An Assessment of Knowledge, Attitude, and Practice (KAP) of Colorectal Cancer among Community Pharmacists in the Qassim Region of Saudi Arabia.

Background: The global burden of colorectal cancer remains a major public health issue and one of the leading causes of death worldwide. In Saudi Arabia, it continues to be a health concern. Any delays in diagnosis for any reason may contribute to advanced complications; therefore, pharmacists' knowledge and awareness of colorectal cancer are crucial for the welfare of society. Studies of colon cancer-related knowledge, attitude, and practice (KAP) among community pharmacists have not previously been conducted in the Al-Qassim region of Saudi Arabia. In the present study, therefore, we sought to investigate the KAP on colon cancer among pharmacists in Al-Qassim. Methods: This was a prospective, cross-sectional, observational study. A sample of 150 community pharmacists was recruited using a convenience sampling method. A self-administered questionnaire was used to evaluate levels of knowledge and practice. Results: Out of a total of 150 pharmacists, the majority of respondents (60.7%) possessed an adequate level of knowledge. About 50% of participants had heard of the early screening test, and 68.7% knew that colonoscopy is necessary in such scenarios. On the basis of their attitudes, 41.3% of study participants were aware of colon cancer symptoms and risk factors. In practice, however, the majority of pharmacists (81%) did not perform early cancer screenings, while 19% did screen when advised to do so by a physician. Conclusions: Our results indicate that pharmacists in Qassim have an adequate level of knowledge of colon cancer in terms of awareness, assessment, and screening. Since community pharmacists are among the most reliable members of the medical community, a greater awareness of colon cancer among pharmacists may improve public knowledge of the disease.

Pharmacy Students' Attitudes Toward Distance Learning After the COVID-19 Pandemic: Cross-Sectional Study From Saudi Arabia.

BACKGROUND: Electronic learning refers to the use of assistive tools in offline and distance learning environments. It allows students to access learning tools and materials anytime and anywhere. However, distance learning courses depend on several factors that affect the quality of learning, which consequently affect students' preferences in the settings and tools used to deliver educational materials. OBJECTIVE: This study aimed to evaluate students' preferences for continuing distance learning after the pandemic and to assess the distance educational environment after the pandemic. It also aimed to identify the factors affecting distance learning and evaluate students' preferences regarding modes of communication with instructors. METHODS: A web-based survey was used to conduct this cross-sectional study. The target participants of this study were students in the doctor of pharmacy program at Unaizah College of Pharmacy, Qassim, Saudi Arabia. All students enrolled from December 2022 to January 2023 received an invitation with a link to the web-based survey. RESULTS: The survey was completed by 141 students (58 female students and 83 male students). The research results showed that most students (102/141, 72.3%) did not wish to continue distance education for laboratory courses, and 60.3% (85/141) did not wish to continue taking distance team-based learning after the pandemic. Additionally, 83.7% (118/141) of the students indicated that distance courses were simple. More than half of the participants (79/141, 56%) stated that having a camera on during class negatively impacted their learning, and only 29.1% (41/141) of the students stated that nonvisual communication with their fellow students impacted their learning. A large proportion of students (83/141, 58.9%) reported impairment of social engagement on campus, 44% (62/141) in-person interactions during classes, and 73.7% (104/141) were relieved that their classes were not disrupted. CONCLUSIONS: Similar to all types of education, distance learning is characterized by advantages and disadvantages, as reported by students. Students felt that the course material was intelligible, and the distance course was uncomplicated. Moreover, they expressed relief that their studies were not disrupted. However, they also reported the loss of face-to-face contact during courses as the most significant drawback of distance learning versus face-to-face learning, followed by a lack of social connection on campus.

Valuation of EQ-5D-5L in the Kingdom of Saudi Arabia: A National Representative Study.

OBJECTIVES: To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol. METHODS: Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used. RESULTS: The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least. CONCLUSION: The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making.

An analysis of the intention of female pharmacy students to work in community pharmacy settings in Saudi Arabia using the theory of planned behavior.

Objective: This study aimed to determine the intention of female Saudi pharmacy students to work in community pharmacies and the factors associated with this intention. Methods: This cross-sectional study was conducted between April 2022 and June 2022 and included female students from pharmacy colleges in Saudi Arabia. The survey was created based on the Theory of Planned Behavior. It included items that measure student intentions, attitudes, subjective norms, and perceived behavioral control regarding working in community pharmacies in Saudi Arabia. The study also included items that assessed sociodemographic characteristics, pharmacy program degrees, training, and job preferences of students. Results: A total of 407 participants completed the survey. The average age was 21.8 (±1.6) years, and most participants were Saudi nationals (97.79 %). The intention of participants to work in community pharmacies after graduation was low (mean = 3.2 ± 1.8; range: 1-7). Slightly positive attitudes toward working in a community pharmacy after graduation were revealed as participants showed an overall attitude mean of 4.5 ± 1.6 (range: 1-7). Furthermore, the participants perceived a low social pressure toward working in a community pharmacy after graduation (mean of 3.3 ± 1.9; range: 1-7). The intention of female pharmacy students to work in community pharmacies was significantly predicted by attitudes (p-value < 0.0001), perceived behavioral control (p-value = 0.0017), nationality (p-value = 0.0151), residence in the Saudi Arabian region (p-value = 0.0013), monthly income (p-value = 0.0231), pharmacy degree program (p-value = 0.0035), training received in community pharmacies (p-value = 0.0145), had a relative working in a community pharmacy (p-value = 0.0257), and preference to work in community pharmacies after graduation (p-value = 0.0001). Conclusion: Female pharmacy students in Saudi Arabia had a low intention to work in community pharmacies, a positive attitude toward working in community pharmacies, and perceived no social pressure to work in them. A positive attitude and behavioral perception of control toward working in community pharmacies were demonstrated among pharmacy students who study at a university outside Riyadh, undertaking a bachelor's degree in pharmacy, have a monthly income higher than 5000 Saudi riyals (USD 1,333.3), previously received training in community pharmacies, having a relative working in a community pharmacy, prefer to work in community pharmacies after graduation.

Development of a Prediction Model to Identify the Risk of Clostridioides difficile Infection in Hospitalized Patients Receiving at Least One Dose of Antibiotics.

OBJECTIVE: This study's objective was to develop a risk-prediction model to identify hospitalized patients at risk of Clostridioides difficile infection (CDI) who had received at least one dose of systemic antibiotics in a large tertiary hospital. PATIENTS AND METHODS: This was a retrospective case-control study that included patients hospitalized for more than 2 days who received antibiotic therapy during hospitalization. The study included two groups: patients diagnosed with hospital CDI and controls without hospital CDI. Cases were matched 1:3 with assigned controls by age and sex. Descriptive statistics were used to identify the study population by comparing cases with controls. Continuous variables were stated as the means and standard deviations. A multivariate analysis was built to identify the significantly associated covariates between cases and controls for CDI. RESULTS: A total of 364 patients were included and distributed between the two groups. The control group included 273 patients, and the case group included 91 patients. The risk factors for CDI were investigated, with only significant risks identified and included in the risk assessment model: age older than 70 years (p = 0.034), chronic kidney disease (p = 0.043), solid organ transplantation (p = 0.021), and lymphoma or leukemia (p = 0.019). A risk score of ≥2 showed the best sensitivity, specificity, and accuracy of 78.02%, 45.42%, and 78.02, respectively, with an area under the curve of 0.6172. CONCLUSION: We identified four associated risk factors in the risk-prediction model. The tool showed good discrimination that might help predict, identify, and evaluate hospitalized patients at risk of developing CDI.

Health status outcome among cannabis addicts after treatment of addiction.

The abuse of Cannabis is a widespread issue in the Asir region. It has a lot of legal and occupational repercussions. The purpose of this study was to evaluate the health status of cannabis addicts at admission and after treatment using body mass index, glycemic status, liver function, renal function, and oxidative stress. A cross-sectional study was conducted with 120 participants. The study was conducted at Al Amal Hospital for Mental Health in Asir region of Saudi Arabia, with 100 hospitalized patients receiving addiction treatment and 20 healthy volunteers. The participants were divided into two groups: group I, the control group, and group II, the cannabis addicts. The socio-demographic data were gathered. The level of cannabis in the urine and the CWAS [Cannabis Withdrawal Assessment Scale] were determined. In addition, the Body Mass Index [BMI], vital signs [temperature, heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate], serum levels of albumin, total bilirubin, direct bilirubin, AST, ALT, and ALP, urea, creatinine, Thiobarbituric acid-reactive substances [TBARS], superoxide dismutase [SOD], reduced glutathione [GSH], and catalase [CAT] were analyzed on the first day of admission and after treatment. According to the results, there was no significant change in the body mass index. The vital signs in the cannabis user group were significantly lower than the corresponding admission values. Regarding renal function tests such as urea and creatinine, we found that after treatment, the mean urea and creatinine values in the cannabis user group did not differ significantly from the corresponding admission values. However, after treatment, the mean values of fasting blood glucose levels in the cannabis user group were significantly lower than at admission. Also, the mean values of liver function tests such as albumin, total bilirubin, direct bilirubin, AST, ALT, and ALP in the cannabis user group were significantly lower than the corresponding admission values after treatment. In assessing the antioxidant system, we found that the mean values of TBARS, SOD, GSH, and CAT in the cannabis user group did not differ significantly from the corresponding admission values after treatment. The current findings have revealed that cannabis addiction harms the various body systems and has significant implications for the addict's state of health. The values of oxidative stress biomarkers did not change in this study, but other measured parameters improved after treatment.

Pharmacists' Knowledge and Intention to Provide Palliative Care Services in Saudi Arabia: Using the Theory of Planned Behaviour.

Providing palliative care to patients with life-threatening illnesses requires multidisciplinary efforts from different healthcare providers. Identifying the attitude, knowledge, and intentions of pharmacists to provide this service in Saudi Arabia is essential. Therefore, this study aimed to identify the palliative care knowledge, intentions, attitudes, subjective norms, and perceived behavioural control of pharmacists and what factors predict their intentions. Cross-sectional questionnaires based on the theory of planned behaviour were distributed to pharmacists in hospitals and community pharmacies. They included items that measured palliative care knowledge, attitudes, intentions, subjective norms, and the perceived behavioural control of pharmacists and identified other sociodemographic and pharmacy-practice-related items. In total, 131 pharmacists completed the questionnaires, showing an average score on palliative knowledge (8.82 ± 1.96; range: 1-14), strong intentions (5.84 ± 1.41; range: 1-7), positive attitudes (6.10 ± 1.47; range: 1-7), positive subjective norms (5.31 ± 1.32; range: 1-7), and positive perceived behavioural control (5.04 ± 1.21; range: 1-7). Having completed a pharmacy residency program, working longer hours per week, having a more positive attitude, and perceived stronger subjective norms were significantly associated with a strong intention to provide palliative care services. Therefore, enabling and motivating pharmacists to complete pharmacy residency programs and improve their attitudes could increase their intentions to provide these services.

Effect of Occupational Stress on Pharmacists' Job Satisfaction in Saudi Arabia.

Work stress occurs when employees have to deal with pressures that do not align with their skills, knowledge, or expectations. This study aimed to assess the impact of work stress on job satisfaction among pharmacists in Saudi Arabia. Therefore, a cross-sectional, self-administered, paper-based survey was conducted between August 2019 and October 2020 using three scales. Descriptive and analytical statistical analyses were performed. A linear regression analysis was used to determine the relationship between occupational stress and job satisfaction among Saudi pharmacists. A total of 284 questionnaires were completed. Multiple linear regression analyses showed a significant negative relationship between occupational stress and job satisfaction (ß = -0.456, 95% CI, -0.561 to -0.350), a positive relationship between confirmation and satisfaction (ß = 0.147, 95% CI, 0.005 to -0.290), and a negative relationship between working in hospitals and job satisfaction (ß= -3.009; 95% CI, -5.424 to -0.593) when other variables were kept constant. The results of this study indicated that occupational stress and satisfaction negatively influenced pharmacists, whereas confirmation was associated with better satisfaction. Moreover, hospital pharmacists had lower job satisfaction. The job satisfaction of pharmacists may help improve medication safety and ensure an adequate pharmacist workforce.

Sukkari dates seed improves type-2 diabetes mellitus-induced memory impairment by reducing blood glucose levels and enhancing brain cholinergic transmission: In vivo and molecular modeling studies.

Cognitive decline is one of the serious complications associated with diabetes mellitus (T2DM) of type-2. In this reported work, the effect of aqueous sukkari dates seed extract (ASSE) was evaluated in T2DM-induced rats. T2DM was induced using intraperitoneal injection of nicotinamide and streptozocin (STZ) administration. The diabetic rats were then treated orally with 200 mg/kg and 400 mg/kg of dates seed extract for 30 days and results were compared with metformin-treated groups. The memory functions were assessed using three maze models. Glucose and insulin levels in the blood and acetylcholine, acetylcholinesterase brain homogenates were estimated. The results showed a significant reduction in transfer latency (TL) (p < 0.001) during the elevated plus maze (EPM) test. The novel object recognition (NOR) test revealed a longer exploration time (p > 0.05) with novel objects and a higher discrimination index (p > 0.05). The Y-maze test also showed a significant increase in the number of entries to the novel arm (p > 0.05) and the total number of entries in the trial (p > 0.01) as well as in test (p > 0.05) sessions. Reduction in blood glucose (p > 0.05) and improvement in blood insulin (p > 0.05) levels were also noted. Improvement in ACh levels (p > 0.001) with 400 mg/kg of ASSE and reduction in AChE (p > 0.001) with both doses of ASSE were also observed in the brain homogenates. The results of ASSE were found comparable with the metformin-treated rats. The estimation of phytochemical constituents displayed a significant presence of phenolic content. Further, molecular modeling studies showed ellagic acid, catechin, and epicatechin as the potential molecule interacting with GSK-3ß, α-amylase, and AChE and may be responsible for observed bioactivity. In conclusion, ASSE has the ability to alleviate T2DM-related cognitive impairments.

Restriction on antimicrobial dispensing without prescription on a national level: Impact on the overall antimicrobial utilization in the community pharmacies in Saudi Arabia.

BACKGROUND: High rates of non-prescription dispensing of antimicrobials have led to a significant increase in the antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate the antimicrobial utilization following the enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA. METHODS: Data were extracted from the IQVIA database between May 2017 and May 2019. The antimicrobial utilization rates, based on sales, defined daily dose in grams (DDD), DDD/1000 inhabitants/day (DID), and antimicrobial-claims for the pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods were assessed. RESULTS: Overall antimicrobial utilization declined slightly (~9-10%) in the post-policy versus pre-policy period (sales, 31,334 versus 34,492 thousand units; DDD, 183,134 versus 202,936), with higher claims (~16%) after policy implementation. There was a sudden drop in the utilization rate immediately after policy enforcement; however, the values increased subsequently, closely matching the pre-policy values. Utilization patterns were similar in both periods; penicillin was the most used antimicrobial (sales: 11,648-14,700-thousand units; DDD: 71,038-91,227; DID: 2.88-3.78). For both periods, the highest dip in utilization was observed in July (sales: 1,027-1,559 thousand units; DDD: 6,194-9,399), while the highest spike was in March/October (sales: 3,346-3,884 thousand units; DDD: 22,329-19,453). CONCLUSION: Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacies across SA. Effective implementation of prescription-only regulations is necessary.

Association between intention to leave work and quality of work-life of Saudi pharmacists.

Background/Aim: Pharmacists are one of the most essential healthcare professionals, with substantial clinical knowledge and skills in the use of medications. Pharmacists provide patient care services and contribute to the enhancement of health outcomes, which increases their workload. This study was conducted to determine the association between intention to leave work and quality of work life (QWL) of pharmacists in Saudi Arabia. Methods: This cross-sectional study was conducted using a self-administered questionnaire provided as a paper-based survey using two scales (the Work-related Quality of Life [QoL] and Intention to Leave scales). In addition, this was combined with demographics to determine the relationship between intention to leave work and quality of work-life. Data were analyzed using descriptive and analytical statistical tests. Results: A total of 284 (76.5%), out of the 371 surveys distributed, were completed and returned. The average age and annual income of the respondents were 33.4 ± 6.5 years and 196,401 ± 82,306.7 SAR, respectively and 61.2% and 38.9% were male and female, respectively, whereas 62.9% were married and 53.2% reported having children. The multiple linear regression analysis conducted showed a significant negative relationship between QWL and the intention to leave work (ß = -0.131; 95% CI, -0.185 to -0.076). Conclusion: We found a significant association between the QWL and intention to leave. This indicates that a greater intention to leave was associated with a low or lousy QWL among Saudi pharmacists.

Aqueous Ajwa dates seeds extract improves memory impairment in type-2 diabetes mellitus rats by reducing blood glucose levels and enhancing brain cholinergic transmission.

Diabetes is a metabolic disorder prevalent across the globe and is known to cause brain dysfunction, especially memory and cognitive decline. The current study investigates the effect of aqueous Ajwa seeds extract (AASE) on type-2 diabetes mellitus (T2DM)-induced memory deficits using a rat model. T2DM was induced by an administration of nicotinamide (120 mg/kg, i.p.) and streptozotocin (STZ) (60 mg/kg, i.p.). AASE (200 and 400 mg/kg, p.o.) were treated to T2DM rats for 30 days and the results were compared with the metformin (200 mg/kg). Elevated plus maze (EPM), Y-maze, and novel object recognition (NOR) tests were performed to assess the memory functions. The blood glucose and plasma insulin levels were estimated to assess the anti-diabetic effects of AASE. Acetylcholine (ACh) and acetylcholinesterase (AChE) levels were estimated from brain homogenates to assess cholinergic transmission. Treatment with AASE resulted in the reversal of behavioral deficits. EPM showed, a significant reduction in transfer latency (TL) among T2DM rats. High exploration time with a novel object and improvement in discrimination index were observed among treated groups during the NOR test. The Y-Maze test improved the entries and also time spent in the novel arm. Moreover, treatment of AASE reversed hyperglycemic and enhanced plasma insulin levels (200 mg/kg: 3.81 ± 0.08 ng/ml and 400 mg/kg: 4.09 ± 0.10 ng/ml) among T2DM rats (2.81 ± 0.15 ng/ml). Improved ACh levels (200 mg/kg: 186.6 ± 9.51 pg/mg protein and 400 mg/kg: 165.5 ± 9.25 pg/mg protein) and reduced AChE levels (200 mg/kg: 0.29 ± 0.02 ng/mg protein and 400 mg/kg: 0.32 ± 0.03 ng/mg protein) were also noted in the brain of AASE treated groups as referred to diabetic group (ACh: 107.1 ± 7.16 pg/mg protein and AChE: 0.51 ± 0.03 ng/mg protein). The above results were found to be comparable with the metformin-treated groups. From the results, it can be concluded that AASE has the potential to improve T2DM associated cognitive deficits.

Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour.

Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists' intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists' willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.

Factors Affecting Pharmacy Students' Decision to Study in Pharmacy Colleges in Saudi Arabia: A Cross-Sectional Questionnaire-Based Analysis.

(1) Background: Many factors may play a role in deciding to opt for pharmacy as a major. However, no previous studies have been conducted in Saudi Arabia to explore these factors. This study aims to identify the potential factors that prompted students to join the pharmacy program. (2) Methods: A cross-sectional questionnaire was distributed among undergraduate pharmacy students in Saudi Arabia, addressing areas such as reasons that encourage them to choose pharmacy as a major, and students' socio-demographic characteristics. Descriptive statistics were used to describe the study variables, and a simple logistic regression analysis was performed to identify the potential factors. (3) Results: A total of 491 students completed the questionnaire. Around 40% of them had chosen to study pharmacy as their first choice. Only gender, current GPA, and reasons related to the pharmacy field were found to have a statistically significant association with students selecting pharmacy as their first choice. (4) Conclusions: This study shows that pharmacy students have a future-oriented outlook and selected pharmacy as their first choice because it will develop them professionally, financially, and intellectually. Educating high school students about the characteristic of pharmacy would help attract more talented students to the pharmacy carrier.

The Effect of Depression on Treatment Adherence Among a Sample of Saudi Patients Diagnosed with Acne Vulgaris.

PURPOSE: Acne vulgaris is an inflammatory disorder of the skin and is the most common dermatological disease, affecting all ages and races. Acne is known to be associated with depression. This study aimed to assess the impact of depression on patient adherence to acne vulgaris treatment using The Expectation Confirmation Theory (ECT). PATIENTS AND METHODS: This cross-sectional study was conducted with 204 patients with acne using four scales (depression, satisfaction, intention to adhere to acne medication, and control for confirmation). ECT scales were used to assess patient satisfaction and intention to adhere to medication. Demographic data were also collected, and descriptive and analytical statistical analyses were performed. RESULTS: A total of 204 questionnaires were completed. The mean age of the respondents was 25 ± 7.2. The majority were female; 167 (83.50%). Multiple linear regression analysis indicated a negative association between depression (ß= -0.121, p = 0.033; 95% CI, -0.232 to -0.009) and satisfaction, when holding other variables constant, and the expected medication effect (confirmation) had a positive association with satisfaction (ß= 0.334, p< 0.001; 95% CI, 0.202 to 0.466), keeping all other factors constant. Male sex was negatively associated with satisfaction (ß= -2.388, p= 0.015; 95% CI -4.303 to -0.473), while keeping all other covariate sconstant. Residence in central provinces was a significant predictor of satisfaction (ß= 2.562, p= 0.004; 95% CI, 0.832 to 4.292), when holding other factors constant. After conducting a simple linear regression, a positive significant association was found between adherence and satisfaction (ß = 0.1713; 95% CI, 0.068 to 0.274). CONCLUSION: Adherence is the cornerstone for a successful treatment plan and prevention of relapse or treatment failure, and satisfaction is an essential indicator for improving health policies and implementing social service provisions.

Predictors of waterpipe smoking among university students in the Qassim region, Saudi Arabia.

INTRODUCTION: Waterpipe smoking has gained global popularity among adolescents and young adults. This study aimed to identify the predictors of waterpipe smoking among university students in the Qassim region of Saudi Arabia. METHODS: A cross-sectional study was conducted using a pre-tested, validated, and self-administered questionnaire to identify the predictors of waterpipe smoking among university students aged >18 years in the Qassim region. RESULTS: Of the 1158 questionnaires distributed, 928 were returned with complete responses. Of these 928 participants, 820 were men (88.7%) and the majority were unmarried (95.6%). The risk of waterpipe smoking was significantly higher in students aged >26 years (OR=3.39; 95% CI: 1.30- 8.80), those who had a brother who smoked (OR=1.78; 95% CI: 1.13-2.79), and those who were married (OR=3.21; 95% CI: 1.36-7.59). Furthermore, participants who had smoked cigarettes (OR=3.18; 95% CI: 1.89-5.34) or other tobacco products (OR=6.39; 95% CI: 3.69-11.07) within the past 30 days, and students who believed that waterpipe smoking was less harmful than cigarette smoking (OR=2.61; 95% CI: 1.54-4.41) had a higher risk of engaging in waterpipe smoking. However, the risk was lower among students receiving a monthly financial aid of more than US$264 (OR=0.34; 95% CI: 0.13-0.89). CONCLUSIONS: This study revealed that higher age, being male, being married, low student financial aid, waterpipe smoker sibling, cigarette and other types of tobacco smoking in the past 30 days, and believing waterpipe smoking to be less harmful than cigarette smoking, were significant predictors of waterpipe smoking. Educational programs targeted at improving awareness of the adverse effects of waterpipe smoking should be considered for early prevention in young adults.

The Effect of Occupational Stress on the Quality of Life of Pharmacists in Saudi Arabia.

PURPOSE: The job of a pharmacist is extremely demanding, and pharmacists play a vital role in improving the success of patients' treatment plans and disease management outcomes. The objective of this study was to evaluate the association between pharmacists' quality of life (QOL) and occupational stress in Saudi Arabia. METHODS: This was a prospective, paper-based, cross-sectional survey. The World Health Organization Quality of Life - Brief scale (WHOQOL-BREF) was used to evaluate quality of life, and the Effort-Reward Imbalance (ERI) scale was used to assess occupational stress. The two scales were administered to licensed pharmacists working in Saudi Arabia, and demographic data were collected. Descriptive and analytical statistical tests were performed. Multiple linear regression was conducted to evaluate the association between work stress and QOL. RESULTS: A total of 371 questionnaires were distributed, and 284 questionnaires were returned. The average age of the participants was 33.4 ± 6.5 years. Most were male (61.2%), married (62.9%), and had children (51.1%). Multiple linear regression analysis showed significant negative relationships between stress (ß = -0.454; 95% CI, -0.697 to -0.211) and QOL, and between the presence of chronic diseases (ß = 3.779; 95% CI, 0.597 to 6.961) and QOL, when holding other variables constant. Also, a positive association between male sex (ß = 3.779; 95% CI, 0.597 to 6.961) and QOL was reported, when other variables were kept constant. CONCLUSION: Occupational stress and the presence of chronic diseases were found to have a negative influence on pharmacists' QOL, while the male sex was associated with a better QOL. Moreover, QOL was linked to performance. Pharmacists are intensely involved in medication safety (use and administration), which might impact patients (at the micro-level) and the healthcare system (at the macro-level). Therefore, stress control is crucial to improve pharmacists' QOL and performance in relation to patient health.

Qualitative Exploration of Barriers to Medication Adherence Among Patients with Uncontrolled Diabetes in Saudi Arabia.

Uncontrolled diabetes is associated with macrovascular and microvascular complications that compromise the quality of life; however, the patients' perspectives about medication non-adherence are unclear. We aimed to understand patient behavior and explore the barriers to medication adherence in uncontrolled diabetes patients. We employed a qualitative method of face-to-face interviews conducted with adult patients in Saudi Arabia who had uncontrolled diabetes mellitus (glycosylated hemoglobin >7% or fasting blood glucose >7.2 mmol/L). All interviews were audio-recorded and analyzed using thematic analysis. The interviews were conducted for 68 patients. Sixty-seven patients were suffering from Diabetes Mellitus Type 2, and one patient was suffering from Diabetes Mellitus Type 1. We identified the barriers to medication adherence and classified them under six main factors: patients-, medications-, healthcare-, provider-, social-, and disease-related factors. The main barriers identified were the use of alternatives, hard-pressed for time, polypharmacy, bad relationship with the physician, cultured beliefs, self-alteration of the dose, exposed side effects, ineffective medications, refusal of insulin, multiple doctor visits, uncontrolled diet, and forgetfulness. Multiple barriers that prevented the patients from medication adherence were related to poor knowledge, counseling, psychological management, and social support. Appropriate educational programs, suitable patient-specific counseling, and close follow-ups would be required to improve the knowledge, outcomes, and quality of life in uncontrolled diabetes patients.

Smoking Cessation Beliefs Among Saudi University Students in Qassim Region, Saudi Arabia.

INTRODUCTION: Despite Saudi officials initiating a variety of smoking cessation programs, smoking in the country has not decreased. Thus, the objective of this study was to identify the factors associated with Saudi students' beliefs about available smoking cessation interventions. METHODS: A cross-sectional, pre-tested, and validated paper-based survey was administered to a cohort from a university in the Qassim region. Bivariate analyses and logistic regression were conducted to explore the factors associated with the students' beliefs regarding behavioral and pharmacotherapy interventions for smoking cessation. RESULTS: Out of 1158 surveys distributed, 958 responses were received (82.7% response rate). Students aged >23 years were more likely to believe in a behavioral intervention (marginal effect = 10.4%; 95% CI, 2.3%-18.6%). However, the respondents who indicated that they had smoked a hookah over the past 30 days were less likely to believe in either the pharmacotherapeutic (marginal effect = -7.9%; 95% CI, -15.6 to -0.3%) or the behavioral (marginal effect = -8.1%; 95% CI, -16.2% to -0.1%) interventions. Students who believed that the hookah was the same as or less harmful than cigarettes (marginal effect = -25.6%; 95% CI, -34.7% to -16.6%) and (marginal effect = -12.3%; 95% CI, -22.3% to -2.3%), respectively, were less likely to believe in pharmacotherapeutic interventions. Multiple logistic regression analyses found that hookah smokers with a willingness to quit smoking were more likely to believe in the effectiveness of cessation medications (marginal effect = 42.9%; 95% CI, 28.2%-57.6%) and behavioral interventions (marginal effect = 28.6%; 95% CI, 9.3%-48.0%). CONCLUSION: This study found that smoking a hookah and its harmfulness were negatively associated with smoking cessation medications interventions. Regarding beliefs about behavioral interventions, while age was positively associated, hookah smoking and its harmfulness had a negative association. Willingness to quit smoking was positively associated with both medication and behavioral interventions.

Metformin Improves the Depression Symptoms of Women with Polycystic Ovary Syndrome in a Lifestyle Modification Program.

BACKGROUND: Metformin is commonly prescribed to manage polycystic ovary syndrome (PCOS), which is one of the most common endocrine disorders among women of childbearing age and is associated with high prevalence rates of depression and anxiety. OBJECTIVE: This study's objective was to determine the impact of prescribed metformin on depression and anxiety levels of patients with PCOS. METHODS: This prospective, multi-center, cohort study examined the impact of prescribed metformin on the depression and anxiety of women with PCOS in four gynecology clinics in Saudi Arabia and Jordan. The women had recently been prescribed metformin along with lifestyle modifications, such as diet and exercise, and were compared to another group of women with PCOS who were prescribed lifestyle modifications only. Depression and anxiety were assessed at baseline and three months later using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) scale, respectively. Health-related quality of life was measured using the Short Form Health Survey (SF-36). Multiple logistic regression analyses were conducted to examine the impact of metformin on depression and anxiety. RESULTS: Eighty-six women participated in the study: 53 were prescribed metformin with lifestyle modifications, and 33 were prescribed lifestyle modifications only. The women on metformin had 70% lower odds of having major depression (PHQ-9≥10) (OR=0.302, P=0.045); however, no significant effect of metformin on anxiety (GAD-7≥10) was found. CONCLUSION: Metformin may have a role in the management of depression symptoms among patients with PCOS; however, its potential antidepressant effect should be further examined in randomized double-blind placebo-controlled clinical trials.