, diabetes information, and CAM use. A total of 499 participants completed the questionnaire. Results CAM use was reported by 106 (21.2%) participants, with fenugreek (51, 48.1%), cinnamon (48, 45.3%), and blackseed (29, 27.4%) being the most common. Key factors associated with CAM use included residence in the Eastern or Northern Region, older age, having diabetic complications, and lower frequency of doctor visits. Only 24 (22.6%) participants consulted their doctor about CAM, and 83 (78.3%) believed that CAM could prevent diabetes progression. Conclusion This study provides insights into the use of CAM among T2DM patients in Al-Ahsa, Saudi Arabia. The findings highlight the need for larger-scale longitudinal research to better understand the patterns and potential benefits and/or harms of CAM use. Developing targeted interventions and promoting evidence-based integration of CAM into the healthcare system could optimize patient care and encourage patient-provider communication regarding these therapies.

Prevalence of Lifestyle Factors Among Primary Care Physicians: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia.

Introduction The importance of a healthy lifestyle has grown in significance on a global scale, as it offers a vital means of preventing and managing a range of related illnesses. Consequently, maintaining a healthy lifestyle is of paramount importance for the prevention and management of non-communicable diseases. The lifestyle behaviors of healthcare workers exert a significant influence on their attitudes and counseling methods, as they play a pivotal role in the promotion of health and the dissemination of lifestyle education to patients and the general population. Objective The objective of this study was to examine the prevalence of lifestyle factors among primary care physicians in Al-Ahsa Governorate, including smoking, body mass index, nutrition, physical activity, and caffeine consumption. Methods The study was conducted between December 2023 and February 2024. A total of 233 primary care physicians in Al-Ahsa were selected through a probability multistage clustering sampling method. Data were collected via the distribution of a self-administered questionnaire to the primary care physicians and were analyzed using the chi-square test. Results A greater proportion of primary care physicians exhibited multiple unhealthy lifestyle factors (166/233, 71.2%). The most prevalent lifestyle factor was low physical activity (169/233, 73%), followed by poor nutrition (121/233, 52%), obesity (120/233, 51.51%), smoking (37/233, 15.88%), and caffeine consumption (22/233, 9%). The majority of primary care physicians with optimal health status are employed in primary healthcare (PHC) facilities situated in the eastern region followed by the southern region in Al-Ahsa Governorate. Conclusion The study findings revealed a prevalence of unhealthy lifestyle factors among the majority of primary care physicians in the Al-Ahsa Governorate. The most prevalent unhealthy lifestyle factor among the participants was low physical activity.

Identifying innovations produced by primary health care centers and evaluating their scalability: the SPRINT Occitanie cross-sectional study in France.

BACKGROUND: Practice-based research is one of the levers identified by the World Health Organization (WHO) to strengthen primary health care. The scaling of health and social care innovations has the potential to reduce inequities in health and to expand the benefits of effective innovations. It is now rapidly gaining the attention of decision-makers in health and social care, particularly in high-income countries. To meet the challenge of declining numbers of primary care physicians in France, Multi-professional Healthcare Centers (MHC) were created to bring together medical and paramedical professionals. They are a source of innovation in meeting the health challenges facing our populations. Specific methodology exists to identify health innovations and assess their scalability. A working group, including end-users and specialists, has adapted this methodology to the French context and the University department of general practice of Montpellier-Nîmes (France) launched a pilot study in Occitanie, a French region. OBJECTIVE: To identify and evaluate the scalability of innovations produced in pluri-professional healthcare centers in the Occitanie region. METHODS: A pilot, observational, cross-sectional study was carried out. The SPRINT Occitanie study was based on a questionnaire with two sections: MHC information and the modified Innovation Scalability Self-Administered Questionnaire (ISSaQ), version 2020. The study population was all 279 MHC in the Occitanie region. RESULTS: 19.3% (54) of MHC in the Occitanie region, responded fully or incompletely to the questionnaire. Four out of 5 U-MHCs were represented. Five MHC presented multiple innovations. The average per MHC was 1.94 (± 2.4) innovations. 26% of them (n = 9) had high scalability, 34% (n = 12) medium scalability and 40% (n = 14) low scalability. The main innovation represented (86%) were healthcare program, service, and tool. CONCLUSIONS: In our cross-sectional study, a quarter of the innovations were highly scalable. We were able to demonstrate the importance of MHC teams in working on primary care research through the prism of innovations. Primary-care innovations must be detected, evaluated, and extracted to improve their impact on their healthcare system.

Who seeks care and for what reasons at a nurse-led walk-in center in an immigrant-dense area-A quantitative survey.

OBJECTIVE: To describe who seeks care and for what reasons at a nurse-led primary healthcare walk-in center in an immigrant-dense area. Studies evaluating the use of nurse-led walk-in centers in primary healthcare, emphasizing migrants, are limited. Due to language difficulties and a healthcare system based on telephone consultations, access to care is limited/problematic for the care seeker and the healthcare provider. The center aims to provide migrants and Swedish-born persons equal access to primary healthcare. Care was integrated into a healthcare center with a multi-professional environment, offering Arabic and Somali interpreters. DESIGN: Cross-sectional descriptive registry study. SAMPLE: All consecutive patients visiting during 1-month. RESULTS: Most individuals (70%) seeking care at the nurse-led walk-in center were non-European migrants from Syria, Iraq and Somalia, but Swedish-born persons (30%) also consulted the clinic. Women, middle-aged, and lower-educated patients dominated. Reasons for seeking care included different kinds of pain, ear/nose/throat issues, and skin problems. Migrants prioritized non-specific pain and dizziness/headaches, while Swedes sought help primarily for upper respiratory tract infections. About 25% of the migrants needed interpreters, mostly females. CONCLUSION: The nurse-led walk-in center provides accessible care in a multi-professional team, if needed, serving migrants and Swedish-born persons, promoting equal healthcare for all.

Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia.

Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran's sample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.

The assessment of readiness to change among head managers of primary healthcare centers in Makkah, KSA.

Background: KSA is currently undergoing significant changes in its healthcare system, with a particular emphasis on enhancing the role of primary healthcare centers (PHCs) to elevate patient experience and overall healthcare quality. At the forefront of this transformation are head managers in PHCs, who play a crucial role in implementing these changes effectively. The readiness of these managers is paramount to the successful execution of the envisioned transformation and the subsequent improvement of patient experience. Objective: This study aims to assess the readiness to change among head managers of primary healthcare centers in Makkah, KSA. Methodology: Cross-sectional study utilized the ADKAR model questionnaire, consisting of 22 Likert scale questions, to assess PHCs head managers' awareness, desire, knowledge, ability, reinforcement, and overall change readiness. Results: The study found a significant association between higher educational levels and increased awareness (ß = 0.214, p = 0.030), along with greater desire (ß = 0.207, p = 0.029) among primary healthcare (PHC) managers. Additionally, a positive association was found between age (≥41 years) and knowledge among PHC managers (ß = 0.138, p = 0.030). However, managers with 11 or more years of experience showed a negative association with change readiness (ß = -0.112, p = 0.001). Conclusion: The ADKAR model outlines five dimensions that are useful for identifying the readiness and willingness of head managers in PHCs in Makkah cluster to undergo change. Assessing change readiness is crucial for organizational transformation, with head managers playing a significant role. Factors such as age, education, and experience influence managers' readiness for change in primary healthcare centers (PHCs) in Makkah.

Food Parenting Practices Promoted by Childcare and Primary Healthcare Centers in Chile: What Influences Do These Practices Have on Parents? A Qualitative Study.

Chile, like many other countries in the world, is experiencing a high prevalence of childhood overweight. Among the factors influencing children's eating behaviors are the food parenting practices promoted by community organizations. More information is needed on the influences of these recommendations on the parenting practices of parents of preschoolers. This study examined what types of food parenting practices are promoted in childcare and primary healthcare centers and how these recommendations influence subsequent parental behavior. Interviews using photo-elicitation were conducted with 25 parents of Chilean preschoolers. The interviews were analyzed using inductive thematic analysis. Five themes were identified to describe food parenting practices promoted by community organizations and the influences that these practices had on parents of preschoolers. Healthcare centers were found to educate parents and provided a structured feeding. However, parents found their advice regarding dietary restriction challenging to follow. Childcare centers also provided information about healthy diet, food monitoring, and diversifying the child's diet in a way that was perceived as adequate. While childcare centers encouraged structured and autonomous food parenting practices in a positive and supportive manner, healthcare centers tended to provide more restrictive guidance that posed challenges for parents struggling with preschool nutritional care.

Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future.

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.

Comparing Job Satisfaction Among Healthcare Workers at Emergency Departments and Primary Healthcare Units During the COVID-19 Pandemic.

Background The primary healthcare professionals' work description changed during the COVID-19 pandemic, as was the case of all other healthcare departmental operation systems. Objectives This investigation compares job satisfaction between emergency department (ED) and primary healthcare professionals during the COVID-19 pandemic to ascertain the possible effect of the pandemic on healthcare providers. Methods A cross-sectional online self-assessment questionnaire consisting of 36 questions was distributed using available social media to target all frontline healthcare workers (HCWs) in emergency departments and primary healthcare centres in Riyadh. The inclusive criterion was that the respondents should have been frontline HCWs during the pandemic era. The questionnaire was validated by a pre-test of responses of 10 frontline HCWs. This was to ensure the comprehensibility and validity of the questions. Thereafter, necessary corrections were made to the final questionnaire. Responses were collected with an Excel sheet (Microsoft Corp., Redmond, WA), while data were analysed with SPSS version 23 (IBM Corp., Armonk, NY) and GraphPad Prism version 9.2.0 (GraphPad Software, San Diego, CA). Results The targeted sample size was 400; however, 159 HCWs responded to the questionnaire and were thus included in the investigation. There were more male (60.4%) than female (39.6%) respondents, the majority of whom were Saudi nationals (86.6%) while the remaining were non-Saudi nationals working in the Kingdom. Also, 67% of the respondents were emergency medical service professionals while the remaining (23%) were primary healthcare professionals. Significantly, 71.8% of the respondents (p < 0.05) disagreed with adequate enumeration, rewards, and chances of promotion compared to those who agreed (28.2%) during the COVID-19 pandemic. Job satisfaction was not significantly correlated to gender or the work departments (p > 0.05). Respondents significantly (p < 0.05) agreed to the competence of their supervisors, and liked their colleagues and work environment. Conclusion The study has shown that although supervision during the pandemic era was with competence; however, hours of work put in by these frontline emergency professionals were not adequately remunerated. Also, the services they provide seemed not to have been appreciated and hence did not lead to promotion either. Therefore, there was job satisfaction. As expected, the workload was huge while chances of promotion were lacking. These observations could lead to a substandard service should there be another pandemic. There is a need for all stakeholders to look into this more cautiously should there be another pandemic.

Giant Lipoma of the Arm Masquerading as an Accessory Breast: A Report of a Rare Case.

Accessory breast is an extremely rare condition that develops in 0.4%-6% of females. It is primarily found in the axilla and is frequently misdiagnosed. It is usually bilateral and manifests during pregnancy or lactation as an asymptomatic tumor. The diagnosis of ectopic breast tissue is crucial because it is capable of undergoing the same pathological changes as normal breast tissue, including mastitis, fibrocystic changes of the breast tissue, and, in extreme cases, even malignancy. We present the case of a 40-year-old female who presented with swelling in the left upper arm for the past eight years, which was associated with pain. Initially, accessory breast was kept as the clinical diagnosis. However, further imaging and histological analysis revealed it to be a giant lipoma of the upper arm.

Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability.

BACKGROUND: In primary healthcare settings, chronic low back pain (cLBP) is a widespread health issue with a great global impact. METHODS: A cross-sectional analytical study was performed on 918 adults attending primary healthcare settings in Makkah, Saudi Arabia, to estimate the cLBP prevalence, its effect on health-related quality of life (QOL), and predictors of subsequent disability. The visual analog scale of pain (VAS), World Health Organization Quality of Life Scale (WHO-QOL), and Oswestry low back pain disability index (ODI) were used to assess back pain severity, impact on QOL, and physical disability, respectively. RESULTS: The prevalence of cLBP among adults attending primary care settings in Makkah City was 25.9%, and 88.6% of them had a limited range of motion of the spine. About 58.1% had abnormal radiological findings detected by MRI. Based on the VAS scale, most patients (83.8%) had mild pain. The median (IQR) QOL score was 70 (60-80). Minimal and moderate disability scores were prevalent among 16.2% and 65.7% of patients, respectively. Disability scores were independently predicted by a lower QOL score (beta = -0.39, 95%CI = -0.49 to -0.29, p < 0.001) and higher VAS scores (beta = 0.47, 95%CI = 0.38-0.56, p < 0.001). Furthermore, disability was independently associated with having post-void residual volume (PVRV) (beta = 5.84, 95%CI = 1.97-9.72, p = 0.004) and abnormal X-ray findings (beta = 7.10, 95%CI = 1.77-12.4, p = 0.010). CONCLUSION: cLBP is common among adults attending primary care settings in Makkah City; it is associated with moderate disability and lower health-related QOL.

Prevalence and Risk Factors for Gastroesophageal Reflux Disease (GERD) Among Visitors to the Health Center of Imam Mohammad Ibn Saud Islamic University.

BACKGROUND: A considerable majority of people have gastroesophageal reflux disease (GERD), a common gastrointestinal ailment. Globally, the prevalence of GERD has been rising, and it is linked to several risk factors. In this study, the incidence of GERD in a sample of the population was examined, along with the associated factors that may have an impact on it. METHODOLOGY:  The Gastroesophageal Reflux Disease Questionnaire (GERD-Q) was included in a self-administered survey given to 490 participants in a cross-sectional study to help determine who was more likely to have GERD. The questionnaire collected data on demographic elements, health-related traits, and past GERD diagnoses. RESULTS: The findings revealed that 32.7% of the individuals had previously received a GERD diagnosis. Of the patients, 17.1% had a GERD-Q score of 8 or above, which indicates a higher likelihood of having GERD. Participants who had previously been diagnosed with GERD had a noticeably greater incidence of GERD, and females had a higher incidence of GERD than males. The frequency of caffeine consumption was substantially correlated with the occurrence of GERD. CONCLUSION: Our study emphasizes the value of early GERD diagnosis and therapy to reduce problems and enhance the quality of life for those who are affected. According to our research, coffee use, gender, and prior GERD diagnoses are all linked to an increased risk of developing GERD. The GERD-Q is a trustworthy and proven tool for GERD diagnosis and might be used in clinical practice to recognize GERD patients and offer suitable treatment. Additional research is required to determine how additional risk variables affect the prevalence of GERD.

Association Between Maternal Literacy and Child Immunization According to the Expanded Program on Immunization Schedule in a Primary Health Care Center of a Squatter Settlement in Karachi.

Background An increase in maternal education may influence vaccine administration to a significant extent, therefore reducing the childhood mortality rate. Hence, this survey aims to establish an association between maternal literacy and childhood immunization in children under five years of age. Methods A questionnaire-based cross-sectional study was conducted in a primary healthcare center of a squatter settlement in Karachi, Pakistan. Mothers of 250 children under the age of five years were interviewed. We used IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States) for data analysis to assess the relationship between maternal education and childhood immunization. Results The survey revealed that complete vaccination coverage among children under five years of age (n=250) was 71.7%, while 24.6% were partially vaccinated and 2% were unvaccinated. The most common reason for unvaccinated children was the parents' personal choice (80%), while incomplete vaccination was majorly due to a medical condition (30.2%).  Conclusion According to the survey, maternal educational qualification did not prove to be directly associated with vaccination coverage in children. However, a multi-centered study with larger sample size and multiple populations as targets would provide more accurate outcomes.

Distribution of Primary Healthcare Centers Between 2017 and 2021 Across Saudi Arabia.

BACKGROUND AND AIM: Access to adequate healthcare systems is seen as a fundamental human right. Therefore, healthcare services must be distributed and accessible in the most efficient way possible to those who need them the most. Primary healthcare centers are the backbone of any healthcare system as they provide essential healthcare services to the general population. Inequalities in the distribution of primary healthcare centers can lead to disparities in healthcare access and outcomes. This study aimed to assess the equity of primary healthcare centers distribution, we analyzed and evaluated the allocation of primary healthcare centers in Saudi Arabia from 2017 to 2021. METHOD: This cross-sectional study utilized data from the Health Statistical Yearbook published by the Ministry of Health, Saudi Arabia, during the period of 2017-2021. The number of primary healthcare centers per 10,000 population was calculated for the 20 health regions. We used the Gini index to measure inequality in the distribution of primary healthcare centers. The Pearson coefficient was calculated to assess the correlation between the number of primary healthcare centers and the population in each health region. RESULT:  The overall ratio of primary healthcare centers to population decreased from 0.72 to 0.62 between 2017 and 2021. The Gini index showed relative equality in the distribution of primary healthcare centers from 2017 to 2021 with values between 0.2 and 0.3. There was a positive correlation between the population and the primary healthcare centers in Jeddah, Tabouk, and the Northern Region. However, in Riyadh, Makkah, Taif, Madinah, Qaseem, Eastern Region, Al-Ahsa, Aseer, Hail, Jazan, Najran, Al-Baha, and Al-Jouf, the correlation was found to be negative. CONCLUSION:  From 2017 to 2021, primary healthcare facilities are distributed fairly throughout 20 health regions of Saudi Arabia. However, there are still some disparities between provinces, and efforts must be made to ensure that primary healthcare centers are distributed equitably across the country to improve healthcare access and outcomes for all.

Primary Healthcare Center's Healthcare Providers' Perception and Practice Toward Pediatric Cow's Milk Allergy in Qassim Region, Saudi Arabia.

BACKGROUND: Cow's milk allergy (CMA) typically first manifests in the first year of life, and it is the most challenging food allergy to detect since the clinical symptoms can vary significantly in both types and severity. This study is carried out to evaluate the level of knowledge and practice of healthcare providers (HCPs) in the Qassim Region regarding CMA. RESEARCH METHODOLOGY: This is a cross-sectional study conducted among HCPs in the Qassim Region, Saudi Arabia. A self-administered questionnaire was distributed among HCPs using face-to-face interviews compromising four governorates of Qassim such as Buraydah, Unaizah, AlRass, and Albukairyah. The questionnaire includes socio-demographic characteristics and questions to assess the knowledge and practice of HCPs regarding CMA. RESULTS: Among 124 HCPs, 29% were aged between 25 and 30 years, 50.8% were males and 49.2% were females. Over three-quarters (77.4%) were categorized as having poor knowledge levels, while poor practice was also prevalent (83.1%). Factors associated with increased knowledge and practice were being non-Saudi, being a consultant/specialist, and having more than 10 years of experience. There was a significant positive correlation between knowledge and practice scores (p<0.001). CONCLUSION: The knowledge and practice of HCPs regarding CMA were insufficient. Non-Saudi consultants/specialists with more years of experience tend to be more knowledgeable and have better skills in managing the disease. Further longitudinal studies are required to establish the level of knowledge and practices toward CMA.

Contrasting Presentations of Spigelian Hernia in a Single Surgical Unit of a Tertiary Healthcare Center: A Case Series.

A Spigelian hernia is a very rare type of anterior abdominal wall hernia. The etiology revolves around the dehiscence of the transverse abdominis and internal oblique aponeurosis. The majority of Spigelian hernias develop in the lower abdomen where the posterior sheath is absent. This condition is also known as a spontaneous lateral ventral hernia or hernia of the semilunar line. It is mostly asymptomatic and is generally proven by radiological diagnosis. In the worst-case scenario, strangulation of the Spigelian hernia can occur. Here, we report a case series of contrasting presentations of Spigelian hernia in a single surgical unit of a tertiary healthcare center, considering the rarity and associated complications of Spigelian hernia.

The Effect of COVID-19 Vaccine on Women's Reproductive Health: A Cross-Sectional Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) vaccine was developed to stimulate acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms of reproductive health abnormalities have been reported following the administration of the adenovirus and mRNA-containing vaccine. Such complaints included irregular menstrual cycles, miscarriages, changes in sexual interest, vaginal bleeding, and decreased milk supply in breastfeeding mothers. This study aimed to explore the effect of the COVID-19 vaccine on the reproductive health of women attending five primary healthcare centers in the western region of Saudi Arabia. METHODS: A cross-sectional study was conducted with 300 women between 15 and 50 years. Five primary healthcare centers were included from May to September 2022. Non-probability convenient sampling technique was used; data were collected via a self-administered questionnaire from women who received any number or type of COVID-19 vaccine. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics, Armonk, NY, USA). RESULTS: Of those who responded to the questionnaire (297 participants), 74% were married, and 52% had 1-3 children. Of the pregnant women, only 4% lost their pregnancy. In addition, of the breastfeeding mothers, 10% noticed a decrease in milk production after the vaccination. The effect of the vaccination status on decreased libido was 11%. A small proportion (18%) of the participants reported worsening dietary habits after the vaccine. Less than half of the participants (44%) reported a change in the length and amount of the menstrual cycle, and 29% worsened premenstrual syndrome (PMS). There was no significant association between the type and the number of doses on the rate of miscarriage (p=0.47), breastmilk production (p=0.47), libido (p=0.11), health diet habits (p=0.15), monthly cycle (p=0.570), heavy menses (p=0.999), and PMS symptoms in the study participants. CONCLUSION: COVID-19 vaccination remains necessary to prevent severe infection and is safe for females of reproductive age, whether trying to get pregnant or lactating, and has no significant effect on the menstrual cycle. This research can be used as a basis when deciding on vaccines in case of future pandemics and remove misinformation and doubts regarding the vaccines that should be adequately addressed.

Levels and Associated Factors of Clients' Satisfaction Toward Child Immunization at Grassroot Health Care Centers in Ho Chi Minh City, Vietnam.

Purpose: Immunization is the most cost-effective health strategy, contributing significantly to public health interventions for all ages, particularly for children. However, caregivers' satisfaction with immunization systems affects their decisions on immunization for their children. This study evaluated the levels of clients' satisfaction toward child immunization and to identify its associated factors. Methods: A cross-sectional study was conducted at 40 commune health centers (CHCs) in 24 districts in Ho Chi Minh City, Vietnam among 1200 caregivers of children aged under 5 years. Clients who took their children to CHCs for immunization were recruited based on convenience sampling technique and were asked to complete a self-report questionnaire. Satisfaction was measured using the Satisfaction with Immunization Service Questionnaire (SWISQ). Ordinal logistic regression models were fitted to identify factors associated with satisfaction levels. Results: The majority of participants were female (85.5%) with a mean age of 33.3 (standard deviation = 9.0). Approximately 60% of participants reported a moderate (40.2%) or high (17.1%) level of satisfaction. Participants with older children and those who waited for a longer duration had a lower satisfaction level. In contrast, high satisfaction level was found to be positive associated with being reminded by healthcare workers and the condition of follow-up areas, vaccine storage and the immunization process met participant's need. Conclusion: The level of clients' satisfaction toward child immunization at grassroot healthcare centers in Ho Chi Minh City is relatively low, with 40.2% having moderate satisfaction and 17.1% having high satisfaction. Strategies to improve vaccination programs at CHCs are needed, focusing on clients' experiences at CHCs during vaccination sessions. Further studies are also needed to have an in-depth understanding of more factors affecting satisfaction in this population.

Profile of health care workers in a context of instability: a cross-sectional study of four rural health zones in eastern DR Congo (lessons learned).

BACKGROUND: The crisis in human resources for health is observed worldwide, particularly in sub-Saharan Africa. Many studies have demonstrated the importance of human resources for health as a major pillar for the proper functioning of the health system, especially in fragile and conflict-affected contexts such as DR Congo. However, the aspects relating to human resources profile in relation to the level of performance of the health districts in a particular context of conflicts and multiform crises have not yet been described. OBJECTIVE: This study aims to describe the profile of staff working in rural health districts in a context of crisis and conflicts. METHODS: A cross-sectional study was carried out from May 15, 2017 to May 30, 2019 on 1090 health care workers (HCW) exhaustively chosen from four health districts in Eastern Democratic Republic of Congo (Idjwi, Katana, Mulungu and Walungu). Data were collected using a survey questionnaire. The Chi2 test was used for comparison of proportions and the Kruskal-Wallis test for medians. As measures of association, we calculated the odds ratios (OR) along with their 95% confidence interval. The α-error cut-off was set at 5%. RESULTS: In all the health districts the number of medical doctors was very insufficient with an average of 0.35 medical doctors per 10,000 inhabitants. However, the number of nurses was sufficient, with an average of 3 nurses per 5000 inhabitants; the nursing / medical staff (47%) were less represented than the administrative staff (53%). The median (Min-Max) age of all HCW was 46 (20-84) years and 32% of them were female. This was the same for the registration of staff in the civil service (obtaining a registration number). The mechanism of remuneration and payment of benefits, although a national responsibility, also suffered more in unstable districts. Twenty-one percent of the HCW had a monthly income of 151USD and above in the stable district; 9.2% in the intermediate and 0.9% in the unstable districts. Ninety-six percent of HCW do not receive Government' salary and 64% of them do not receive the Government bonus. CONCLUSION: The context of instability compromises the performance of the health system by depriving it of competent personnel. This is the consequence of the weakening of the mechanisms for implementing the practices and policies related to its management. DR Congo authorities should develop incentive mechanisms to motivate young and trained HCW to work in unstable and intermediate health districts by improving their living and working conditions.

Adults' Visual Cue Preferences and Wayfinding Abilities in Healthcare Centers.

OBJECTIVES: Physical and visual elements that help people find their way around an environment are called visual cues (VCs). The current study aims to evaluate adults' wayfinding abilities (navigation, orientation, spatial anxiety, and distance estimation) and VC (navigational color coding) preferences in terms of color and position; additionally, investigates their differences in adults' life span phases (young adults, early middle-aged adults, and late middle-aged adults). BACKGROUND: Wayfinding in complex environments such as healthcare centers has been challenging for most people. Although VCs are being used increasingly to facilitate wayfinding, considering people's preferences regarding VCs, especially navigational color coding, are neglected. METHODS: Obtained data from a survey of 375 healthcare center visitors with textual and photo questionnaires were analyzed by descriptive statics and one-way analysis of variance. RESULTS: Young adults preferred VCs with "mixed colors and positioned in the middle of the floor," early middle-aged adults preferred "warm color VCs in the middle of the wall," and late middle-aged adults preferred "warm color VCs at the bottom of the wall." Additionally, the results demonstrated that with aging, navigation and distance estimation abilities deteriorate, and spatial anxiety increases. CONCLUSIONS: The outcomes of the present study increase our knowledge regarding the impact of adults' life span phases on their wayfinding abilities and VC preferences and offer suggestions for architects and healthcare center stakeholders to provide environments that improve adults' wayfinding.