Translation and validation of the Test of Adherence to Inhalers (TAI) questionnaire among adult patients with asthma in Malaysia.

OBJECTIVE: The Test of Adherence to Inhalers (TAI) is a validated self-reported questionnaire that can reliably assess adherence to inhalers through patient self-report. However, it was not available in Bahasa Melayu (BM) language, nor has it been validated for use in the Malaysian population. The study aimed, therefore, to translate the 10-item TAI questionnaire into BM and evaluate its psychometric properties. METHODS: The translation of the English version of the valid 10-item TAI questionnaire into BM was followed by subjecting it to a series of tests establishing factorial, concurrent and known group validities. Concurrent validity was assessed through Spearman's rank correlation coefficient against pharmacy refill-based adherence scores. Known group validity was assessed by cross-tabulation against asthma symptom control and using chi-square test. The internal consistency of the test scale was determined by a test-retest method using Cronbach's alpha (α) value and intraclass correlation coefficients. RESULTS: A total of 120 adult asthma patients participated in the study. A 2-factor structure was obtained and confirmed with acceptable fit indices; CFI, NFI, IFI, TLI >0.9 and, RMSEA was 0.08. The reliability of the scale was 0.871. The test-retest reliability coefficient for the total sum score was 0.832 (p < 0.01), which indicated good reliability. The 10-item TAI-BM established concurrent and known group validities. The sensitivity and specificity of the tool were >85%. CONCLUSIONS: The scale successfully translated into BM and validated. The 10-item TAI-BM appears fit for use in testing inhaler adherence of Malaysian patients with asthma.

Assessment of quality of work life (QWL) among healthcare staff of intensive care unit (ICU) and emergency unit during COVID-19 outbreak using WHOQoL-BREF.

OBJECTIVE: The study aimed to document the quality of work life (QWL) among healthcare staff of intensive care units (ICUs) and emergency units during COVID-19 outbreak using the WHOQoL-BREF. METHODS: A multicenter cross-sectional study was conducted for two months (May - June 2020) among healthcare staff working in intensive care units (ICUs) and emergency units of the hospitals under the National Guard Health Authority (NGHA) across five cities of Saudi Arabia. The study used the WHOQoL-BREF instrument to document the QWL through an electronic institutional survey. The data was analyzed through IBM SPSS version 23. The study was approved by an ethics committee. RESULTS: A total of 290 healthcare professionals responded to the survey. The mean overall quality of life score was 3.37 ± 0.97, general health = 3.66 ± 0.88, domains, i.e., physical = 11.67 ± 2.16, psychological = 13.08 ± 2.14, social = 13.22 ± 3.31 and environment = 12.38 ± 2.59. Respondents aged > 40 years, male gender, married status, being a physician and, having a work experience > 15 years and no extra working hours, had higher mean scores for several domains of Quality of life (QoL), overall QoL and general health (p < 0.05). CONCLUSION: The QWL among healthcare staff during COVID-19 pandemic was low. Demographic factors were mainly the determinants for a higher QWL while the variable of extra working hours was a determinant of lower QWL. Despite the pandemic, no COVID-19 related variables affected the work life of healthcare staff.

Concurrent validity of the Arabic version of General Medication Adherence Scale using two validated indirect adherences measures in Saudi patients with non-communicable diseases.

PURPOSE: This study aimed to evaluate the concurrent validity of the Arabic version of the General Medication Adherence Scale (GMAS) using two validated scales namely Adherence to Refills and Medications Scale (ARMS) and Medication Adherence Rating Scale (MARS) in Saudi patients with non-communicable diseases. METHODS: A cross sectional study was conducted for 2 months in out-patient departments at a tertiary care hospital in Khobar, Saudi Arabia. The study collected data from patients with chronic illnesses through convenience sampling. Pearson correlation (ρ) was conducted to report concurrent validity of GMAS. A correlation coefficient value ≥ 0.5 with p-value < 0.01 was considered threshold for establishing concurrent validity. The study was approved by an ethics committee (IRB-2019-05-002). RESULTS: A total of 406 patients responded to the study. The average age was 42.4 ± 5.94 years, and most patients were females (53.7%), married (70%), graduates (65.3%), employed (39.9%) and, had a monthly family income > SAR 10,000, i.e., USD 2666.2 (56.4%). The mean adherence scores obtained from MARS, ARMS and GMAS were 7.09, 19.9, and 27.4. The correlation (ρ) between GMAS and MARS scores was 0.65, and between GMAS and ARMS scores was -0.79, p < 0.01 for both comparisons. CONCLUSION: The concurrent validity of GMAS-AR was established in this study that would further substantiate psychometric properties of the scale in this population.

Comparison of cystatin C and creatinine-based estimated glomerular filtration rate equations among elderly chronic kidney disease patients attending a tertiary care hospital: A prospective cross-sectional study
.

BACKGROUND: Serum creatinine has been solely used in clinical practice to identify chronic kidney disease (CKD) staging in the elderly population. Serum cystatin C is believed to more accurately define the CKD staging and is also ratified as an endogenous biomarker by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. MATERIAL AND METHODS: A total of 300 elderly Malay participants (age ≥ 65 years) with CKD, attending the Hospital University Sains Malaysia were included in the study. Demographic data and history were also recorded. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe method). While serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader. RESULTS: Out of 300 study participants, 169 (56.3%) were females. Mean age of patients was 67.6 ± 6.7 years. 64 male (64.6%) and 35 female (35.4%) patients were between 70 and 79 years. When estimated by MDRD equation, the prevalence of CKD stage 3 (defined as eGFR = 30 - 59 mL/min/1.73m2) was 27.7%, while based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 28%, 36.3%, and 36.3%, respectively. The prevalence of CKD stage 4 (defined as eGFR = 15 - 29 mL/min/1.73m2) when estimated by MDRD was 37.6%, whereas based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, it was 36.3%, 46.4%, and 46.4%, respectively. CKD stage 5 (defined as eGFR < 15 mL/min/1.73m2) when estimated by the MDRD equation was 34.7%. While based on CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, the prevalence of CKD stage 5 was 35.7%, 17.3%, and 17.3%, respectively. CONCLUSION: The staging of CKD is different between the creatinine- and cystatin C-based equations. Creatinine-based equations classify patients as having CKD stage 5 twice as often as cystatin C-based equations.

Pharmacists' viewpoint towards their professional role in healthcare system: a survey of hospital settings of Pakistan.

BACKGROUND: Pharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist's role as healthcare professional is limited. This study aimed to document pharmacists' attitude towards their role in Pakistan's healthcare system, their experience with doctors and their perceptions towards involvement in medicines management. METHODS: A 4-month cross-sectional survey (Jan - Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists' attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer's V ≥ 0.3 was considered cut-off for establishing statistical significance. The study was approved by ethical committee and local hospital committees. RESULTS: Three hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors. CONCLUSION: Pharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist's role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan's healthcare system.

Development and validation of the General Rehabilitation Adherence Scale (GRAS) in patients attending physical therapy clinics for musculoskeletal disorders.

BACKGROUND: Non-adherence to physical therapy ranges from 14 to 70%. This could adversely affect physical functioning and requires careful monitoring. Studies that describe designing and validation of adherence measuring scales are scant. There is a growing need to formulate adherence measures for this population. The aim was to develop and validate a novel tool named as the General Rehabilitation Adherence Scale (GRAS) to measure adherence to physical therapy treatment in Pakistani patients attending rehabilitation clinics for musculoskeletal disorders. METHODS: A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15). RESULTS: A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value< 0.01). Exploratory factor analysis revealed a 3-factor model that was fixed and confirmed at a 2-factor model. Incremental fit indices, i.e., normed fit index, comparative fit index and Tucker Lewis index, were reported > 0.95 while absolute fit index of root mean square of error of approximation was < 0.03. These values indicated a good model fit. The value for Cronbach (α) was 0.63 while it was 0.77 for McDonald's (ω), i.e., acceptable. Test-retest reliability coefficient was 0.88, p < 0.01. Education level was observed to affect adherence (p < 0.01). A cut-off value of 12 was identified. The sensitivity and accuracy of the scale was 95%, and its specificity was 91%. CONCLUSION: The scale was validated in this study with satisfactory results. The availability of this tool would enhance monitoring for adherence as well as help clinicians and therapists address potential areas that may act as determinants of non-adherence.

Ethnobotany, ethnopharmacology, phytochemistry, biological activities and toxicity of Pistacia chinensis subsp. integerrima: A comprehensive review.

Pistacia chinensis subsp. integerrima (J. L. Stewart ex Brandis) Rech. F. is a valuable medicinal plant used in south Asian communities for the treatment of asthma, diarrhea, diabetes, liver diseases, fever, pain and inflammation. This review critically evaluates the available information on P. integerrima's ethnobotany, ethnopharmacology, phytochemistry, pharmacology and toxicology. Electronic databases such as Google Scholar, PubMed, Springer Link, and so forth, books and theses were used to find relevant information about P. integerrima using keywords such as "Pistacia integerrima," "P. integerrima," "Ethnopharmacology," "Phytochemistry," "Traditional uses". A number of in vitro and in vivo pharmacological activities have been reported; however, the most promising and attractive activity observed was its role in Alzheimer, diabetes, convulsions, cancer, asthma, diabetes, diarrhea and as an immunomodulatory, analgesic and antiinflammatory. In addition, Pistagremic acid exerted anti-Alzheimer's activity based on a hitherto unknown mechanism through interference with the amyloidogenic pathway. Most of the pharmacological activities were linked with traditional uses. A range of compounds have been reported from P. integerrima extracts including triterpenes, volatile oils, flavonoids, fatty acids, phenolic, phytosterols, tannins and oligosaccharides as well as unknown triterpenes and flavonoids. Pistagremic acid, a novel triterpene, was attributed to most of the activities. in vivo toxicological studies in animal suggested a toxic dose of 1,500 mg kg-1 , for its methanolic extract. All reported pharmacological activities were carried out in vitro and a gap in research, that is, preclinical and clinical investigation exists. Its outstanding activity as an antiglycating agent is the most promising and a so far unique activity and needs further evaluation. In-depth research and clinical trials on human subjects in order to investigate P. integerrima pharmacological activity, clinical efficacy and safety are crucial next steps.

Assessment of beverage consumption by young adults in Saudi Arabia.

OBJECTIVE: The primary objective was to assess beverage consumption pattern and calorie intake among undergraduate students on weekly and daily basis. Secondary objectives were to determine the relationship between demographic variables and beverage intake, assess mean differences in calorie intake between students' groups and, report the predictors of beverage consumption. METHODS: A cross-sectional study was conducted for 3 months (January-March 2019) among currently enrolled undergraduate students studying in 8 colleges of a public sector university in Dammam, Saudi Arabia. The study used the Arabic version of Beverage Frequency Questionnaire (BFQ) and collected data through purposive stratified sampling. Total intake in ml and calories in kcals were calculated. Data was analyzed through SPSS version 23 and the study was approved from ethics committee of the university (IRB-2019-05-021). RESULTS: A total of 507 students responded to the survey. The average volume of sugar sweetened beverages (SSBs), caffeine containing beverage (CCBs) and carbonated beverages (CarBs) consumed was 4.2 L, 4 L and 1.5 L per week and 650.6 ml, 575.2 ml and 224.6 ml per day, respectively. Average daily calorie intake from SSBs, CCBs and CarBs was 187.6 kcals, 87.6 kcals and 52.5 kcals, respectively. Body mass index (BMI) was significantly related to CCB (ρ = 0.130) and CarBs (ρ = 0.100) intake (mL) (p < 0.05). Mean difference in calorie intake was mostly significant (p < 0.05) when accounted for students' demographics, gender, BMI, residence, illness and, examination time, in case of SSBs, CCBs, CarBs and, all beverages. Averge % contribution towards total daily energy expenditure (TDEE) for SSBs, CCBs and CarBs were 10.2%, 6.3% and 2.8%, respectively. Year of study, BMI, residence and illness were predictors of SSBs consumption while BMI, residence and examination time were predictors of CCBs consumption. Gender and BMI were predictors of CarBs intake. CONCLUSION: There was a high consumption of beverages in students that was related to their demographic characteristics. There is a need to create awareness among the students regarding the detrimental effects of chronic consumption of these beverages.

Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses.

PURPOSE: The study aimed to translate and validate the Arabic version of General Medication Adherence Scale (GMAS) in Saudi patients with chronic diseases. METHODS: A multi-center cross sectional study was conducted for a month in out-patient wards of hospitals in Khobar, Dammam, Makkah, and Madinah, Saudi Arabia. Patients were randomly selected from a registered patient pools at hospitals and the item-subject ratio was kept at 1:20. The tool was assessed for factorial, construct, convergent, known group and predictive validities as well as, reliability and internal consistency of scale were also evaluated. Sensitivity, specificity, and accuracy were also evaluated. Data were analyzed using SPSS v24 and MedCalc v19.2. The study was approved by concerned ethics committees (IRB-129-25/6/1439) and (IRB-2019-05-002). RESULTS: A total of 282 responses were received. The values for normed fit index (NFI), comparative fit index (CFI), Tucker Lewis index (TLI) and incremental fit index (IFI) were 0.960, 0.979, 0.954 and 0.980. All values were >0.95. The value for root mean square error of approximation (RMSEA) was 0.059, i.e., <0.06. Hence, factorial validity was established. The average factor loading of the scale was 0.725, i.e., >0.7, that established convergent validity. Known group validity was established by obtaining significant p-value <0.05, for the associations based on hypotheses. Cronbach's α was 0.865, i.e., >0.7. Predictive validity was established by evaluating odds ratios (OR) of demographic factors with adherence score using logistic regression. Sensitivity was 78.16%, specificity was 76.85% and, accuracy of the tool was 77.66%, i.e., >70%. CONCLUSION: The Arabic version of GMAS achieved all required statistical parameters and was validated in Saudi patients with chronic diseases.

Epidemiology of rheumatoid arthritis, clinical aspects and socio-economic determinants in Pakistani patients: A systematic review and meta-analysis.

OBJECTIVE: The study aimed to evaluate literature on rheumatoid arthritis disease in Pakistani patients, to have an understanding about its epidemiology, clinical aspects and socio-economic determinants. METHODS: The review study was conducted from December 2017, to May 2018. An online search was conducted in international and local health databases using appropriate search keywords as well as scanning reference lists of related articles. Literature published after year 2000 that reported epidemiological, demographic, clinical and socioeconomic data of Pakistani rheumatoid arthritis patients was included. Meta-analysis was performed where possible. This systematic review was registered on the international prospective register of systematic reviews PROSPERO (CRD42018090582). RESULTS: Of the 334 research articles found, 29 (8.7%) were selected. Patients were mostly females, but no study explored impact of disease on household and family role functioning of rheumatoid arthritis-affected women in Pakistan. Most patients were uneducated (55%) and unemployed; had low disease knowledge (N = 149, 74.5%) and poor adherence to disease-modifying anti-rheumatic drugs (N = 23, 23%). Point prevalence of rheumatoid arthritis reported from Karachi was high at 26.9%. Moderate disease activity, i.e., 4.5}0.7 and mild functional disability (N = 66, 51.6%) were seen in RA patients. Almost half (N = 799, 46.9%) had comorbidities. Almost a fifth proportion of RA patients had dyslipidaemia as a comorbidity (N = 134, 16.77%) and higher cardiovascular risk score as modifiable risk factor. Undiagnosed depression (N = 134, 58.3%) and low bone mineral density (N = 93, 40.6%) were reported in RA patients. Direct monthly treatment cost of disease was significantly high considering patients' socio-economic status, i.e., USD 16.47 - 100.68. Most commonly used drug was methotrexate. CONCLUSIONS: There is a paucity of data on Pakistani rheumatoid arthritis patients' demographic and socio-economic parameters, especially the gender element.

A qualitative study investigating perceived barriers to medication adherence in chronic illness patients of Karachi, Pakistan.

OBJECTIVE: The study aimed to perceived barriers to medication adherence in patients with chronic illnesses.. METHODS: A qualitative study was conducted in a tertiary care hospital in Karachi in September 2017, using grounded theory and inductive approach. Interviews were conducted using a checklist in Urdu language from patients of chronic illnesses determined based on medicines dispensed from the out-patient pharmacy in hospital. Interviews were recorded, transcribed verbatim, translated in English and validated. The translated quotations were analysed using a qualitative analysis software, and thematic analysis was conducted. Codes were generated and analysed by semantic linkages and network analysis using ATLAS.ti qualitative research software. RESULTS: Of the 16 patients interviewed, 8(50%) were males and 8(50%) were females. Barriers to medication adherence identified were patient behaviour (intentional and un-intentional non-adherence), comorbidity and pill burden, cost-related non-adherence, and low patient knowledge. The last barrier was associated with the rest. CONCLUSIONS: Counselling has the potential to increase patient knowledge regarding medication use, and active pharmacist-physician collaboration can improve medication adherence..

Report: Interactions and conflicts of interests between prescribers and medical sales representatives (MSRs) regarding prescribing and drug promotion practices in Karachi, Pakistan.

Pharmaceutical drug promotion practices are found to have potentially controversial ethical standards. They may compromise on patient's wellbeing especially when it inordinately affects the clinical care and patient's interests by influencing the prescribing behavior of physicians. There is no proper system to keep a watch on the drug marketing and promotion strategies by the pharmaceuticals in Pakistan. A cross sectional study using a specially designed questionnaire and convenience sampling was conducted in Karachi for 6 months targeting prescribers and medical sales representative (MSRs). A total of 600 MSRs and prescribers consented to participate. 66% of MSRs highlighted that prescribers follow ethical prescribing but only (58%) seek evidence base behind promoted drug. This was contradictory to prescribers' response to same, which was 87%. Only (10%) of prescribers acknowledged demanding expensive gifts such as laptops, ACs, furniture and renovation of the clinic which was about 40% according to MSRs. This study offered intricate insights into the MSR and physicians interactions. It highlighted various aspects of these relationships from both MSRs' and prescribers' point of view. Although majority of the physicians negated the notion of expecting expensive favors from the sales representatives, responses by MSRs suggest that anticipation of gifts and incentives exists on part of the physicians. This has the potential to indulge in unethical promotion and irrational prescribing on part of MSRs and prescribers respectively that may further contribute to untoward patient outcomes such as increased treatment costs and adverse drug reactions.

Dietary supplement use among undergraduate male students in health and non-health cluster colleges of a public-sector university in Dammam, Saudi Arabia.

BACKGROUND: Dietary supplements (DS) are nutraceuticals that improve overall health and well-being of an individual as well as reduce the risk of diseases. Evidence indicates a rising prevalence of these products worldwide especially among college students. Studies have reported an increasing use of supplements among Saudi students. However, the scope of those researches was limited to prevalence data. Hence, the aim of our study was to document the prevalence, opinions, attitudes, reasons for use and monthly cost attributed to dietary supplement use. METHODS: A 3-month cross-sectional study was conducted to evaluate use of dietary supplement among health and non-health college students at a public-sector university in Dammam city, Saudi Arabia. It was conducted using Arabic version of the Dietary supplement questionnaire (DSQ-A). A total of 469 male students responded to the survey giving a response rate of 93.8%. The students were from ten colleges of the university. The data was analyzed by SPSS version 22. The study was approved by Institutional Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (IRB-UGS-2018-05-074). RESULTS: The overall prevalence of dietary supplement use in the university was 29.42%. In health cluster colleges, it was reported at 35.91% while in non-health cluster college it was 23.69%. Maintaining general health and well-being was the most common reason for use. Prevalence of multivitamins and whey proteins was approximately 23%. Average monthly cost of supplement was SAR 278.92 (USD 74.39). Cost was positively correlated (ρ = 0.305) with satisfaction score. Students preferred brand products (16.4%). 41.4% students opined that DS may prevent chronic illness if used regularly and agreed that they are good for health. Majority of students (65%) recommended DS use only upon physician's recommendation. College clusters and study-year was associated (p-value< 0.01) with students' opinion. Students in health cluster colleges were more likely to recommend supplements (OR 3.715, p-value< 0.0001). CONCLUSION: Prevalence of dietary supplement use was lower than other local and international university students. Health cluster colleges had higher prevalence as compared to non-health cluster colleges. Multivitamins and whey protein were the most commonly used types of DS. Students preferred brand products, had positive opinions and attitudes towards dietary supplement. However, they recommended supplements use to others only upon a physician's recommendation.

Awareness, knowledge and attitude towards breast cancer, breast screening and early detection techniques among women in Pakistan.

OBJECTIVE: To document the knowledge and attitudes of women towards breast cancer, breast screening and early detection techniques. METHODS: This cross-sectional survey was conducted from December 2015 to May 2016 in Karachi and Islamabad, Pakistan, and comprised women aged above 18 years. The survey used breast cancer inventory as a research instrument after piloting and validation. SPSS 20 was used for data analysis. RESULTS: Of the 1,304 respondents, 948(72.7%) were single, 1,082(83%) belonged to the 18-30 age group, 800(61.3%) had Urdu-speaking ethnicity and 794(60.9%) were educated. The prevalence of breast cancer in family was 226(17.33%). Besides, 446(34.2%) had low knowledge regarding the subject, 646(49.5%) appeared welcoming to the idea of breast screening, 1,008(77.3%) indicated their discomfort in discussing the topic, whereas 1,080(82.8%)preferred a female physician. CONCLUSIONS: There was a dearth of knowledge regarding breast cancer among the participants..

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review.

BACKGROUND: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

Which aspects of job determine satisfaction among pharmacists working in Saudi pharmacy settings?

OBJECTIVE: The aim of this study was to evaluate the impact of several employment-related aspects on overall job satisfaction among pharmacists working in Saudi pharmacy settings. METHODS: A cross-sectional survey was conducted for a period of 1-month (December 2020) among pharmacists working in community pharmacies located in 3 cities of Saudi Arabia. Convenience sampling was employed, and the data was collected using the English version of Job Satisfaction Survey (JSS) questionnaire. The data was analyzed using IBM SPSS version 23. Descriptive statistics such as mean ([Formula: see text]) and 95% confidence interval range were used to report continuous data; frequency (%) and sample counts (N) were used to report categorical data. Bivariate analyses were conducted using chi square (χ2) test. A multiple linear regression model was formulated to report the employment aspects that determined overall job satisfaction of pharmacists. The study was approved by an ethics committee. RESULTS: A total of 241 samples were analyzed. Less than a quarter of pharmacists (N = 54, 22.4%) were satisfied with their job. The overall job satisfaction score was 130.74 out of 199. The sub-scales for co-workers and communication had scores > 15.8 out of 24; subscale for operating conditions had score > 12.5 out of 20. The subscales for promotion and rewards had scores < 14 out of 24. The aspects of communication, fringe benefits and nature of work had the highest contribution towards overall job satisfaction. For a unit increase in score for communication, fringe benefits, and nature of work, the overall job satisfaction score increased by 0.204, 0.2, and 0.199, respectively. CONCLUSION: A very small number of pharmacists seemed satisfied with their job. Satisfaction with communication, nature of work and fringe benefits contributed the most toward overall job satisfaction. Results of this study could provide the means for human resource managers and organizational policy makers to delve into the determinants of satisfaction among pharmacists working in community settings.

Validation of the Arabic version of the general medication adherence scale in patients with type 2 diabetes mellitus in Jordan.

Background: Medication adherence is a major challenge for patients with diabetes. Adherence rates are often low, and this can lead to poor glycaemic control and increased risk of complications. There are a number of tools available to measure medication adherence, but few have been validated in Arabic-speaking populations. Aim: This study aimed to validate the Arabic version of the General Medication Adherence Scale in patients with type 2 diabetes in Jordan. Methods: A cross-sectional study was conducted for 3 months among patients attending diabetes mellitus outpatient clinic in Irbid, Jordan. The validation procedure included confirmatory factor analysis (CFA) and equation modelling (SEM). Fit indices, namely, goodness of fit index (GFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were observed. Corrected item-total correlation (ITC) was reported. Reliability was assessed using Cronbach's alpha (α) and α value based on item deletion was also carried out. Intraclass correlation coefficient (ICC) was reported. Data were analyzed using IBM SPSS v23 and IBM AMOS v25. Results: Data from 119 participants were gathered. The mean adherence score was 27.5 (±6) ranging from 6 to 33. More than half of the patients were adherent to their therapy (n = 79, 66.4%). The reliability of the scale (n = 11) was 0.907, and ICC ranged from 0.880-0.930: 95% CI. The following values were observed in CFA; χ2 = 62.158, df = 41, χ2/df = 1.516, GFI = 0.913, AGFI = 0.860, TLI = 0.960, CFI = 0.971 and RMSEA = 0.066. A total of 10 out of 11 items had corrected ITC >0.5. The α remained between 0.89-0.92 during item deletion. Conclusion: The results obtained in this study suggest that the scale is valid and reliable in measuring adherence to medications in the studied sample of patients with diabetes. This scale can be used by clinicians in Jordan to assess adherence and may further aide in evaluating interventions to improve adherence rates in persons with type 2 diabetes.

Translation and validation of the Sindhi version of the general medication adherence scale in patients with chronic diseases.

Background: There is no medication adherence scale available in Sindhi language currently. Hence, the Sindhi speaking population will either use a translator or provide their medical history in another language for documentation of medical conditions. This poses a challenge in monitoring and evaluating adherence to medications within this linguistic community. Aim: The aim of this study was to translate and validate the Sindhi version of the General Medication Adherence Scale (GMAS-S) in patients with chronic diseases. Methods: This was a cross-sectional study of 4 months duration and was conducted in out-patient department of a university affiliated hospital in Karachi, Pakistan. All adults with chronic diseases, who were on long-term medications, and able to read and understand Sindhi language were invited. Convenience sampling was employed and a questionnaire consisting of demographic questions and the Sindhi version of GMAS was used. The translation of the scale was carried out. Confirmatory factor analysis (CFA) was conducted, and a structural equation model (SEM) was developed. Fit indices, namely, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were reported. Reliability was assessed using Cronbach's alpha (α), intraclass correlation coefficient (ICC), corrected item-to-total correlation (ITC) and item deletion. Data were analysed through IBM SPSS version 23 and IBM AMOS version 25. The study obtained ethical clearance. Results: A total of 150 responses were analysed. The reliability of the Sindhi version of GMAS was (α) = 0.696. The intraclass correlation coefficient (ICC) was reported at 0.696 (95% CI: 0.618-0.763). The values for the fit indices were as follows: χ2/df = 1.84, GFI = 0.918, TLI = 0.920, CFI = 0.942, AGFI = 0.864, and RMSEA = 0.075. All values except AGFI were in the acceptable ranges and indicated good fitness. Most participants (80.7%) appeared non-adherent to their medications. Conclusion: The results of the study demonstrate that the Sindhi version of the GMAS is a valid and reliable scale to measure adherence in Sindhi speaking persons with chronic diseases.

How anxiety attributed to COVID-19, disease knowledge, and intention to vaccinate against SARS-CoV-2 viral infection prevail in general public of Saudi Arabia?

Aim: The study aimed to document the anxiety attributed to COVID-19, disease knowledge, and intention to vaccinate against the disease in general public. Moreover, the interplay among these three outcomes was also investigated. Methods: A cross-sectional study was conducted for 2 months in three cities of Dammam Region of Saudi Arabia. The target segment was the adult population of Saudi Arabia. Convenience sampling was used and all adults aged ≥18 were invited to participate. The questionnaire used in the study was available in both Arabic and English languages. It included a demographic section, a section dedicated to vaccination intention and, a section containing coronavirus anxiety scale (CAS). The data analysis was carried out using IBM SPSS version 23. The study was approved by an ethics committee (IRB-2021-05-297). Results: A total of 542 responses were analyzed. Most respondents had no anxiety attributed to COVID-19 (92.1%), self-reported good knowledge of COVID-19 (79.7%) and intended to administer a vaccine (57.4%). Age groups 18-29 years and 30-45 years, and having a chronic medical condition, were found to be determinants of having COVID-19 anxiety (p < 0.05). The variables of self-rated good knowledge of disease, never contracted COVID-19, and incomes of SAR 5,000 (i.e., USD 1333), and SAR 7,500-10,000 (i.e., USD 1999.5-2666), were found to be determinants of having positive intention toward vaccination (p < 0.05). Conclusion: The anxiety due to COVID-19 was present in a few participants. Besides, self-reported knowledge about COVID-19 and intention to administer a vaccine, were positively linked to each other. However, both variables had no effect on COVID-19 anxiety. It is important to review and address the determinants of positive intention to further increase vaccine acceptance rate.

Knowledge, attitude, and perceptions about polycystic ovarian syndrome, and its determinants among Pakistani undergraduate students.

OBJECTIVE: The aim of the study was to evaluate knowledge, attitude, perception, and assess the determinants of polycystic ovarian syndrome (PCOS) among undergraduate students. METHODS: A cross-sectional study was conducted among female undergraduate students in Pakistan using a survey. The questionnaire was formulated in English language by a review of literature and expert consensus. The sampling approach was convenient, and survey was available as electronic as well as hardcopy. Data were analyzed using IBM SPSS v23. Descriptive statistics namely mean ([Formula: see text]), standard deviation (SD), or median ([Formula: see text]) and interquartile range (IQR) were used dependent upon data distribution. In addition, range (R) was also utilized to express the results. The logistic and linear regression analyses were also conducted. Study received ethical clearance from ethics committees. RESULTS: A total of 646 responses were analyzed. The average PCOS knowledge score was 11.58 ± 4.99 (overall), 12.02 ± 4.73 (medical students), 9.36 ± 5.65 (non-medical students) (α = 0.861). 68.6% participants did not feel embarrassed while discussing PCOS in the society, but 67.3% never discussed it with a doctor. Lack of self-knowledge (31.6%) and shyness/reluctance (21.4%) were identified as barriers by most students. Further, obesity, irregular menstrual periods, family history, hirsutism and contraceptive use were observed to be determinants for having PCOS (AOR > 2, p<0.05). The disease knowledge score was higher for participants studying in medical college (ß = 0.184), having menstrual periods < 5 days (ß = 0.125), and with a family history (ß = 0.121) (p<0.05). CONCLUSION: The disease knowledge among undergraduates was inadequate. However, there is greater acknowledgement of PCOS as a problem for Pakistani women and barriers have been identified in the study. Conducting awareness campaigns within academic institutions which include promoting disease education, arranging talks, distributing merchandise with disease awareness signage, would greatly help in raising awareness of the disease and lowering stigma and hesitancy.