Hand hygiene compliance and improvement interventions in the Eastern Mediterranean Region: a systematic review and meta-analysis.

Hand hygiene compliance among healthcare workers is crucial for preventing infections in healthcare settings. This systematic review and meta-analysis aimed to assess the compliance of healthcare workers in the Eastern Mediterranean region with hand hygiene guidelines and synthesize evidence on the success rate of strategies to improve hand hygiene. Five electronic databases (PubMed, CINAHL, Cochrane, Web of Science, and Scopus) were searched up to August 2020. Articles were included if they were conducted in the Eastern Mediterranean Region. A manual search was conducted for reference lists of included papers, and relevant additional references were reviewed. Two reviewers independently screened articles for inclusion, performed data extraction, and assessed quality. A meta-analysis was conducted to synthesize findings and determine the prevalence of hand hygiene compliance interventions. The search yielded 6678 articles. After removing duplicates and applying inclusion/exclusion criteria, 42 articles were included, of which 24 were meta-analyzed. The meta-analysis showed a compliance prevalence of 32% with significant heterogeneity (I2= 99.7% p <0.001). Interventions using the World Health Organization (WHO) guidelines were over two times more likely to improve compliance rates (OR= 2.26, [95% CI:(2.09 - 2.44)], I2= 95%, p<0.001) compared to no intervention. Other interventions were close to two times more likely to improve compliance rates (OR= 1.84, [95% CI:(1.66 - 2.04)], I2= 98% p= 0.001). Approximately two-thirds of healthcare providers in the Eastern Mediterranean region were non-compliant with standard hand hygiene practices, highlighting the need for increased efforts, awareness, observation, and control policies.

Detection of Specific Immunoglobulins in the Saliva of Patients With Mild COVID-19.

Saliva has many advantages over blood as a biofluid, so using it for measuring and monitoring antibody responses in COVID-19 would be highly valuable. To assess the value of saliva-based IgG and IgM/IgA antibody testing in COVID-19, this cross-sectional pilot study evaluated the accuracy of salivary and serum IgG and IgM/IgA for detecting mild COVID-19 and their correlation. Fifty-one patients with mild COVID-19 (14-28 days post-symptom onset) were included in the study. Enzyme-linked immunosorbent assays (ELISA) were used to measure IgG and IgM/IgA responses to SARS-CoV-2 spike protein in both serum and saliva samples using a slightly modified protocol for saliva samples. Saliva-based IgG testing had 30% sensitivity and 100% specificity, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 50%. Saliva-based IgM/IgA testing had 13.2% sensitivity and 100% specificity, with a PPV of 100% and an NPV of 28.3%. Blood and saliva IgG values were positively correlated. Saliva currently has limited diagnostic value for COVID-19 testing, at least for mild disease. Nevertheless, the significant positive correlation between blood and saliva IgG titers indicates that saliva might be a complementary biofluid for assessing systemic antibody responses to the virus, especially if the assay is further optimized across the full disease spectrum.

Clinical Effects of Dental Caries on the Quality of Life of Paediatric Patients Aged 8-10 Years: Utilisation of the PUFA Index.

PURPOSE: Saudi children have poor oral health; however, little data are available on the effects of dental caries and its clinical complications on the oral health-related quality of life (OHRQoL) in school-aged children. This study evaluated the impact of caries and its clinical effects on the OHRQoL of a sample of 8- to 10-year-old children attending King Abdulaziz University Hospital. MATERIALS AND METHODS: The following variables were assessed for each child: sociodemographic data, OHRQoL using an Arabic-validated Child Perception Questionnaire for 8- to 10-year-old children (CPQ8-10), and two global health rating questions. Caries and its clinical effects on oral health were also assessed using the decayed-missing-filled teeth (dmft/DMFT) and pulpal involvement, ulceration, fistula, and abscess (pufa/PUFA) indices. Descriptive statistics of the sociodemographic variables and responses to the CPQ8-10 questions are presented as absolute values and percentages. The CPQ8-10 scores between children with different dmft/DMFT and pufa/PUFA scores were compared. RESULTS: In total, 169 children participated in this study. The means ± SD of dmft and DMFT were 5.03 ± 2.5 and 2.35 ± 1.7, respectively. However, the pufa and PUFA scores were 1.03 ± 1.6 and 0.05 ± 0.2, respectively. The most common oral health complaint affecting OHRQoL was food stuck to the teeth. Participants with higher dmft and pufa/PUFA scores had statistically significantly higher CPQ8-10 scores than did their counterparts. CONCLUSION: High dmft and pufa/PUFA scores have a statistically signifcantly negative effect on the OHRQoL among healthy 8- to 10-year-old children. Worse global health ratings correlate with lower OHRQoL.

Knowledge- and Experience-Based Perceptions of Radiation Therapists during the COVID-19 Outbreak.

Objective: To assess the perceived risks and impact of the COVID-19 outbreak on radiation therapists in Saudi Arabia. Methods: A questionnaire was distributed to all radiation therapists in the country. The questionnaire contained questions about demographic characteristics, the extent of the pandemic's impact on hospital resources, risk perception, work-life, leadership, and immediate supervision. The questionnaire's reliability was assessed using Cronbach's alpha; >0.7 was considered adequate. Results: Out of the 127 registered radiation therapists, 77 (60.6%) responded; 49 (63.6%) females; and 28 (36.4%) males. The mean age was 36.8 ± 12.5 years. Nine (12%) of the participants had a past experience with pandemics or epidemics. Further, 46 (59.7%) respondents correctly identified the mode of transmission of COVID-19. Approximately, 69% of the respondents perceived COVID-19 as more than a minor risk to their families and 63% to themselves. COVID-19 had an overall negative impact on work at the personal and organizational levels. However, there was a positive attitude toward organizational management during the pandemic in general; positive responses ranged from 66.2% to 82.4%. Ninety-two percent considered protective resources and 70% considered the availability of supportive staff to be adequate. Demographic characteristics were not significantly associated with the perceived risk. Conclusions: Despite the high perception of risk and negative impact on their work, radiation therapists conveyed a positive overall perception regarding resource availability, supervision, and leadership. Efforts should be made to improve their knowledge and appreciate their efforts.

Are parents' willing to vaccinate their children against COVID-19? A qualitative study based on the Health Belief Model.

In response to the COVID-19 pandemic, several countries have started implementing voluntary or involuntary mass vaccination programs. Although vaccine acceptance is high among adults, uncertainty about whether to vaccinate children against COVID-19 remains a controversial theme. To date, few qualitative studies have explored parents' views on this topic. A qualitative descriptive study design was used to collect data and individual in-depth interviews were conducted with 50 parents in the Makkah region of Saudi Arabia. The Health Belief Model (HBM) was used as a guide in developing the interview guide. Each question was related to a construct of the HBM. The data were then analyzed using thematic content analysis and interpreted using NVivo software. Two major themes emerged: motivation to vaccinate children, which was influenced by perceived benefits, perceived severity, perceived suitability, collective responsibilities, confidence, and cues to action; and barriers to vaccination in children, which included complacency, rapid vaccine development, and uncertainty about the long-term side effects of the vaccine. The findings of this study revealed that the public is not sufficiently informed about the efficacy or side effects of the COVID-19 vaccine, increasing the awareness of which will help parents make informed decisions regarding vaccinating their children and potentially increase vaccine acceptance.

Currently, the debate about whether children should be vaccinated for COVID-19 is ongoing worldwide. This research explored the thoughts of Saudi Arabian parents in this regard through in-depth interviews. The viewpoints were grouped into two themes: motivators and barriers toward vaccination. The motivators included factors such as parents' beliefs that the vaccine would help protect their children and the aged against the severity of the disease, especially those with existing conditions such as obesity. They also felt that the vaccination would help develop the society's herd immunity against the virus and felt an obligation to have their children vaccinated. Barriers toward vaccination included factors such as concerns about the long-term side effects of the vaccine on children, and the belief that children's immune systems are strong enough to fight the virus and that the vaccine might negatively affect their immune systems. This study showed that parents need to be educated on the benefits and side effects of COVID-19 vaccination for children. The results of this study will help health authorities and the government to increase the uptake and acceptability of the COVID-19 vaccine for children.

Does human papillomavirus modify the risk of oropharyngeal cancer related to smoking and alcohol drinking? A systematic review and meta-analysis.

Objective: To synthesize evidence for interactions of traditional oropharyngeal squamous cell carcinoma (OPSCC) risk factors-tobacco smoking and alcohol drinking-with human papillomavirus (HPV). Data Sources: MEDLINE, Embase, Cochrane Database of Systematic Reviews, ProQuest, and Global Health were searched with no restrictions on language or publication date. Methods: All case-control studies assessing interactions between these factors in OPSCC were considered. Quality was assessed using the Newcastle-Ottawa Scale for case-control studies. The main outcome was the OR for developing OPSCC for the following interactions: (1) HPV and smoking, (2) HPV and alcohol drinking, and (3) HPV, alcohol drinking, and smoking. Interactions were assessed from stratified analysis (by HPV status) and/or joint effect analysis (synergy index and multiplicative index). Results: The search provided 3084 relevant studies, of which 9 were included. In the stratified analysis, the OR of developing OPSCC among smokers with HPV was less than that among smokers without HPV. A similar pattern was observed for alcohol drinking. This effect persisted among smokers and heavy alcohol drinkers with HPV compared with those without HPV. Joint effect analysis on the additive scale showed sub-additive antagonistic interactions between HPV and smoking, and between HPV and alcohol. On the multiplicative scale, sub-multiplicative interactions were found between HPV and smoking, and HPV and alcohol. Conclusions: This meta-analysis suggests a negative directed interaction of HPV and smoking; and HPV and heavy alcohol drinking in the development of primary OPSCC on stratified analysis and joint effect analysis. Level of Evidence: 3A.

A comparison of manikin and live patient-based dental hygienist clinical licensing exam.

OBJECTIVES: The Central Regional Dental Testing Service in the United States administered its first manikin-based (M) dental hygiene licensing exam in 2020. The aim of this study was to compare the licensure exam results of dental hygiene students examined using manikins versus live patients. METHODS: After obtaining the ethical approval, the de-identified exam scores of three different cohorts (2019, 2020, and 2021) were collected from the academic record database of Carrington College, Dental Hygiene School, San Jose, California. The exam scores of the students were grouped based on the exam format conducted: either M or patient-based (P). Mann-Whitney U test and two-tailed Fisher's exact were used to compare the scores of the groups. RESULTS: The scores of 108 dental hygiene graduates between 2019 and 2021 were analyzed. The study included 65 participants examined in group P and 43 participants in group M. There was no significant difference in the mean score between groups P and M (p = 0.46) or in the passing rate between the two groups (p = 0.52). However, a higher first-attempt passing rate was noted in the M group. Moreover, calculus removal scores were comparable between the two examination groups (p = 0.18). CONCLUSION: The findings of this study supported the comparability of both manikin and live P exam outcomes. Therefore, the use of M exams may be considered for future examinations. Further studies are needed in other settings to confirm the efficacy of M exams in evaluating the students' clinical performance.

The Association between Adenotonsillectomy and Frequency of Vaso-Occlusive Crises in Patients with Sickle Cell Disease.

Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10 years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3 years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3 years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.

Outcomes of Cytoreduction and Oxaliplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Patients With Peritoneal Carcinomatosis From Colorectal Cancer.

Among patients with metastatic colorectal cancer, 25% have isolated peritoneal carcinomatosis. We performed a systematic review and meta-analysis to assess the disease-free survival (DFS) and overall survival (OS) of patients undergoing hyperthermic intraperitoneal chemotherapy with oxaliplatin. Eleven studies were included in the final assessment. Pooled three- and five-year OS rates were 58.60% and 42.19%, respectively. The estimated pooled three- and five-year DFS rates were 23.47% and 14.26%, respectively.

Men's Knowledge of and Behavior toward Mammography Screening: A Cross-Sectional Study.

BACKGROUND: Breast cancer (BC) is a public health problem that affects many populations worldwide. Women's health care behavior, including seeking mammography screening, might be affected by men, especially in conservative Arab societies. Few studies have investigated men's behavior toward mammography for female relatives. The main aims of this study were (i) to evaluate men's knowledge about mammography screening and (ii) to assess men's behavior toward women regarding mammogram screening and the factors influencing their behavior. METHODS: A cross-sectional study was conducted among male residents of the five main geographic areas of Saudi Arabia. Data were obtained with a self-administered questionnaire. In addition to sociodemographic data, the questionnaire assessed respondents' general knowledge about mammograms, their behavior toward female family members who use mammography, and their perceptions about awareness campaigns. RESULTS: A total of 9691 male respondents were included in the study. The majority (79%) recommended mammography to their female family members. Multiple factors were significantly associated with men recommending mammograms, including age (p <0.01), education (p <0.01), employment status (p <0.01), and region (p <0.01). Only 33.8% of the participants had a high knowledge score about mammography. Approximately 45% of respondents reported that BC awareness campaigns were weak, while 48% were not aware of BC screening programs. CONCLUSIONS: Despite their positive behavior in recommending mammograms to female relatives, men exhibited a notable lack of knowledge about mammography. Establishing national programs and educational campaigns for men to explain the benefits of screening and access to free mammography are essential.
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Short-term outcomes of stents in obstructive rectal cancer: A systematic review and meta-analysis.

BACKGROUND: With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients. METHODS: We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates. RESULTS: We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I2 = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I2 = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I2 = 79.3%, P < 0.001). CONCLUSION: The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.

Prevalence and Predictors of Musculoskeletal Pain Among Undergraduate Students at a Dental School in Saudi Arabia.

OBJECTIVE: Musculoskeletal disorders (MSDs) are injuries to the musculoskeletal (MSK) system that occur due to repetitive or singular trauma and negatively affect one's daily life. Dentistry is a field that exposes professionals to the highest rate of work-related MSDs. This study aimed to assess the prevalence and predictors of MSK pain among a sample of dental students. METHODS: A cross-sectional study was conducted among a sample of 377 dental students and interns at the dental school of King Abdulaziz University, Jeddah, Saudi Arabia. We distributed a validated questionnaire, the Nordic Back Pain Questionnaire, which included additional questions, to all dental students participating in clinical practice and to dental interns. Categorical variables were described by presenting frequencies and percentages, and continuous variables by displaying means and standard deviations. Logistic regression was performed to identify predictors for developing MSK pain over the last 12 months. RESULTS: Overall, 91.2% of the participants experienced MSK pain or discomfort in one or more body parts over the last 12 months. The highest prevalence was for neck pain (69.2%), followed by shoulder pain (67.1%) and lower back pain (65%). Females were more likely than males to experience MSK pain (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.3-6.7), and those who exercised regularly were less likely to experience MSK pain than were those who did not (OR = 0.27, 95% CI: 0.1-0.6). CONCLUSION: This study showed a concerningly high prevalence of MSD symptoms among dental students, especially in the neck, shoulders, and lower back. Educational and occupational health programs in preclinical years could be effective for reducing MSK pain.

Human papillomavirus knowledge and vaccine acceptability among male medical students in Saudi Arabia.

Human papillomavirus (HPV), the most common sexually transmitted infection worldwide, is responsible for a variety of cancers. HPV vaccines can help prevent this infection and its potentially devastating carcinogenic outcomes. Although the incidence of HPV-related oropharyngeal cancers among males is increasing, few studies have been published on HPV knowledge and vaccine acceptability among males. In this cross-sectional study, we assessed knowledge about HPV and the vaccine, as well as its acceptability, among third- and fourth-year male medical students in Jeddah, Saudi Arabia. Respondents were enrolled in any of the medical colleges in Jeddah from February to December 2018. A validated survey was used to collect information on HPV infection and vaccine knowledge and to ask questions assessing vaccine acceptability. HPV knowledge scores were created, and vaccine acceptability predictors were assessed with logistic regression. We collected data from 517 participants. Approximately 74% of the students had heard of HPV, with a mean knowledge score of 5.9 ± 4.6 out of 16; only 42% had heard of the HPV vaccine, with a mean knowledge score of 0.9 ± 1.6 out of 7. Among the respondents, 48.9% were interested in receiving the HPV vaccine. Although HPV infection and vaccine knowledge did not correlate with vaccine acceptability, those who had previously received the hepatitis B vaccine were more interested in receiving the HPV vaccine. In conclusion, male medical students had low HPV knowledge. Improving their HPV knowledge is important, as they are future health-care providers. The promotion of HPV vaccines in this potentially influential group is crucial for achieving effective disease prevention.

Sustainability of Improvement in Oral Health-Related Quality of Life in Children After Dental Treatment.

PURPOSE: Dental treatment has been associated with improvement in the oral health-related quality of life (OHRQoL) in children. There is little evidence of whether the effect of treatment is sustainable over time or not. The aim of this study was to determine whether the effect of dental treatment on OHRQoL is maintained or diminishes over time. MATERIALS AND METHODS: A consecutive sample of parents of 47 children between 2 and 6 years who received comprehensive dental treatment at a postgraduate dental clinic were recruited. Parents completed the Early Childhood Oral Health Impact Scale (ECOHIS) prior to treatment and at 1 and 4 months after treatment. Parents were also asked three global questions. Score changes (overall and for each section) between time points were analyzed by a repeated-measures analysis of variance and Bonferroni tests. RESULTS: The children's mean age was 4.7 ± 1.1, and 60% were females. ECOHIS scores were significantly improved from baseline (22.2 ± 6.9) to 1 month after treatment (8.7 ± 6.8) and were further improved at 4 months after treatment (1.9 ± 2.7), P < 0.001, with large effect sizes (2.8 for the child impact section and 2.2 for the family impact section). Parents' perception of changes in the OHRQoL of their children obtained from a global question indicated an improvement in OHRQoL that was sustained over the follow-up period; at 1-month and 4-month follow-up, 89% and 94% of mothers reported that their child's oral health improved a lot after dental treatment, respectively. CONCLUSION: The impact of dental treatment on OHRQoL continued to remarkably improve during the 4 months following dental treatment.

Knowledge of Human Papillomavirus (HPV) and Oropharyngeal Cancer and Acceptability of the HPV Vaccine among Dental Students.

OBJECTIVES: To assess knowledge about human papillomavirus (HPV), vaccination, and HPV-related oropharyngeal cancer (OPC) and to evaluate HPV vaccine acceptability among a sample of undergraduate dental students. METHODS: All third- and fourth-year dental students enrolled in any of the dental schools in Jeddah, Saudi Arabia, were invited to participate in this cross-sectional study. In total, 500 students completed a self-administered questionnaire on HPV, HPV vaccines, and HPV-related OPC knowledge. HPV, HPV vaccine and HPV-related OPC knowledge scores were calculated. Associations of participants characteristics with the knowledge scores and with willingness to take the HPV vaccine were assessed. RESULTS: Of the participants, 62% had heard of HPV infections, and 57% of HPV vaccines. Average knowledge scores were low: HPV knowledge score 3.8±4.5 out of 16, HPV vaccination knowledge score 0.9±1.6 out of 7, OPC knowledge score 0.9±1.2 out of 5. Clinical-year students had better knowledge and were more willing to take the HPV vaccine than were preclinical-year students, as were those vaccinated for hepatitis B versus those not vaccinated for hepatitis B. Students with higher HPV knowledge scores were more willing to take the HPV vaccine (66%) than were those with lower scores (43%) (p=0.018). Only 4% of males and 12% of females reported taking the HPV vaccine. Of those who refused it, 51% cited lack of knowledge as the primary reason. CONCLUSIONS: Knowledge about HPV, its vaccine, and HPV-related OPC is low among this sample of Saudi undergraduate dental students. Improving knowledge among them may increase their awareness, which could affect the care provided to patients.
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Oral Health Knowledge, Attitudes, and Behaviors Among University Students in Jeddah, Saudi Arabia.

PURPOSE: This study aimed to evaluate oral health knowledge, attitudes, and behaviors among a sample of senior students at King Abdulaziz University (KAU), and to assess differences among these factors between genders. METHODS: A total of 1177 senior university students at KAU were included in this cross-sectional study. Participants were selected by stratified random sampling. KAU has three main streams categorized by field of study. One faculty was randomly selected from each stream. Information regarding oral health knowledge, attitudes, and behaviors was collected with a validated self-administered questionnaire. A knowledge score was calculated, and predictors of oral health knowledge were assessed by linear regression. RESULTS: In general, the mean oral health knowledge score of females (8.1 ± 1.8) was significantly higher than that of males (7.2 ± 2.1) out of 13. Relative to males, females reported a greater frequency of teeth cleaning and of using a toothbrush with proper technique (p < 0.001). Females were also more likely to have ever visited a dentist than males (95% and 86%, respectively). The linear regression model revealed that students in non-medical faculties and those who were not shown how to brush their teeth by a dentist had lower oral health knowledge scores, than their counterparts. Students older than 22 years and females were more likely to have higher oral health knowledge scores than were their counterparts. CONCLUSION: Oral health knowledge was relatively low among the university students, but females showed better oral health knowledge and behaviors than males did.

Do Men and Women in Saudi Arabia Have the Same Level of Awareness and Knowledge of Breast Cancer? A Cross-Sectional Study.

CONTEXT: Awareness is important in combating breast cancer, as early detection (through mammograms) and prompt treatment offer the greatest chance of long-term survival. AIMS: The aim of this study was to assess public knowledge of breast cancer (signs, symptoms, and risk factors) and awareness of screening programs; and compare it among men and women. MATERIALS AND METHODS: A cross-sectional study was conducted among male and female residents of five of the geographic regions of Saudi Arabia from February 2015 to May 2015. Information was collected using a questionnaire, and included sociodemographic data, general knowledge about breast cancer, and awareness of screening programs. Chi-squared test was used to compare the binary knowledge variables (correct/incorrect) between men and women. Logistic regression was utilized to assess predictors of breast cancer knowledge. RESULTS: A total of 9691 men and 31,022 women were surveyed. Women had better knowledge regarding breast cancer symptoms than men, except for breast cancer being related to death. Men and women had similar knowledge of breast cancer risk factors; however, more women correctly identified family history (68%), large breast size (46%) as increasing risk, and breastfeeding (60%) as reducing the risk of breast cancer compared to men (56%, 32%, and 47%, respectively). Older age and higher education were related with high breast cancer knowledge, and it was more pronounced among men. Employment was a predictor for better knowledge among women. Participants with no history of breast cancer were less likely to have good breast cancer knowledge compared with those with a family history, (OR: 0.5, 95% CI: 0.5-0.6) and (OR: 0.6, 95% CI: 0.5-0.6) among men and women, respectively. More women (24%) than men (19%) knew of breast cancer screening programs, although the awareness was low in both genders. CONCLUSION: Awareness campaigns in Saudi Arabia, especially those aimed at men, remain critical to increase knowledge and change behavior toward early detection of breast cancer.

Validity and reliability of the Arabic version of the child perceptions questionnaire for 8-10-year-old children.

PURPOSE: To develop an Arabic version of the CPQ8-10 and test its validity and reliability for use among Arabic-speaking children. METHODS: The 25-item professionally translated questionnaire included two global rating questions across four domains, which was assessed through a pilot study on 20 participants who were not included in the main study. Children (n = 175) aged 8-10 years were consecutively recruited: group I (n = 120) included pediatric dental patients, group II (n = 25) included children with orofacial clefts, and group III (n = 30) included orthodontic patients. Construct (convergent and discriminant) validity, internal consistency, and test-retest reliability were assessed using Spearman's rank correlation coefficients, Cronbach's alpha coefficient, and intraclass correlation coefficient, respectively. All children were clinically examined; 66 children completed the questionnaire a second time. A cross-sectional study design was employed. RESULTS: CPQ8-10 scores and global ratings were positively correlated. CPQ8-10 scores were highest in group II, followed by groups I and III, respectively. CPQ8-10 scores were significantly higher in children affected with caries or malocclusion compared to unaffected children. Cronbach's alpha was 0.95 and the intraclass correlation coefficient was 0.97. CONCLUSIONS: The Arabic CPQ8-10 was valid and reliable; therefore, it can be utilized with Arabic-speaking children in this age group.

Need for dental care drives utilisation of dental services among children in Saudi Arabia.

OBJECTIVES: This study used Andersen's predisposing, enabling and need behavioural model to predict factors that influence utilisation of oral health services for children in Saudi Arabia. METHODS: The model was tested in a random sample of parents of third- and eighth-grade children in Jeddah (n = 1,668) using the access to care questionnaire adapted from the Basic Screening Survey. Predisposing (sex, parent education, nationality); enabling (school type, family income, government financial support, health insurance); and need for dental care (examined or perceived) were modelled to assess children's use of dental services. Univariate and multivariate logistic regression models were conducted. Significant findings were reported at P ≤ 0.05. RESULTS: About 84% of parents responded to our questionnaire (n = 1,397). One in four children have never visited a dentist. Our findings indicate that need and predisposing factors explained oral health services' use among younger children, whereas need, predisposing and enabling factors predicted use of services among older children. Perceived barriers to dental care for children who never went to a dentist and for those who needed dental care and could not get it included oral health illiteracy (82.3%, 49.7%), dentist-related (19.9%, 42.1%), financial (22.8%, 37.1%) and transportation (9.8%, 20.8%), respectively. CONCLUSIONS: The need for dental care, predominantly for illness-related dental care, drives utilisation of dental health services among children in Saudi Arabia. Enhancing oral health literacy and mitigating organisational and financial barriers to dental care for families will increase children's access to quality oral healthcare, and promote better oral health practices and outcomes.

Impact of Dental Rehabilitation on Oral Health-related Quality-of-life in Healthy Children and Those with Special Health Care Needs.

Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent-child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date. Keywords: Children with special health care needs, Dental caries, Early childhood oral health impact scale, General anesthesia, Oral health-related quality-of-life.