Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study.

BACKGROUND: Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors. METHODS: A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6-18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3-6 months later. RESULTS: Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child's age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child's age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001). CONCLUSIONS: Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.

Knowledge of cervical cancer screening among Omani women attending a university teaching hospital: a cross-sectional study.

OBJECTIVES: To assess knowledge, attitudes, and practices regarding cervical cancer and Pap smear screening among Omani women attending a tertiary clinic in Muscat, Oman, and to establish correlations with selected sociodemographic factors. METHODS: An observational, cross-sectional study was carried out among Omani women aged 18-50 years old attending the outpatient clinic of the Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, from October 2019 to February 2020. A validated Arabic-language questionnaire was utilized to collect data regarding the participants' sociodemographic characteristics, their knowledge of cervical cancer and related risk factors, and their knowledge, attitudes, and practices related to cervical cancer screening and Pap smear testing. RESULTS: Of the 380 respondents, 86 and 55% had previously heard of cervical cancer and Pap smear testing, respectively; however, only 26% were knowledgeable concerning these topics. Knowledge scores were significantly associated with various sociodemographic factors, including marital status and a previous awareness of cervical cancer (odds ratio: > 1, p < 0.05). Only 21% had themselves previously undergone Pap smear testing; however, 75% reported being willing to undergo such screening in future. CONCLUSIONS: Knowledge regarding cervical cancer-related risk factors and Pap smear screening was poor among a cohort of Omani women attending a tertiary clinic in Muscat, Oman. This may play a role in the increased frequency of cervical cancer cases observed in Oman over recent years. As such, a well-structured public education program is recommended to raise awareness of this issue.

Introduction of Cancer Education Program in Secondary School Curriculum: Perceptions of Education Teachers and Policymakers in Oman.

The prevalence of cancer is expected to increase worldwide for reasons related to a lack of awareness of cancer prevention, diagnosis, and treatment. Implementing cancer education programs in schools in the developing countries with similar demographic, economic, and health transition to that of Oman is crucial for enhancing students' cancer knowledge and promoting healthy behavior. This study aims to explore the perceptions of education, policymakers, and teachers regarding the inclusion of cancer education in secondary school curriculum. The study employed a qualitative method, conducting semi-structured interviews with ten education policymakers and ten school teachers. Interviews were audio recorded, transcribed, and analyzed verbatim and qualitatively using the framework approach. Three main themes have emerged: (1) perception of the importance of cancer education inclusion within the school curriculum, (2) the perception of cancer education implementation in schools, and (3) the perceived challenges of introducing cancer education in schools. Policymakers and teachers in Oman recognize the importance of cancer education in schools and emphasized the need to prioritize it due to the increasing prevalence of the disease and the belief that negative lifestyle habits played a role in its increased prevalence. Implementing cancer education programs in schools is essential in improving students' knowledge of cancer and health behaviors. Collaboration between the department of school health in ministry of education and in ministry of health and incorporating cancer education into different school activities can be beneficial. However, the perceived challenges of cancer education in schools include the decision on the priority of cancer education among other topics, the required procedures to introduce cancer education in schools, and the financial and logistics obligations of implementing cancer education programs. Therefore, addressing the financial and logistic requirements is essential to overcome the associated challenges for implementing cancer education programs within the school curriculum.

Effectiveness of an Educational Program on Awareness of Cancer Risk Factors, Symptoms, and Barriers to Medical Help-Seeking Among Adolescent Omani Students: an Interventional Study.

Cancer is the second leading cause of death worldwide, with attributable mortality expected to continue increasing over time. High school students are often targeted to enhance awareness of cancer risk factors and symptoms and promote early medical help-seeking behaviors. This study aimed to evaluate the effectiveness of a cancer education program among Omani adolescents. A total of 12 public schools were randomly selected from three governorates and assigned to either the intervention or control group. Students attending grades 10 and 11 at the selected schools were targeted. The Cancer Awareness Measure tool was used to evaluate knowledge of cancer risk factors and symptoms, perceived barriers to seeking medical help, and anticipated time to consult a doctor for cancer warning symptoms at baseline (T0) and after 4 weeks (T1). After T0, the intervention group participated in a 1-h cancer education program involving a slideshow presentation and group discussion; they also received a leaflet and online access to program materials and videos. A total of 1716 students were enrolled in the study, including 886 (51.6%) assigned to the control group and 830 (48.4%) to the intervention group. Recognition of cancer risk factors (Z = 24.86; p ˂ 0.001) and cancer symptoms (Z = 24.91; p ˂ 0.001) significantly improved in the intervention group between T0 and T1, and compared to the control group at T1 (U = 33.28; p ˂ 0.001, and U = 34.55; p ˂ 0.001, respectively). In addition, anticipated time to help-seeking (Z = 20.15; p ˂ 0.001) and barriers to help-seeking (Z = 10.33; p < 0.001) decreased significantly between T0 and T1, and compared to the control group at T1 (U = 19.00; p ˂ 0.001, and U = 3.58; p < 0.001, respectively). The intervention effectively increased knowledge of cancer risk factors and symptoms and promoted early medical help-seeking behaviors among school-aged Omani adolescents. Integration of cancer education within high school curricula can aid cancer prevention and early intervention efforts. However, additional follow-up is required to confirm the long-term effectiveness of such programs.

Health-Related Quality of Life of Omani Colorectal Cancer Survivors.

BACKGROUND: Colorectal cancer (CRC) patients often experience physical and psychological symptoms which affect quality of life (QOL). PURPOSE: This study aimed to identify factors affecting QOL among adult Omani CRC survivors. METHODS: A prospective cross-sectional study of 124 adult CRC survivors was conducted at the two main oncology referral hospitals in Oman. A validated Arabic version of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire for Colorectal Cancer-29 (EORTC QLQ-CR29) was used to collect data. RESULTS: Of the 118 participants (response rate: 95.2%), 59 (50.0%) were male. The mean age was 52.7 years. Overall, 102 (86.4%) had been diagnosed with CRC at stages II or III. High mean scores on the QLQ-CR29 functional scale were reported for body image (88.9), weight (79.3), and anxiety (75.4). Mean scores for sexual interest were lower in men (31.4) compared to women (62.2). Severe anxiety was reported in 12 survivors (10.2%). Age, gender, the presence of comorbidities, and tumor location were significant predictors of QOL (P ≤.05). CONCLUSION: Omani CRC survivors demonstrated satisfactory QOL, although men reported more anxiety and sexual problems. Healthcare providers in Oman should conduct regular assessments of CRC survivors and offer counseling services if necessary.

The Effectiveness of Interventional Cancer Education Programs for School Students Aged 8-19 Years: a Systematic Review.

The implementation of effective interventional cancer education programs in schools could help to reduce delays in diagnosis and improve cancer survival by increasing awareness of risk factors and symptoms among students. The aim of this review was to determine the effectiveness of interventional cancer education programs delivered to school students aged 8-19 years. Various databases were searched to identify controlled and uncontrolled studies published in English language articles between January 2000 and January 2020. Selected publications were then critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. A total of 12 studies meeting these criteria were identified. Of these, eight were randomized, and five included control groups. All of the studies conducted the intervention over the course of 1, 3, or 4 days, and there was no follow-up phase in seven studies. Various modes and materials were used in the delivery of the interventions, including children's books and booklets, expert talks or presentations, videos, discussions, role-playing exercises, hands-on activities, group work, quizzes, and homework. There was some evidence to indicate that the interventions enhanced short-term knowledge, attitudes, self-efficacy, and behavioral intentions; however, there was less evidence regarding their long-term effectiveness, particularly in terms of help-seeking barriers. Interventional education programs are important to increase knowledge of cancer among school students aged 8-19 years. Decision-makers should consider including relevant topics within the educational curricula. Both healthcare providers and non-educational organizations should work together to support effective cancer interventional education programs for school students as part of their long-term cancer prevention efforts.

Knowledge and Experiences of Final Year Medical and Nursing Students with Regard to Palliative Care at Government University in Oman: A Questionnaire Based Study.

Palliative care (PC) is an essential part of the healthcare system, aiming to improve the quality of life of terminally ill patients and their families through prevention, relief of suffering, and providing psychosocial and spiritual support. To achieve high-quality PC, medical education should encompass PC training, including knowledge of PC, and skills and attitudes towards PC, at the undergraduate level. The aim of this study is to identify PC knowledge and experience among undergraduate medical and nursing students at Sultan Qaboos University (SQU), a government university in Oman. A validated questionnaire that measures knowledge and experiences of PC was administered to all final year medical and nursing students (N = 196) at SQU. The majority of the students (93.4%) were aware of the term PC, but most of them (68.9%) did not have any experience of PC. Around half of the students (54.9%) had a vague notion of how to implement PC, and only 41.3% felt confident in providing PC for terminally ill patients. Less than half of the students (44.8%) were aware that the patient's family should be included in PC, as well as the patient. The majority of students (71.3%) thought that PC should be included in the undergraduate teaching curriculum, though few students (17.9%) knew that PC is currently a specialized medical unit (sub-department) in Oman. Most of the students (73.0%) thought that terminally ill patients have the right to choose "do not resuscitate," but few students agreed that patients should be able to request a lethal dose (24.0%) or consent to a physician-assisted suicide (35.7%). Most of the students (84.7%) believed that special psychological support should be provided for doctors and nurses working in PC. Bivariate analysis showed no significance in the knowledge of applied PC in relation to which of the colleges the students were from (p = 0.283) or gender of the students (p = 0.068). Despite the fact that SQU students had favorable attitudes towards PC, they have insufficient knowledge and lack of experience. As the number of geriatric and terminal cancer patients increases across Oman, there is a need for the healthcare system to provide high-quality and effective PC services. Thus, there is an urgent need to integrate PC teaching courses as part of the undergraduate medical education for medical and nursing students.

Knowledge and Awareness of Prostate Cancer Among Omani Men Attending a Teaching Hospital.

Prostate cancer is ranked as the fourth most prevalent cancer in the world and the second most common cancer affecting men. In Oman, prostate cancer is one of the most common cancers among men, with the majority of prostate cancer patients presenting in the more advanced stages of the disease. Public awareness of the risk factors, symptoms and emphasising the importance of seeking early medical attention could help to improve the outcomes and survival rates of prostate cancer patients. The aim of this study is to determine the awareness levels of the risk factors, symptoms and barriers to seeking early medical intervention among adult Omani men. A validated questionnaire measuring the knowledge of risk factors, symptoms and barriers to seeking early medical help was used to collect data from adult Omani men attending a teaching hospital in Muscat, Oman. Out of 720 men who were invited, 600 participated in the study (response rate = 83%). The most recognised risk factor was obesity (366; 61.0%), and the least was sexually transmitted diseases (204; 34.0%); the most recognised symptom was unexplained weight loss (26.5%), the least was changes in seminal fluid (13.3%); the most common barrier to seeking early intervention was "not trusting the medical knowledge of the doctors" (57.5%), the least was "difficulty in arranging transport" (19.5%). Age, education level, marital status and family history of cancer were significantly associated with the participants' knowledge of prostate cancer. Participants received a significant part of their prostate cancer awareness via the social media. National awareness campaigns using social media and information leaflets are needed to educate Omani men on prostate cancer awareness and prevention and to increase trust in the expertise of medical professionals. Further research exploring the barriers to seeking early medical intervention is needed.

Awareness of Stomach and Colorectal Cancer Risk Factors, Symptoms and Time Taken to Seek Medical Help Among Public Attending Primary Care Setting in Muscat Governorate, Oman.

Colorectal and stomach cancers are the top ranking cancers in Oman. Most of the patients are diagnosed at advanced disease stages. The aim of this study is to explore the knowledge of risk factors, symptoms and the time needed to seek medical care for stomach cancer and colorectal cancer (CRC) among Omani participants attending 28 local health centres (LHCs) in the governorate of Muscat, the capital city of Oman. The Bowel Cancer/CRC Awareness Measure (CAM) questionnaire (translated into Arabic) was used to collect data from Omani adult participants (aged 18 years and above) who attended the LHCs during the study period. There was a total of 405 participants in the study out of the 500 who were invited (response rate = 81%). The most recognised risk factors were excessive drinking of alcohol (73.1%) and smoking (70.6%); the least recognised were doing less exercise (37.3%), eating food which was high in salt (26.8%) and a diagnosis of diabetes mellitus (24.9%). Multinomial logistic regression showed that young participants recognised more risk factors than older participants; highly educated participants recognised more risk factors than the less-educated and married participants recognised more risk factors than single participants. Participants with a high level of education were more likely to identify signs and symptoms of stomach cancer and CRC than less-educated participants. Multinomial logistic regression showed women were more likely than men to report barriers to seeking medical help (fear, difficulty in arranging transport, worried what the doctor might find). Also, participants with less education were more likely to report barriers than the highly educated (worried about wasting the doctor's time, difficulty in arranging transport, did not feel confident talking about symptoms, embarrassed, scared, worried what doctor might find). The majority of participants (93.6%) were not aware of any CRC screening programme or had undergone any screening (98.3) for CRC. Only 52.6% of participants would have a colonoscopy if the doctors advised; the main reasons for refusal were embarrassment (40.0%), lack of trust in the doctors (33.3%) and religious or culture beliefs (21.3%). Around 39% of participants would prefer to have their colonoscopy examination abroad. There is an urgent need to increase the public's awareness of stomach cancer and CRC in Oman, particularly with evidence emerging of an increase in the incidence. School curriculums could include sessions on cancer education and the information be reiterated to students periodically. A strategy to establish a CRC screening programme in Oman might be paramount as the incidence of CRC increased.

Patients' attitudes and experiences of relational continuity in semi-urban general practices in Oman.

BACKGROUND: Relational continuity is a cornerstone of primary care. In developing countries, however, little research has been conducted to determine the perception and experiences of patients in view of relational continuity in primary care. OBJECTIVE: To study the role of relational continuity in primary care settings and its effect on patients' perceptions and experiences. METHODS: A questionnaire-based survey was conducted at eight primary care health centres (PCHCs) in Al-Seeb province, Muscat, the capital city of Oman. All Omani patients aged 18 years and above attending their PCHCs during the study period were invited to participate in the study. RESULTS: From a total of 1300 patients invited, 958 Omani patients agreed to participate in the study (response rate = 74%). More than half of the patients (61%) expressed the preference of consulting the same primary care physician (PCP) to whom they were accustomed. This increased to 69% if the patients had psychosocial problems and to 71% if the patients had chronic medical conditions. A significant proportion of the respondents (72%) felt comfortable and relaxed when consulting the same PCP and 67% expressed an interest in maintaining continuity with the same PCP. The general perspective held by the majority of the studied patients (61%) indicated that relational continuity improved both the patients' medical conditions (51%) and the quality of services (61%). In actuality, however, only 18% experienced relational continuity in their PCHCs. The preference for relational continuity was significantly increased among patients who identified a favourite PCP (P = 0.029) and among educated patients (P = 0.023). CONCLUSION: Although it is relatively difficult to consult with the same PCP, the majority of Omani patients have experienced several benefits from relational continuity within the context of patient-physician relationship. The preference for relational continuity was highly expressed by patients with chronic or psychosocial problems, patients who were educated and those who identified a named PCP. In view of these findings, the basis of relational continuity if progressed, a great effort is needed to develop and implement strategies to promote relational continuity in primary health care in Oman.

Prevalence and Clinical Profile of Adults with ADHD Attending a Tertiary Care Hospital for Five Years.

(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group 'under 20' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.

Factors affect knowledge, attitudes, and practices in colorectal cancer screening: A systematic review.

OBJECTIVES: This review aimed to synthesize the available evidence on exploring various factors that affect knowledge, attitudes, and practices (KAP) in colorectal cancer (CRC) screening. METHODS: A systematic search across five databases was performed to identify factors influencing KAP scores towards CRC screening. The PRISMA guidelines were used to conduct the literature search, and the time spanned is from March to June 2023. The search included observational studies published between January 2000 and June 2023 that met the predetermined review criteria. Data were extracted following the Joanna Briggs Institute (JBI) appraisal checklist to evaluate the quality of the articles. RESULTS: Out of 16,904 records, 1174 articles were reviewed in full text, resulting in 43 high-quality studies included based on the JBI checklist. These studies assessed knowledge (42), attitudes (26), and practices (11) related to CRC screening. Key factors to improving KAP towards CRC screening in the general public were sociodemographic, social media influence, and physician recommendations. For healthcare professionals, factors promoting KAP included screening methods, guidelines, qualifications, and understanding of CRC screening. Educators lacked awareness of CRC symptoms and needed training to teach CRC screening and prevention. Pharmacists showed positive attitudes towards early CRC detection but had varying knowledge levels. CONCLUSIONS: KAP towards CRC screening is suboptimal among the general public, healthcare professionals, students, educators, and pharmacists worldwide. Routine CRC screening counselling is paramount to improving screening rates. Continuous medical education and training programmes are essential for healthcare professionals to enhance their KAP towards CRC screening. Students and university teachers should be educated and trained about CRC screening to improve their knowledge and foster positive behavioural changes. These comprehensive measures are critical for establishing an effective screening programme.

Effectiveness of an Educational Program on Awareness of Breast Cancer Risk Factors, Symptoms, and Barriers to Seeking Medical Help among Adolescent Omani School Students-An Interventional Study.

BACKGROUND AND AIM: Women in Oman and low- and middle-income countries (LMICs) are usually diagnosed with BC at a younger age and more advanced stage, with poor five-year survival. This study aims to evaluate the effectiveness of breast cancer (BC) related educational programs among female Omani adolescents. MATERIALS AND METHODS: Six female-only public schools were randomly selected from three governorates of Oman and assigned to the control or interventional group. An Arabic version of the Breast Cancer Awareness Measure questionnaire was used to evaluate students attending grades 10 and 11 at baseline (T0) and after 4 weeks (T1). After T0, the intervention group participated in a one-hour BC education program involving group discussions, a slideshow presentation, leaflets, and online access to program materials and videos. Non-parametric tests were used to compare scores between intervention and control groups and within each group across time (T0 vs. T1). RESULTS: A total of 1106 students participated, of which 547 (49.5%) and 559 (50.5%) were allocated to the control and intervention groups, respectively. Recognition of BC risk factors (Z = 18.67; p < 0.001) and symptoms (Z = 20.01; p < 0.001) increased significantly in the intervention group between T0 and T1 and compared to the control group at T1 (U = 27.27; p < 0.001, and U = 25.75; p < 0.001, respectively). Anticipated time to seeking medical help (Z = 18.67; p < 0.001) and barriers to help-seeking (Z = 7.91; p < 0.001) decreased significantly between T0 and T1 in the intervention group and compared to the control group at T1 (U = 15.78; p < 0.001, and U = 3.44; p = 0.001, respectively). CONCLUSION: The program increased knowledge of BC risk factors and symptoms and promoted early medical help-seeking among Omani female adolescents. Healthcare strategic planners and policy-makers in Oman and low- and middle-income countries should consider incorporating cancer education programs in the national school curriculum to minimize delays in BC diagnosis and improve the survival rate.

The Impact of Sociodemographic, Macroeconomic, and Health Status and Resources on Infant Mortality Rates in Oman: Evidence from 1980 to 2022.

BACKGROUND: The infant mortality rate (IMR) is an important reflection of the well-being of infants and the overall health of the population. This study aims to examine the macroeconomic (ME), sociodemographic (SD), and health status and resources (HSR) effects on IMR, as well as how they may interact with each other. METHODS: A retrospective time-series study using yearly data for Oman from 1980 to 2022. Partial Least Squares-Structural Equation Modelling (PLS-SEM) was utilized to develop the exploratory model of the determinants of IMR. RESULTS: The model indicates that HSR determinants directly, but negatively, affect IMR (ß = -0.617, p < 0.001). SD directly and positively affects IMR (ß = 0.447, p < 0.001). ME only indirectly affects IMR (ß = -0.854, p < 0.001). ME determinants also exert some direct influences on both HSR (ß = 0.722, p < 0.001) and SD (ß = -0.916, p < 0.001) determinants. CONCLUSIONS: This study has indicated that IMR is a multi-faceted issue. It also highlighted the interplay of numerous variables and their influence on IMR, particularly the role that social status, the health sector, and the wealth of the country and its population play in reducing IMR. These findings indicate that an integrated policy that addresses socioeconomic and health-related factors and the overall ME environment is necessary for the health and well-being of the children and the population overall in Oman.

Prevalence of psychological distress and associated factors among Omani women diagnosed with breast cancer: a single-centre, cross-sectional study.

OBJECTIVES: To determine the prevalence of psychological distress (ie, anxiety and depressive symptoms) among Omani women diagnosed with breast cancer (BC) and to investigate associations with socio-demographic factors. DESIGN: A cross-sectional, self-administered survey was conducted between September 2021 and June 2022. SETTING: Sultan Qaboos Comprehensive Cancer Care and Research Centre (Muscat, Oman). PARTICIPANTS: Adult Omani women diagnosed with BC during the study period. OUTCOME MEASURES: Data regarding anxiety and depressive symptoms were collected using an Arabic version of the Hospital Anxiety and Depression Scale (HADS). Socio-demographic and clinical information was obtained from the participants and their hospital medical records. RESULTS: 190 Omani women diagnosed with BC were invited to participate in the study, of whom 171 participated (response rate: 90.0%). The mean age was 50.3±10.9 years. 52.3% of participants had been diagnosed with BC at stages III or IV and 28.9% had metastasis. 29 women (17.0%) exhibited depressive symptoms (HADS-D score: ≥8), while 37 (21.6%) exhibited anxiety symptoms (HADS-A score: ≥8). Women with anxiety symptoms were almost 15-times more likely to have depressive symptoms than those without anxiety symptoms (OR: 14.87, p<0.001). Younger women were less likely to exhibit depressive symptoms than older women (≤39 vs ≥60 years, p=0.050; 40-59 vs ≥60 years, p=0.005). Women at the school/diploma education level were less likely to have depressive symptoms than those at college/university level (OR: 0.19, p=0.017). CONCLUSIONS: More than half of the women surveyed had been diagnosed at an advanced stage, with up to 21.6% presenting with symptoms of anxiety and depression. Healthcare professionals in Oman should consider additional screening for anxiety and depressive symptoms in this group and encourage patients with BC to disclose emotional information during consultations, particularly for those aged ≥60 years.

The Effect of Sage (Salvia sclarea) Essential Oil on the Physiochemical and Antioxidant Properties of Sodium Alginate and Casein-Based Composite Edible Films.

The aim of this study was to examine the effect of Sage (Salvia sclarea) essential oil (SEO) on the physiochemical and antioxidant properties of sodium alginate (SA) and casein (CA) based films. Thermal, mechanical, optical, structural, chemical, crystalline, and barrier properties were examined using TGA, texture analyzer, colorimeter, SEM, FTIR, and XRD. Chemical compounds of the SEO were identified via GC-MS, the most important of which were linalyl acetate (43.32%) and linalool (28.51%). The results showed that incorporating SEO caused a significant decrease in tensile strength (1.022-0.140 Mpa), elongation at break (28.2-14.6%), moisture content (25.04-14.7%) and transparency (86.1-56.2%); however, WVP (0.427-0.667 × 10-12 g·cm/cm2·s·Pa) increased. SEM analysis showed that the incorporation of SEO increased the homogeneousness of films. TGA analysis showed that SEO-loaded films showed better thermal stability than others. FTIR analysis revealed the compatibility between the components of the films. Furthermore, increasing the concentration of SEO increased the antioxidant activity of the films. Thus, the present film shows a potential application in the food packaging industry.

A Comparative Study of the Properties of Gelatin (Porcine and Bovine)-Based Edible Films Loaded with Spearmint Essential Oil.

Gelatin (bovine/porcine)-based edible films are considered as an excellent carrier for essential oils (EOs) to preserve food quality and extend their shelf life. Spearmint essential oil (SEO) is known for its potential antioxidant and antimicrobial effects; nevertheless, its food applications are limited due to the volatile nature of its active components. Thus, edible films loaded with essential oil can be an alternative to synthetic preservatives to improve their food applications. In the present study, the effect of SEO addition was investigated on the physicochemical properties of bovine and porcine gelatin films, and antioxidant activity was assessed. GCMS (Gas chromatography mass spectrometry) analysis revealed the presence of carvone (55%) and limonene (25.3%) as major components. The incorporation of SEO into the films decreased the opacity, moisture content, water solubility, and elongation at break of bovine and porcine gelatin films. However, with the addition of EO, the thickness and water vapor permeability of bovine and porcine-based gelatin films increased. Moreover, the addition of SEO increased the tensile strength (TS) of the porcine-based film, whereas bovine samples demonstrated a decrease in tensile strength. XRD (X-ray diffraction) findings revealed a decrease in the percentage crystallinity of both types of gelatin films. SEM (scanning electron microscope) results showed the changes in the morphology of films after the addition of SEO. Antioxidant properties significantly increased with the incorporation of EO (p < 0.05) when compared with control films. Therefore, the addition of SEO to gelatin-based edible films could be an effective approach to prepare an active food packaging material to prevent food oxidation.

Combined Effect of Drying Temperature and Varied Gelatin Concentration on Physicochemical and Antioxidant Properties of Ginger Oil Incorporated Chitosan Based Edible Films.

In the present work, ginger essential oil (GEO) loaded chitosan (CS) based films incorporated with varying concentrations of gelatin (GE) were fabricated and dried at different conditions (25 °C and 45 °C). The physio-chemical, mechanical and antioxidant potential of the films were determined. Films dried at 45 °C showed better physical attributes and less thickness, swelling degree (SD), moisture content, water vapor permeability (WVP), more transparency, and better mechanical characteristics. Fourier transform infrared spectroscopy (FTIR) revealed the chemical composition and interaction between the functional groups of the film components. X-ray diffraction (XRD), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM) findings revealed that samples dried at 45 °C had more crystalline structure, were thermally stable, and smoother. Antioxidant results showed that films dried at low temperature showed comparatively more (p < 0.0001) antioxidant activity. Additionally, an increase in gelatin concentration improved the tensile strength and swelling factor (p < 0.05), however, had no significant impact on other parameters. The overall results suggested better characteristics of GEO-loaded CS-GE based edible films when dried at 45 °C.

Physicochemical Characterization and Antioxidant Properties of Chitosan and Sodium Alginate Based Films Incorporated with Ficus Extract.

Aqueous extract of fruit obtained from Ficus racemosa enriched with phenolic components was used for the first time to fabricate chitosan (CS) and sodium alginate (SA)-based edible films. The edible films supplemented with Ficus fruit aqueous extract (FFE) were characterized physiochemically (using Fourier transform infrared spectroscopy (FT-IR), Texture analyser (TA), Thermogravimetric analysis (TGA), scanning electron microscopy (SEM), X-ray diffraction (XRD), and colourimeter) and biologically (using antioxidant assays). CS-SA-FFA films showed high thermal stability and high antioxidant properties. The addition of FFA into CS-SA film decreased transparency, crystallinity, tensile strength (TS), and water vapour permeability (WVP) but ameliorate moisture content (MC), elongation at break (EAB) and film thickness. The overall increase in thermal stability and antioxidant property of CS-SA-FFA films demonstrated that FFA could be alternatively used as a potent natural plant-based extract for the development of food packaging material with improved physicochemical and antioxidant properties.

Exploring causes of delays in help-seeking behaviours among symptomatic Omani women diagnosed with late-stage breast cancer - A qualitative study.

PURPOSE: Breast cancer (BC) is the most commonly diagnosed cancer in Oman; however, the majority of women are diagnosed at a relatively young age and late stage. Delays in BC diagnosis may be attributable to patient-related barriers to medical help-seeking, such as embarrassment arising from breast examinations or negative perceptions of cancer or a cancer diagnosis. Identifying and addressing patients-related barriers to medical help-seeking may help early BC detection, increase the survival rate, and improve prognosis. This study aimed to explore causes of delays in medical help-seeking behaviours among symptomatic Omani women diagnosed with late-stage BC. METHODS: Purposeful sampling was used to identify Omani women diagnosed with late-stage BC (i.e., stages III or IV) at the two main referral oncology centres in Oman. Semi-structured individual interviews were utilised to collect data regarding the participants' reasons for delaying seeking medical help. The qualitative framework analysis approach was used for data analysis. RESULTS: A total of 17 women participated in the study. The mean age was 41.94 ± 7.87 years (range: 27-56 years). Six reasons for delays in seeking medical help were identified, including: (1) Being in denial of BC symptoms; (2) normalisation of BC symptoms attributed to hormonal changes, dietary changes, or work-induced stress; (3) misinterpretation of BC symptoms attributed to other diseases or expectation of more alarming/obvious BC symptoms; (4) pursuit of alternative medicine remedies; (5) false reassurance or incorrect advice from family members or friends; and (6) practical barriers, such as childcare responsibilities and lack of access to transport. CONCLUSION: Several reasons were identified for delays in seeking medical help for BC symptoms, including cultural and emotional factors and a lack of knowledge of BC symptoms. Increased awareness of BC symptoms and a better understanding of Omani women's beliefs, cultures, and behaviours may help to reduce delays in BC presentation and diagnosis.