Physicians' attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia.

BACKGROUND: Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS: This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS: The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION: Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.

Community-Based Cross-Sectional Assessment Survey On Herpes Zoster Vaccination Practices.

Background: Herpes Zoster (HZ), also known as Shingles, is a commonly occurring infection especially among the elderly. It is due to the reactivation of the dormant virus in the sensory ends that were present since the primary infection with the virus. Objective: Our study aims at assessing the knowledge, attitudes practices beliefs and current barriers towards the Shingrix vaccine to fully understand where we stand and come up with proper recommendations to services these at-risk individuals and ultimately have a positive impact on the healthcare system. Methods: Questionnaire based cross sectional study using a translated version of a previously developed and tested questionnaire. Results: more than 8000 participants responded to the survey. The vast majority had chicken pox before and did hear about the vaccine from different sources. Most of the participants had minimal knowledge regarding the vaccine and were willing to take it regardless of some safety concerns. Conclusion: more efforts need to be conducted to enhance vaccine uptake in at risk populations in Saudi Arabia.

HPV Vaccine Uptake, Willingness to Receive, and Causes of Vaccine Hesitancy: A National Study Conducted in Saudi Arabia Among Female Healthcare Professionals.

Background: Epidemiological evidence has shown that human papillomavirus (HPV) is the most frequent cause of sexually transmitted infection, and vaccination is an essential measure to prevent associated diseases and complications. This study aimed to assess the HPV vaccine uptake and its associated factors as well as HPV vaccine hesitancy by female healthcare workers (HCWs) in Saudi Arabia. Methods: This online, questionnaire-based, cross-sectional study involved female HCWs in Saudi Arabia between July and October 2022. The study tool included questions about sociodemographic, occupational, and reproductive characteristics, uptake of HPV vaccination, and reasons of hesitancy. Chi-squared and t-tests were used for bivariate analyses, and multivariable logistic regression was used to adjust for confounders. Results: The total number of participants was 1857. Around 20% of HCWs received at least one dose of the HPV vaccine, and around 45% were willing to take it this year. Lower odds of vaccine uptake were reported among older participants and those with a higher level of education. However, nurses, HCWs with a previous HPV infection, those with a family history of cervical cancer, or those with a previous cervical cancer screening test had higher odds of receiving the vaccine. On the other hand, older participants and diploma degree holders were less willing to take the HPV vaccine. Higher odds of willingness were reported in married HCWs, those with a previous HPV infection, those who received a previous HPV vaccine dose, or those who were screened for cervical cancer. Lack of knowledge and some misconceptions were the most reported reasons for hesitancy. Conclusion: Certain factors that affect HCWs personal decisions to take the vaccine were identified. By targeting these issues, epidemiologists, public health officials and women's health care providers can work to increase HPV vaccine uptake and reduce the burden of HPV-related diseases in this population.

Artificial intelligence approaches for early detection of neurocognitive disorders among older adults.

Introduction: Dementia is one of the major global health issues among the aging population, characterized clinically by a progressive decline in higher cognitive functions. This paper aims to apply various artificial intelligence (AI) approaches to detect patients with mild cognitive impairment (MCI) or dementia accurately. Methods: Quantitative research was conducted to address the objective of this study using randomly selected 343 Saudi patients. The Chi-square test was conducted to determine the association of the patient's cognitive function with various features, including demographical and medical history. Two widely used AI algorithms, logistic regression and support vector machine (SVM), were used for detecting cognitive decline. This study also assessed patients' cognitive function based on gender and developed the predicting models for males and females separately. Results: Fifty four percent of patients have normal cognitive function, 34% have MCI, and 12% have dementia. The prediction accuracies for all the developed models are greater than 71%, indicating good prediction capability. However, the developed SVM models performed the best, with an accuracy of 93.3% for all patients, 94.4% for males only, and 95.5% for females only. The top 10 significant predictors based on the developed SVM model are education, bedtime, taking pills for chronic pain, diabetes, stroke, gender, chronic pains, coronary artery diseases, and wake-up time. Conclusion: The results of this study emphasize the higher accuracy and reliability of the proposed methods in cognitive decline prediction that health practitioners can use for the early detection of dementia. This research can also stipulate substantial direction and supportive intuitions for scholars to enhance their understanding of crucial research, emerging trends, and new developments in future cognitive decline studies.

Knowledge and barriers to screening for colorectal cancer among individuals aged 40 years or older visiting primary healthcare clinics in Al-Khobar, Eastern Province.

BACKGROUND: Colorectal cancer (CRC) ranks third as the most common cancer in the world and the 4th most common cause of deaths from cancer. In Saudi Arabia, CRC is the most common cancer in males and the third most common in females. Early screening reduces the risk of CRC and death. However, there is a lack of awareness of CRC screening in Saudi Arabia. The objective of this study was to determine the knowledge, practices, and barriers to CRC screening using the Health Belief Model (HBM). MATERIALS AND METHODS: This study enrolled Saudis aged 40 years or older visiting PHCCs in Al-Khobar. Data were collected using a self-administered questionnaire or a direct interview of the selected participants. Information sought included sociodemographics, past CRC screening, CRC knowledge, and HBM items. Data analysis was done using SPSS; the Chi-squared test and ANOVA were used to determine statistical significance. RESULTS: A total of 206 of the individuals approached completed the questionnaire. The average age was 51.1 years, and 51% were males. Only 10% reported that a physician had provided information on CRC prevention or discussed/recommended screening for CRC, and 10% had undergone screening for CRC. Seventy-five percent of respondents had heard of CRC, and 74% said that CRC was preventable. Regarding the HBM, no significant difference in the mean scores for perceived susceptibility, perceived severity, self-efficacy, and benefits of CRC screening was found by age groups. The mean score for perceived severity was higher for females than males. About 60% of participants were extremely likely to have a screening test for CRC done on the day if recommended by the doctor. CONCLUSION: The knowledge and awareness of CRC screening of the targeted sample is inadequate. Individuals with higher perceived susceptibility, severity of CRC, and perceived benefit of the screening tests were more willing to undergo the test. The highest perceived barrier was having no symptoms, and the lowest was "getting a stool test is too much of a hassle." These findings underline the importance of having a national screening program and campaigns to deal with the concerns of people and raise awareness of CRC.

A Cross-Sectional Analysis into the Willingness and Hesitancy to Test and Vaccinate Against COVID-19 Among the Elderly Population in the Kingdom of Saudi Arabia.

Introduction: COVID-19 remains a public health concern. Vaccinations, testing and tracing have been proven to provide strong protection against severe illness and death. Older adults are amongst the groups with an increased risk of severe illness. This study aimed to explore the willingness and hesitancy of the elderly population in the Kingdom of Saudi Arabia to test and vaccinate against COVID-19. Methods: This cross-sectional study targeted participants aged 65 years and above. The questionnaire included both sociodemographic variables, and variables related to willingness and hesitancy to vaccinate and test for COVID-19 that were mainly based on existing literature. Bivariate analyses were performed to test for associations. Significance was set at the 0.05 level. Results: The total sample of respondents was 502. The results show that 52.4% were not aware of a previous infection. Participants aged above 70 years and females were found to be more aware of a previous infection (51.6% and 53.1% respectively) (P < 0.05). Also, 54.7% felt it necessary to test against COVID-19, and among those, 70.8% believed that testing would contain and control the spread. The results also show that 3.2% were not vaccinated to date, compared to 95.41% who had the complete dose as well as the recommended booster dose for elderlies. Age, sex and level of education were significantly associated with vaccine uptake, where participants aged between 65 and 70 years, males and high levels of education were associated with a complete vaccine uptake. Discussion: The current findings add to the epidemiological evidence and show that the social network theory within the context of health may have played a role in self-awareness of previous infections. Also, social factors should be incorporated in public health interventions and public health campaigns targeting the elderly are still needed especially with the continued discovery of variants of interests.

Intention and practice on personal preventive measures against COVID-19 among older adults in the Kingdom of Saudi Arabia: an epidemiological study using the Theory of Planned Behaviour.

Introduction: Older adults aged 65 years and above are among the most vulnerable to adverse outcomes and death following a COVID-19 infection. The weekly epidemiological updates by the World Health Organisation show that the continued emergence of concerning subtypes of the virus indicates that the pandemic remains a public health concern and the public should continue to comply with personal preventive measures (PPMs). This study applies the Theory of Planned Behaviour (TPB) which is rooted in the field of Public Health, Epidemiology, and Preventive Medicine to Saudi older adults to predict their health behaviour. Methods: This behavioural epidemiological study recruited older adult participants aged 65 years of age and above. A tool which consisted of sociodemographic and health-related questions, as well as questions regarding the components of the TPB, namely, Attitude, Subjective Norm, Perceived Behavioural Control was used. Bivariate analyses, followed by unadjusted and adjusted multivariable logistic regression analyses were performed to derive odds ratios and 95% confidence intervals. Results: The total number of participants was 502. The mean age was 70.34 years, with similar distributions between males and females. In total, 52.2% intended to practice PPMs, whereas only 48% had a good practice. Also, 56% had a favourable Attitude towards PPMs, 61.4% had a positive Subjective Norm and 39.8% had perceived they had a high control over their behaviour. Females, and high educational status were predictors for high intention to practice PPMs (OR = 1.59, 95% CI = 1.01-2.52 and OR = 2.72, 95% CI = 1.44-5.16 respectively). Further predictors included Attitudes, Subjective Norm and Perceived Behavioural Control. Results also show that intention to practice was significantly associated with a lower odd of practicing PPMs (OR = 0.06, 95% CI = 0.04-0.10). Conclusion: Current findings highlight the need to continue with public health efforts targeting vulnerable older adults. Also, the fact that intention negatively predicted practice highlights the need for further behavioural epidemiological studies addressing the intention-behaviour gap.

Beliefs and Utilization of Cervical Cancer Screening by Female Health Care Workers in Saudi Arabia Using the Health Belief Model: A Nationwide Study.

Purpose: Epidemiologically, cervical cancer is the fourth most commonly diagnosed cancer among females globally and the third most commonly diagnosed gynecological cancer in Saudi Arabia. Screening is an important measure to prevent it. The current study aimed to assess, epidemiologically, female healthcare workers' (HCWs) utilization of cervical cancer screening services and its association with their beliefs about cervical cancer and the screening test, as well as their personal characteristics. Methods: This cross-sectional study included female HCWs in Saudi Arabia. A predesigned, self-administered survey was used to collect data, and it included questions about sociodemographic and reproductive characteristics, self-utilization of cervical cancer screening services, and the Health Belief Model (HBM) scale. Regression analyses were conducted to identify predictors of cervical cancer screening service utilization. Results: A total of 1857 females participated. The cervical cancer screening test uptake was 24.6% of ever-married females. However, 45% of the participants were willing to have the test. The odds of utilizing a screening were significantly higher among older participants, those with a higher level of education, and those with a higher number of pregnancies. Furthermore, HCWs with a history of HPV infection, cervical cancer in the family, hormonal contraception, or immunocompromised diseases were more likely to have the screening. An increase in the mean scores of the perceived benefits and motives subscales of HBM was associated with an increase in the uptake of screening. However, an increase in perceived barrier scores was significantly associated with a lower likelihood of cervical cancer screening uptake. Conclusion: Low cervical screening uptake and slightly higher intentions to have the test exist among HCWs. Certain personal factors and health beliefs significantly affect the utilization of the screening test. Approaches that target perceived benefits, health motivation, and perceived barriers to improve the screening rates of cervical cancer among HCWs are recommended.

Prevalence of Digital Eye Strain Among University Students and Its Association with Virtual Learning During the COVID-19 Pandemic.

Introduction: The prolonged use of digital devices is a major risk factor for digital eye strain (DES) syndrome. Aim: To estimate the prevalence of DES symptoms among students at Imam Abdulrahman University who use digital devices for virtual learning and leisure activities. Methods: This was a retrospective cross-sectional study conducted by asking medical students of Imam Abdulrahman bin Faisal University to complete a self-administered online questionnaire. The questionnaire was used to determine the effect of the hours spent on digital devices and other factors, such as screen distance and not using artificial tears, on the development of DES. The severity (moderate or severe) and frequency (occasionally, always, or never) of 16 eye strain-related symptoms, including eye pain, headache, and itching, were evaluated by using the Computer Vision Syndrome Questionnaire. Results: The overall prevalence of DES in the sample was found to be 68.53%. The largest proportion of students were found to have mild DES (43.20%), and only 11% had severe DES. The most common symptoms reported in our sample were headache, dryness, and burning. Female gender, using smartphones for online classes, and not using eye lubricants were significantly associated with increased severity of DES. Conclusion: In the wake of the COVID-19 pandemic, virtual learning has become an integral part of education, leading to increased use of digital technology. The aim of this study was to investigate the impact of virtual learning on eye strain and to determine the prevalence and effects of DES. A questionnaire was administered to participants, and the findings revealed a DES prevalence of 68.53%. The use of eye drops for lubrication and smartphones for classes was significantly associated with DES. Furthermore, females were found to be more susceptible to severe DES symptoms than males. The development of a tool such as the Computer Vision Syndrome Questionnaire to predict DES prevalence could reduce clinic time and resources by minimizing unnecessary follow-up and ophthalmology referrals.

Disparities in cervical cancer screening among Arabic-speaking women refugees.

OBJECTIVES: Cervical cancer remains one of the most common cancers among females and one of the top causes of cancer-related deaths worldwide. Minority women are disproportionately more vulnerable. This study addressed disparities in cervical cancer screening among Arabic-speaking women refugees. DESIGN: We conducted a cross-sectional study using qualitative and quantitative research methods at a Federally Qualified Health Center (FQHC) in Cleveland, Ohio, in the United States of America (USA). A structured phone-based survey was developed and administered in Arabic. The study was conducted from 2018 to 2019 and involved 20 participants. RESULTS: Inequity in cervical cancer screening exists among Arab women refugees (41% being up to date with their screening) compared to their English- and Spanish-speaking counterparts (51%). These women perceived that the top three barriers to cervical cancer screening were fear of cancer, language, and lack of knowledge. The top three perceived facilitators were the doctor's recommendation, reminders from the provider's office, and awareness of cervical cancer screening. CONCLUSION: Our work brings unique insights into improving preventive care services for Arabic-speaking women. These findings add unique insight focused on improving preventive care in this group and can inform interventions to increase cancer screening amongst Arabic-speaking women.

Breaking Bad News of a Cancer Diagnosis: A Mixed-Methods Study of Patients' Perspectives.

Purpose: A cancer diagnosis is an overwhelming process for both patients and doctors. Many studies have addressed doctors' opinions and knowledge regarding breaking bad news (BBN). However, scarce knowledge exists regarding patients' perspectives for communicating bad news. Therefore, the current study aims to assess cancer patient preferences and satisfaction about BBN. Patients and Methods: This is a mixed methods study consisting of two phases; an in-depth interview and cross-sectional quantitative analysis. Thematic analysis was used for the qualitative data to explore patients' satisfaction and preferences about BBN. For quantitative analyses, the overall satisfaction was calculated as satisfaction percent. Bivariate analyses were performed, and statistical significance was set as p < 0.05. Quality function deployment was used to effectively define patient requirements of highest priority. Results: Thematic analysis revealed two main themes. Theme 1; patients' requirements for BBN and theme 2; patients' reaction at the time of diagnosis with their categories. For the quantitative part, a total of 222 patients responded to the survey, females made up 70% of the sample. Satisfaction score percent ranged from 25.5 to 100%, with a mean of 82.7±11.9%. The most preferred items were mainly concerned with the doctor being honest and encouraging, good listener and interacting giving simple smooth explanations without using medical terms, and empathetic (average score 4.8/5). Also, providing the diagnosis in a calm and private environment (4.7/5). Analysis also found that the requirements for improvement included providing a written summary after receiving the diagnosis and patient perception assessed by the doctor before telling the diagnosis. Conclusion: Communicating bad news effectively is crucial in the management of cancer patients. The process of BBN should be patient-centered, focusing on patients' needs. Thus, the current study has demonstrated the patients' preferences and the requirements, which should be incorporated into BBN protocols.

Public Health and General Preventive Medicine Training: A National Survey.

Little is known about the current experiences of Public Health/General Preventive Medicine (PH/GPM) residents and graduates in the United States. This cross-sectional study of PH/GPM residents and graduates examined their knowledge of the field and career choices after graduation. We developed a questionnaire to address medical education, graduate medical training prior to Preventive Medicine (PM), current PM training, and post-graduation goals. Data was stratified by residency status (resident vs graduate), and board-eligibility (dual-eligible vs solely PH/GPM). Bivariate analysis of quantitative data was performed using Fisher's test. Qualitative data were organized into themes and analyzed quantitatively. Of those invited to participate, a total of 153 (18.25%) PH/GPM residents and graduates responded to the survey. We found diversity in prior medical education/training among respondents. Overall, debt burden at the start of training was low compared to national trends. Compared to residents, a higher proportion of graduates were board-eligible in another specialty (p<0.001). Most respondents felt that their programs provided them with opportunities to acquire skills essential for a career in PM. Ninety-one percent of graduates were board-certified in PH/GPM. Respondents expressed a wide range of career interests, including government work and academia. Difficulty with marketing themselves as PM physicians was frequently cited as a reason for the difficulty in securing a PM job. The results inform the PM community with current trends in PH/GPM training and career obstacles faced by PM graduates.

ABO and Rhesus Blood Group Distribution and Blood Donation Willingness Among First-Year Health Students in a Saudi University.

BACKGROUND: Understanding the distribution of blood groups and blood donation willingness in a population is crucial in managing blood banks and transfusion services. Moreover, awareness of one's own blood group is essential especially in emergencies that mandate blood donation. This study aimed to determine the distribution of ABO and Rhesus (Rh) blood groups among health students, the students' knowledge about their blood group, and their willingness to donate blood. METHODS: This cross-sectional study included all newly accepted health students in a large university in the Eastern Province of Saudi Arabia (N=1145) during August 2020. The data included a self-administered questionnaire and the serology results of ABO and Rh factors. Chi-squared and Fisher's exact tests were performed followed by a multivariable binary logistic regression analysis which identified the predictors of willingness of blood donation. RESULTS: Blood group O was the most frequent type among students (51.1%), followed by group A (24.5%) and B (20.4%). The majority (93.3%) of students had Rh-positive factor. When we compared students' answers with their sample results, most students (75.5%) correctly reported their ABO and Rh blood groups. Male students and those with a previous history of blood donation correctly reported their blood group more than others. Of the total sample, 47.3% were willing to donate blood within the next year. Positive predictors of the willingness of student to donate blood included being male, and those with a history of blood donation. Interestingly, students with a family member in the healthcare field were significantly less likely to donate blood. CONCLUSION: Blood group O and Rh positive were the most frequent blood groups. Most students had a good knowledge about their blood groups, and about half of students were willing to donate blood. Efforts to encourage the young population to participate in blood donation are crucial.

Pediatric Hypertension: Parent Perspectives.

Clinical practice guidelines for diagnosis and management of pediatric hypertension have been available for decades. Yet, most cases of hypertension in children are undiagnosed. Provider and system-based factors, such as the complexity of diagnostic standards, and a failure among physicians to recognize the importance of hypertension in children, play a role in underdiagnosis. It is unclear, however, how patient and family behaviors impact the diagnosis and treatment of pediatric hypertension. We aimed to explore the perspectives of parents whose children have had multiple high blood pressure readings or have been diagnosed with hypertension to inform clinicians with areas for practice improvement. In a 2 site qualitative study, we interviewed parents of 15 children diagnosed with hypertension. Results from semi-structured interviews with parents revealed barriers to the diagnosis of pediatric hypertension, including uncertainty about the diagnosis and concerns around the accuracy of blood pressure measurements. Delay in diagnosis and lack of child engagement emerged as obstacles to the treatment of pediatric hypertension.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.