Gender Differences in Sleep and Mental Health among Saudi Adolescents.

Among adolescents, mental health issues (i.e., stress and depressive symptoms) negatively affect sleep. We assessed whether the association between mental health and sleep varied between genders among Saudi adolescents. A total of 2206 school students (grades 7-12) from 40 randomly selected schools in four cities of Al-Qassim province in Saudi Arabia participated in this cross-sectional study. The survey assessed demography, lifestyle, sleep (12-item Medical Outcomes Study Sleep Scale), depression (Depression, Anxiety, Stress Scale (DASS-21)) and stress (10-item Perceived Stress Scale). Adjusted associations with sleep were tested with linear and logistic regressions. Of the sample, 55% were girls, and their average sleep score was lower than that of the boys (58.7 vs. 63.4, p < 0.001). Girls had worse mental health than boys; the proportion of girls with both severe stress and severe depressive symptoms was three times higher than that of the boys (12% vs. 4%, p < 0.001). For both boys and girls, those with severe depressive symptoms only or both severe depressive symptoms and severe stress had significantly lower sleep scores than those who had neither of the two conditions (reference group). On the other hand, among those who had severe stress only, the sleep score was significantly lower for the girls (p = 0.002) than for the boys (p = 0.19). Overall, girls had a significantly lower sleep score and worse mental health than boys. The association between mental health and sleep significantly differed between the sexes. Severe stress was negatively associated with sleep in girls but not in boys.

Assessment of handwritten prescriptions from Saudi Arabia according to international guidelines.

OBJECTIVE: Prescription dispensing services are not digitalized in the majority of governmental hospitals and private clinics in Saudi Arabia, which makes them prone to error. We aimed to evaluate handwritten prescriptions in a region in Saudi Arabia for consistency and accuracy according to international guidelines. METHODS: A sample of handwritten prescriptions (dated 2016 or 2017) from selected pharmacies in the Al-Qassim region (n = 556) were evaluated for missing information on items related to prescriber, patient, and medication according to the World Health Organization and Food and Drug Administration guidelines. RESULTS: We found that the prescriber's name and contact information were missing in two-thirds of the prescriptions (66%). Patients' addresses were always missing (100%). No prescription contained medication warnings; a majority lacked information on mode of administration (68%) and methods to avoid refilling (66%). CONCLUSION: Saudi Arabia should take a multipronged approach, including digitalization of prescription dispensing services, in both public and private health care facilities in order to reduce prescription errors.

Gaming addiction and perceived stress among Saudi adolescents.

INTRODUCTION: Adolescents (age: 10-19 years) make up 15% of the Saudi population and have easy access to electronic gadgets and the Internet, yet data on gaming addiction among adolescents are negligible. We aimed to determine the prevalence of gaming addiction and its association with stress among Saudi school students. METHODS: In this cross-sectional survey, 2675 school students (grades 7-12) from 40 randomly selected schools in four main cities of Al-Qassim province in Saudi Arabia participated. The questionnaire inquired about demography, lifestyle, gaming addiction (7-item Game Addiction Scale), and stress (10-item Perceived Stress Scale). Multinomial logistic regression assessed the association between gaming addiction (yes, no) and stress (high, moderate, low). RESULTS: Participants' mean age was 16.1 (SD = 1.6) years; 50% were female; 64% reported >3 h of daily screen time; 5% were addicted to gaming; 11.4% had high-level stress. Addiction to gaming was strongly associated with stress in the adjusted analysis (moderate OR = 6.7, 95% CI = 2.9-15.5; high OR = 11.9, 95% CI = 4.7-30.1). Additionally, those who were older, female, had poor grades, unhealthy dietary habits, an inactive lifestyle, and smoked were more likely to experience high stress. CONCLUSIONS: Gaming addiction is strongly associated with stress among Saudi adolescents.

Ascitic calprotectin for the diagnosis of spontaneous bacterial peritonitis: a systematic review and meta-analysis.

Calprotectin is a promising diagnostic biomarker for spontaneous bacterial peritonitis (SBP) among cirrhotic patients, but published studies report a wide variation of its diagnostic accuracy. We systematically searched six databases for eligible studies (i.e., all original studies that reported ascitic calprotectin as a diagnostic marker for SBP in cirrhotic patients), and assessed their quality with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We calculated the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), and diagnostic odds ratio (DOR) using the bivariate mixed-effect model. We constructed the summary receiver operating characteristic and determined the area under the curve (AUC). We registered the study protocol in PROSPERO (CRD42019125476). Our search retrieved 102 studies, of which 10 were included in the analysis. The overall risk of bias of these studies ranged from low to moderate. There was no heterogeneity from the threshold effect (Spearman correlation coefficient = 0.100, P value = 0.770). The pooled estimates [95% confidence intervals (CIs)] for ascitic calprotectin were as follows: sensitivity 0.91 (95% CI: 0.88-0.94), specificity 0.87 (95% CI: 0.68-0.96), PLR 7.18 (95% CI: 2.52-20.43), NLR 0.10 (95% CI: 0.07-0.15), DOR 71.91 (95% CI: 19.42-266.34), and AUC 0.92 (95% CI: 0.90-0.94). The sensitivity analysis did not detect outliers, and the model had a robust goodness of fit. There was no significant publication bias detected (Deeks test of asymmetry, P value = 0.79). Ascitic calprotectin is a promising diagnostic biomarker for SBP in cirrhotic patients.

A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia.

OBJECTIVE: Adequate sleep is integral to better mental health and facilitates students' learning. We aimed to assess sleep quality among medical students and to see whether it was associated with their mental health (e.g., depression, anxiety, and stress) and academic performance. RESULTS: A total of 206 responded, and 95 of them had complete data on demography, lifestyle, academic performance, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Depression Anxiety Stress Scales). The prevalence of poor sleep was 63.2%; it was higher among students who were physically inactive and had more screen time. Poor sleepers demonstrated higher academic performance than sufficient sleepers (p = 0.04). The prevalence of depression, anxiety, and stress were 42%, 53%, and 31% respectively. Sleep quality was significantly associated with depression (p = 0. 03), anxiety (p = 0.007), and stress (p = 0.01).

Sleep duration is associated with depressive symptoms among expatriate nurses.

BACKGROUND: There is limited data on sleep and its impact on mental health among expatriate nurses in Saudi Arabia. This study aimed to assess the association between sleep duration and symptoms of depression among expatriate nurses. METHODS: Nurses in government healthcare facilities in Al-Qassim, Saudi Arabia responded to an electronic survey (n = 977) on demography, lifestyle, job features, and symptoms of depression (Depression Anxiety Stress Scale 21). Binary and multinomial logistic regression, respectively, assessed the adjusted associations of daily sleep hours (≤5, 6-7, ≥8) with having any (no, yes) or degree of symptoms (no, mild to moderate, and severe to extremely severe). RESULTS: There was a dose-response relationship between sleep hours and depressive symptoms (any as well as degree) (p-values for trend <0.05). For nurses who slept 6-7 h, the odds ratio (OR) of having any symptoms of depression was 1.6 (95% CI: 1.2 - 2.2), 'mild to moderate' symptoms 1.5 (95% CI: 1.1 - 2.2), and 'severe to extremely severe' symptoms 1.9 (95% CI: 1.1 - 3.4). For nurses who slept ≤5 h, the OR of having any symptoms was 2.1 (95% CI: 1.4-3.3), 'mild to moderate' symptoms 1.7 (95% CI: 1.0-2.6), and 'severe to extremely severe' symptoms 4.2 (95% CI: 2.2-8.1) (reference group ≥ 8 h). LIMITATIONS: The sleep data pertained to duration only and not to sleep quality. CONCLUSION: There was a strong association between sleep duration and symptoms of depression among expatriate nurses.

Association of cumulative job dissatisfaction with depression, anxiety and stress among expatriate nurses in Saudi Arabia.

AIMS: We aimed to (a) determine the prevalence of depression, anxiety and stress among expatriate nurses in Saudi Arabia, and (b) assess how dissatisfaction with salary, workload and teamwork, individually and in combination, was associated with those conditions. BACKGROUND: Prevalence estimates for depression, anxiety and stress among nurses are higher than those in the general population. Available data on the mental health of expatriate nurses are limited. METHODS: Expatriate nurses (n = 977) from governmental hospitals completed an electronic survey on demography, lifestyle, job factors, depression, anxiety and stress (assessed with DASS-21 scale). Multinomial logistic regressions were used for analyses. RESULTS: Dissatisfaction with workload and teamwork was significantly associated with both mild/moderate and severe depression in adjusted models. Dissatisfaction with workload was significantly associated with both anxiety and stress, but teamwork was not. There was a significant dose-response relationship between the number of domains of dissatisfaction and depression, anxiety and stress (p for trend was < 0.001). CONCLUSIONS: Dissatisfaction with salary, workload and teamwork is associated with depression, anxiety and stress in expatriate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital and nursing administrators should identify specific aspects related to workload and teamwork and offer solutions to reduce mental health distress among nurses.

Mental Health Status of Expatriate Nurses in Northcentral Saudi Arabia.

Mental health status may vary by nationality among expatriate workers; no conclusive data is available in Saudi Arabia. We invited expatriate nurses employed in governmental hospitals in Al-Qassim, Saudi Arabia to fill out an electronic survey that contained questions on demography (including nationality), lifestyle, job, depression, anxiety, and stress (assessed with DASS-21 scale). We categorized each outcome into normal, mild to moderate, and severe, and used adjusted multinomial logistic regressions for analyses. Nurses (n = 999) were from India (54.1%), the Philippines/Indonesia (37.0%), Pakistan (4.9%) and Arab countries (4.0%). Indian nurses were three times (OR = 2.93; 95% CI 1.84, 4.67), Pakistani nurses were 2.5 times (OR = 2.54; 95% CI 1.07, 6.00), and Arab nurses were five times (OR = 5.65; 95% CI 2.40-13.31) more likely to suffer from severe depression compared to Filipino/Indonesian nurses (reference group). Results were similar for stress. Depression and stress varied significantly by nationality among expatriate nurses.

Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia.

INTRODUCTION: Few studies have estimated screen time among Arab adolescents, and no studies, to date, have published data on addiction to video games or Internet games among Arab adolescents. This study aimed to assess the prevalence of addiction to video games and its correlation with mental health in a sample of expatriate high school students from the Al-Qassim region of Saudi Arabia. METHODS: The survey was conducted in 2016 among 276 students enrolled in ninth through twelfth grades in the International Schools in Buraidah, Al-Qassim. Students who returned signed consent forms from their parents filled out a self-administered questionnaire that included validated scales on addiction to video games, general health, and lifestyle. RESULTS: The proportion between the sexes and the schools were roughly equal. Around 32% were overweight or obese, 75% had screen time ≥ 2 h/day, and 20% slept < 5 h/night. Sixteen per cent (16%) were addicted to video games and 54% had psychological distress. Addiction to video games was strongly associated with psychological distress (OR = 4.1, 95% CI = 1.80, 9.47). Other significant correlates were female gender, higher screen time, and shorter sleep hours. CONCLUSIONS: The proportion of students with psychological distress was high. Future studies should investigate other potential correlates of distress such personal traits, family relations, and academic performance.

Knowledge and Attitudes about Basic Life Support among Secondary School Teachers in Al-Qassim, Saudi Arabia.

OBJECTIVE: Despite the strong evidence that basic life support including cardiopulmonary resuscitation (CPR) improves survival rates after cardiac events, the awareness and training among citizens of Saudi Arabia is low. The study objective was to determine the current level of knowledge and CPR-skills among secondary school teachers. The second objective was to assess their attitudes and willingness to participate in regular CPR training. METHOD: A cross-sectional study was conducted in the secondary schools in Al-Qassim region in 2015. Thirty of 99 schools were randomly selected; ten teachers from each school were enrolled. Teachers completed the questionnaire. T-tests were used to examine whether participants with either previous CPR training or previous resuscitation experiences had higher scores on the skills test than those without training or experience. RESULTS: The study included 305 teachers (80% Saudi nationality); 75.4% were males and 66.5% were between the ages of 31 and 50. Among the teachers, 35.7% had completed CPR training previously; but overall, CPR knowledge and skills were low (mean =4.0, sd = 1.62). In fact, the average scores did not differ between those who had training and those who did not. The majority of teachers wanted more training (64.9%) and were willing to take a free course (78.4%). CONCLUSION: In Al-Qassim, secondary school teachers lack CPR training and hence have little knowledge or skills. Teachers are willing and desire to have more CPR training available to them. Should health officials provide future training, teachers could serve the community better.