Assessment of knowledge, attitude, and practices regarding the relationship of obesity with diabetes among the general community of Pakistan.

This study sought to evaluate the influence of knowledge, attitude, and practices assessment on diabetes related to obesity in Pakistani society. Data was collected both through door to door and online survey approaches from 518 participants by using a pre-validated questionnaire. A total of 15.6% were underweight, 61.2% were normal weight, 17.2% were overweight and 5.8% were in obesity class I and 2.9% were classified as obesity class II. The co-occurrence of obesity and diabetes was 29% (n = 22) among diabetic individuals (n = 84). A majority of the residents (59.1%) were from cities. While 94% of the participants responded to what obesity was, 83.8% knew what diabetes was. Fast food, soft drinks, and mayonnaise were deemed to be healthy by 75.1% of the respondents. Obesity was viewed as a disease by 94.8%, a major health issue by 78.2%, and a weight-loss necessity by 44.6% of participants. Only 24.9% exercised every day, and 23.9% engaged in any physical activity daily. The majority of respondents (50.6%) never tried to lose weight and 23.2% ate junk food daily. The sociodemographic variables showed that the age ranges of 25-34 years (P < 0.001; OR 0.531), 45-54 years (P < 0.05; OR 0.527), and urban residency (P < 0.001; OR 0.128) had a significant association with knowledge. The factors of urban residency (P < 0.001; OR 3.996), being unmarried (P < 0.001; OR 1.95), and having an income of 51,000-70,000 (P < 0.001; OR 11.29) showed a very highly significant association with a good attitude regarding the relationship of obesity with diabetes (P < 0.05). Similarly, practices of the participants showed significant association with BMI range of 18.5-24.9 and 25-29.9 (P < 0.001). Our study revealed significant knowledge and understanding of the relationship between obesity with diabetes. However, it was observed that majority of respondents exhibited fundamental knowledge regarding obesity and diabetes, there was a notable absence of understanding regarding crucial elements, such as the significance of maintaining a healthy body weight, participating in physical activity, and implementing appropriate dietary strategies for weight control. We recognize the necessity for education initiatives and strongly encourage them to assist individuals in managing diabetes resulting from obesity.

Patient-physician communication in intercultural settings: An integrative review.

Background: Intercultural communication between physicians and patients is a prominent challenge faced by health sectors. This integrative review aims to explore and summarize the current literature examining the cultural factors impacting the communication experience of patients and physicians in healthcare settings and provide an evidence-based solution. Methods: We used Whittemore and Knafl's (2005) approach to conduct this integrated review of the literature. Primary research studies meeting the search criteria were accessed from Medline/PubMed, Embassy, CINAHL, PsycInfo, ProQuest, Scopus, Web of Science, and Cochrane Review. We included studies published in English from 2008 to 2022. A total of 1731 studies were identified, of which 34 articles were included in this review. Results: The findings revealed a difference in physicians' communicative behaviour when encountering patients from different cultural backgrounds compared to encounters with patients from the same cultural background. When communicating with patients from different cultural backgrounds, physicians were found to be authoritarian, biomedical-focused, and not involve patients in decision-making. Patients' behaviours during consultations and experience and perception of quality of care in intercultural consultations were varied and inconclusive. Often patients were found to exaggerate respect for physicians, feel uncomfortable with the direct communication style of physicians, have a less proactive attitude, demonstrate low health literacy, and feel shy. These behaviours were attributed to language differences, differences in perception of disease, perception of health communication, prejudice, assumptions, training experience of physicians, and time allocated for consultations. Further, ineffective communication in intercultural consultations was found to impact patient satisfaction, medical adherence, continuity of care, physician's job satisfaction, and ability to diagnose correctly. Conclusions: Effective communication plays a significant role in patient and physician satisfaction. Health policymakers must formulate appropriate policies that encourage expatriate physicians to develop intercultural competencies to enhance intercultural communication, improve satisfaction, quality decision-making, correct diagnosis, and enhance public health.

Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom: Systematic Review.

BACKGROUND: Nosocomial infections are infections incubating or not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear, particularly for the hospitalized population of the United Kingdom. OBJECTIVE: The aim of this systematic literature review was to explore the risk factors of nosocomial infections in hospitalized adult patients in the United Kingdom. METHODS: A comprehensive keyword search was conducted through the PubMed, Medline, and EBSCO CINAHL Plus databases. The keywords included "risk factors" or "contributing factors" or "predisposing factors" or "cause" or "vulnerability factors" and "nosocomial infections" or "hospital-acquired infections" and "hospitalized patients" or "inpatients" or "patients" or "hospitalized." Additional articles were obtained through reference harvesting of selected articles. The search was limited to the United Kingdom with papers written in English, without limiting for age and gender to minimize bias. The above process retrieved 377 articles, which were further screened using inclusion and exclusion criteria following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The retained 9 studies were subjected to critical appraisal using the Critical Appraisal Skills Programme (cohort and case-control studies) and Appraisal Tool for Cross-Sectional Studies (cross-sectional studies) checklists. Finally, 6 eligible publications were identified and used to collect the study findings. A thematic analysis technique was used to analyze data extracted on risk factors of nosocomial infections in hospitalized patients in the United Kingdom. RESULTS: The risk factors for nosocomial infections that emerged from the reviewed studies included older age, intrahospital transfers, cross-infection, longer hospital stay, readmissions, prior colonization with opportunistic organisms, comorbidities, and prior intake of antibiotics and urinary catheters. Nosocomial infections were associated with more extended hospital stays, presenting with increased morbidity and mortality. Measures for controlling nosocomial infections included the use of single-patient rooms, well-equipped wards, prior screening of staff and patients, adequate sick leave for staff, improved swallowing techniques and nutritional intake for patients, improved oral hygiene, avoiding unnecessary indwelling plastics, use of suprapubic catheters, aseptic techniques during patient care, and prophylactic use. CONCLUSIONS: There is a need for further studies to aid in implementing nosocomial infection prevention and control.

Menstruation among In-School Adolescent Girls and Its Literacy and Practices in Nigeria: A Systematic Review.

Background and Objectives: Menstruation is a natural occurrence marked by the periodic release of endometrial cells within the uterine lining from the female genital area. Menstruation knowledge remains highly essential for young adolescents. Inadequate awareness and understanding of menstruation have far-reaching consequences on the overall wellbeing and health outcomes of young adults worldwide. Adolescent girls make up a large percentage of high school students in Nigeria. Girls in countries with low to middle incomes are frequently misled or uneducated regarding menstruation. Menstrual health literacy (MHL) is the level of knowledge concerning matters related to menstrual health. It is observed that a lack of menstrual health literacy is seen among young adults. This systematic review aimed to examine menstruation literacy, attitudes, and adolescent girls' practices in Nigeria. Materials and Methods: This systematic review included quantitative, cross-sectional, quasi-experimental, and qualitative primary research studies relating to menstruation literacy, attitudes, and practices of adolescents in Nigeria. Articles for this study were searched for on databases such as PubMed and BioMed Central using keywords. These studies were subjected to stringent inclusion and exclusion criteria where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and 13 articles were included after critical appraisal. Data extracted were analysed using narrative synthesis. Results: Findings indicated that knowledge regarding menstruation among adolescents (82.6%) was poor. Menstruation information was obtained from mothers, which was positive as some adolescents reported their closeness to their mothers. Regarding attitudes towards menstruation among adolescents, it was reported that more respondents (70.3%) had negative attitudes towards menstruation. Conclusions: Most of the respondents in Nigeria were not adequately prepared for the onset of their first menstrual period. Knowledge and attitude levels were low regarding periods for adolescents. The only exception was their positive attitude towards using water and soap to wash their hands during menstruation. The review shows a significant gap between adolescents' menstruation knowledge and actual hygienic methods during menstruation. It is therefore required for educational awareness programmes and campaigns to be put in place to educate adolescents about menstruation.

Diabetes education self-management intervention in improving self-efficacy for people with type 2 diabetes in the Gulf Cooperation Council countries: A systematic review.

AIMS: This research aims to evaluate the effectiveness of diabetes education self-management intervention for improving self-efficacy for people with type 2 diabetes mellitus in the Gulf Cooperation Council countries. METHODS: The Joanna Briggs Institute's methodology was applied to conduct a systematic review of type 2 diabetes interventions published from 2012 to 2022. This involved searching major databases, including Ovid, CINAHL, Scopus, Web of Science, and PubMed, with specific inclusion and exclusion criteria. The focus was on studies involving adults aged 18 or older with a Type 2 Diabetes (T2D) diagnosis, randomized controlled trials, and full-text English-language articles, while excluding materials such as editorials and conference abstracts. RESULTS: A total of 689 relevant articles initially retrieved; ultimately, only five studies met the inclusion criteria of this review. All five included studies were randomised control trials, and all five studies indicated that there was a significant and positive impact of diabetes education self-management intervention on diet and physical activities. Furthermore, three of the included studies indicated that interventions led to a substantial reduction in the levels of glycosylated haemoglobin (HbA1c) among people with type 2 diabetes. CONCLUSIONS: Diabetes education is an effective way of improving the health outcomes of people with type 2 diabetes. Diabetes education self-management interventions significantly increase the self-efficacy of people with Type 2 Diabetes (T2D) by enabling them to effectively control their blood glucose levels. Therefore, this study recommended that the GCC countries need to implement education intervention programmes to help and support people with Type 2 Diabetes.

Sustainable transformation agenda for enhanced global food and nutrition security: a narrative review.

The world's population is currently growing at an exponential rate, which is estimated to be over 8 billion inhabitants as reported by United Nations on November 15, 2022. According to FAO, 870 million people out of this population do not have enough food to eat, with the vast majority of hungry people (98%) living in developing countries, where almost 15% of the population is undernourished. Furthermore, the world's population is estimated to come to 9 billion by 2050, which would incur severe food scarcity and would seriously hamper global food security. Food losses, especially post-harvest loss as a result of poor agricultural practices have also been reported to greatly impact the economy, the environment, and the livelihoods of low and medium countries and Sub-Saharan-African. Therefore, realistic options should be established for promoting sustainable agriculture systems, improving nutrition, and achieving food security to end hunger in our nations. This paper elucidates the drivers of food insecurity including food losses, escalating population growth, hunger, and food production, among others, and provided some transformation approaches such as value addition through appropriate and emerging food processing and preservation techniques, application of biotechnological options through genetically modified foods and functional foods consumption and integration of indigenous underutilized nutrient-dense food crops which could serve as all-inclusive and sustainable transformation options for enhanced food and nutrition security, especially in developing countries, which is where the hunger burden and the prevalence of malnutrition and non-communicable diseases are high.

Patients' Perceptions of Safety in Primary Healthcare Settings: A Cross-Sectional Study in the Qassim Region of Saudi Arabia.

This study assessed patients' perceptions of safety and experiences in primary healthcare in the Qassim region of Saudi Arabia. Between July and September 2022, 730 patients from primary healthcare centers were surveyed using a multi-staged cluster random sampling approach. The Patient-Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was used to measure patients' perceived safety and experience in primary healthcare settings within the past year. Descriptive analyses were performed to report patients' perceived safety experiences. The statistical analysis examined individual items and scales. A considerable proportion of patients reported encountering safety problems, ranging from 11% (vaccine-related) to 27% (diagnosis-related). Diagnostic errors were the most common perceived safety problem (26.7%), followed by communication issues (24.1%) and medication errors (16.3%). Between 26% and 40% experienced harm, including financial problems (40%), increased care needs (32.4%), physical health issues (32%), limitations in activities (30.6%), increased healthcare needs (30.2%), and mental health concerns (26.8%). Patient-reported safety experiences reported in our study offer valuable insights into primary care safety in Saudi Arabia. Collecting routine patient feedback is crucial for addressing identified safety problems and implementing standardized procedures.

Challenges of having a child with congenital anomalies in Saudi Arabia: a qualitative exploration of mothers' experience.

Background: Congenital anomalies in children lead to morbidity, mortality, or lifelong disabilities. Mothers of children with congenital anomalies face considerable obstacles in parenting their children because of their lack of knowledge about such health conditions, lack of family support, and lack of health, rehabilitation, and social care support. In Saudi Arabia, less attention are given to researching this important issue. In this context, the purpose of the study was to explore mothers' experiences and perceptions toward children with congenital anomalies. Methods: We employed a qualitative phenomenological study design. We purposively recruited 10 mothers of children with congenital anomalies from different cities in Saudi Arabia. We interviewed the mothers with an in-depth interview guideline. The interview questions were designed to explore their perception of congenital anomalies in children and their experience of parenting and seeking health, rehabilitation, education, and social care services for children with such anomalies. Result: Analysis of our data suggest that mothers of children with congenital anomalies face considerable challenges because of a lack of medical, rehabilitation, and social care support, lack of knowledge about these conditions and their management, lack of responsiveness of the healthcare providers, lack of support from the family and the stigma associated with such conditions. Consequently, mothers experience poor mental and social well-being. Conclusion: Mothers are facing considerable challenges in raising children with congenital anomalies. Regular screening for early detection of congenital anomalies, counseling support for mothers, and improving healthcare providers' responsiveness, knowledge, and skills are necessary. In addition, appropriate awareness-raising programs need to be implemented at the community level to counteract the stigma and negative attitudes of the community toward children with congenital anomalies and their families.

The psychological experience of nursing students in their internship year during the COVID-19 pandemic in Saudi Arabia.

The COVID-19 pandemic produced challenges and troubling issues in Saudi Arabia and worldwide. During the height of the pandemic, the psychological status of nursing students was complicated by challenges that affected their educational future. We used qualitative approach to explore the psychological status of 20 Saudi nursing students from Nursing College in their internship program during the COVID-19 pandemic by investigating their perceptions, experiences, and challenges. Thematic analysis methods were used to present the data as themes and subthemes. Themes that emerged during interviews revealed: Interns' experiences from the outbreak; Perceptions of students toward COVID-19; Mental distress associated with the situation; Level of support from either or both university authorities or hospital education and training departments; Financial challenges; and Readiness to complete a nursing internship. COVID-19 presented several challenges to Saudi nursing students in internship year including psychological distress in several aspects such as fear of infection for themselves and their families. However, this study findings do not apply to all nursing students as it only included nursing interns actively engaged in clinical practice. Additional studies are required to examine how the clinical practice of internships varied across the country during any epidemic situation.

Emergency Medical Service Response Time for Road Traffic Accidents in the Kingdom of Saudi Arabia: Analysis of National Data (2016-2020).

Despite preventive measures and initiatives, road traffic accidents are on the rise in the Kingdom of Saudi Arabia. This study aimed to investigate the emergency medical service unit's response to RTA by socio-demographic and accident-related variables in the Kingdom of Saudi Arabia. This retrospective survey included Saudi Red Crescent Authority data on road traffic accidents between 2016 and 2020. As part of the study, information on sociodemographic characteristics (e.g., age, sex, and nationality), accident-related data (type and place of the accident), and response time to road traffic accidents were extracted. Our study included 95,372 cases of road traffic accidents recorded by the Saudi Red Crescent Authority in the Kingdom of Saudi Arabia between 2016 and 2020. Descriptive analyses were performed to explore the emergency medical service unit's response time to road traffic accidents, and linear regression analyses were performed to investigate the predictors of response time. Most of the road traffic accident cases were among males (59.1%), and the age group of 25-34 years accounted for about a quarter (24.3%), while the mean age of the road traffic accident cases was 30.13 (±12.86) years. Among the regions, the capital city of Riyadh experienced the highest proportion of road traffic accidents (25.3%). In most road traffic accidents, the mission acceptance time was excellent (0-60 s; 93.7%), movement duration was excellent (<120 s; 91.1%), reaching site duration was excellent (<12 min; 57.9%), treatment start time was excellent (<120 s; 76.4%), duration at the scene was poor (>15 min; 40.8%), reaching hospital duration was good (30-60 min; 52.7%), and in-hospital duration was poor (>15 min; 44.1%). Regions, places and types of accidents, age, gender, and nationality of victims were significantly associated with different parameters of response time. Excellent response time was observed in most of the parameters except the duration at the scene, reaching hospital duration, and in-hospital duration. Apart from the initiatives to prevent road traffic accidents, policymakers should focus on strategies to improve accident response time to save lives.

Sociodemographic determinants of depression, anxiety, and stress immediately after the COVID-19 pandemic: a cross-sectional study among university students in Saudi Arabia.

Background: The public health measures taken in educational institutions during the COVID-19 pandemic had complex influences on students' mental health. This study aimed to evaluate the prevalence and sociodemographic determinants of Depression, Anxiety, and Stress immediately after the COVID-19 pandemic among students at Qassim University, Saudi Arabia. Methods: We conducted a cross-sectional study among Qassim University students in Saudi Arabia. All students registered for the academic year 2022 were invited to participate in a survey through social media. A total of 453 participants completed an online survey that included the DASS-21 for assessing the emotional states of Depression, Anxiety, and Stress.. Results: The mean scores for Depression, Anxiety, and Stress, were 10.70, 11.18, and 10.40, respectively. At least 18% of the students reported experiencing moderate-to-severe levels of Depression, Anxiety, and Stress. The study showed that the feminine gender was associated with higher Depression, Anxiety, and Stress scores. Conclusion: Students in the current study described experiencing higher levels of Depression, Anxiety, and Stress during the COVID-19 pandemic. The findings of the present study can help universities take targeted measures to address the impact of a pandemic like COVID-19 on students' mental health.

The impact financial resources on implementation of large-scale electronic health records in the Saudi Arabia's primary healthcare centers: Mixed methods.

Introduction: There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organizations. This move to e-health transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges such as cost. Aim of the study: To evaluate the impact of financial resources (FR) on the implementation of the EHRS in PHCs in SA. Methods: A mixed methods approach was implemented. SPSS and AMOS-SEM are used to test reliability and validity and hypotheses. Thirty-one (59%) out of 51 policy makers at the MoH filled and returned the questionnaire while 13 policymakers were interviewed using semi-structure interviews. Results: Results revealed that both measurement model and structural models met the threshold. All scales are found reliable and valid. Furthermore financial resources have positive impact on EHRS implementation. Findings from both studies show that financial resources have a very positive impact to facilitate large-scale EHRs implementation and overcome barriers that may lead to the failure of the project.

Jellyfish as Food: A Narrative Review.

Studies toward a sustainable future conducted by international organizations uniformly agree about having to change some of our present consumer behaviors. Regarding food, suggestions include eating locally farmed, less industrialized and renewable food to promote health and circularity, and limiting waste. Jellyfish are frequently sorted and discarded after being caught with fish in fishing nets and gear. In contrast, we propose utilizing this by-catch as food. This review discusses the economic value and sustainability of jellyfish, the technologies used to prepare them for human consumption, their nutritional profile and health impacts and, finally, consumer acceptability and sensory evaluation of jellyfish food products. This discussion is critical for promoting jellyfish as an important aquatic resource to support blue and circular economies.

Consumer Behaviour and Attitude towards the Purchase of Organic Products in Riobamba, Ecuador.

The development of organic agriculture has been promoted worldwide to improve the nutritional health of families, and Ecuador is no exception. The aim of this research was to identify the behaviour and attitudes of consumers toward the commercialization of organic products in the city of Riobamba. This will help us to understand in what situations the consumers access these foods, the producer position in relation to the market, and to know their attitude towards these products. The study used a quantitative approach, and is descriptive, incorporating the deductive method and a non-experimental design. The techniques used were a survey as a source of data collection, with a sample including 195 consumers. Linear regression was applied to test the hypotheses; this made it possible to identify those demographic and cultural factors that determine, to a lesser extent, consumer purchase behaviour in regard to organic products. The study determined that motivation, emotions, and feelings are significantly related to the consumer's attitude and purchase of organic products.

Vaccination Intention against COVID-19 among the Unvaccinated in Jordan during the Early Phase of the Vaccination Drive: A Cross-Sectional Survey.

Objective: This study assessed the intention and predictors of accepting the corona virus disease 2019 (COVID-19) vaccine in Jordan. Method: A national-level online survey was conducted among adults (≥18 years) in Jordan between June and September 2021. Descriptive analyses were performed to report vaccination intent. In addition, bivariate and multivariate logistic regression analyses were done to evaluate the association between vaccination intent and its predictors. Results: A total of 2307 adults participated. Most of them (83.7%) expressed an intention to receive a COVID-19 vaccine. Their vaccination intention was significantly (p < 0.001) associated with male gender (aOR: 2.6), residence in the Amman region (aOR: 51.8), and no history of COVID-19 infection (aOR: 6.0). In contrast, individuals aged 50-64 years (aOR: 0.2, p < 0.001), Jordanians (aOR: 0.7, p = 0.038), and those with an occupation designated as "other" (unemployed, general workers, housewives) (aOR: 0.2, p < 0.001) were less likely to have a positive vaccination intent. Among the health belief model constructs, perceived future (aOR: 2.8) and present (aOR: 5.0) susceptibility to COVID-19 infection; severity of complications (aOR: 9.9); and benefits (aOR: 100.8) were significantly (p < 0.001) associated with a higher likelihood of having a vaccination intent. On the other hand, individuals who are concerned about the efficacy (aOR: 0.2) and side effects (aOR: 0.2) of the vaccine were less likely to have a positive vaccination intent (p < 0.001). Conclusion: Despite having high rates of intention to receive a COVID-19 vaccine, Jordanians, older adults and housewives, general workers and unemployed individuals were less likely to be vaccinated. These findings highlight that need-based public health campaigns are necessary to ensure maximum COVID-19 vaccination uptake in Jordan.

E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study.

E-cigarette use is increasing globally. Recent evidence suggests that e-cigarettes contain harmful substances that could cause adverse health outcomes. This study investigated the prevalence and associated factors of e-cigarette use among male current smokers in Saudi Arabia. We conducted a cross-sectional survey of adult male current smokers in the Al-Ahsa province of Saudi Arabia. Data were collected using a structured questionnaire. We performed logistic regression analyses to investigate the factors associated with e-cigarette use among adult male current smokers. 325 current smokers participated in the study. A third of them (33.5%) were e-cigarette users. Almost all the study participants (97.0%) had heard about e-cigarettes. Participants who were occasional smokers (Odds Ratio (OR): 2.28; 95% Confidence Interval (CI): 1.17-4.41) and had good knowledge perception of e-cigarettes (OR 3.49; 95% CI: 2.07-5.90) had higher odds of using e-cigarettes when compared to regular smokers of conventional cigarettes and current smokers with poor knowledge perception of e-cigarettes, respectively. In contrast, private employees (OR: 0.25, 95% CI: 0.07-0.85), and business owners (OR: 0.09, 95% CI: 0.01-0.63) had lower odds of using e-cigarettes compared to unemployed individuals. Compared with non-e-cigarette users, the rate of conventional cigarette smoking per day was significantly lower among e-cigarette users. Use of e-cigarette (OR: 3.57, 95% CI: 2.14-5.98), believing that e-cigarette quitting is hard (OR: 2.02, 95% CI: 1.17-3.49) and trying to quit e-cigarettes (OR: 2.17, 95% CI: 1.1-4.25) were found to be significant predictors of good knowledge perception of e-cigarettes among the current smokers. The use and knowledge perception of e-cigarettes were higher among occasional conventional male cigarette smokers than regular male smokers in Al-Ahsa province. The use of e-cigarettes as smoking cessation aids should be examined further in the Saudi Arabian setting.

Quality Improvement Attitudes among Saudi Nurses in Hospitals in Qassim, Saudi Arabia: A Cross-Sectional Survey.

BACKGROUND: This study aimed to provide an overview of perceptions of quality improvement among nurses working in Saudi Arabia. METHODS: We conducted a descriptive cross-sectional study of 497 Saudi nurses working in public and private hospitals in Al-Qassim Province. Descriptive statistics were computed for quality improvement nursing attitude items and demographic factors. RESULTS: A total of 497 nurses took part in the study; 29.1% of participants were females, and half of the participants were between the ages of 25-30 years. Most respondents were employed in governmental hospitals (98.7%), and 41.9% of participants had work experience ranging between 1 and 5 years. Nurses involved in providing direct patient care recognize the quality improvement attitudes related to changes in the healthcare delivery processes. Saudi nurses' quality improvement nursing attitudes were moderate. Female, married, and older age group nurses and nurses who were working fewer hours per week showed better quality improvement attitudes. CONCLUSIONS: Saudi nurses' quality improvement nursing attitudes are found to be moderate. Age, gender, marital status, and working hours of nurses are associated with their quality improvement attitudes. To empower nurses to improve healthcare, nursing administrators need to focus on improving the quality improvement attitudes environment.

A Qualitative Investigation of Factors Affecting Saudi Patients' Communication Experience with Non-Saudi Physicians in Saudi Arabia.

(1) Background: Communication is the main issue between the patient and physician. Communication gaps lead to medical errors, mistakes, and wrong diagnoses and treatments. It would certainly be a cause of patient dissatisfaction, the physicians' job dissatisfaction, and the increase in the cost of health services. (2) Objectives: The objective of the study was to explore the perception of Saudi patients when they meet non-Saudi consultants at hospitals. (3) Material and Methods: This study is exploratory in nature. Semi-structured face to face interviews were conducted. Study participants were patients from the outpatient department of the Hospitals of Qassim province, Saudi Arabia. A total of eight respondents, four male and four female, participated in the study. (4) Results: Interviews were transcribed verbatim and analyzed using a thematic analysis approach. Two main themes emerged: the first theme is encountering difference, with three sub-themes, while the second one is the absence of partnering, with four sub-themes. (5) Conclusions: The analysis of the patients' experiences of their medical encounters revealed that the effectiveness of the physician-patient communication was jeopardized by two challenges: encountering differences and the absence of partnering. (6) Limitations: This study was conducted in one site only and hence findings must be tested in application to other sites in other parts of Saudi Arabia and in other similar countries. A further limitation of this study was the cultural barrier that was encountered by the researcher during the interview process.

Dietary Behavior of Adolescents in the Qassim Region, Saudi Arabia: A Comparison between Cities with and without the Healthy Cities Program.

This study reports dietary behaviors of adolescents in the Qassim region, Saudi Arabia, and comparison of these behaviors between cities with and without the Healthy Cities Program (HCP). We surveyed 1133 school-attending adolescents aged 15-19, using a multi-staged cluster sampling with probability proportionate to size. Prevalence of daily breakfast consumption was 27.7% among the adolescents. Prevalence of daily vegetables, fruits and milk or milk products consumption was 35.9%, 28.6% and 51.1%, respectively. Meanwhile, the prevalence of daily consumption of fast-food and carbonated drinks was 7.5% and 37.1%, respectively. There was no significant association between living in the healthy cities and daily intake of breakfast (OR: 1.15, 95% CI: 0.87-1.53), fruits (OR: 1.02; 95% CI: 0.77-1.36), vegetables (OR: 1.27; 95% CI: 0.98-1.67), or milk/milk products (OR: 1.0; 95% CI: 0.77-1.29); and the daily intake of fast-food (OR: 0.81; 95% CI: 0.49-1.35) or carbonated drinks (OR: 0.80; 95% CI: 0.60-1.05). These findings warrant further in-depth evaluation of the HCP in the Qassim region of Saudi Arabia.

Physical inactivity and its predictors among adolescents in Saudi Arabia: A cross-sectional comparison between cities with and without a Healthy Cities Program.

OBJECTIVES: To estimate the prevalence of insufficient physical activity and excessive screen time among adolescents living in cities participating in the Healthy Cities Program (HCP) and cities not running the program in the Qassim region of Saudi Arabia. METHODS: We surveyed 1133 adolescents from the Qassim region using systematic random sampling between April and September 2017. Multivariable logistic regression analyses were conducted to investigate the predictors of insufficient levels of PA and excessive screen time. RESULTS: The prevalence of <60 minutes of moderate- to vigorous-intensity physical activity/day was 82.4% and <3 days of vigorous intensity physical activity/week among adolescents was 59%. There was no significant association between living in healthy cities (HCPs) and insufficient levels of physical activity. The odds of excessive screen time were higher in HCPs than in cities not running the program (NHCPs) (OR: 1.49). The odds of insufficient daily PA (OR: 2.19) are higher among girls than boys. Increasing age is positively associated with insufficient weekly PA (OR: 1.19). The prevalence of excessive recreational screen time is 84.6% with higher odds in HCPs than in NHCPs (OR: 1.51). CONCLUSION: Our findings report a lack of evidence of any impact of the HCP on adolescents' physical activity behaviors. This outcome warrants a further in-depth evaluation of the process and outcomes of the HCP in Saudi Arabia.