The prevalence and sociodemographic determinants of tobacco and nicotine use among students in healthcare disciplines in Saudi Arabian universities: a cross-sectional survey.

Background: Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited. Methods: This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression. Results: Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively. Conclusion: Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use.

Menstrual Changes Following COVID-19 Vaccination: A Cross-Sectional Study.

Background and Objectives: Menstrual changes, including altered cycle length and bleeding patterns, have been reported following COVID-19 vaccination. This study aimed to determine the prevalence and types of menstrual changes occurring after COVID-19 vaccination among female students and staff at a university in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among women aged 18-39 years who received at least one dose of a COVID-19 vaccine. Eligible participants, including university students and staff, were recruited between May 2022 and November 2022. Participants completed a questionnaire detailing their sociodemographic characteristics, general medical and reproductive history, and menstrual characteristics before and after vaccination. The prevalence of various menstrual changes (cycle length, bleeding days, flow, and mid-cycle spotting) was calculated. The demographic factors associated with menstrual changes were analyzed using chi-squared tests. Results: The 472 included participants had a mean age of 20.9 years, and 95.3% were unmarried. Changes in menstrual cycle characteristics after COVID-19 vaccination were reported by 54.7% of respondents overall. The most common change was in cycle length, followed by the number of menstruation days and bleeding flow. Menstrual changes were not associated with age, BMI, occupation, marital status, or medical history. Changes in intermenstrual bleeding were more frequently reported after the third dose of the Pfizer vaccine compared to the Moderna vaccine (p = 0.014). Conclusions: More than half of the recruited female students and staff reported menstrual changes following COVID-19 vaccination, with altered cycle length being the most common. The potential underlying mechanisms and implications of these menstrual alterations require further investigation. These findings provide evidence of the menstrual side effects of COVID-19 vaccines among women in Saudi Arabia.

Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey.

INTRODUCTION: Health warnings on cigarette sticks are emerging as a tool to control tobacco consumption; hence, understanding how they are perceived is valuable in determining their effectiveness. Our study aimed to evaluate the perception of health-related messages and warnings on individual cigarette sticks. It also aimed to evaluate the perceptions of the effectiveness of cigarette packaging warnings and the acceptance level for the inclusion of health warnings on cigarette sticks. METHODS: This cross-sectional survey was conducted on 285 individuals in Al-Madinah, Saudi Arabia. The survey was distributed online using a non-probability convenience sampling technique. The chi-squared test and logistic regression analysis were used to determine the association of sociodemographic characteristics and smoking-related variables with participants' perceptions of health warnings on cigarette sticks and packaging. The responses were also assessed qualitatively using conceptual content analysis. RESULTS: In all, 18.6% of participants perceived that the package warnings were either 'quite effective' or 'very effective' in prompting smokers to quit. For health warnings on cigarette sticks, 28.1% of participants perceived that the theme of statistics on mortality was either 'quite effective' or 'very effective' in prompting smokers to quit, compared to 35.0 % for the theme of social and financial consequences. Respondents who had secondary education and lower were almost two times more likely to support the inclusion of health warnings than those who had a university education and higher (OR=1.9; 95% CI: 1.02-3.7, p=0.042). Most of the comments were positive for the inclusion of health warnings on cigarette sticks. CONCLUSIONS: Most participants perceived that package warnings were ineffective, but warnings on cigarette sticks were effective methods of dissuasion of cigarette use. Smokers were almost twice as likely to perceive as effective supportive messages to quit than non-smokers. The majority of participants 'agreed' or 'strongly agreed' to the inclusion of health warnings on cigarette sticks.

The association between cultural and social occasions and smoking cessation: The case of Saudi Arabia.

INTRODUCTION: Tobacco use remains high in Saudi Arabia, necessitating an understanding of the influence of cultural and social events on smoking cessation. This study examined whether cultural and social events like Ramadan, Eids, and birthdays, motivate Saudi adults to quit smoking. METHODS: Convenience sampling of 742 Saudi tobacco users was conducted between July 2021 and May 2022. A cross-sectional survey was used to assess self-reported desire to quit (1 = 'least desire' to 10 = 'highest desire') and behaviors in relation to special occasions. Multiple linear regression was performed to examine the association between cultural and social occasions and the desire to quit, while logistic regression was used to assess the relationship between cultural and social occasions and historical quit attempts, medicinal nicotine product use, visiting smoking cessation clinics, and calling the national Quitline. Demographic variables and tobacco types were controlled for in the analyses. RESULTS: Considering quitting during Ramadan, Eids, and birthdays was associated with a higher desire to quit (Ramadan: B=2.99; 95% CI: 2.51-3.47, Eids: B=2.83; 95% CI: 2.12-3.54, and birthdays: B=2.76; 95% CI: 1.93-3.60, p<0.01) and a greater likelihood of past quit attempts (Ramadan: AOR=8.2; 95% CI: 5.5-12.1, Eids: AOR=5.8; 95% CI: 3.2-10.5, and birthdays: AOR=4.8; 95% CI: 2.4-9.4). Only considering quitting during Ramadan was associated with calling the national Quitline (AOR=2.9; 95% CI: 1.8-4.9). CONCLUSIONS: Cultural and social events like Ramadan and Eids motivate adults in Saudi Arabia to attempt tobacco cessation. Targeting interventions around meaningful cultural occasions may promote successful quitting. These findings highlight the importance of understanding cultural and religious influences on cessation behaviors in Saudi Arabia and in other countries.

Dissuasive cigarettes as a tobacco control measure: a scoping review.

OBJECTIVE: The aim was to identify and review the research literature on dissuasive cigarettes, including key concepts, types, sources of evidence and research gaps. DATA SOURCES: PubMed, Scopus and Web of Science databases were searched up to January 2023 with no language or date restrictions. All study designs were included. Reference lists of the identified studies were manually searched. Studies on tobacco products other than cigarettes or on external cigarette packaging alone were excluded. STUDY SELECTION: Two reviewers screened titles and abstracts independently using eligibility criteria. The full text of the selected articles was subsequently screened independently by two reviewers to confirm eligibility. DATA EXTRACTION: Two reviewers independently extracted data from all studies using data abstraction forms. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS: We identified 24 original studies, 3 review articles and 4 commentary articles. Research on dissuasive cigarettes was reported from Australia, New Zealand, Europe and North America. We presented results in four themes: the concept of dissuasive cigarettes; approaches and types; potential benefits, barriers and concerns; and current research gaps. CONCLUSIONS: Dissuasive cigarettes represent a promising strategy that could be used in tobacco control. Parallel implementation with plain packaging would be feasible and synergistic.

Awareness and utilization of smoking cessation clinics in Saudi Arabia, findings from the 2019 Global Adult Tobacco Survey.

BACKGROUND: Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization. METHOD: This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users' awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed. RESULTS: One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31-2.68; mobile SCCs: OR = 2.09; CI = 1.37-3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17-0.56; mobile SCCs: OR = 0.42; CI = 0.20-0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25-34 (OR = 5.61; CI = 1.73-18.21) and 35-44 (OR = 4.22; CI = 1.07-16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09-0.73). CONCLUSION: The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

Silver Spike Point Therapy in smoking cessation: What is it and does it work?

Smoking is a global health challenge that causes a myriad of diseases. Smoking cessation services are part of the armamentarium to combat smoking epidemic. In addition to the approved treatments, alternative therapies, including electrical stimulation, have been proposed. The aim of this study is to review and summarize the evidence for the efficacy of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. A historical background and descriptive summary of various acupuncture and related therapies is provided. Systematic reviews and original studies were reviewed, and their results were summarized. In conclusion, the current best available evidence does not support the use of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. Policy makers and healthcare providers should aim to utilize the available resources to provide evidence-based treatment options for patients seeking to quit tobacco use.

The associations between cigarette smoking behavior and the use of heated tobacco products among Arab cigarette smokers: Findings from Saudi Arabia, Egypt, Kuwait, and Yemen.

As the availability of tobacco forms has evolved, emerging products known as heated tobacco products (HTPs) are increasingly being consumed worldwide and are claimed to be less harmful than tobacco cigarette smoking. To date, it is unknown whether Arab cigarette smokers are using or susceptible to HTPs. Therefore, this study aimed to assess the association between cigarette smoking behavior and the use of and susceptibility to HTPs in the Eastern Mediterranean region. Arab cigarette smokers (n = 628) from Saudi Arabia, Egypt, Kuwait, and Yemen were recruited using a convenience sampling technique. A cross-sectional survey comprised questions related to sociodemographic characteristics, cigarette smoking behavior characteristics (quitting attempts and desire to quit cigarette smoking, nicotine dependence, and consideration of switching to nicotine products with reduced health risks), and awareness of, use of, and susceptibility to use of HTPs. Descriptive and logistic regression models were used for analysis. The participants indicated a high frequency of past quitting attempts and a desire to quit smoking cigarettes. They were also considering switching to a nicotine product with reduced health risks. However, their awareness of HTPs was relatively low (24.2%), and the proportion of participants who had ever used HTPs or were currently using them was quite low as well (10.7% and 5.0%, respectively). A history of quit attempts was associated with more likely lifetime use of HTPs (adjusted odds ratio [AOR] = 2.63, 95% confidence interval [CI] [1.21-5.71]). Nicotine-dependent cigarette smokers were more likely to be susceptible to HTP use (AOR = 1.12, 95% CI [1.01-1.24]). Moreover, those who would consider switching to a product that provided nicotine and could reduce health risks by 99% were more likely to be susceptible to using HTPs (AOR = 2.17, 95% CI [1.05-4.51]). Awareness of HTPs is relatively low among Arab cigarette smokers. Attempts to quit cigarette smoking, nicotine dependence, and the consideration of switching to a product that delivers nicotine with reduced health risks were significantly associated with using HTPs. The findings of this study provide potential for evidence-based treatment for smokers and will help prevent the use of tobacco industry tactics in marketing HTPs.

The associations between the credibility of the tobacco control regulatory body and smoking behavior change among Saudi smokers.

INTRODUCTION: Recently, Saudi Arabia has extensively reformed its tobacco control policies and extended its smoking cessation services. A public outrage on social media among smokers was witnessed, especially after the implementation of plain cigarette packaging, which might have discredited the significant efforts of tobacco treatment services and tobacco control policies. However, it is not known how the credibility of the tobacco control regulatory body among Saudi smokers might affect their smoking behavior. METHODS: Saudi tobacco smokers (n=511) were recruited using a convenience sampling technique. A cross-sectional survey was conducted comprising questions related to the credibility of the tobacco control regulatory body (modified Food and Drug Administration Tobacco Credibility Scale), quit attempts, use of nicotine replacement therapy (NRT), and motivation to change smoking behavior in the future. Logistic and linear regression models were used for the analysis. RESULTS: The public interest subscale of the credibility of the tobacco control regulatory body, was positively associated with confidence in changing smoking behavior (ß=0.204; 95% CI: 0.078-0.713; t=2.449, p=0.015) and readiness to change smoking behavior (ß=0.237; 95% CI: 0.127-0.727; t=2.802, p=0.005). Moreover, the subscale of expertise was positively associated with confidence in changing smoking behavior (ß=0.190; 95% CI: 0.006-0.697; t=1.999, p=0.046) and readiness to change smoking behavior (ß=0.225; 95% CI: 0.063-0.710; t=2.352, p=0.019). However, public interest in the credibility of the tobacco control regulatory body was negatively associated with NRT use among smokers who tried to quit (adjusted odds ratio, AOR=0.691; 95% CI: 0.526-0.909). The credibility of the tobacco control regulatory body, however, was not associated with the last month's or ever quit attempts. CONCLUSIONS: The credibility of the tobacco control regulatory body was positively associated with motivation to change smoking behavior but negatively associated with NRT use. Optimizing communication tools with the public is a potential avenue for improving smoking treatment and prevention in Saudi Arabia.

Tea consumption and risk of bladder cancer in the Bladder Cancer Epidemiology and Nutritional Determinants (BLEND) Study: Pooled analysis of 12 international cohort studies.

BACKGROUND & AIMS: Tea has been shown to be associated with reduced risk of several diseases including cardiovascular diseases, stroke, metabolic syndrome, and obesity. However, the results on the relationship between tea consumption and bladder cancer are conflicting. This research aimed to assess the association between tea consumption and risk of bladder cancer using a pooled analysis of prospective cohort data. METHODS: Individual data from 532,949 participants in 12 cohort studies, were pooled for analyses. Cox regression models stratified by study centre was used to estimate hazard ratios (HR) and corresponding 95% CIs. Fractional polynomial regression models were used to examine the dose-response relationship. RESULTS: A higher level of tea consumption was associated with lower risk of bladder cancer incidence (compared with no tea consumption: HR = 0.87, 95% C.I. = 0.77-0.98 for low consumption; HR = 0.86, 95% C.I. = 0.77-0.96 for moderate consumption; HR = 0.84, 95% C.I. = 0.75-0.95 for high consumption). When stratified by sex and smoking status, this reduced risk was statistically significant among men and current and former smokers. In addition, dose-response analyses showed a lower bladder cancer risk with increment of 100 ml of tea consumption per day (HR-increment = 0.97; 95% CI = 0.96-0.98). A similar inverse association was found among males, current and former smokers while never smokers and females showed non-significant results, suggesting potential sex-dependent effect. CONCLUSIONS: Higher consumption of tea is associated with reduced risk of bladder cancer with potential interaction with sex and smoking status. Further studies are needed to clarify the mechanisms for a protective effect of tea (e.g. inhibition of the survival and proliferation of cancer cells and anti-inflammatory mechanisms) and its interaction with smoking and sex.

Lifestyle factors and quality of life among primary health care physicians in Madinah, Saudi Arabia.

BACKGROUND: Physicians are considered to be a high-risk population for a poor quality of life (QoL), but few studies of lifestyle factors include the QoL among them. OBJECTIVES: This study aimed to investigate the relationship between lifestyle factors and a positive QoL among primary health care (PHC) physicians. METHODS: A cross-sectional study was conducted at 20 primary healthcare centers in Madinah, Saudi Arabia. A self-administered questionnaire was used, including sociodemographic characteristics, lifestyle data, and the short version of the World Health Organization Quality of Life questionnaire. Appropriate statistical analyses were used, including multivariate logistic regression models. RESULTS: The response rate was 85.7% (72/84) physicians. The mean score of the total QoL and its four studied domains (physical, psychological, social, and environmental) was relatively high, with no statistically significant difference between the consultants and general practitioners. The positive total QoL in this study was significantly lower among physicians with obesity (OR = 0.55, 95%CI = 0.25-0.97), those using butter and animal fat for cooking (OR = 0.10, 95%CI = 0.02-0.81), and those eating meals out > 3 times per week (OR = 0.30, 95%CI = 0.10-0.90). Although non-significant, vegetable consumption and a high level of physical activity were associated with a positive QoL, with adjusted ORs of 2.5 (95%CI = 0.82-7.58) and 1.5 (95%CI = 0.33-6.65), respectively. CONCLUSION: The findings indicate a relatively good QoL among the participating physicians; however, a lower QoL was associated with unhealthy lifestyle factors. QoL was significantly associated with obesity, cooking practices, and eating meals from restaurants.

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019.

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Association of Viral Load in SARS-CoV-2 Patients With Age and Gender.

Background: The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global public health emergency. Age and sex are two important factors associated with risks and outcomes of various diseases. COVID-19 morbidity also seems to be affected by patient age and sex. It has been found that older age groups have more severe COVID-19 symptoms and higher fatality rates while children tend to have lower prevalence and milder symptoms than adults. Methods: The study reviewed electronic medical records of COVID-19 patients from Madinah city, Saudi Arabia. The study included all cases who tested positive (n = 3,006) between March 20 and May 22, 2020. Data were obtained from the Health Electronic Surveillance Network (HESN) database. Results: Approximately 80% of the study sample were males and half were in the 30-40-year-old age group. The Ct value of the whole sample ranged from 15.08 to 35, with a mean of 27.44 (SD: 5.23; 95% C.I. = 27.25-27.66). The means of Ct values varied between age groups from 27.05 to 27.82. Analysis of the mean differences between age groups using one-way ANOVA indicated no statistically significant difference among the groups (F6,2999 = 1.63; p-value = 0.135). A comparison of mean Ct values of males (n = 2,422) and females (n = 584) revealed that males had a statistically significant higher mean Ct value (27.61 ± 5.20) than females (26.72 ± 5.31). The difference between the means of the two groups was -0.89 (95% C.I. = -1.36 to -0.42; t-test -3.71; df = 3,004; p-value < 0.001). Conclusion: The study found no statistically significant difference in viral loads between age groups. It showed that females had a higher SARS-CoV-2 viral load compared to males. The findings have implications for preventive strategies. Further studies are needed to correlate viral load with clinical symptoms and outcomes.

The seroprevalence of SARS-CoV-2 IgG antibodies among asymptomatic blood donors in Saudi Arabia.

BACKGROUND: In late 2019, cases of severe pneumonia with unidentified etiology began to emerge in Wuhan, China, before progressively spreading first nationally and then globally.The current study sought to investigate the seroprevalence of immunoglobulin G (IgG) antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among blood donors in Al-Madinah, Saudi Arabia. To our knowledge, this is the first study in Saudi Arabia to screen blood donors who were not known to be previously infected with SARS-CoV-2. METHODS: This study was a cross-sectional study to assess individuals who donated blood to the central blood bank in Al-Madinah between mid-May and mid-July 2020. An enzyme-linked immunosorbent assay (ELISA) was designed and established to detect antibodies directed against the SARS-CoV-2 spike protein in serum samples. A total of 1,212 healthy blood donors participated in this study. The donors were males and met the requirements for blood donation during the COVID-19 pandemic period in Saudi Arabia. RESULTS: The SARS-CoV-2 seroprevalence among blood donors in Al-Madinah was 19.31% (n = 234/1212; 95% confidence interval: 17.12%-21.64%). No statistically significant difference was identified in seropositivity according to age. However, significant differences (p < 0.001) were identified according to ABO blood groups, with those with type A blood presenting the highest rate of seropositivity (29.18%) compared with the other blood groups (12.65% for type B, 16.36% for type AB, and 15.11% for type O). CONCLUSION: A high prevalence of SARS-CoV-2 antibodies was detected among blood donors in Al-Madinah, which indicated a high level of exposure to the virus within the population. This further suggested that as high as one-fifth of the population may have acquired innate immunity against the virus.

Delphi consensus on research priorities in tobacco use and substance abuse in Saudi Arabia.

This is the first study to develop research priorities in tobacco use and substance abuse in Saudi Arabia. Health personnel and community volunteers participated in a national internet survey using the Delphi method. In Round 1, 75 experts identified 33 research priorities. In Round 2, 47 experts divided those research priorities into five primary research categories. The panelists then scored both the categories and priorities. Preventive services received the highest priority in research categories. Smoking relapse and its determinants were ranked the top research priorities. Future research should focus on cigarette smoking relapse and factors associated with long-term smoking cessation.

Prevalence of Klebsiella pneumoniae Antibiotic Resistance in Medina, Saudi Arabia, 2014-2018.

Antibiotic resistance is a rising dilemma of significant implications on global public health. Few data exist for the prevalence and trends of Klebsiella pneumonia antibiotic resistance in Saudi Arabia. Therefore, we have set out to identify the prevalence and trends of Klebsiella pneumonia antibiotic resistance in King Fahad Hospital in Medina over the period between February 27, 2014, and December 31, 2018. The research was carried out as a retrospective cross-sectional study. A total of 15708 isolates taken from 1149 patients were included in the study. Statistical analysis was done using SPSS (IBM Corp, Armonk, NY). We used descriptive and trend analysis using the linear regression method. In the results, we have found unprecedented emergence of resistance to carbapenems, with 38.4% (n=436) for imipenem and 46.1% (n=371) for meropenem, which are the first choice of treatment in local guidelines, as well as high resistance rates for commonly used alternative options of treatment (40.7% (n=105) for colistin and 53.3% (n=220) for tigecycline). In addition, third and fourth generation cephalosporins showed resistance ranging from 57.5% to 77.8%. Co-resistance with imipenem was found at rates exceeding 75% for other choices of management (aminoglycosides and cephalosporins), apart from colistin and tigecycline that had rates of 53.6% (n=89) and 61.4% (n=167), respectively. In conclusion, the research showed increased resistance rates to beta-lactams, as well as an emergence of resistance to carbapenems and other alternatives of treatment like colistin and tigecycline.

Asthma control and its association with knowledge of caregivers among children with asthma. A cross-sectional study.

OBJECTIVES: To investigate the level of asthma control among children and to investigate the association between asthma control and the knowledge of caregivers. METHODS: A cross-sectional study was conducted from January 2018 to July 2018 among 278 children with asthma aged 1-12 with their caregivers attending the primary health care centers in Al Madinah Al Munawarah, Saudi Arabia. An asthma knowledge questionnaire was used to measure the parents' knowledge. The Test for Respiratory and Asthma Control in Kids (TRACK) and the Childhood Asthma Control Test (C-ACT) were used to evaluate asthma control among the children. Univariate and multivariate analyses were used to compare the knowledge level between the controlled and uncontrolled asthma groups. RESULTS: Approximately 62.6% of children had uncontrolled asthma and 37.4% were controlled. The knowledge scores of the caregivers ranged from 43 to 64, with a mean score of 52.55. The mean knowledge score was higher in the controlled group (55.57) than in the uncontrolled group (50.76). There was a statistically significant difference in the knowledge scores between the participant groups (t=9.892, p less than 0.001). CONCLUSION: There is a high percentage of children with uncontrolled asthma and 3 is a high knowledge deficit among the caregivers of children with asthma. An educational program targeting the general population and the caregivers should be implemented to correct any false beliefs regarding asthma and asthma medications.

Implementation of Cigarette Plain Packaging: Triadic Reactions of Consumers, State Officials, and Tobacco Companies-The Case of Saudi Arabia.

OBJECTIVES: In August 2019, Saudi Arabia started implementing plain packaging for cigarettes. Three months later, an opposing campaign on twitter using an Arabic hashtag "the new smoke" gained momentum amongst smokers. The purpose of this study is to document this opposing campaign's timeline and describe consumers, government, and tobacco industry rhetoric. METHODS: We created a timeline of the campaign events then performed online social listening of Arabic twitter hashtags related to the campaign. RESULTS: Campaigners mainly complained of an unfavorable new taste in cigarette packs with plain packaging. The messaging developed to accusations to government entities and neighboring countries, and then after threats to boycott tobacco companies. The campaign received a significant amount of media coverage and elicited an official response from a number of Saudi government bodies, such as the Saudi Food and Drug Authority and Ministry of Commerce and Investment. CONCLUSION: This case points at a need for risk communication training, possible tobacco industry manipulation, and a need to gain consumer trust with evidence-based messaging techniques. The case of cigarette plain packaging adoption in Saudi Arabia serves as an example to other countries of potential consumer interaction, tobacco industry interference, and state official counter-reactions.