Positive social support improves self-esteem among married women in Riyadh, Saudi Arabia.

Recent literature has highlighted the role of social support in improving self-esteem. This study aimed to measure self-esteem and its association with social support among married women aged 30-75 years, in Riyadh city, Saudi Arabia. A cross-sectional survey was conducted during 2015-2016, on 1883 married Saudi women visiting the primary health care centers. Female data collectors conducted questionnaire-based interview and took anthropometric measurements. Self-esteem and social support were measured by utilizing the Rosenberg self-esteem scale and social support survey scale, respectively. The majority of women reported moderate to high levels of self-esteem. Multivariate linear regression analysis found that one unit increase in availability of emotional support, education, and physical activity were significantly associated with 0.18 (0.22, 0.39, p < .001), 0.17 (0.26, 0.48, p < .001) and 0.09 (0.39, 1.13) increase in self-esteem scores, respectively. Similarly, a unit increase in tangible support, education and physical activity were significantly associated with 0.20 (0.27, 0.44, p < .001), 0.17 (0.26, 0.47, p < .001), and 0.07 (0.17, 0.89) unit increase in self-esteem scores, respectively. The results highlight the importance of emotional and tangible support associated with high self-esteem. We recommend that social support groups should be created for providing counseling and support to the socially isolated women with low self-esteem.

Association between standardized vitamin 25(OH)D and dyslipidemia: a community-based study in Riyadh, Saudi Arabia.

BACKGROUND: Vitamin D deficiency associated with dyslipidemia can contribute towards cardiovascular diseases. Previous studies have found that Saudi Arabia has a high burden of vitamin D deficiency and cardiovascular disease risk factors. We aimed to explore the relationship between vitamin D deficiency and dyslipidemia, including total cholesterol, low-density lipids, high-density lipids (HDL), and triglycerides (TG) in apparently healthy Saudi male and female participants aged 30-75 years. METHODS: A cross-sectional study was conducted on 1717 apparently healthy Saudi participants from 18 primary health care centers in Riyadh. Data collectors conducted the interviews, took anthropometric measurements, and collected the blood samples. Serum 25-hydroxyvitamin vitamin D (25(OH)D) levels were measured using an electrochemiluminescence assay method. Lipid panel was measured by a fully automated analyzer using enzymatic methods. RESULTS: Multivariable logistic regression analysis revealed that the adjusted odds ratio (ORA) of low level of HDL cholesterol in association with 25(OH)D deficiency was 2.1 times higher in males (ORA = 2.1; 95% CI = 1.1, 3.9) and 1.3 times higher in females (ORA = 1.3; 95% CI = 0.9, 1.9). A significant excess odds ratio of high levels of TG in association with 25(OH) D deficiency was observed in females (ORA = 3.0; 95% CI = 1.1, 7.9) but not in males. CONCLUSION: Vitamin D deficiency is highly prevalent in Saudi Arabia. Low levels of HDL cholesterol in men and high TG levels in women are associated with vitamin D deficiency. The results emphasize the importance of treating vitamin D deficiency in the general population.

Sedentary lifestyle and Framingham risk scores: a population-based study in Riyadh city, Saudi Arabia.

BACKGROUND: Studies from Saudi Arabia have reported a continued increase in the prevalence of cardiovascular diseases and their associated risk factors. The objective of this study was to measure the gender differences in the cardiovascular disease (CVD) risk based on Framingham risk scores (FRS) and to explore the association of FRS with sedentary life style including physical inactivity, sitting time and central obesity among Saudi adults. METHODS: A cross-sectional survey was conducted on 2997 Saudi adults (males = 968, females = 2029) selected from 18 primary health care centres in Riyadh city, from December 2014 to August 2015. A detailed interview that evaluated lifestyle and past medical history was conducted; furthermore, anthropometric measurements and blood samples were collected for lipid profiling. The FRS were calculated based on the age, gender, systolic blood pressure, treatment for hypertension, diabetes, smoking status, total blood cholesterol and high-density lipoprotein levels. These scores were categorized into low risk (FRS < 10) and high/intermediate risk (≥10). A multivariable logistic regression analysis was performed. RESULTS: The mean (±SD) age of the males and females was 43.1(±11.7) vs 43.8(±10.9) years (p = 0.07), respectively. The number of Saudi male participants with intermediate-to-high FRS scores (≥10) was almost twice that of females (males 33% vs 17%). The multivariable logistic regression model after adjusting for education level and housing type, found that low physical activity (aOR & 95%CI for males 2.91 (1.45, 5.80); females 1.38 (1.06, 1.81); prolonged sitting time (aOR &95%CI for males 1.36 (0.98, 1.90) females 1.58 (1.20, 2.07), high central obesity (defined as waist circumference in males > 102 cms, and females > 88 cms) (aOR & 95%CI for males 2.38 (1.67, 3.41); females 3.35 (1.92, 5.87) were associated with high/ intermediate risk for CVD. CONCLUSIONS: A significant percentage of Saudi population revealed FRS ≥10. Females beyond the age of 50 were found to have a higher prevalence for CVD risk compared with males of the same age group. Modifiable risk factors like low physical activity, prolonged sitting time and central obesity have strong implications for primary prevention and management services that can change the risk profile of the Saudi population.

Prevalence and correlates of anaemia in adolescents in Riyadh city, Kingdom of Saudi Arabia.

OBJECTIVE: To determine the prevalence and correlates of anaemia in male and female adolescents in Riyadh, Kingdom of Saudi Arabia. DESIGN: A cross-sectional community-based study. SETTING: Five primary health-care centres in Riyadh. SUBJECTS: We invited 203 male and 292 female adolescents aged 13-18 years for interview, anthropometric measurements and complete blood count. Blood Hb was measured with a Coulter Cellular Analysis System using the light scattering method. RESULTS: Using the WHO cut-off of Hb<12 g/dl, 16·7 % (n 34) of males and 34·2 % (n 100) of females were suffering from anaemia. Mean Hb in males and females was 13·5 (sd 1·4) and 12·3 (sd 1·2) g/dl, respectively. Values for mean cell volume, mean cell Hb, mean corpuscular Hb concentration and red cell distribution width in male and female adolescents were 77·8 (sd 6·2) v. 76·4 (sd 10·3) µm(3), 26·1 (sd 2·7) v. 25·5 (sd 2·6) pg, 32·7 (sd 2·4) v. 32·2 (sd 2·6) g/dl and 13·9 (sd 1·4) v. 13·6 (sd 1·3) %, respectively. Multivariate logistic regression revealed that a positive family history of Fe-deficiency anaemia (OR=4·7; 95 % CI 1·7, 12·2), infrequent intake (OR=3·7; 95 % CI 1·3, 10·0) and never intake of fresh juices (OR=3·5; 95 % CI 1·4, 9·5) and being 13-14 years of age (OR=3·1; 95 % CI 1·2, 9·3) were significantly associated with anaemia in male adolescents; whereas in females, family history of Fe-deficiency anaemia (OR=3·4; 95 % CI 1·5, 7·6), being overweight (OR=3·0; 95 % CI 1·4, 6·1), no intake of fresh juices (OR=2·6; 95 % CI 1·4, 5·1), living in an apartment (OR=2·0; 95 % CI 1·1, 3·8) and living in a small house (OR=2·5; 95 % CI 1·2, 5·3) were significantly associated with anaemia. CONCLUSIONS: Anaemia is more prevalent among Saudi female adolescents as compared with males. Important factors like positive family history of Fe-deficiency anaemia, overweight, lack of fresh juice intake and low socio-economic status are significantly associated with anaemia in adolescents.

Correlates of cardiovascular disease risk scores in women in Riyadh, Kingdom of Saudi Arabia.

Saudi Arabia has a high prevalence of obesity and physical inactivity. We measured cardiovascular (CVD) risk scores and determined the factors associated with them in women in Riyadh, Saudi Arabia. A cross-sectional study using a self-administered questionnaire was conducted on 291 women aged ≥ 30 years. Information was collected on socio-demographics and physical health status. Anthropometric and blood pressure measurements were taken. Physical activity was measured using Kaiser's Physical Activity Survey and Godin's Leisure Time Exercise questionnaire. CVD risk scores were calculated using the non-laboratory-based Framingham Risk (FRS) prediction model for primary care. FRS scores ranged from 0.50 to 21.9. A total of 2.7% (n = 8) of women had a high FRS score (>20), 5.5% (n = 16) had intermediate scores (11-20), and 91.8% (n = 267) of women had low scores (<10) CVD risk scores. Multiple linear regression results indicated that a one-unit change in physical activity (household/caregiver index), strenuous exercise, waist circumference, number of children, television watching, and knee pain were significantly associated with -0.20 (p < .01), -0.12 (p = .03), 0.19 (p = .001), 0.29 (p < .01), 0.13 (p = .04), and 0.11 (p = .05) unit change in CVD risk scores, respectively. Household activities and strenuous exercise had a protective role in females in relation to CVD risk. Programs recommending physical activity at all levels should be encouraged.

A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform?

BACKGROUND: Since a decade, low and middle income countries have a rising trend of contracting their primary healthcare services to NGOs. In Pakistan, public sector often lacks capacity to effectively & equitably manage the healthcare services. It led the government to outsource the administration of primary health care services to a semi-autonomous government entity i.e. Peoples' Primary Healthcare Initiative (PPHI). This small scale study has assessed the quality of healthcare services at the contracted Basic Health Units (BHUs) with the PPHI and compared it with those managed by the local district government in the province of Sindh. METHODS: A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each type were selected from the districts Karachi and Thatta in Sindh province. BHUs were selected randomly and a purposive sampling technique was used to recruit the study participants at the two study sites. Focus group discussions were conducted with patients visiting the facility while in-depth interviews were conducted with service providers. An observation based resource availability checklist was also administered. RESULTS: There was a significant difference between the PPHI and the district government administered BHUs with regard to infrastructure, availability of essential medicines, basic medical appliances, mini-lab facilities and vehicles for referrals. These BHUs were found to have sufficient number of trained clinical staff and no punctuality and retention issues whatsoever. The district government administered BHUs presented a dismal picture in all the aspects. CONCLUSION: Out-sourcing of primary healthcare facilities has resulted in significantly improved certain aspects quality and responsiveness of primary healthcare services. This strategy is likely to achieve an efficient and perhaps an equitable healthcare delivery in low and middle income countries where governments have limited capacity to manage healthcare services.

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

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

Association Between Harsh Disciplinary Methods and Child Functioning in Children Aged 7-14 Years in Punjab, Pakistan.

Despite having adverse physical and mental health outcomes, harsh disciplinary methods are commonly practiced all over the world. This study aims to measure the harsh disciplinary actions taken by parents and their association with child functioning in children, aged 7 to 14 years in Punjab, Pakistan. This study is based on secondary data obtained from the United Nations Children's Fund (UNICEF's) Multiple Indicator Cluster Survey, conducted in the Punjab province from 2017 to 2018. Parents/caregivers of 19,721 children were included in the analysis. Questionnaire-based interviews were conducted, and the data collection form included sociodemographic information, questions on different "Methods of Child Discipline" and the "Child functioning module." The data was analyzed using STATA 15.0. Multiple logistic regression analysis was conducted to calculate the adjusted odds ratio and 95% CI exploring the association between harsh disciplinary methods and child functioning. More than 50% of children were exposed to severe physical, psychological, and emotional disciplinary methods. Exposure to severe physical aggression was associated with increased difficulty in learning (2.60 [1.27, 5.31]), remembering (2.83 [1.47, 5.44]), controlling behavior (1.63 [1.21, 2.18]), anxiety (1.98 [1.25, 3.13]), depression (2.57 [1.57, 4.22]) and making friends (1.94 [1.01, 3.79]). Whereas moderate physical aggression and psychological aggression were associated with (1.48 [1.19, 1.84]) and 1.5 times (1.20, 1.84) increase in difficulty in controlling behavior, respectively. Nonviolent actions were associated with protective odds for self-care (0.33 [0.17, 0.65]), communication (0.51 [0.27, 0.96]), learning (0.56 [0.33, 0.95]), remembering (0.62 [0.39, 0.90]), concentration (0.50 [0.31, 0.80]), anxiety (0.60 [0.46, 0.79]) and depression (0.67 [0.49, 0.92]). Severe disciplinary methods are detrimental to the child's personal care, mental, social, emotional, and psychological well-being, whereas nonviolent actions are associated with positive child functioning. In a third-world country such as Pakistan, this topic is widely undiscovered and understudied, thus emphasizing the need for awareness and education of parents and healthcare providers.

A Survey on the Knowledge and Awareness of Testicular Cancer and Testicular Self-Examination Among Men in Saudi Arabia.

Objectives The aim of the study was to assess the knowledge and awareness of testicular cancer (TC) and testicular self-examination (TSE) and to identify the associated factors in men in Saudi Arabia. Methods An online questionnaire-based study was conducted in Saudi Arabia with a representative sample of 794 participants. The questionnaire comprised knowledge, awareness and attitude questions regarding TC and TSE in addition to signs/symptoms and risk factors. Multivariate logistic regression analysis was conducted to identify the significant variables associated with knowledge of TC and TSE. Results Around 43% (n=340) of the participants had inadequate knowledge of TC, whereas 26% (n=205) had heard about TSE and only 65 (8.2%) performed TSE. The first model for knowledge found that participants with a low level of education [2.75 (1.18, 6.42)]; no past history of a testicular problem [2.20 (1.22, 3.95)] and those who had not heard about TSE [1.79 (1.24, 2.57)] were at higher odds for inadequate knowledge, whereas those whose mothers had received college-level education [0.39 (0.19, 0.79)] and those who received information from school/college [0.61 (0.37, 0.97)] were more likely to have adequate knowledge about TC. The second model for TSE found that a low level of education 5.24 (1.34, 20.52) was associated with not performing TSE. Receiving information from social media [0.08 (0.03, 0.17)], school/college [0.06 (0.02, 0.13)], family and friends [0.17 (0.05, 0.57)] and medical staff [0.08 (0.03, 0.17)] were associated with higher odds of performing TSE. Conclusion The majority of Saudi males have knowledge about TC. On the contrary, only a small percentage of the respondents have heard of or performed TSE as a screening technique. Educated sources of information can be a reliable way of giving correct knowledge on sensitive topics like TSE.

Relationship Between Violence Against Women, Social Support, Self-Esteem, and Mental Health in Riyadh, Saudi Arabia.

The objectives of this study were to measure the prevalence of mental distress and to explore the relationship between violence against women (VAW), social support, self-esteem, and mental distress in women in Riyadh, Saudi Arabia. A questionnaire-guided, cross-sectional, interview-based study was conducted with 1,932 women, in primary healthcare centers. Around 29% reported moderate to severe distress levels, whereas 40% of women reported lifetime exposure to at least one type of violence. Linear regression analysis found that VAW was positively associated with mental distress with a unit increase associated with a 0.13 (0.58, 1.15) increase in distress level, whereas, for both social support and self-esteem, a unit increase in violence was associated with -0.23 (-0.47, -0.32) and -0.22 (-0.49, -0.33) unit decrease in the mental distress. Structural equation modeling found that violence had direct significant negative effects on social support (ß = -.156, p < .001) and self-esteem (ß = -.135, p < .001). Both social support (ß = -.266, p < .001) and self-esteem (ß = -.183, p < .001) had direct significant negative effects on distress. VAW exerted a direct significant positive effect on distress (ß = .171, p < .001) as well as an indirect effect (ß = .068, p < .001). Both social support (ß = .044, p < .001) and self-esteem (ß = .025, p < .001) were significant mediators of the effect of violence on mental distress. VAW can lead to mental distress and low self-esteem. Identification, counseling, and social support for women are important to improve their self-confidence and reduce the adverse effects of violence.

Determinants of sexual health knowledge in adolescent girls in schools of Riyadh-Saudi Arabia: a cross sectional study.

BACKGROUND: There are many social and cultural factors affecting the sexual knowledge of adolescents. This study measured the sexual health knowledge level of adolescents and identified its association with role of parents, friends and school environment in adolescent girls in Riyadh, Saudi Arabia. METHODS: Four hundred and nineteen Saudi female students belonging to intermediate and secondary grades were randomly selected from four public and private girl schools. 255 (69.8%) students were ≤15 years and 164 (39.2%) were >15 years. A self-administered structured questionnaire comprising of socio-demographic information, role of parents and teachers, availability of school curriculum on sexual health was used. Sexual health knowledge was assessed through questions on identification of physical changes during puberty for ≤15 years and separate questions on sexually transmitted infections for >15 years. RESULTS: 54% of ≤15 years and 70.7% of >15 years had poor sexual health knowledge. Multivariate analysis found determinants for poor sexual health education in ≤15 years are: lower education level of both parents (OR 10.87; 95% CI 2.44-48.38), second birth order or more (OR 2.32; 95% CI 1.24-4.33) and absence of school curriculum on sexual health (OR 0.56; 95% CI 0.33-0.95). Determinants for >15 years of age are : mothers with low literacy (OR 3.08, 95% CI 1.42-6.71), as for sources of poor sexual knowledge : parents (OR 10.10; 95% CI 2.70-37.74), schools (OR 6.95; 95% CI 1.95-24.78) maids (OR 4.57; 95% CI 1.26-16.59) and media (OR 5.12; 95% CI 1.29-20.07) were statistically significant factors. CONCLUSION: Government agencies with collaboration of all stake holders should develop policies and programs for implementing and evaluating integrated and comprehensive sexual educational programs for adolescents in Saudi Arabia.

Burden of skin lesions of arsenicosis at higher exposure through groundwater of taluka Gambat district Khairpur, Pakistan: a cross-sectional survey.

Prior surveys conducted have found higher proportion of arsenic-contaminated wells in villages along river Indus in Pakistan. This study aims to determine the prevalence of arsenicosis skin lesions among population exposed to higher exposure in taluka Gambat district Khairpur in Sindh. The cross-sectional survey was conducted from August 2008 to January 2009 among 610 households. A total of 707 water sources (hand pumps/wells) were tested from the villages of union councils of Agra and Jado Wahan for arsenic levels with Quick rapid arsenic field test kits. A total of 110 households exposed to arsenic levels >50 ppb were identified. Case screening for arsenic skin lesions was performed for 610 individuals residing in these 110 high-risk households. Information regarding household and socio-demographic characteristics, height and weight measurements and arsenic exposure assessment were collected. Physical examinations by trained physicians were carried out to diagnose the arsenic skin lesions. After data cleaning, 534 individuals from all age groups were included in the final analysis which had complete exposure and outcome information. Overall prevalence of arsenicosis skin lesions was 13.5 % (72 cases). Of the 534 individuals, 490 (91.8 %) were exposed to arsenic levels of ≥100 ppb in drinking water (8.2 % to >50-99 ppb, 58.6 % to 100-299 ppb, 14.6 % to 300-399 ppb and 18 % to ≥400 ppb). Prevalence rate (per 100 population) of arsenicosis was highest at arsenic levels of 100-199 ppb (15.2 cases) followed by ≥400 ppb (13.5 cases) and 300-399 (12.8 cases). Prevalence rate was higher among females (15.2) compared to males (11.3). Our study reports arsenicosis burden due to exposure to higher arsenic levels in drinking water in Pakistan. Exposure to very high levels of arsenic in drinking water calls for urgent action along river Indus. Prevalence of skin lesions increases with increasing arsenic levels in drinking groundwater. Provision of arsenic-free drinking water is essential to avoid current and future burden of arsenicosis in Pakistan.

Urinary Incontinence Affects the Quality of Life and Increases Psychological Distress and Low Self-Esteem.

Urinary incontinence is a common problem among women of reproductive age. The objectives of this study were to measure the prevalence of urinary incontinence and the association with quality of life, psychological distress and self-esteem in Saudi women in the city of Riyadh. A questionnaire-based cross-sectional study was conducted in primary healthcare centers with Saudi women aged between 30 and 75 years. The questionnaire consisted of Urinary Distress Inventory, Incontinence Impact Questionnaire, Kessler Psychological Distress Scale, Rosenberg Self-esteem Scale, and the Female Sexual Function Index. Around 47.5% of women were suffering from urinary incontinence. The most common type of incontinence was stress (79%), followed by urge (72%) and mixed type (51%). Multivariate logistic regression analysis found that stress (5.83 (3.1, 11.1)), urge (3.41 (2.0, 5.8)), mixed (8.71 (3.4, 22.4)) incontinence and severe urinary distress (8.11 (5.2, 12.7)) were associated with impaired quality of life. Women suffering from stress and urge incontinence were twice (2.0 (1.3, 2.2)) as likely of reporting moderate/severe mental distress. Women suffering from urge incontinence (1.92 (1.4, 2.7)) and severe urinary distress (1.74 (1.1, 2.8)) were at a higher prevalence of reporting low self-esteem. Urinary incontinence affects the physical, psychological, social, and sexual health of women. Healthcare providers should be knowledgeable about the adverse consequences of UI on women's personal and social life, and provide counseling and treatment accordingly.

Social Anxiety, Social Support, and Quality of Life in Patients With Epilepsy at a Tertiary Care Hospital in Saudi Arabia.

Objectives The objectives of this study were to measure the prevalence of social anxiety disorder and its association with quality of life (QoL) in patients with epilepsy (PWE) in King Khalid University Hospital, Riyadh City, Saudi Arabia. Methodology A self-administrated, online, questionnaire-based, cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia on PWE 18 years of age and above from February 2021 to January 2022. Social anxiety and the five domains of QoL were measured using the validated Arabic versions of the Liebowitz social anxiety scale and European quality-of-life 5-dimensions 3-levels (EQ-5D-3L), respectively. Information was collected on sociodemographic characteristics, social support, and adverse life events. Results This study included 246 patients, of which approximately 25% and 15% had mild/moderate and severe/very severe levels of social anxiety, respectively. Severe social anxiety was significantly associated with poor QoL domains, namely, restricted mobility (2.65 [1.00, 6.99]), inability to perform usual activities (3.88 [1.61, 9.36]), pain or discomfort (3.21 [1.38, 7.48]), and anxiety and depression (5.77 [2.45, 13.61]). Similarly, the lack of social support was also significantly associated with poor QoL, such as restricted mobility (2.42 [1.12, 5.22]), restricted self-care (3.64 [1.18, 11.17]), inability to perform usual activities (2.86 [1.42, 5.75]), pain/discomfort (2.53 [1.38, 4.66]), and anxiety and depression (1.93 [1.04, 3.57]). Females showed higher odds for restricted mobility (2.79 [1.29, 6.03]) and low education with limited self-care (7.38 [1.49, 36.71]). Conclusion Patients with epilepsy reported high levels of social anxiety that have a negative effect on their QoL. Healthcare providers should be able to provide counseling to the patient and their family members. In addition, social support is important to improve their mobility and socialization with friends and neighbors.

Health-Seeking Behaviors and Misconceptions about Osteoarthritis in Patients and the General Population in Saudi Arabia.

Osteoarthritis (OA) is a public health disease that causes decreased mobility and leads to poor quality of life. A person's health-seeking behavior can influence their understanding of a disease, which in turn can alter its course. The objectives of this study were to measure the misconceptions about osteoarthritis and to identify the associated health-seeking behaviors. An online, self-administered, questionnaire-based study was conducted with 872 Arabic-speaking participants divided into three strata, group 1 comprising of patients with OA, group 2 participants with joint pain (without OA) and group 3 comprised of general population. Multivariate logistic regression analysis found that seeking care from general practitioners [3.29 (1.19, 9.16)], taking advice from friends [2.83 (1.08, 7.42)], seeking care from chiropractors [3.67 (1.02, 13.60)] and podiatrist [4.64 (1.31, 16.51)] were significantly associated with misconceptions, whereas, the odds were lower for those using social media [0.16 (0.06, 0.46)] and expert websites [0.63 (0.40, 0.99)]. The findings of this study imply that the level of misconceptions is high amongst all three strata.. Expert websites and social media have a positive effect on the management of osteoarthritis. However, general practitioners and allied health workers should regularly update their knowledge using refresher courses.

Risk factors for depression among married women belonging to higher and lower socioeconomic status in Karachi, Pakistan.

OBJECTIVES: To determine the risk factors for depression among married women belonging to low and high socioeconomic status in Karachi. METHODS: The study design was cross-sectional. The data was collected from 128 adult married women during July to September 2005. The women were selected from different socioeconomic classes from five hospitals/institutes in Karachi. The Centre for Epidemiology Studies-Depression (CES-D) scale was used to screen the subjects for depression and a structured questionnaire was used to identify the factors for depression. RESULT: According to the CES-D scale, 65% of the study population was found to be depressed. Among the women from high socioeconomic status, social conditions were identified as a significant factor for causing depression, whereas social relations, specifically relationship problems with husband, were the major factor for depression among women belonging to the low socioeconomic status. CONCLUSION: The prevalence of depression among married women living in Karachi is high. However, underlying factors for causing depression vary among women belonging to low and high socioeconomic status.

Experience of devolution in district health system of Pakistan: perspectives regarding needed reforms.

OBJECTIVE: To identify the strengths and weaknesses of the devolved district health system from the experiences of different stakeholders, and recommend direction for reforms in the existing system. METHODS: Using qualitative exploratory design, the study was conducted in 3 cities of the province of Sindh in Pakistan--Karachi, Khairpur and Larkana--from January to March 2010. Nine in-depth interviews were conducted with multiple stakeholders (District Coordination Officer, Executive District Officer, Medical Superintendent, Medical officers, Health system experts) of the district health system. Interviews included questions on autonomy in decision-making at the district level and the effectiveness of the devolved health system. Data transcripts were made from the recorded tapes and notes taken during the interviews. Thematic analysis was done and the data was classified into 3 broad themes of governance, financing and factors related to resources and service delivery. RESULTS: The main strengths identified included formation of District Health Management Team for wider inter-sectoral collaboration, creation of new posts at sub-district level for close monitoring and supervision, and greater financial autonomy to prioritise according to needs. The reported weaknesses included lack of team work, limited autonomy, lack of capacity, nepotism and poor accountability. CONCLUSION: While devolution has been scrapped in most parts of the country, the findings of the study provide recommendations for the delegation of further powers at sub-district and union council level, enhanced capacity and increased transparency and accountability to make the system work.

Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms.

Purpose: To measure the associations of diet, psycological distress, and lifestyle factors with premenstrual symptoms (PMSx) in women in Riyadh, Saudi Arabia. Patients and Methods: An interview-based, cross-sectional study was conducted on 1831 women aged 18-50 years seen in primary healthcare centers and teaching institutes in Riyadh from December 2015 to June 2016. Question topics included sociodemographics, physical activity, smoking, and dietary habits information. PMSx were assessed using a symptom checklist with 6 domains: anxiety/mood changes; abdominal/back/joint pain; increased appetite/weight gain, breast pain/tenderness, severe headache, and ≥3 PMS symptoms (any). Multivariable logistic regression analyses were conducted to provide adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each PMSx domain. Results: Except for breast pain, drinking >5 cups of Arabic coffee was associated with increased odds of anxiety/mood [aOR 2.44 (95% CI 1.44, 4.12)], pain [1.83 (1.13, 2.98)], appetite/weight gain [1.66 (1.10, 2.50)], headache [1.57 (1.00, 2.56)] and ≥3 symptoms [1.50 (1.07, 2.11)]. A significant association was noted between sugar intake and anxiety/mood symptoms [1.53 (1.07, 2.19)] and abdominal/back pain symptoms [1.84 (1.17, 2.88)]. Increased severity of psychological distress was associated with all symptom domains: anxiety/mood [2.75 (1.92, 3.94)]; pain [1.45 (0.92, 2.28)]; appetite/weight gain [2.01 (1.53, 2.65)]; breast pain [2.19 (1.68, 2.88)]; headache [1.86 (1.37, 2.54)] and ≥3 symptoms [3.52 (2.49, 4.95)]. Low physical activity was significantly associated with odds of breast pain symptoms [1.29 (1.04, 1.59)]. Smokers were 3.41 (1.19, 9.77) times as likely to report any ≥3 symptoms compared to nonsmokers. Conclusion: Several potentially modifiable factors, such as diet and stress, were positively associated with PMSx. Thus, we suggest that increasing women's awareness of healthy lifestyles, particularly diet and stress reduction, may help to reduce the occurrence of premenstrual symptoms.

Sexual Harassment and Mental Health of Female Healthcare Workers in a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Background In this study, we aimed to estimate the prevalence and identify the correlates of sexual harassment among female healthcare workers in a tertiary care hospital in Riyadh, Saudi Arabia. Methodology A cross-sectional study was conducted among 432 female healthcare workers in both Arabic and English languages. The questionnaire consisted of five sections which included the sociodemographic characteristics, a sexual harassment survey, the Kessler distress scale, social support, and the Rosenberg self-esteem scale. Unadjusted odds ratios with 95% confidence intervals were calculated to identify the significant factors associated with harassment. Results Sexual harassment was reported by 15.5% of the participants, with verbal harassment being the most commonly reported (66%), followed by physical harassment (34%). Around three-fourths of harassment acts took place during the daytime, and 18% of the participants preferred to keep quiet about it. Moderate distress [2.38 (1.17, 4.84)] and severe distress [2.31 (1.09, 4.90)], feeling hopeless [2.86 (1.47, 5.57)] and feeling depressed [3.70 (1.62, 8.48)] were significantly associated with sexual harassment. Low self-esteem items, such as "I don't have good qualities" [4.78 (2.0, 11.43)], "don't have much to be proud of" [2.10 (1.22, 3.63)], "wish that I have more respect for myself" [2.30 (1.36, 3.90)], and "inclined to feel that I am a failure" [2.27 (1.24, 4.16)] were significantly associated with sexual harassment. Conclusions It is important for all employees to know about their rights and report all types of harassment acts. Counseling sexually harassed victims should focus on improving the self-esteem and mental distress of these women. Prevention of harassment against female healthcare workers can improve their mental health as well as their quality of work.

The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study.

BACKGROUND: High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth; however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth. METHODS: In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively, and had a blood cortisol level drawn. Women were followed up after delivery to determine birth outcomes. Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth, stress, depression and cortisol. Logistic regression analysis was used to determine the key factors predictive of preterm birth. RESULTS: 132 pregnant women participated of whom 125 pregnant women had both questionnaire and cortisol level data and an additional seven had questionnaire data only. Almost 20% of pregnant women (19·7%, 95% CI 13·3-27·5) experienced a high level of stress and nearly twice as many (40·9%, 95% CI 32·4-49·8%) experienced depressive symptoms. The median of cortisol level was 27·40 ug/dl (IQR 22·5-34·2). The preterm birth rate was 11·4% (95% CI 6·5-18). There was no relationship between cortisol values and stress scale or depression. There was a significant positive relationship between maternal depression and stress. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model. CONCLUSIONS: Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. There was no relationship between stress, and depression, cortisol and preterm birth. There were high rates of stress and depression among this sample suggesting that there are missed opportunities to address mental health needs in the prenatal period. Improved methods of measurement are required to better understand the psychobiological basis of preterm birth.