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.

Correction: Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study.

[This corrects the article DOI: 10.1371/journal.pone.0210024.].

Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study.

OBJECTIVES: The objectives of this study were to determine incidence and risk factors of glucose intolerance one year after delivery in a sub-cohort of Riyadh Mother and Baby Cohort Study (RAHMA) study. METHODS: This is a follow-up study of a sub-cohort from RAHMA study from King Khalid University Hospital (KKUH). All women from RAHMA database who completed one year since delivery at KKUH were contacted by phone to participate in the study. Previously collected data from RAHMA registry for each participant were linked to this study data. Clinical data measured for each participant included current weight and height to calculate the BMI and waist circumference. Blood tests done for each participant were fasting blood glucose (FPG) and HbA1c. Based on the blood tests results, participants were classified into three groups; diabetic, pre-diabetic and normal. The incidence of diabetes and prediabetes was calculated for the whole cohort. Clinical, biochemical, and sociodemographic predictors of glucose intolerance were compared between the three groups. Risk factors with P-value less than 0.05 were tested in multivariate regression model with bootstrapping to calculate the relative risk (RR) and its 95% Bias corrected Confidence Interval (C.I.). RESULTS: From the sub-cohort, 407 women fulfilled the inclusion criteria and agreed to participate in the study. From the study participants; 250 (61.4%) women were normoglycemic, 142 (35%) women had prediabetes and 15 (3.6%) women were diabetic. Following multivariable regression analysis only history of gestational diabetes mellitus (GDM), (RR 1.74, 95% CI (1.06 to 2.84), P = 0.01), obesity (RR 1.69, 95% CI (1.01-3.11), P = 0.04) and diastolic blood pressure, (RR 1.04, 95% CI (1.01-1.09), P = 0.03) remained as predictors of postpartum glucose intolerance. CONCLUSION: The incidence of postpartum glucose intolerance (diabetes and prediabetes) is very high in Saudi women. Both GDM and obesity are strong predictors of glucose intolerance.

Asthma quality of life in Saudi Arabia: Gender differences.

OBJECTIVES: To explore potential gender differences in the factors associated with asthma-specific quality of life (AQL). METHODS: A cross-sectional study of consecutive series of adult patients attending primary care centers at three major hospitals in Riyadh, Saudi Arabia, was performed. AQL was measured using a standardized version of the AQL questionnaire (min = 1, max = 7), with higher scores indicating a better AQL. Multiple linear regression analysis was performed. RESULTS: The mean AQL was 4.3 (standard deviation [SD] = 1.5) for males and 4.0 (SD = 1.3) for females (p = 0.113). With each unit increase in asthma control, the AQL improved by 0.19 points (95% confidence interval [CI] = 0.14-0.23) in men and by 0.21 points (95% CI = 0.16-0.25) in women. Daily tobacco smoking was associated with a 0.72 point (95% CI = 0.14-1.30) decrease in the AQL among males. Women who had a household member who smoked inside the house had a significantly lower AQL (B = -0.59, 95% CI = -1.0 - -0.19). A monthly household income of 25,000 Saudi Riyals or more was associated with a better AQL among men (B = 0.51, 95% CI = 0.01-1.01), whereas being employed exhibited a protective effect in women (B = 0.48, 95% CI = 0.11-0.84). Higher levels of perceived asthma severity were associated with better AQL in women (B = 0.82, 95% CI = 0.36-1.28). CONCLUSIONS: Our findings revealed gender-specific differences in the correlates of AQL in Saudi Arabia, particularly in tobacco exposure, socio-economic factors and perceived asthma severity.

Evaluation of applied public health emergency system at Prince Mohammed International Airport in Almedinah during Hajj season 2014: a qualitative case study.

BACKGROUND: During the Hajj season 2014, several public health measures were applied by the Ministry of Health at Prince Mohammed International Airport in Almedinah. However, several operational defects affected the provision of preventive health services for passengers and airport workers. This study aims to evaluate the applied public health emergency system at the airport, detect any potential gaps and to provide appropriate operational solutions. METHODS: This is a qualitative case study conducted at Prince Mohammed International Airport in Almedinah during the 2014 Hajj season, September 2014. Data were collected via semi-structured interviews, focus groups and policy document reviews. Interviews were conducted with the 14 individuals of the airport's decision makers and relevant health practitioners. Data were recorded via taking notes during interviews and data coding was performed to produce the main themes and subthemes of the study. RESULTS: The main findings of the study revealed three main defects affecting the applied public health emergency system at the airport. The main themes were mainly related to shortage in logistics related to public health emergency systems, shortage in proper documentation of policies and lack of documented protocols of communications among airport stakeholders. CONCLUSIONS: The study highlighted the main factors hindering the application of public health emergency measures at the airport. A Public Health Emergency Contingency Plan was proposed as a method to regulate the process of providing logistics for public health preventive services, the method of producing documented policies and methods of producing Memoranda of Understandings as communication regulators.

Evaluation of knowledge and behavior of workers in Prince Mohammed International Airport in Western Saudi Arabia regarding public health emergency measures applied during Hajj season 2014.

OBJECTIVES: To evaluate the knowledge and behavior of workers at a Saudi airport regarding public health emergency measures applied during Hajj season. METHODS: This study is a cross-sectional study conducted at the Prince Mohammed International Airport in Al-Madinah Al-Munawwarah, Saudi Arabia between August and September 2014. Data were collected by semi-structured questionnaires during personal interviews. Non-random purposive sampling was conducted to target workers at higher risk of acquiring infection from travellers. RESULTS: One hundred and eighty-six participants were recruited of whom 92.5% were males. The study participants were workers in 8 different sectors. Twenty-six percent of the participants were health workers. Non-health workers were more likely to be concerned on acquiring infection while working at the airport compared with health workers (p=0.023). The most commonly feared disease was Ebola viral disease (EBV) among 30% of health workers, and 47% of non-health workers. Approximately 47% of non-health workers reported no knowledge of the procedures implemented during public health emergencies. The proportion of participants who received public health related training among non-health workers was significantly lower compared with health workers (p less than 0.00001). CONCLUSION: More emphasis should be given to educating airport workers on the potential health threats at the airport. Specific guidelines for public health emergencies at the airport should be established and communicated with airport sectors.

Evidence-Based Decision Making in Public Health: Capacity Building for Public Health Students at King Saud University in Riyadh.

Translation of research evidence into public health programs is lagging in Eastern Mediterranean Region. Graduate level public health curriculum at King Saud University (KSU), College of Medicine, Riyadh, is designed to equip students to integrate best available evidence in public health decision making. The objectives of study were to explore students' opinion about the evidence based public health (EBPH) courses and to survey the knowledge, opinion, and attitude of the students towards EBPH and perceived barriers for implementation of EBPH in decision making in public health. EBPH courses are designed based on a sequential framework. A survey was conducted at the completion of EBPH courses. Forty-five graduate students were invited to complete a validated self-administered questionnaire. It included questions about demography, opinion, and attitude towards EBPH and perceived barriers towards implementation of EBPH in the work environment. The response rate was 73%. Mean age of students was 30.1 (SD 2.3) years, and 51% were males. More than 80% had sound knowledge and could appreciate the importance of EBPH. The main perceived barriers to incorporate EBPH in decision making were lack of system of communication between researchers and policy makers and scarcity of research publications related to the public health problems.

trans-2-Tritylcyclohexanol as a chiral auxiliary in permanganate-mediated oxidative cyclization of 2-methylenehept-5-enoates: application to the synthesis of trans-(+)-linalool oxide.

The permanganate-mediated oxidative cyclization of a series of 2-methylenehept-5-eneoates bearing different chiral auxiliaries was investigated, leading to the discovery of trans-2-tritylcyclohexanol (TTC) as a highly effective chiral controller for the formation of the 2,5-substituted THF diol product with high diastereoselectivity (dr ∼97:3). Chiral resolution of (±)-TTC, prepared in one step from cyclohexene oxide, afforded (-)-(1S,2R)-TTC (er >99:1), which was applied to the synthesis of (+)-trans-(2S,5S)-linalool oxide.

Sickle cell disease in Middle East Arab countries.

The sickle cell (HbS) gene occurs at a variable frequency in the Middle Eastern Arab countries, with characteristic distribution patterns and representing an overall picture of blood genetic disorders in the region. The origin of the gene has been debated, but studies using ß-globin gene haplotypes have ascertained that there were multiple origins for HbS. In some regions the HbS gene is common and exhibits polymorphism, while the reverse is true in others. A common causative factor for the high prevalence and maintenance of HbS and thalassaemia genes is malaria endemicity. The HbS gene also co-exists with other haemoglobin variants and thalassaemia genes and the resulting clinical state is referred to as sickle cell disease (SCD). In the Middle Eastern Arab countries, the clinical picture of SCD expresses two distinct forms, the benign and the severe forms, which are related to two distinct ß-globin gene haplotypes. These are referred to as the Saudi-Indian and the Benin haplotypes, respectively. In a majority of the Middle Eastern Arab countries the HbS is linked to the Saudi-Indian haplotype, while in others it is linked to the Benin haplotype. This review outlines the frequency, distribution, clinical feature, management and prevention as well as gene interactions of the HbS genes with other haemoglobin disorders in the Middle Eastern Arab countries.

Synthesis, characterization and reactivity ratio study of poly(di(tri-n-butyltin) citraconate-co-N-vinylimidazole).

The organotin monomer di(tri-n-butyltin) citraconate (DTBTC, I) was synthesized. Subsequently this monomer was copolymerized with N-vinylimidazole (VI) using a free radical technique. The overall conversion was kept low (< or = 14% wt/wt) for all studied samples and the copolymer composition was determined from tin analysis using the Gilman and Rosenberg method. The synthesized monomer and copolymer were further characterized by elemental analysis, (1)H- and (13)C-NMR, and FTIR spectroscopy.

The profile of long-term care patients in Al-khobar and dammam, saudi arabia.

OBJECTIVES.: To find out the profile of patients who stay more than 20 days in hospital in Al-Khobar and Al-Dammam. METHODS.: A cross sectional descriptive study was designed using a questionnaire completed by health care providers (physicians, nurses, physiotherapists, and social workers) of a random sample of 159 patients out of 318 patients identified as having stayed in the hospital for more than 20 days. RESULTS.: The mean length of stay of the patients were 358.6 ±776 days in government hospitals, and 1014.4 ±1018.3 days in private hospitals. Patients were seen as stable by their doctors, 66.7% in government hospitals and 93.9% in private hospitals (statistically significant different at p<0.001. Physicians agreed that about two thirds of the patients could have been managed at home. 57.2% of the patients had no active problems. Diseases of the nervous system and sense organs accounted for 67.9% of the diagnoses, followed by endocrine, nutritional, and metabolic diseases (37.1%), diseases of the circulatory system (32.7%), and neoplasms (1.9%). Diabetes mellitus was the commonest illness making up 53.2% and 57.1% of the long-term patients in private and government hospitals respectively. The active problems of 25% and 23.5% of the patients was tracheostomy care and ventilation respectively. CONCLUSIONS.: Long-term patients tended to stay longer in private hospitals than in government hospitals, had diseases related to the nervous and endocrine systems and nutritional metabolism, were in stable condition with no active problems, and could thus, be managed at home.

Health care professionals' knowledge on home health care in Al-khobar and Al-dammam.

OBJECTIVE: To survey self-reported knowledge of home health care (HHC) services of health care professionals in Al-Khobar and Al-Dammam. METHODS: A specially developed questionnaire was used to conduct a cross-sectional study to find out how knowledgeable 11 hospital administrators, 16 PHHC medical directors, and 637 health care team were of HHC services. RESULTS: When asked whether they knew of HHC services, 90.9% of medical directors, 62.5% of primary health care center directors, 83.1% of physicians, 92.9% of nurses, 98.6% of physiotherapists, 95.9% of social workers, and 57.6% of the health team members replied that they did, although this knowledge was very scanty. Health care workers' source of information on HHC services was hospital work (65.0%) while administrators' sources were journals (65.0%). Only 11.1% of the administrators and 30.3% of the health team members indicated having had HHC training from university, and 3.7% of administrators and 20.4% of health team members indicated having attended a HHC lecture or symposium. The only finding with significant difference of responses (p<0.001) was on the knowledge of HHC services among health care professionals. All other responses showed no significant differences between them. No significant differences in the responses were found between the two groups of administrators. CONCLUSIONS: Health professionals and administrators showed little knowledge of HHC services. The main source of HHC information for health professionals was from their hospital experience while administrators learned more about HHC services from medical journals. RECOMMENDATIONS: HHC training centers must be set up in Saudi Arabia. Home health care concepts and skills should be part of the regular health science undergraduate curriculum.