Childhood vaccination hesitancy in Saudi Arabia: A time for action.

OBJECTIVES: This study aims to assess the health care provider (HCP) perception and knowledge about vaccination and to determine the presence of hesitancy toward it. METHODS: An observational study on HCPs was conducted in King Abdullah Specialized Children's Hospital (KASCH), Saudi Arabia using a questionnaire. The HCPs were categorized as physicians, nurses, and allied health care specialists with total participants of 344. RESULTS: 24% expressed disagreement with the vaccination schedule required by the Saudi Ministry of Health and 17% expressed reluctance in recommending or receiving vaccines in general. There was an apparent reluctance toward the influenza vaccination among allied health care specialists compared to nurses and physicians (42.5% vs 6% vs 11.8% respectively, p = <0.0001). Furthermore, 6% of the HCPs stated they believe of a strong correlation between GBS and the seasonal influenza vaccine, and 8% expressed an association between measles vaccine and autism. Years of experience significantly implicated HCP perceived confidence in explaining vaccine safety and efficacy. HCPs with less experience expressed a lack of confidence in the matter compared to their colleagues with more experience (20.9% vs. 10.7%, respectively, p = 0.0262). CONCLUSIONS: HCPs' confidence in vaccination are essential in influencing their patients. Therefore, it is essential to improve the knowledge and awareness of vaccination among HCPs.

The Use of Antidepressants in Patients with Heart Failure.

BACKGROUND: Heart failure (HF) is a chronic disease affecting patients' quality of life (QoL) and may cause depression. Recent studies reported that the prevalence of depression in patients with HF is 21.5%. Antidepressants, mainly selective serotonin reuptake inhibitors, are usually prescribed for HF patients diagnosed with depression. Some evidence supports antidepressant's role in improving symptoms by enhancing the psychological aspect of their QoL. Depression screening and treatment are important in the multidisciplinary management; however, their survival benefits are inconsistent. In our study, we aim to investigate the prevalence of depression and the use of antidepressants in patients with HF as well as to determine the acceptance of using antidepressants in such patients. METHODS: This is a cross-sectional study conducted by interviewing HF outpatients at National Guard Hospital in Riyadh. Patients were assessed using Hamilton depression rating scale. RESULTS: A total of 306 patients were included, with the majority (69%) being male and aged >61 years (60%). Patients' medical history was classified into different groups, with the largest proportion (39.9%) in the diabetic-hypertensive group, followed by a diabetic group (21.2%) and a hypertensive group (10.8%). Patients were classified according to the New York Heart Association Functional Classification, and most patients were in Class I (61.8%). Some of the patients (8.5%) had been diagnosed with depression. There was no statistically significant association between HF and depression (p > 0.05). However, 5.6% of patients had been prescribed antidepressants and 17.1% of patients believed that they required antidepressants. Moreover, there was a statically significant association between medical history and development of depression (p = 0.014). CONCLUSIONS: The prevalence of depression in HF patients in our population was lower than reported. There was no association between HF stage, depression, and antidepressant use.

Five-year survival, performance, and neurodevelopmental outcome following cardiopulmonary resuscitation after pediatric cardiac surgery, preliminary investigation in a single-center experience.

BACKGROUND AND AIM: Children who suffer cardiopulmonary arrest (CPA) after cardiac surgery frequently survive with return of spontaneous circulation. However, their neurodevelopmental outcomes and performance are still unclear. The aim of this study is to evaluate the midterm neurodevelopmental outcome and overall performance of children who survived CPA following cardiac surgery. MATERIALS AND METHODS: In this cohort study, we followed-up children who received cardiopulmonary resuscitation (CPR) post cardiac surgery during 2012-2013. We assessed their 5-year survival, functional, and neurodevelopmental outcomes using two performance scales: Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC). Both scales ranged from 1 for normal to 6 for brain death/death. We compared CPR group with a matching group (1:1) that had similar characteristics and conditions but no CPR. RESULTS: Out of 758 postoperative cardiac children, 15 (2%) children had 19 episodes of CPA. Their median age was 10 months (0.5-168). Survival rates were 12/15 (80%) on hospital discharge and 10/15 (66%) after 5 years. Among 12 survivors, two patients (17%) scored 6, one (8%) scored 4, five (42%) scored 2, and four (33%) scored 1 on both PCPC and POPC. The median PCPC and POPC scores were [2, (interquartile range: 1-6) and 1, (interquartile range: 1-3, p = 0.018] for CPR and matching group, respectively. Regression analysis identifies duration of CPR, number of CPR session, and late-occurring CPA as risk factors for poor outcome. CONCLUSION: Two-thirds of children requiring CPR post cardiac surgery survived after 5 years. Their neurodevelopmental and functional evaluation demonstrated worse outcome in comparison with their matching cases. CPR duration, number of CPA events, and late CPA were risk factors for poor outcome. Rehabilitation and special education programs might be needed for these groups of children with special needs.