Association Between Musculoskeletal Pain and Frailty Over Time in Older Adults.

BACKGROUND AND PURPOSE: There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults. PARTICIPANTS AND METHODS: A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year follow-ups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years. RESULTS: After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05). CONCLUSIONS: Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.

Biomarkers of Physical and Mental Health for Prediction of Parkinson's Disease: A Population-Based Study from 15 European Countries.

OBJECTIVES: Early diagnosis of Parkinson's disease (PD) is critical for optimal treatment. However, the predictive potential of physical and mental health in PD is poorly characterized. METHODS: We evaluated the potential of multiple demographic, physical, and mental factors in predicting the future onset of PD in older adults aged 50 years or older from 15 European countries. Individual study participants were followed over four waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2013-2020. RESULTS: Of 57,980 study participants, 442 developed PD during the study period. We identified male sex and advancing age from the sixth decade of life onward as significant predictors of future PD. Among physical factors, a low handgrip strength (HGS; men <27 kg, women <16 kg), being bothered by frailty, and recent falls were significantly associated with future PD. Among mental factors, a higher depression (Euro-D depression score >6) emerged as an independent predictor of future PD. Finally, the presence of hypertension or Alzheimer's disease (AD) increases the risk of future PD. CONCLUSIONS: Altogether, male sex, advancing age, low HGS, frailty, depression, hypertension, and AD were identified as critical risk factors for future PD. Our results may be useful in the early identification and treatment of populations at risk for PD.

The quality of life in Alzheimer's disease is not associated with handgrip strength but with activities of daily living-a composite study from 28 European countries.

OBJECTIVES: The relationship between handgrip strength (HGS) and quality of life is inconsistent. The purpose of this study was to investigate the potential association between HGS and quality of life in the settings of ageing and Alzheimer's disease (AD). METHODS: We investigated the HGS, CASP-12 (control, autonomy, self-realization, and pleasure) measure of quality of life, and physical capacity in European adults above 50, including controls (n = 38,628) and AD subjects (n = 460) using the survey of health, ageing, and retirement in Europe (SHARE; 2022). RESULTS: AD subjects exhibited lower HGS and CASP-12 scores than controls (both p < 0.05). Participants with higher CASP-12 quartiles had higher HGS in controls but not in AD subjects. A linear positive relation was found between HGS and CASP-12 in controls (0.0842, p < 0.05) but not in AD subjects (0.0636, p = 0.091). There was no effect of gender on this finding. Lastly, we found significant negative associations of difficulties walking, rising from chair, climbing stairs, and fatigue with CASP-12 scores in controls and AD subjects (all p < 0.05). CONCLUSIONS: Altogether, HGS was not associated with quality of life in individuals with AD. Conversely, difficulties in activities of daily living seem to be negatively associated with quality of life; thus, strategies are recommended to improve physical capacity.

Allergic rhinitis guidelines knowledge, attitudes, and practices among primary health care physicians: A national multicentre cross-sectional study.

Background: Allergic rhinitis (AR) is considered one of the most common reasons for patients visiting primary health care clinics. Physicians' adherence to management guidelines for AR results in better patient outcomes. Therefore, the present study aimed to assess the knowledge, attitudes, and practices of primary health care practitioners (PHCPs) towards allergic rhinitis guidelines in Saudi Arabia. Methods: This observational cross-sectional study conducted from August 2021 to November 2021 included 282 primary care physicians across all regions of Saudi Arabia. We used a two-part, validated, self-administered Perception Attitude and Practice of Primary Care Practitioners questionnaire. The first part was demographics, and the second part comprised three domains (perception, attitude, and practice) including 48 items. Statistical Package for the Social Sciences (SPSS), version 21 was used to analyze the data. Results: Most of the 282 physicians were Saudis (79%). Allergic rhinitis and its impact on asthma (ARIA) guidelines were recognized by 71% of the physicians. Second-generation oral antihistamines were considered the safest drug by the majority (82%), followed by intranasal corticosteroids (75.2%). Most physicians diagnosed AR based on clinical history (95%), while (43%) utilized allergy testing. Intranasal corticosteroids were the most preferred treatment option (70%) followed by second-generation and first-generation oral antihistamines (66% and 55%, respectively). Conclusion: Our study demonstrates the importance of education and awareness for PHCPs managing AR. ARIA guidelines should be implemented as a standard of care for AR, as PHCPs are the first ones to encounter patients with AR, to improve outcomes and avoid undertreatment and complications.

Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic.

Purpose: Smartphone addiction is prevalent among medical students, and there is a concern that the coronavirus disease 2019 (COVID-19) pandemic fueled a rise in smartphone addiction. Earlier studies suggest a link between excessive smartphone usage and negative outcomes such as depression, stress, and reduced academic achievement. However, there is a dearth of both local studies in Saudi Arabia and studies conducted during the COVID-19 pandemic exploring the prevalence of smartphone addiction and its association with academic performance, depression, and perceived stress, which is the purpose of the current study. Methods: In 2021, a cross-sectional research project took place among medical students at King Saud University and the Vision Colleges located in Riyadh, Saudi Arabia. An online self-administered questionnaire consisting of demographic variables, grade point average (GPA), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Stress Scale-4 (PSS-4), and the Smartphone Addiction Scale-Short Version (SAS-SV) was deployed. Results: Three hundred and fifteen students participated. Around 47.9% of students reported smartphone addiction, and the mean SAS-SV score was 32.31 ± 12.01 points. Both PHQ-9 and PSS-4 scores showed a significant positive correlation with the SAS-SV score (r = 0.216, p < 0.001 and r = 247, p < 0.001, respectively), while GPA did not (r = -0.027, p = 0.639). An adjusted analysis showed that the PSS-4 score was positively associated with the SAS-SV score (odds ratio (OR) = 1.206, p < 0.001), while the PHQ-9 score was not (OR = 102, p = 0.285). Conclusions: Smartphone addiction is prevalent among medical students and associated with perceived stress. Additional research is required to gain a deeper comprehension of this issue and to assess the success of intervention initiatives aimed at encouraging healthy smartphone usage, particularly in times of crisis like the COVID-19 pandemic.

Association between non-communicable diseases and physical activity level in older adults visiting primary health care centers in Jizan, Saudi Arabia.

OBJECTIVES: To examine the association between the number of non-communicable diseases (NCDs) and physical activity (PA) in older adults visiting primary healthcare centers (PHCCs) in Jizan, Saudi Arabia. METHODS: This cross-sectional study was carried out on men and women aged ≥60 who visited PHCCs, Jizan City between June and September 2021. Eleven self-reported NCDs were identified and summed to produce a single score, and PA scores were calculated based on the self-reported PA Scale for the Elderly (PASE). Multiple linear regression models were used to examine the association between the number of NCDs and PA in the included population. RESULTS: In total, 94 participants were included in this study. Of these, 62 were men, and 32 were women. The mean age was 67.29±6.58 years, and the mean PASE score was 53.67±29.72. A significant negative association was found between the number of NCDs and PA, even after a fully adjusted analysis. CONCLUSION: This study found a significant inverse association between the number of NCDs and PA in older adults. In addition, age was associated with lower PA, even among older adults. PA should be recommended to older adults to prevent or reduce the number of NCDs. Future research should focus on examining cause-and-effect associations at a national level.

Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia.

Objective: This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design: Retrospective cross-sectional descriptive study. Setting and Participants: A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods: Only individuals fulfilling the HHC program's eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications: In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.

Empathy among Saudi Residents at a Tertiary Academic Center during the COVID-19 Pandemic and Its Association with Perceived Stress.

Background and Objectives: Empathy is an important attribute of a healthy doctor−patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels of empathy and to identify if there is an association with stress in general and across the demographic and training characteristics of residents. Materials and Methods: A cross-sectional questionnaire-based study was carried out from December 2020 to March 2021 among residents training at a tertiary academic center in Riyadh, Saudi Arabia. Empathy and perceived stress were measured using the Jefferson Scale of Empathy (JSE) and the Perceived Stress Scale (PSS). Results: A total of 229 residents participated. The mean JSE score was 105.25 ± 15.35. The mean JSE scores were significantly higher among residents training in pediatrics (mean difference (MD) = 17.35, p < 0.001), family medicine (MD = 12.24, p = 0.007), and medical specialties (MD = 11.11, p = 0.012) when compared with surgical specialties and anesthesia. In addition, residents who worked 1−4 on-calls per month had a higher mean JSE score (MD = 11.23, p = 0.028) compared with those who worked 7 or more on-calls. Lastly, no correlation between empathy and perceived stress was detected in the whole sample (r = −0.007, p = 0.913); however, there was a correlation among residents training in medical specialties (r = −0.245, p = 0.025). Conclusion: Residents in our study had empathy levels comparable with Asian but lower than Western residents. We recommend qualitative studies that explore potential factors that might affect empathy among residents and studying the association between empathy and perceived stress among medical residents. Postgraduate curricula should incorporate interventions that foster a more empathetic doctor−patient relationship.

Medication Adherence Among Geriatric Patients with Chronic Diseases in Riyadh, Saudi Arabia.

Background: Medication non-adherence is a common and significant public health problem, especially among the geriatric population. This study's objective was to measure medication adherence and associated factors among geriatric patients with chronic diseases. Methods: A cross-sectional study targeted outpatient geriatrics who suffer from chronic diseases at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Telephone interviews were utilized to collect data from participants using a structured questionnaire and the GMAS validated instrument scale (General Medication Adherence Scale) intended to measure important determinants impacting adherence: patient behaviour, cost, comorbidity, and pill burden. Results: A total of 422 patients were assessed for medication adherence. The Mean overall score for GMAS was 29.9±3.1 out of 33. (64.9%) of the patients had a high level of medication adherence. The patients had a high adherence on the domain of patient behavior related non-adherence (PBNA) (13.5±1.9) out of 15, a high adherence on the domain of additional disease and pill burden (ADPB) (11.2±1.4) out of 12, and good to high adherence on the cost-related non-adherence (CRNA) (5.25±1.1) out of 6. Conclusion: The geriatric population with chronic diseases in our study had a good level of adherence to medication if compared with other international figures. To promote better medication adherence, patients must have a good understanding of their disease and strong beliefs about the medications prescribed.

The Diagnostic Yield of Abdominal Ultrasounds Requested by Family Physicians at an Academic Hospital in Riyadh, Saudi Arabia.

BACKGROUND: Abdominal ultrasound is a non-invasive, relatively inexpensive, and widely available diagnostic modality in family medicine settings. OBJECTIVES: Our study aimed to identify the most common indications for requesting abdominal ultrasounds by family physicians, determine the frequency of abdominal ultrasound with abnormal findings, identify the most common findings, and determine patients' characteristics associated with abnormal findings. METHODS: This retrospective chart-based study was conducted from January 2020 to June 2020 to analyze patients' abdominal ultrasounds reports requested by family physicians in 2019 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. RESULTS: We assessed abdominal ultrasound reports of 1,113 patients. There were 620 (55.7%) female patients. The mean age and body mass index (BMI) were 46.35 years ± 15.04 and 29.33 kg/m2 ± 7.06, respectively. The most common indications were abdominal pain (43.2%), suspicion of gallbladder and biliary system diseases (18.5%), and abnormal liver function tests (14.6%). The frequency of abnormal findings was 793 (71.2%), and the most common findings were fatty liver infiltration (49.7%), liver enlargement (20.1%), and gallstones (13.3%). Females had a lower likelihood to have abnormal findings compared to males (odds ratio (OR)=0.688, p=0.009). Lastly, the likelihood of abnormal findings increased with age and was highest among patients aged 71 years or more (OR=25.9, p< 0.001). CONCLUSION: Abnormal findings were more prevalent in our study compared with other studies. Abnormal findings were more common among males and older age groups. We recommend future studies on patients from community-based family medicine settings, and to examine the association of abnormal findings with patient-centered endpoints. Finally, disseminating the results of this study will inform family physicians with the most common abnormal abdominal ultrasound findings, and will enhance the discussion with patients undergoing an abdominal ultrasound examination.

Which Volunteering Settings Do Medical Students Prefer During a Novel Respiratory Virus Pandemic? A Cross-Sectional Study of Multiple Colleges in Central Saudi Arabia During the COVID-19 Pandemic.

Purpose: Novel respiratory virus outbreaks are a recurring public health concern. Volunteering medical students can be a valuable asset during such times. This study investigated the willingness of medical students to volunteer during the coronavirus disease of 2019 (COVID-19) pandemic and the barriers to doing so, considering the possibility of exposure to COVID-19 and mode of contact. Patients and methods: This cross-sectional study was conducted using a self-administered online questionnaire adapted from the literature. The questionnaire comprised four parts: demographic variables, COVID-19-related variables, willingness scale, and barrier scale. The target population was medical students at four different colleges in Riyadh, Saudi Arabia. Results: A total of 802 students participated in the study. A small proportion of students (10.6%) were willing to participate in volunteering activities that could involve contact with patients with COVID-19 as compared to other settings (39.4-43.4%). More than one-quarter of students (26.8%) had risk factors for severe COVID-19. The main barrier to volunteering was the concern of transmitting the infection to family members (76.8%). Registration to receive the COVID-19 vaccine was positively associated with more willingness to volunteer (ß=0.17, p <0.001), whereas residing in a household with an elderly person was negatively associated (ß=-0.13, p <0.001). Female sex was positively associated with higher barrier score (ß=0.12, p <0.001). Conclusion: Medical students were more willing to volunteer in activities that did not involve direct contact with patients with COVID-19. A considerable proportion of participants had risk factors for severe illness. Sharing a household with an elderly person or child was associated with lower willingness to volunteer. Organizers of volunteering activities should offer various volunteering options considering the risk of infection; and be mindful of barriers to volunteering, especially risk factors for severe illness and eldercare and childcare responsibilities.

Prevalence of Frailty in the Middle East: Systematic Review and Meta-Analysis.

(1) We aimed to systematically search available data on the prevalence of frailty among community-dwelling elders in Middle Eastern countries. The results from available studies are cumulated to provide comprehensive evidence for the prevalence of frailty. (2) Methods: A meta-analysis was done. A literature search was carried out using PRISMA guidelines in PubMed, Web of Science, and SCOPUS websites for studies up to 2020. Inclusion criteria entailed all primary studies conducted in Middle Eastern countries on frailty in community-dwelling older adults aged 60 years and older. (3) Results: A total of 10 studies were selected for this study. Random-effects meta-analysis of nine studies indicated there was a pooled prevalence rate of 0.3924 with a standard error of 0.037. This pooled prevalence point estimate of 0.3924 was statistically significant (p < 0.001). The Egger's regression test and the trim-fill method for detecting publication bias did not detect any evidence of publication bias in the sample of included studies. The Egger's regression test was not statistically significant. The trim-fill method indicated zero studies were missing on either side; (4) Conclusions: The study's findings indicate that the prevalence of frailty is higher in Middle Eastern nations. Despite indications that many of these nations' populations are rapidly ageing, we presently lack information on the incidence of frailty in these populations; this information is essential to health, policymakers, and social care planning.

Frailty, sarcopenia and health related outcomes among elderly patients in Saudi Arabia.

OBJECTIVE: To determine the prevalence of frailty and sarcopenia among elderly patients in Saudi Arabia and explore if there are significant association between frailty and sarcopenia. METHODS: A total of 498 patients from public tertiary hospital in Saudi Arabia participated in this descriptive cross-sectional study between March 2019 to June 2019. All participants answered a 5-part questionnaire, which includes demographic data, Edmonton Frail Scale, SARC-F and questions related to Activities of Daily living. RESULTS: The mean age of the participants was 69.98 ± 6.28. Of the 498 participants, 67.7% were aged 61-70 years and 42% had a BMI of greater than < 30 kg/m2. The prevalence of patients with mild frail, moderate frail and severely frail were 22, 12, and 4%, respectively. The analysis showed that majority of patients who had sarcopenia were females (84%). The analysis show that the level of frailty of patients were significantly different between age, marital status, educational level and patients' needs of home care, activities of daily living, presence of comorbidity and sarcopenia (p = 0.001). In the logistic regression analysis, the pre-frailty group was significantly likely to have sarcopenia (OR 0.02 95% 0.01-0.23p = 0.001) than nonfrailty patients. CONCLUSION: In conclusion, this research highlights the high prevalence of sarcopenia among elderly patients and the increasing percentage of frail patients in Saudi Arabia. In addition, significant difference and association were found with sarcopenia and frailty with many sociodemographic and clinical components of elderly patients in Saudi Arabia.

Quality of life in medical students with internet addiction.

BACKGROUND AND OBJECTIVES: Widespread use of the internet is a serious concern among university students worldwide. Internet addiction affects the students' physically and psychologically and poses social and environmental challenges to their well-being. This study was used to assess the levels of internet addiction among medical students at a major university in Saudi Arabia and to measure the quality of life among these students. METHODOLOGY: A cross-sectional study was used to gain responses from 437 students using questionnaire surveys. These questionnaires were based on the World Health Organization's standard quality of life survey questionnaire (WHOQOL-BREF). RESULTS: Analysis of the results displayed that the students were only moderately addicted to the internet. Moreover, with respect to the quality of life, these students scored high in physical, social, psychological, and environmental sub-domains of the quality of life questionnaire survey. CONCLUSIONS: These results provide evidence that, in contrast to findings in some other countries, medical students in Saudi Arabia enjoy a better quality of life with moderate internet addiction levels. Future studies can broaden the scope of the survey methodology used in this paper to cover medical students in other universities in Saudi Arabia. Moreover, correlations with exam scores can be established using case-control studies for a more thorough analysis. Therefore, this study provides a significant positive step in the direction of further research in this field.

Efficacy of treatment methods for uncontrolled hypertension and its effects on atrial fibrillation: A systematic narrative review.

OBJECTIVES: Uncontrolled hypertension is a main predisposing risk factor leading to chronic atrial fibrillation (AF). Although several treatment methods for patients with HTN and AF were developed in past decades, further investigations of their efficacies are needed. This systematic narrative review presents an overview of studies reporting treatment efficacies in patients with HTN and/or AF. METHODS: A narrative-based systematic review was performed using EMBASE, Medline, PubMed, Google Scholar, and the Cochrane Library searching for relevant papers published between October 2008 and October 2018. Out of 4481 studies, only 15 studies could be included following the inclusion criteria. RESULTS: Included studies reported treatment measures, measured outcomes, and efficacies in adult patients with HTN and AF with defined interventions and methodologies. Treatment methods with effective outcomes were administration of hydrochlorothiazide, losartan or atenolol, telmisartan or amlodipine, or general anti-hypertensive drugs. Treatment methods that showed the most effective outcomes (lowering AF recurrence and improving BP control) were those containing pulmonary vein (or antrum) isolation (PVI/PVAI) (6 studies) and/or in conjunction with renal denervation (RDN)(6 studies). Treatment methods showing the most effective outcomes were PVI/PVAI in conjunction with RDN. CONCLUSION: The latest evidence shows that PVI (in conjunction with RDN in some instances) was more efficacious among patients suffering from HTN and/or AF.

Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes. DESIGN: Systematic review and network meta-analysis (NMA). METHODS: Data sources-Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction-All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis-We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach. RESULTS: A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD -0.92, 95% confidence interval -1.55, -0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes. CONCLUSION AND IMPLICATIONS: Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.

Effect of donor hypertension on renal transplant recipients' blood pressure, allograft outcomes and survival: a systematic review and meta-analysis.

BACKGROUND: The effect of donor hypertension on the blood pressure of renal transplant recipients and the allograft outcomes are unclear. The aim of this study was to summarize the evidence about the effects of donor hypertension on renal transplant recipients' blood pressure, renal allograft outcomes and mortality. METHODS: Studies published from January 1960 to 31 January 2019 in English were identified through a systematic search of six databases; PubMed, Embase, SCOPUS, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL. Eligible observational studies with at least 1 year of follow-up were selected. Pooled estimates were obtained using random effects model. RESULTS: We identified 15 papers from eight countries containing data on donor hypertension and renal transplantation carried out between 1963 and 2014. The median (range) follow-up period of the studies was 3.8 (1-11.9) years. The prevalence of post-transplant hypertension among recipients of a renal allograft from a normotensive donor range from 8 to 17.6%, while the prevalence of post-transplant hypertension among recipients of a renal allograft from a hypertensive donor range from 2.9 to 25%. Overall, pooled risk ratios (RR) indicated that donor hypertension was a risk factor for allograft failure or loss among renal transplant recipients (RR 1.31; 95% CI 1.06-1.63: P = 0.014). However, donor hypertension was not a risk factor for mortality among renal transplant recipients (RR 0.996; 95% CI 0.652-1.519: P = 0.984). CONCLUSIONS: Donor hypertension increases the risk of post-transplant hypertension among renal transplant recipients and increases the risk of allograft failure, However, donor hypertension was not a risk factor for mortality among renal transplant recipients, Closer monitoring should be given to renal allograft recipients from hypertensive donors, and further well-designed studies are needed to expand our knowledge of the impact of donor hypertension on the survival of renal allograft recipients.

Prevalence of sexual dysfunction in saudi women with Type 2 diabetes: Is it affected by age, glycemic control or obesity?

OBJECTIVE: Sexual dysfunction (SD), as a diabetes mellitus (DM)-related complication, is common among patients having diabetes. This study aimed to ascertain the prevalence of SD in Saudi women with type 2 DM and to determine whether age, glycemic control, and obesity are associated with SD or not. METHODS: A total of 275 Saudi women with type 2 diabetes took part in this cross-sectional study and filled out the Female Sexual Function Index through a fill-coded questionnaire in primary care clinics in King Khalid University Hospital, Riyadh, in the period between January 2013 and May 2013. The level of glycosylated hemoglobin and the body mass index were assessed to evaluate the DM control status and obesity among the patients. RESULTS: SD was reported by 88.7% of the Saudi women with type 2 diabetes. The results showed a significant association between the presence of SD and the increase in age of patients at 92% in the age group above 50 years. Glycemic control did not show a significant association with SD. The obesity factor showed a slight increase in SD by weight, but it was not statistically significant. CONCLUSION: The prevalence of SD among the Saudi women having type 2 diabetes is high and increases with age. No association was found between SD and glycemic control.

Appraisal of the communication skills of residents in the Family Medicine Program in Central Saudi Arabia.

OBJECTIVES: To assess patients' perceptions of the communication skills of family medicine residents.   METHODS: This is a cross-sectional study. Data were collected from patients, seeing 23 residents from 4 family medicine residency programs in Riyadh, Kingdom of Saudi Arabia namely, King Khalid University Hospital, Riyadh Military Hospital, Security Forces Hospital, and King Abdul-Aziz Medical City. The translated version of the Communication Assessment Tool (CAT) was used. Data were collected during January and February 2013.  RESULTS: A total of 350 patients completed the CAT, with an 87.5% response rate. Patients rated each resident differently, but the mean percentage of items, which residents rated as excellent was 71%. In general, male residents were rated higher 72.8 ± 27.2 than female residents 67.8 ± 32.2 with a significant difference; (p less than .005). Also, significant differences were found based on the gender of the residents, when each item of the CAT was compared. Comparing training centers, there were no significant differences found in the overall percentage of items rated as excellent or among items of the CAT.   CONCLUSION: The study identified areas of strength and weaknesses that need to be addressed to improve communication skills of physicians.

EMG and pain severity evaluation in patients with TMD using two different occlusal devices.

PURPOSE: The purpose of this study was to compare the electromyographic (EMG) activity level and signs and symptoms in patients with myogenous temporomandibular disorders (TMD) treated with two different types of occlusal devices. MATERIALS AND METHODS: Eleven TMD patients were treated with maxillary occlusal devices. The first group received a flat-plane stabilization occlusal device, while the second group received an anatomic occlusal device that maintained the anatomy of the original occlusal surfaces. The severity of signs and symptoms and the masseter EMG activity were recorded and evaluated before treatment and at 72 hours, 2 weeks, and 4 weeks following the delivery of the occlusal device. EMG activity was measured during maximum clenching and during chewing on the right and left sides. The EMG was also recorded for seven normal subjects as a control group. RESULTS: All patients showed reduction of reported and clinically found muscle pain, with no statistically significant differences between the two groups. A reduction in the EMG activity level at maximum clenching was seen in both patient groups, but was significant only with the anatomic occlusal device. Mean EMG activity during chewing was highly variable within and between groups. CONCLUSION: The subjective and objective improvements with both types of occlusal devices suggest that either type of occlusal device can be beneficial to TMD patients.