The effects of walking on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia: a study protocol of randomized control trial by comparing supervised group-based intervention and non-supervised individual-based intervention.

BACKGROUND: Kingdom of Saudi Arabia (KSA) demographics are also changing with the increase in life expectancy in the country and the rise in the number of older Saudi Arabians. Saudi Arabia has a higher rate of physically inactive people, and most of them are between the ages of 55-64. Walking is one of the most prevalent forms of physical activity in Saudi Arabia and the study showed that most people prefer walking for recreational and health benefits. Therefore, the purpose of the proposed study is to compare the effects of supervised group-based walking and non-supervised individual-based walking interventions on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia. METHOD: This study will apply a three-group (2 intervention groups and 1 control group), double-blinded, randomized controlled trial (RCT) to examine the effect of different forms of walking interventions on Saudi Arabia older adults' frailty, cognitive function and quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions. DISCUSSION: This study aims to determine whether supervised group walking and non-supervised individual walking lead to different effects. Given the limited evidence in the literature regarding Saudi Arabia older adults' physical fitness and health, it is worthwhile to explore the effect of walking, as well as the forms of walking on improving the overall physical fitness and psychological status of older adults in Saudi Arabia. The findings of the current study could also create awareness of the government and the general public in Saudi Arabia of the ageing problems and the effective ways of achieving better intervention results. TRIAL REGISTRATION: The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05151575; Date of first posted: 12/07/2021).

Awareness of inflammatory bowel disease among the general population of Al-Baha region, Saudi Arabia.

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder that encompasses Crohn's disease (CD) and ulcerative colitis (UC). IBD can be debilitating and has severe effects on the quality of life of the affected individuals. However, despite the increasing frequency of IBD around the world, the general population lacks knowledge and comprehension of this illness. The aim of this study was to determine the level of knowledge and awareness of IBD among the general population in Al-Baha region, Saudi Arabia. We carried out a cross-sectional study using an online self-administered validated questionnaire. The questionnaire included demographic questions, as well as questions regarding knowledge and awareness of IBD. The study included 473 participants selected by convenience random sampling with equal chance of selection. Approximately 61% of the participants had never heard about IBD, and for those who did, social media was the most common source of information (40.6%). Also, the majority of participants had limited knowledge about the different types of IBD (74%), their symptoms, and long-term effects. Women had a significantly higher level of adequate knowledge (12.1%) compared to men (4.8%) (P = 0.011). The study demonstrated a substantial lack of understanding and awareness of IBD among the general population in Al-Baha region, notably regarding the different types of IBD, their symptoms, and their long-term effects. The study underscores the need for further educational initiatives and resources to raise public knowledge and comprehension of IBD globally.

Efficient security level in wireless sensor networks (WSNs) using four-factors authentication over the Internet of Things (IoT).

With the increasing demand for the use of technology in all matters of daily life and business, the demand has increased dramatically to transform business electronically especially regards COVID-19. The Internet of Things (IoT) has greatly helped in accomplishing tasks. For example, at a high temperature, it would be possible to switch on the air conditioner using a personal mobile device while the person is in the car. The Internet of Things (IoT) eases lots of tasks. A wireless sensor network is an example of IoT. Wireless sensor network (WSN) is an infrastructure less self-configured that can monitor environmental conditions such as vibration, temperature, wind speed, sound, pressure, and vital signs. Thus, WSNs can occur in many fields. Smart homes give a good example of that. The security concern is important, and it is an essential requirement to ensure secure data. Different attacks and privacy concerns can affect the data. Authentication is the first defence line against threats and attacks. This study proposed a new protocol based on using four factors of authentication to improve the security level in WSN to secure communications. The simulation results prove the strength of the proposed method which reflects the importance of the usage of such protocol in authentication areas.

The Arabic Version of Compulsive Exercise Test among Saudi Population; Translation and Validation.

Compulsive exercise is a condition characterized by uncontrollable exercise behaviour that may lead to severe and harmful physical and psychological consequences. Indeed, compulsive exercise is among the early symptoms of eating disorders that may affect different age groups. Globally and among Arab countries, compulsive exercise is common, while the screening methods used to assess compulsive exercise are limited. Thus, the Compulsive Exercise Test (CET) has emerged as a tool to assess cognitive, behavioural, and emotional factors related to compulsive exercise. The CET is a self-report, Likert-type scale comprising five distinct subscales. The increase in the CET scores is more likely associated with worsened pathology. Since the Arab countries lack such an assessment tool, we aimed to translate the CET into Arabic, validate the translated version, confirm the factor structures, and assess the internal consistency of the different subscales. Herein, we used the forward-backward translation method as recommended by the World Health Organization (WHO). The overall validity index of the translated version showed a score higher than 0.78, while the scale-level content validity index based on the average calculating method (S-CVI/Ave) and the agreement method (S-CVI/UA) were 0.91 and 0.58, respectively. Moreover, we recruited 399 Arabs living in Saudi to measure the internal consistency, and the value of the substantive internal consistency with Cronbach's α was 0.81. Subsequently, four of the Arabic-CET subscales had substantive internal consistency with Cronbach's α values higher than or equal to 0.70. Furthermore, the exploratory factor analysis results supported the substantial use of the five-subscale model. Taken together, our study supports using the Arabic-CET version to measure exercise compulsiveness among Arabs.

Enhancing Physical and Psychosocial Health of Older Adults in Saudi Arabia through Walking: Comparison between Supervised Group-Based and Non-Supervised Individual-Based Walking.

Walking is widely recognized as one of the most common and effective forms of physical activity, particularly for older adults. This study examined the comparative effects of two types of walking interventions, including supervised group-based intervention (SGBI) and non-supervised individual-based intervention (NSIBI), on frailty syndrome, cognitive functions or skills, and health-related quality of life among sedentary older Saudi individuals. A 15-week double-blinded, randomized controlled trial (RCT) including three groups (two were intervention groups while the other was the control group) was conducted among older adults who were inactive to examine the effect of different forms of walking interventions on frailty syndrome, cognitive functions, and health-related quality of life. A total of 107 participants, including 65 males and 42 females, were divided into three groups, which include SGBI, NSIBI, and the control group. Frailty syndrome was measured using the physical performance test (PPT), while cognitive function and health-related quality of life were assessed using the Mini-mental State Examination (MMSE) and the Short Form 36 (SF 36) health survey questionnaire. One-way repeated measures analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA) with the pre- and post-tests were performed for within- and between-group differences. while post-test data for the control group participants were absent due to the change in elderly center regulation, and they were excluded from the analysis. Hence, the comparison was stated only between the intervention groups. Both of the intervention groups (SGBI and NSIBI) showed significant within-subject differences in the Physical Function subscale of the health-related quality of life scale only, with F(1,20) = 23.03, p < 0.001, and F(1,18) = 27.22, p < 0.001, respectively. On the other hand, the Physical Performance Test revealed significant [F(2,51) = 9.21, p < 0.001] between-group differences in the post-test based on the baseline values. In addition, the average step count of older adults was increased from 4000 steps per session to around 7000 steps per session in the intervention group. The average heart rate of the NSIBI group did not show a visible change, and the resting heart rate of both groups showed a slightly declining trend throughout the intervention period. The walking intervention significantly increased participants' physical function, which is a component of health-related quality of life and physical performance (frailty level), along with average daily step counts for older adults in Saudi Arabia. Regular engagement in the recommended level of walking is strongly advisable for Saudi Arabian older adults to maintain their overall quality of life at this stage.

The Impact of Non-pharmacological Interventions on Blood Pressure Control in Patients With Hypertension: A Systematic Review.

Hypertension treatment should involve non-pharmacological interventions such as dietary salt restriction, weight loss, exercise, limiting alcohol intake, and dietary approaches to stop hypertension diet. Significant impacts of these interventions have been suggested for a long time. This systematic review aims to assess the influence of non-pharmacological therapies on hypertension patients' ability to control their blood pressure. The review will concentrate on randomized controlled trials examining how non-pharmacological therapies affect blood pressure regulation in hypertension patients. A systematic review was conducted to investigate the impact of non-pharmacological interventions on blood pressure control in patients with hypertension. A comprehensive search for relevant studies was conducted. The following electronic databases were searched: EMBASE, OVID-MEDLINE, and PubMed. The search covered the period between January 2000 and August 2023. The search strategy included a combination of keywords related to hypertension, non-pharmacological interventions, and blood pressure control. A thorough literature evaluation of papers from the EMBASE, OVID-MEDLINE, and PubMed databases was part of the procedure for choosing the studies. Combinations of the keywords telemedicine, primary care, and effectiveness were used for the search. Only studies published in English between January 2000 and August 2023 were included in the search. Through database searching, 862 entries were found, of which 321 were from EMBASE, 112 from OVID-MEDLINE, and 429 from PubMed. After duplicate records were eliminated, 117 records were checked for eligibility. Of these, 100 were disregarded for a variety of reasons, including not relevant to the objectives of the study (n = 63), abstracts or reviews (n = 8), and studies that failed to present interesting research findings (n = 36). The eligibility of the remaining 10 full-text publications was evaluated. Ten articles passed the inclusion tests and were added to the research after a thorough evaluation. Lifestyle modifications are important and have a significant impact on controlling hypertension and a positive impact on reducing blood pressure. Combination therapy is more effective; however, adherence to the modifications is the most important factor affecting the outcomes.

Risk factors predicting disease severity and mortality in coronavirus disease 2019 Saudi Arabian patients.

CONTEXT: Coronavirus disease 2019 (COVID-19) became a global pandemic that may be associated with significant associated risk factors. AIMS: The aim of this study was to evaluate the factors predisposing risk to death in COVID-19 patients. SETTINGS AND DESIGN: This is a retrospective study that presents the demographic, clinical presentation, and laboratory findings on our patients to determine risk factors contributing to their COVID-19 outcome. METHODS: We used logistic regression (odds ratios) to examine associations between clinical findings and risk of death in COVID-19 patients. All analyses were done using STATA 15. RESULTS: A total of 206 COVID-19 patients were investigated, 28 of them died, and 178 survived. Expired patients were older (74.04 ± 14.45 vs. 55.56 ± 18.41 in those who survived) and mainly of male gender (75% vs. 42% in those who survived). The following factors were strong predictors of death: hypertension (OR: 5.48, 95% CI: 2.10-13.59, P < 0.001), cardiac disease (OR: 5.08, 95% CI: 1.88-13.74, P = 0.001), and hospital admission (OR: 39.75, 95% CI: 5.28-299.12, P < 0.001). In addition, blood group B was more frequent in expired patients (OR: 2.27, 95% CI: 0.78-5.95, P = 0.065). CONCLUSIONS: Our work adds to the current knowledge about the factors predisposing to death in COVID-19 patient. In our cohort, expired patients were of older age and male gender plus they were more likely to have hypertension, cardiac disease, and hospital severe disease. These factors might be used to evaluate risk of death in patients recently diagnosed of COVID-19.

Barriers and Facilitators of Artificial Intelligence in Family Medicine: An Empirical Study With Physicians in Saudi Arabia.

BACKGROUND: Artificial intelligence (AI) is a novel technology that has been widely acknowledged for its potential to improve the processes' efficiency across industries. However, its barriers and facilitators in healthcare are not completely understood due to its novel nature. STUDY PURPOSE: The purpose of this study is to explore the intricate landscape of AI use in family medicine, aiming to uncover the factors that either hinder or enable its successful adoption. METHODS: A cross-sectional survey design is adopted in this study. The questionnaire included 10 factors (performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, personal innovativeness, ethical concerns, and facilitators) affecting the acceptance of AI. A total of 157 family physicians participated in the online survey. RESULTS: Effort expectancy (µ = 3.85) and facilitating conditions (µ = 3.77) were identified to be strong influence factors. Access to data (µ = 4.33), increased computing power (µ = 3.92), and telemedicine (µ = 3.78) were identified as major facilitators; regulatory support (µ = 2.29) and interoperability standards (µ = 2.71) were identified as barriers along with privacy and ethical concerns. Younger individuals tend to have more positive attitudes and expectations toward AI-enabled assistants compared to older participants (p < .05). Perceived privacy risk is negatively correlated with all factors. CONCLUSION: Although there are various barriers and concerns regarding the use of AI in healthcare, the preference for AI use in healthcare, especially family medicine, is increasing.

Vitamin D serum level predicts stroke clinical severity, functional independence, and disability-A retrospective cohort study.

Background: Stroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia. Methodology: A retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50-75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients' clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability. Results: The study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients' distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: -0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13-5.16), p = 0.023] when compared to participants with normal vitamin D level. Conclusion: Low vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings.

Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia.

BACKGROUND: Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications. OBJECTIVES: Assess the effect of AMA on maternal and neonatal outcomes. DESIGN: Analytical cross-sectional study of medical records. SETTINGS: In-patient hospital tertiary care setting in Jeddah. PATIENTS AND METHODS: All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes. MAIN OUTCOME MEASURES: Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery. SAMPLE SIZE: 1586 women. RESULTS: Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P<.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2-3.5, P<.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P<.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2-1.9, P=.002). CONCLUSION: Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery. LIMITATIONS: Cross-sectional design, small sample size, single hospital. CONFLICT OF INTEREST: None.

Mechanisms of obesity in children and adults with phenylketonuria on contemporary treatment.

BACKGROUND & AIMS: Obesity prevalence in people with phenylketonuria (PKU) is comparable to that of the general population but the underlying aetiology remains unknown. To assess body composition, dietary intake, moderate physical activity duration (MPAD) and energy expenditure (MPAEE), resting metabolic rate (RMR), diet-induced thermogenesis (DIT), fasting and postprandial fat (FOx) and carbohydrate oxidation (CHOOx), in PKU people and healthy Controls. METHODS: Participants were PKU people (n = 16) and healthy controls (n = 15). Body composition was measured with stable isotopes using deuterium as tracer, dietary intake from 4-day food diaries, MPAD and MPAEE from 7-day activity counts measured by triaxial accelerometers, calibrated against individual rates of oxygen consumption and carbon dioxide production, RMR, DIT, FOx and CHOOx by indirect calorimetry. RESULTS: Body composition, DIT, FOx, CHOOx and RMR did not differ between the PKU and the Control groups. MPAD (PKU, 73 ± 26 min/week; Control, 152 ± 43 min/week) and MPAEE (PKU, 404 ± 127 kcal/week; Control, 741 ± 153 kcal/week) were lower (P < 0.05) in the PKU than the Control group. Raised phenylalanine levels were inversely related with MPAD and MPAEE. Energy intake and energy provided by protein did not differ between the groups, while energy proportion obtained from carbohydrate was higher (PKU, 60 ± 2%; Control, 51 ± 2%; P < 0.05) and from fat lower (PKU, 24 ± 2%; Control, 35 ± 3%; P < 0.05) in the PKU than in the Control group. CONCLUSION: People with PKU spent less time and expend less energy in moderate physical activity and have a higher intake of energy from CHO which may be involved in the underlying mechanisms of obesity in PKU.