Knowledge, perception, and beliefs of Saudi physicians at King Abdulaziz Medical City, Riyadh related to medical cannabis: Literature review and a cross-sectional survey.

Cannabis is an herbaceous flowering plant, originally an indigenous plant in Eastern Asia, which later spread globally due to widespread agricultural practices. Cannabis was used medicinally until the early twentieth century, but subsequently prohibited due to the psychoactive effects. Aims: To explore the medical cannabis-related level of knowledge of physicians at King Abdulaziz Medical City, including patient needs, perceptions of therapeutic effects, potential harm, and the willingness to prescribe if legalized in future. Methodology: The study was a cross-sectional questionnaire-based survey. It was conducted at King Abdulaziz Medical City in Riyadh from February 2020 to February 2021. All physicians from the different specialties, who consented to participate, were included in this study. Statistical Analysis: Descriptive statistics are presented as mean and standard deviation and proportions. An ANOVA test was applied to measure the association of the beliefs regarding the right to prescribe with overall knowledge. All tests were considered significant at P < 0.05. Results: A total of 249 physicians participated with the majority (70%) male. The sample was similar regardless of the physician's position in the medical hierarchy, with a mean work experience of 8 years. Almost half of the participants indicated that they do not have good knowledge regarding the effects of MC products and more than half that they are unaware of the different MC products and formulations currently available. Conclusion: The majority of the sample lacked knowledge about the medicinal use of cannabis for specific indications and felt uncomfortable to discuss the medicinal use of cannabis with their patients.

Intelligent Transportation Using Wireless Sensor Networks Blockchain and License Plate Recognition.

License Plate Recognition (LPR) is essential for the Internet of Vehicles (IoV) since license plates are a necessary characteristic for distinguishing vehicles for traffic management. As the number of vehicles on the road continues to grow, managing and controlling traffic has become increasingly complex. Large cities in particular face significant challenges, including concerns around privacy and the consumption of resources. To address these issues, the development of automatic LPR technology within the IoV has emerged as a critical area of research. By detecting and recognizing license plates on roadways, LPR can significantly enhance management and control of the transportation system. However, implementing LPR within automated transportation systems requires careful consideration of privacy and trust issues, particularly in relation to the collection and use of sensitive data. This study recommends a blockchain-based approach for IoV privacy security that makes use of LPR. A system handles the registration of a user's license plate directly on the blockchain, avoiding the gateway. The database controller may crash as the number of vehicles in the system rises. This paper proposes a privacy protection system for the IoV using license plate recognition based on blockchain. When a license plate is captured by the LPR system, the captured image is sent to the gateway responsible for managing all communications. When the user requires the license plate, the registration is done by a system connected directly to the blockchain, without going through the gateway. Moreover, in the traditional IoV system, the central authority has full authority to manage the binding of vehicle identity and public key. As the number of vehicles increases in the system, it may cause the central server to crash. Key revocation is the process in which the blockchain system analyses the behaviour of vehicles to judge malicious users and revoke their public keys.

Epidemiological Features and Clinical Manifestations of Patients With Somatoform Disorder at a Tertiary Medical City in Riyadh, Saudi Arabia.

Background Somatoform disorder (SD), known as the presence of physical symptoms suggesting a physical condition, for which there are no demonstrable organic findings or established physiological mechanisms with positive evidence that the symptoms are related to psychological causes. The aim of this study was to highlight the epidemiological characteristics, demographic features, comorbidities, and clinical presentations of patients with SD. Materials and methods This was a retrospective study of SD patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. We reviewed the patients' electronic health records from January 2015 to December 2020 for collecting the patients' demographic information, including gender, age, marital status, and occupation. The types of SD, presenting symptoms of each disorder, department to which patients initially presented, comorbidities, and management were also documented. The diagnosis of SD was based on the International Classification of Diseases, Tenth Revision (ICD-10). Results In total, 89 patients were included in the study. The majority (n=50, 56.2%) were female, with a mean age of 42.7±17.1 years. More than half of the sample was married (n=54, 60.7%). The most common subtype of SD was somatization disorder followed by conversion disorder, pain disorder, and hypochondriasis, diagnosed in 69 (77.5%), 12 (13.5%), 5 (5.6%), and three (3.4%) patients, respectively. Neurological symptoms and pain were the most frequent presenting symptoms for all the somatoform patients. More than half of the sample (n=48, 53.9%) initially presented at an outpatient clinic. Conclusions The number of SD patients was less than expected, and a third did not receive any treatment. This emphasizes the need for more SD awareness among clinicians in various medical specialties. Appropriate SD and other mental disorders education for physicians may support achieving a better identification of SD and subsequently an improved quality of life for the patients.

Health-ID: A Blockchain-Based Decentralized Identity Management for Remote Healthcare.

COVID-19 has made eHealth an imperative. The pandemic has been a true catalyst for remote eHealth solutions such as teleHealth. Telehealth facilitates care, diagnoses, and treatment remotely, making them more efficient, accessible, and economical. However, they have a centralized identity management system that restricts the interoperability of patient and healthcare provider identification. Thus, creating silos of users that are unable to authenticate themselves beyond their eHealth application's domain. Furthermore, the consumers of remote eHealth applications are forced to trust their service providers completely. They cannot check whether their eHealth service providers adhere to the regulations to ensure the security and privacy of their identity information. Therefore, we present a blockchain-based decentralized identity management system that allows patients and healthcare providers to identify and authenticate themselves transparently and securely across different eHealth domains. Patients and healthcare providers are uniquely identified by their health identifiers (healthIDs). The identity attributes are attested by a healthcare regulator, indexed on the blockchain, and stored by the identity owner. We implemented smart contracts on an Ethereum consortium blockchain to facilities identification and authentication procedures. We further analyze the performance using different metrics, including transaction gas cost, transaction per second, number of blocks lost, and block propagation time. Parameters including block-time, gas-limit, and sealers are adjusted to achieve the optimal performance of our consortium blockchain.

Domestic Violence Against Married Women During the COVID-19 Quarantine in Saudi Arabia.

Background  Before the coronavirus disease 2019 (COVID-19) pandemic, cases of domestic abuse and aggressive behaviour between Saudi married couples were increasing annually, a topic of growing concern both socially and medically. With the forced indoor confinement enacted as a containment measure, international studies regarding domestic abuse indicated an almost unanimous increase in prevalence. This cross-sectional national study aimed to assess the change between the pre-and intra-pandemic prevalence of abuse in Saudi Arabia.  Material and methods  Anonymous data were gathered using a web-based Arabic version of the World Health Organization (WHO) multi-country instrument measuring violence against women residing in Saudi Arabia. The previously validated questionnaire included a series of multiple-choice questions related to demographic information, family infrastructure, experienced situations of abuse, and the severity and form of abuse during the quarantine period, from March 23, 2020, to June 21, 2020. Associations were tested using a two-tailed Pearson's Chi-square test and odds ratios. A binary multivariate logistic regression was used to identify the independent factors associated with domestic violence.  Results  In total, 2254 participants were included in the present study. The majority (n=2129, 94.7%) were Saudi nationals. The highest proportion (n=1022, 45.3%) was in the 30 to 40 years age group. The self-reported prevalence of domestic violence before COVID-19 pandemic and quarantine was 25.4% and 16.6% during the confinement, indicating an overall decrease of 8.8% in the reported cases. Regarding the type of violence, of the 315 (16.6%) women who endured violence since the confinement, the majority (n=301, 95.6%) experienced multiple forms of violent abuse, 264 (87.7%) suffered from psychological/emotional violence, 114 (37.9%) from physical violence, and 50 (16.6%) from sexual violence. Of the group who experienced multiple forms of violence, 120 (39.9%) reported an increase in the frequency and perceived intensity of the violence since the confinement. The only variable that directly increased the likelihood of suffering domestic violence had more than three children [OR = 1.59, P = 0.018]. Conclusions  Contrary to trends observed in other countries, the national prevalence of abusive conduct towards married women showed a marked decrease during the quarantine period-more children directly correlated with a higher reported frequency of being abused. Further studies in neighbouring countries with comparable societies and structures must be conducted to assess the validity of our findings in the context of the global trends of violence in the marital home.

Workplace Violence Among Healthcare Workers in a Tertiary Medical City in Riyadh: A Cross-Sectional Study.

Introduction Workplace violence is a common problem that is encountered by healthcare workers worldwide; however, it is still under-studied in Saudi Arabia. This study aims to determine the prevalence of workplace violence and to explore reasons for not reporting it among healthcare workers in a tertiary medical city in Riyadh. Methods This cross-sectional study was conducted among 404 healthcare workers who had direct contact with patients or their relatives in a tertiary care medical city in Riyadh, Saudi Arabia. Data were analyzed using Statistical Analysis Software Package (SPSS; IBM, Armonk, NY, USA). Results Most participants (81.4%) had experienced verbal, physical, academic, or sexual violence. Approximately 39.6% of those who experienced workplace violence did not report the incident, and the most common reason for not reporting was identified as "reporting would not accomplish anything" (49.4%). About 27.5% of violence victims did not know how to report the incidents. Patients or their relatives were the main sources of violence across all violence categories except academic violence, in which consultant physicians were the main source. Conclusions The prevalence of workplace violence in the population studied was higher than anticipated compared to similar studies both in Saudi Arabia and globally. Almost half of those who were subjected to violence did not report the incident, believing that reporting would not change anything. There is arguably an urgent need to develop strategies that reduce workplace violence and facilitate reporting it in hospitals. Moreover, awareness programs regarding the negative impacts of violence against healthcare workers on the quality of care are necessary.

Factitious Disorder in Seven Patients: A Saudi Experience.

Background Factitious disorder (FD) is a psychiatric disease where signs and symptoms are produced, falsified, or exaggerated consciously in the absence of clear external motivations. Through needless medical visits, costly investigatory testing, and potentially long hospital stays, patients with FD waste valuable time and resources, which affects both the patient and the healthcare system. It can be very challenging for physicians who have never encountered patients with FD to recognize them promptly as symptoms of FD vary greatly. Methodology This was a retrospective study of patients diagnosed with FD attending King Abdulaziz Medical City in Riyadh, Saudi Arabia, a tertiary care military hospital and one of the most prominent academic and referral medical institutions in the country. Using the BESTCare health information system, we reviewed patients' electronic health records from January 2015 to December 2020. The diagnosis of FD was based on the International Classification of Diseases and Related Health Problems 10th edition. Results A total of seven patients were included in the study, of whom five (71%) were males and two (29%) were females. Of the total seven patients, three were 21 years old and younger, one was 38 years old, and three were 56 years old and older. Three (43%) patients were married and four (57%) were single. In terms of occupation, three (43%) patients were retired, one (14%) worked in a private company, one (14%) was unemployed, and two (29%) were students. A total of four (57%) patients initially presented to the Emergency Department (ED), and only three (43%) presented to the outpatient clinics. Induced disease or injury was found in five (71%) patients. Induced skin injury was found in four (57%) patients. Counseling and psychotherapy were only offered to one (14%) patient. Conclusions FD remains a rare psychiatric condition that is difficult to recognize. Despite a small sample size, FD in the present study showed a male predominance, affecting patients of all age groups. About half of the patients presented initially to the ED. Induced disease or injury was the most commonly reported pattern of clinical presentation. Induced skin injury was the most common clinical presentation found in around half of the patients. We believe that the number of FD patients in the present study is likely underreported and is expected to be higher. This highlights the need for better awareness of FD among physicians in different medical fields. We emphasize that there is a need for better professional training in the identification of FD.

Correlates of Psychotropic Polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia.

BACKGROUND: Polypharmacy is meaningful and clinically justified under certain circumstances. However, the prescription of multiple psychiatric medicines is mostly based on practical experience rather than evidence. The aim of this study was to assess the current practice of and factors associated with the use of polypharmacy among patients attending outpatient psychiatric clinics. MATERIALS AND METHODS: A cross-sectional study was conducted among patients attending outpatient psychiatric clinics in two tertiary care hospitals in the kingdom of Saudi Arabia (KSA). Patients aged 18 years and above and who were taking any prescription or nonprescription medications were included. Data were collected by face-to-face interviews, followed by a review of electronic medical charts to determine the drugs being taken by patients, and track their current computerized drug prescriptions. Data were analyzed using SPSS statistical software version 21 (Chicago, IL, USA), applying both descriptive and inferential statistical analysis as appropriate. RESULTS: Of the 401 study participants, 53.6% were aged 25 years or older, and 63.6% were married and > 50% were unemployed. The overall prevalence of polypharmacy was 46.9%. The prevalence of polypharmacy was 67.3% in psychosis, 37.7% in depression, 27.1% in anxiety, 74.1% in bipolar disorders, and 53.6% for patients with two or more disorders, and 42.1% for patients diagnosed with "other" disorders. Overall, there was a significant association between polypharmacy and gender, marital status, and diagnosis of disorder. CONCLUSIONS: Psychotropic polypharmacy is common in outpatient practice. Patients with psychosis and bipolar disorders, especially those aged 25-45 years are exposed to high psychotropic polypharmacy. The concomitant use of large numbers of drugs should be periodically reviewed to improve the quality and safety of psychiatric care.

Knowledge, attitudes and use of anabolic-androgenic steroids among male gym users: A community based survey in Riyadh, Saudi Arabia.

Recreational use of anabolic-androgenic steroids (AAS) is a growing worldwide public health concern. However, studies assessing the level of awareness and knowledge of its effects on health are fairly limited, especially in developing countries, including Saudi Arabia. This community-based cross-sectional study was conducted to assess knowledge, attitudes and practices among male gym members toward AAS in Riyadh (Saudi Arabia) from March to October 2016. Twenty gyms were randomly selected from four different geographical regions (clusters) within Riyadh. In total, 482 participants responded to the self-administered anonymous questionnaire, which covered socio-demographic data, data assessing knowledge, attitude and behavior related to AAS use. The mean (±standard deviation) age of study participants was 27.2 (±6.9) years. Among these, 29.3% of participants reported having used AAS, while the majority (53.5%) reported hearing of AAS use, mostly through friends. Most study participants reported awareness of the effects of AAS on muscle mass, body weight and muscles strength (53.2%, 51.1% and 45.5%, respectively). In contrast, a higher proportion of study participants were unaware of the side-effects of AAS use. A high proportion of study participants (43.2%) reported that they had been offered AAS and 68.7% believed that AAS are easily accessible. Most of the gym users (90.1%) reported never having used any narcotics or psychoactive drugs. Regression analysis revealed that use of anabolic-androgenic steroids is significantly associated with "weight lifting practice" OR [95%CI] = 1.9[1.02 - 3.61], P = 0.044; "using supplementary vitamins, OR [95%CI] = 7.8[4.05 - 15.03], P < 0.0001, knowing anyone using anabolic-androgenic steroids' OR [95%CI] = 7.5[3.78 - 14.10], P < 0.0001, and someone advised Gym users to take anabolic-androgenic steroids" OR [95%CI] = 2.26[1.23 - 4.14], P < 0.008. Our findings suggest that the level of awareness regarding the possible side-effects of AAS is fairly limited. Thus, efforts directed toward educating the public and limiting access to AAS as well as health policy reforms are crucial to reduce future negative implications of AAS use.

Knowledge and attitude about sexually transmitted diseases among youth in Saudi Arabia.

BACKGROUND: Sexually transmitted diseases (STDs) are one of the most serious diseases in the world. Our aim was to explore the knowledge and attitude about STDs among the youth. PATIENTS AND METHODS: This cross-sectional survey was conducted from August 1 to August 13, 2016. Male and female youth between 18 and 25 years were invited to participate in the survey using social media open to all Internet users consisting of questions and statements about STDs, and then the data were analyzed. RESULTS: We received 5040 responses to the survey; out of these participants 76.6% were females and 23.4% were males with a mean age 21.5 and most of them were single (85.1%). We noticed that most of the respondents selected the Internet (71.7%) as the main source of their knowledge about STDs followed by school, television, and others, respectively. In spite of, 94.08% knew that human immunodeficiency virus/AIDS is an STD, only 43.61% knew that herpes simplex virus is an STD, and only 31.03% knew that Chlamydia is an STD. A high percent (93.1%) agreed that sexual intercourse transmits STDs. Only 59.6% agreed that condom does not provide complete protection from STDs. To our surprise, only 55% considered themselves capable of protecting themselves against STDs. About 95.8% of the participants agreed that STDs should be taught in schools, while 4.2% disagreed. CONCLUSION: We noticed a lack of participant's knowledge regarding the types, mode of transmission, and the ways of protections from STDs and their desire to find out information about STDs. Hence, awareness programs about STDs should be started that aim at encouraging youth to follow our religion and culture.