Pathways to socioeconomic health differences in Armenian adolescents: The role of bullying perpetration.

Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. This study aimed to investigate the role of bullying perpetration in the relationship between SES and health among Armenian adolescents. A nationally representative sample of 3679 adolescents aged 11-15 years (mean = 13.1, standard deviation = 1.6) participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP] and material well-being) and three health outcomes (perceived health status, psychosocial well-being, and psychosomatic symptoms). Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family SEP and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06-3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77). Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Consequently, bullying prevention activities in Armenia should focus on both low and high-SES adolescents, considering SES-specific pathways and mechanisms.

The bacterial colonization of healthcare workers' mobile phones in a large tertiary care teaching hospital in Saudi Arabia.

INTRODUCTION: The use of mobile phones by healthcare workers is a risk factor for microorganism transmission in healthcare settings. Pathogenic bacteria such as methicillin-resistant Staphylococcus aureus and gram-negative bacteria like Escherichia coli that are known to cause nosocomial infection have been isolated from mobile phones. In this cross-sectional study, we assess the burden and related risk factors of the bacterial colonization of healthcare workers' mobile phones. METHODOLOGY: We collected samples from the mobile phones of 130 healthcare workers' in a Saudi Arabian teaching hospital, using moistened cotton swabs. The isolated organisms were identified using an automated identification and susceptibility system. Multiple logistic regression analysis was used to test the data. RESULTS: Of 130 swabs collected, 45 (34.6%) grew one species and 48 (36.9%) grew two or more. Staphylococcus epidermidis was the most commonly isolated bacteria (52.3%), followed by Micrococcus and related species (25.4%), Staphylococcus hominis (13.8%), and Bacillus species (6.9%). Clinically significant microorganisms such as S. aureus and Pseudomonas sp. were identified in 2 (1.5%) samples, respectively. The odds of mobile phone colonization were 8.5 times higher (95% CI = 3.2-23.1) in the laboratory, neonatal intensive care unit, and medicine departments. Mobile phones owned for more than one year were more likely to be culture positive (OR = 2.9, 95% CI = 1.1-7.6). CONCLUSIONS: In our study, the prevalence of bacterial colonization among healthcare workers' mobile phones was high. Our findings suggest that high-risk groups for mobile phone colonization-such as laboratory, neonatal intensive care unit, and medicine department staff-should be a priority for preventative measures, to improve infection control.

Socioeconomic Inequalities in Health among Armenian Adolescents.

We aimed to study the hypothesis of socioeconomic equalization in health among Armenian adolescents participating in the Health Behavior in School-Aged Children 2013/14 survey. Classes corresponding to the ages 11, 13, and 15 were selected using a clustered sampling design. Multiple logistic regression analyses were used. In a nationally representative sample of 3679 students, adolescents with a low family socioeconomic position (SEP) had greater odds of reporting less than good health (odds ratio (OR) = 2.81, 95% CI = 2.25-3.51), low psychosocial well-being (OR = 1.94, 95% CI = 1.44-2.61), or psychosomatic symptoms (OR = 1.29, 95% CI = 1.07-1.56). Low levels of material well-being were associated with a higher likelihood of reporting less than good health (OR = 1.32, 95% CI = 1.06-1.65) or low psychosocial well-being (OR = 1.27, 95% CI = 1.04-1.54). The presence of both risk factors had a synergistic effect on having low psychosocial well-being (P-interaction = 0.031). Refuting the equalization hypothesis, our results indicate that low SEP might be strongly related to adolescent health in middle-income countries such as Armenia. Low material well-being also proved important, and, for further research, we hypothesized an association via decreased peer social status and compromised popularity.

Asthma control in Saudi Arabia: Gender implications.

BACKGROUND: Gender-related factors in asthma control should be considered in clinical consultations to substantially improve asthma control in women. Meanwhile, a limited number of studies have been reported on gender differences in factors related to asthma control, especially in Saudi Arabia. OBJECTIVE: To study the potential gender differences in factors associated with asthma control among adult patients with physician-diagnosed asthma. METHODS: A cross-sectional study was conducted in adult patients with asthma who attended primary care clinics at three major hospitals in Riyadh, Saudi Arabia. Asthma control was measured by using the Asthma Control Test. Asthma control status was classified as either controlled (Asthma Control Test score of >19) or uncontrolled (Asthma Control Test score of ≤19). Multiple logistic regression analysis was performed. RESULTS: In this study, 58.9% of men and 77.0% of women had uncontrolled asthma (p = 0.002). Factors associated with uncontrolled asthma were different between men and women, except for household income. Reporting higher levels of stress (odds ratio [OR] 4.3 [95% confidence interval {CI}, 1.7-11.1]), daily tobacco smoking (OR 5.8 [95% CI, 1.5-23.5]), and a monthly household income of <15,000 Saudi Arabian Riyals (OR 4.5 [95% CI, 1.9-10.5]) were associated with uncontrolled asthma in men. Being unemployed (OR 3.4 [95% CI, 1.3-9.4]), being obese (OR 3.2 [95% CI, 1.1-9.2]), or having a monthly household income of <15,000 Saudi Arabian Riyals (OR 3.1 [95% CI, 1.2-8.0]) were associated with uncontrolled asthma in women. CONCLUSION: This study demonstrated that many factors, such as stress, occupation, and obesity, had a differential relationship with uncontrolled asthma among men and women in Saudi Arabia that could provide more insight into methods of improving asthma control, especially in women.

Asthma quality of life in Saudi Arabia: Gender differences.

OBJECTIVES: To explore potential gender differences in the factors associated with asthma-specific quality of life (AQL). METHODS: A cross-sectional study of consecutive series of adult patients attending primary care centers at three major hospitals in Riyadh, Saudi Arabia, was performed. AQL was measured using a standardized version of the AQL questionnaire (min = 1, max = 7), with higher scores indicating a better AQL. Multiple linear regression analysis was performed. RESULTS: The mean AQL was 4.3 (standard deviation [SD] = 1.5) for males and 4.0 (SD = 1.3) for females (p = 0.113). With each unit increase in asthma control, the AQL improved by 0.19 points (95% confidence interval [CI] = 0.14-0.23) in men and by 0.21 points (95% CI = 0.16-0.25) in women. Daily tobacco smoking was associated with a 0.72 point (95% CI = 0.14-1.30) decrease in the AQL among males. Women who had a household member who smoked inside the house had a significantly lower AQL (B = -0.59, 95% CI = -1.0 - -0.19). A monthly household income of 25,000 Saudi Riyals or more was associated with a better AQL among men (B = 0.51, 95% CI = 0.01-1.01), whereas being employed exhibited a protective effect in women (B = 0.48, 95% CI = 0.11-0.84). Higher levels of perceived asthma severity were associated with better AQL in women (B = 0.82, 95% CI = 0.36-1.28). CONCLUSIONS: Our findings revealed gender-specific differences in the correlates of AQL in Saudi Arabia, particularly in tobacco exposure, socio-economic factors and perceived asthma severity.

Interaction Effects of Happiness and Physical Activity on Smoking Initiation.

OBJECTIVE: Our aim was to assess the potential relationships among happiness, physical activity, and smoking initiation among undergraduate medical students in Saudi Arabia. METHODS: We performed a cross-sectional study of randomly selected first- to fifth-year undergraduate medical students. Smoking initiation was defined as "ever trying smoking a cigarette, waterpipe, cigar/cigarillo, or other type of tobacco, even one or 2 puffs." The short scale Oxford Happiness Questionnaire was used to assess each student's happiness. Multivariate logistic regression analysis was performed. RESULTS: Of the 406 students surveyed (208 boys, 198 girls), 86 (21.1%) had initiated smoking. We found an interaction between physical activity (PA) and happiness on smoking initiation (p-interaction = .012). Among boys with low levels of PA, lower levels of happiness were associated with a greater likelihood of smoking initiation (OR = 5.8, 95%CI = 1.9 - 17.5). Also, high levels of PA increased the chance of smoking initiation among male students with high levels of happiness (OR = 5.6, 95%CI = 2.1 - 14.5). CONCLUSION: Our results suggest that young men with low levels of happiness and low levels of PA, as well as high levels of PA and high levels of happiness, may be targeted as a priority population in tobacco control intervention programs.

The role of rapid testing and clinical decision in the diagnosis of human influenza A H1N1 infection.

OBJECTIVE: To evaluate the role of the rapid influenza diagnostic test (RIDT) and clinical decision in the diagnosis of H1N1. METHODS: In November 2009, 290 suspected influenza patients were examined for H1N1 during an outbreak in Riyadh, Saudi Arabia. Nasopharyngeal swabs were analyzed using Directigen EZ Flu A+B kit. Monoclonal anti-human influenza A/B and reverse transcription- polymerase chain reaction (RT-PCR) were used. Positive and negative controls were used in each run of specimens. Validity indices were calculated for RIDT and clinical diagnostic criteria. RESULTS: The sensitivity and specificity of RIDT were 40.5% (95% confidence interval [CI]: 33.0-48.5), and 94.5% (95% CI: 88.6-97.6). The sensitivity of clinical decision was 66.3% (95% CI: 58.4-73.4), and the specificity was 65.4% (95% CI: 56.3-73.4). The sensitivity of clinical decision was higher in early presenters (79.2%; 95% CI: 57.3-92.1). The RIDT sensitivity was higher in younger patients (48.4%; 95% CI: 35.7-61.3). The positive predictive value (PPV) was 90.4% (95% CI: 80.7-95.7) for RIDT, and 71.1% (95% CI: 63.1-78.0) for clinical decision. The PPV for RIDT was greater for older (94.7%; 95% CI: 80.9-99.1) and late (90.7%; 95% CI: 76.9-97.0) presenters. The adjusted odds ratio for clinical decision was significant for cough, headache, and fatigue. CONCLUSION: The RIDT can be useful in epidemics and high prevalence areas, whereas clinical decision, and RT-PCR complement the diagnosis of H1N1 in any setting.

Extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: does vancomycin play a role?

BACKGROUND: Extended-spectrum ß-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. METHODS: A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. RESULTS: During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. CONCLUSION: Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.

Determinants of asthma control among children in Saudi Arabia.

OBJECTIVE: Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children. METHODS: A cross-sectional study was conducted among children with asthma aged 4-11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables. RESULTS: Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10-0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04-0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81-0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02-5.21) and 3.33 (95% CI = 1.33-8.35), respectively. CONCLUSIONS: In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.