Identification of Child Abuse and Neglect Based on the Perception of Training Physicians in Jeddah, Saudi Arabia.

Introduction Child abuse and neglect (CAN) affects many countries, including Saudi Arabia (SA). CAN in SA is more commonly detected in hospitals. Therefore, healthcare professionals must identify and report the cases. This study aims to assess knowledge and perceptions toward CAN among training physicians. Methodology A cross-sectional survey was conducted through a self-administrated structured questionnaire and involved 123 residents and fellows who deal with children in Jeddah, SA. The participants were recruited using convenient sampling methods. Descriptive statistics, t-test, and Chi-square test were used for statistical analysis. Results We found that approximately 78% would report their findings to the legal authority, document them, and assess their consistency with parents and the child's explanation. However, only 41.5% of the participants would report CAN to the proper authority. Most participants believed that CAN should be redefined according to Saudi culture and religious standards. In contrast, 68.9% of the participants believed that CAN cases are under-reported in SA. The main barrier to not reporting is the fear of consequences (63.4%). About 77% of the participants agreed to the need for further training. Identifying the CAN indicators was higher among those who handled a CAN case previously (median = 66.67, p = 0.023). Conclusions In conclusion, the study showed that appropriate undergraduate and postgraduate curriculum training should be developed to strengthen future healthcare practitioners in dealing with CAN cases to protect children's welfare.

Determinants of ever smoking and active smoking among school-aged children in Jeddah.

Objectives: This study estimated the prevalence and investigated the determinants of ever-smoking and active smoking among school-aged children in Jeddah. Such data are crucial for developing optimal preventive and corrective strategies to address smoking among youth. Method: A school-based, cross-sectional study was conducted in Jeddah City, KSA, from September 2020 to December 2020. It included 6770 children attending grades 4-12, who were selected from 60 public and private elementary, middle, and secondary schools through multistage random-cluster sampling. An Arabic version of the Global Youth Tobacco Survey questionnaire was used to assess the prevalence and predictors of tobacco use. Result: The prevalence of ever smoking was 14.1% (95% CI = 13.2-14.9%), and the mean age at which children smoked their first cigarette or took any puffs was 13.76 years (SD = 2.23). The prevalence of active smoking was 3.8% (95% CI = 3.3-4.3%), and the amounts and frequency of cigarettes smoked in the past 30 days among smokers were relatively low. The most commonly consumed tobacco products were cigarettes (47.2%) and hookah (42.9%). In most cases, active smokers bought cigarettes by themselves from groceries or convenience stores, or received them from a person to whom they were close. Ever smoking was independently associated with older age, male gender, private school, the mother's working status, and exposure to passive smoking indoors or outdoors. Active smoking was independently associated with older age, male gender, private school, a high amount of pocket money, perceived ease of obtaining tobacco products, and exposure to passive smoking. Conclusion: The observed smoking patterns among school-aged children in Jeddah corresponded to occasional smoking, and family-related determinants were significant contributors. The findings highlight the relevance of implementing smoking cessation interventions and awareness campaigns, at both the school and community levels, to achieve maximal benefit.

Uncontrolled Asthma Among Children and Its Association With Parents' Asthma Knowledge and Other Socioeconomic and Environmental Factors.

Objective To estimate the frequency of uncontrolled asthma among asthmatic children from Jeddah and to analyze its association with parental asthma knowledge and other socioeconomic and environmental factors. Method A cross-sectional study was conducted at the Pediatrics Departments of King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, from July to December 2018. It involved the caregivers of 150 children with asthma, who were following at KAUH. A structured questionnaire was administered by a phone interview to collect the following: socioeconomic and environmental factors of asthma, answers to the Arabic version of the Asthma Control TestTM (ACT), and answers to the Arabic version of the caregiver Asthma Knowledge questionnaire (AKq). Result The frequency of uncontrolled asthma was 32.7% (95%CI: 25.2 - 40.8). Parents had myths about asthma such as "children with asthma should use asthma control medications (inhaled corticosteroids) only when they have symptoms" and "it's not good for children to use the inhaler for too long". Besides, we observed mixed results regarding parents' knowledge about the disease, with correct answers ranging from 56.0% to 88.7% depending on the item. Exposure to bakhoor (aromatic woodchips) at home (OR = 0.41, p=0.044), two or more ICU admissions during the past 12 months (OR = 3.30, p=0.030), and using a rescue inhaler even if there's no cough or wheeze when the child gets the flu (OR = 0.22, p=0.001) were the three independent factors of uncontrolled asthma among children. Conclusion Uncontrolled asthma concerns one-third of the asthmatic children following at our centre, representing a less concerning figure compared to the national data. The contribution of parents' knowledge to asthma control did not show significant results, although uncontrolled asthma may represent an opportunity to increase parents' knowledge and awareness. We emphasize the significance of exposure to bakhoor, the use of oral steroids, and the number of ICU admission as strong indicators for uncontrolled asthma in children. An adaptive national strategy should be designed to enable effective and personalized interventions, resources, and objectives for maximized benefits.

The validity and reliability of the Arabic translation of the Pediatric Sleep Questionnaire.

OBJECTIVE/BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder in childhood. Polysomnography is the gold standard for the diagnosis of OSA. However, it is expensive and time-consuming, and it may be unavailable. The self-administered Pediatric Sleep Questionnaire (PSQ) is a reliable and validated screening test featuring high sensitivity (0.85) and specificity (0.87). It has been translated into multiple languages and is widely used to screen for OSA in children. This study translated the PSQ into Saudi Arabian Arabic and validated it. PATIENTS/METHODS: The Arabic-PSQ was translated using forward-backward translation, following established guidelines. A review committee monitored the process and approved the final version. The reliability of the scale was measured using Cronbach's alpha and kappa statistics. The validity of the Arabic-PSQ was evaluated using confirmatory factor analysis (CFA). RESULTS: Our study recruited 220 Saudi children with potential adenoid hypertrophy from King Abdulaziz University hospital clinics. The Arabic-PSQ had excellent internal consistency (Cronbach's α 0.946). Additionally, all subscales had excellent reliability, with Cronbach's α of 0.924 for snoring, 0.762 for sleepiness, and 0.820 for behavior. Test-retest reliability showed excellent agreement of >80% in all items (p < 0.0001). CFA for the Arabic-PSQ confirmed a significant correlation between the items of each subscale. CONCLUSIONS: The Arabic-PSQ is reliable, validated, and culturally adapted. It can be safely used to screen for OSA in children. However, given this study's limitations, the diagnostic efficacy of the Arabic-PSQ should be assessed in future studies.

Effect of the COVID-19 Pandemic on Treatment Adherence Among Children With Congenital Adrenal Hyperplasia.

BACKGROUND: This study determined the effect of the COVID-19 pandemic on adherence to medication among children with congenital adrenal hyperplasia (CAH) living in the Kingdom of Saudi Arabia (KSA). METHODS: Data were collected from April 2020 to April 2022 through face-to-face or telephonic interviews at a virtual paediatric endocrine clinic in Jeddah, KSA. RESULTS: A total of 55 children, with a mean age of 12.9 ± 5.8 years, participated in the study. Most children (32/55, 58%) were administered treatment by their mother. Before the COVID-19 pandemic, 51 patients (93%) reported adhering to their CAH treatment. After the onset of the COVID-19 pandemic, this number decreased to 49 (89%, p = 0.516). The most common reasons for non-adherence before and after the pandemic included restricted access to medication (supply and financial problems) and challenges in obtaining new prescriptions and refills. These challenges increased after the onset of the pandemic. Before and after the onset of the pandemic, mothers with a university degree were significantly more likely to administer medication than mothers without a university degree, but fathers' education level did not affect their role in medication administration, before or after the onset of the pandemic. CONCLUSION: This study confirms that the COVID-19 pandemic did not have a significant effect on medication adherence in children with CAH in Jeddah.

Tranexamic Acid Use for Massive Hemoptysis in a Child: A Case Report.

Massive hemoptysis is a rare life-threatening condition in children. Individuals with non-cystic fibrosis bronchiectasis may present with various degrees of hemoptysis. Therapeutic measures are mainly derived from studies involving adults or various case reports of children with cystic fibrosis. The standard management of massive hemoptysis is limited to invasive bronchoscopy, bronchial artery embolization, and surgical resection. Tranexamic acid (TXA) use is limited to non-massive hemoptysis or as an adjuvant and temporizing measure before definitive treatment. We report the potential use of TXA as an emergency treatment for massive hemoptysis in a 10-year-old boy with non-cystic fibrosis bronchiectasis and chronic infection. The use of systemic TXA (250 mg every eight hours for five days) successfully stopped active bleeding beginning from the first dose and altered the need for invasive interventions. Although he experienced another episode of massive hemoptysis because of pneumonia and pulmonary exacerbation, invasive measures were not required because he responded to systemic TXA immediately. Moreover, no further recurrence of hemoptysis was noted on cessation of TXA and throughout two years of regular follow-up. Therefore, TXA could be considered a non-invasive therapy for children with massive hemoptysis, especially in the absence of standard invasive therapies.

Methacholine challenge test: Comparison of tidal breathing and dosimeter methods in children.

INTRODUCTION: Methacholine Challenge Test (MCT) is used to confirm, assess the severity and/or rule out asthma. Two MCT methods are described as equivalent by the American Thoracic Society (ATS), the tidal breathing and the dosimeter methods. However, the majority of adult studies suggest that individuals with asthma do not react at the same PC20 between the two methods. Additionally, the nebulizers used are no longer available and studies suggest current nebulizers are not equivalent to these. Our study investigates the difference in positive MCT tests between three methods in a pediatric population. METHODS: A retrospective, chart review of all MCT performed with spirometry at the Montreal Children's Hospital from January 2006 to March 2016. A comparison of the percentage positive MCT tests with three methods, tidal breathing, APS dosimeter and dose adjusted DA-dosimeter, was performed at different cutoff points up to 8 mg/mL. RESULTS: A total of 747 subjects performed the tidal breathing method, 920 subjects the APS dosimeter method, and 200 subjects the DA-dosimeter method. At a PC20 cutoff ≤4 mg/mL, the percentage positive MCT was significantly higher using the tidal breathing method (76.3%) compared to the APS dosimeter (45.1%) and DA-dosimeter (65%) methods (P < 0.0001). CONCLUSION: The choice of nebulizer and technique significantly impacts the rate of positivity when using MCT to diagnose and assess asthma. Lack of direct comparison of techniques within the same individuals and clinical assessment should be addressed in future studies to standardize MCT methodology in children.

Effect of lowering methacholine challenge test cutoff in children.

BACKGROUND: The diagnosis of asthma is based on clinical judgment, history of personal or familial atopy, and testing, typically with a methacholine challenge test (MCT). Guidelines suggest a provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20% (PC20) cutoff of 4 mg/mL for a positive test result. OBJECTIVE: To investigate the effect of lowering the MCT PC20 cutoff from 8 to 4 mg/mL on the number of positive test results and the distribution of test results. METHODS: A retrospective study was conducted at the Montreal Children's Hospital from January 1, 2006, through June 31, 2012, on patients referred by nonrespiratory physicians. A 2-minute tidal breathing dosing protocol was used, and the PC20 was calculated by linear interpolation. RESULTS: A total of 748 patients were tested using spirometry. A total of 134 (17.9%) had a negative MCT result, and 614 (81.1%) responded at 8 mg/mL or less. A total of 570 patients (92.8% of respondents) responded at a dose of 4 mg/mL or higher (median PC20 of 0.47 mg/mL), with the remainder (7.2% of respondents) responding at a dose between 4 and 8 mg/mL (median PC20 of 6.37 mg/mL). There was no difference in the number of positive test results between the sexes, regardless of cutoff. The sensitivity of MCT was 82.1% at a cutoff of 8 mg/mL and 76.2% at 4 mg/mL. With a pretest likelihood of asthma of 75%, the specificity was 71.2%. CONCLUSION: In a standard pediatric referral population, using a PC20 cutoff of 4 mg/mL provided a sensitivity of 76.2%, and only excluded 5.8% of all those referred for suspicion of asthma (7.2% of all test results were ≤8 mg/mL). This finding suggests that a PC20 of 4 mg/mL can reasonably be used as a cutoff for a positive MCT result in children.