Knowledge, attitude and practice among non-ophthalmic health care providers regarding eye management of diabetics in private sector of Riyadh, Saudi Arabia.

BACKGROUND: The levels of knowledge, attitude and practice among primary physicians concerning both diabetic retinopathy screening and treatment of sight threatening diabetic retinopathy have been studied by different groups, such as medical students, pharmacists, Primary Health Care staff and opticians. In some studies, the levels were very high, while in others it was noted to be less than desired. AIM: This study's intent is to estimate and improve level of Knowledge (K), Attitude (A) and Practice (P) among non-ophthalmic health care providers regarding eye management of diabetes and barriers that people with diabetes face in Saudi Arabia. METHODS: This cross-sectional survey targeted medical doctors (except ophthalmologists) working at private sector institutions in Riyadh. They were interviewed using closed-ended questions for knowledge (8), attitude (5), practice (5), and reasons for their current KAP status comprised of 8 questions. The level of Knowledge was assessed as good if its score was (> 50%); positive attitude (> 50%) and excellent practice (> 75%) were estimated and associated to the risk factors. RESULTS: Out of the 355 participants that were interviewed, the percentages of good knowledge, positive attitude and excellent practice concerning diabetic retinopathy (DR)were 193 [54.3% (95% CI 49.2-59.5)], 111 [31.3% (95% CI 26.4-36.1)], and 145 [40.8% (95% CI 35.7-46.0) participants, respectively. Gender, place of work and type of doctor were not significantly associated with the level of KAP. Salient reasons for low KAP status included a busy schedule (54.6%), less resources (75.2%), inadequate periodic training in eye care (69%), and absence of retinal evaluation training (49.6%). CONCLUSIONS: Improving KAP level is urgently needed. Addressing underlying causes of low KAP could enhance eye care of people with diabetes. Additionally, training for primary health care providers for early detection of DR and timely management of sight threatening diabetic retinopathy (STDR) is necessary.

Phytostabilization of heavy metals by the emergent macrophyte Vossia cuspidata (Roxb.) Griff.: A phytoremediation approach.

The present study was conducted to investigate the potential of Vossia cuspidata as a phytoremediator to accumulate heavy metals from polluted water bodies. Thirty-two quadrats, distributed equally in eight sites (six polluted sites along the Ismailia canal and two unpolluted sites along the Nile River) were selected seasonally for plant, water, and sediment investigations. Winter plants recorded the highest values of shoot height, diameter, and leaf width, but the lowest shoot density. Plants collected in autumn had the lowest values of leaf length, width, and area, while those collected in spring had the highest shoot density, with the lowest shoot height. Summer populations had the highest fresh and dry plant biomass, while winter plants had the lowest. Fresh production and dry biomass of V. cuspidata in the unpolluted Nile were significantly higher than those in polluted canals. Chlorophyll a and carotenoid concentrations were reduced under pollution stress. Spring plants accumulated the highest concentrations of Cr, Cu, and Pb in their root, and the lowest concentrations of Al, Cd, Cr, and Zn in their shoot. The bioaccumulation factor for most investigated metals, except Al, Cr, and Fe was greater than 1, while the translocation factor of all metals was less than 1, therefore this plant is considered to be a potential for these metals phytostabilization.

Physical accessibility, availability, financial affordability, and acceptability of mobile health clinics in remote areas of Saudi Arabia.

Introduction: Access to primary healthcare (PHC) services is a significant concern, especially for those living in remote areas. Mobile health clinics (MHCs) are a model widely used to enhance access to healthcare in rural areas. In Saudi Arabia, the Ministry of Health has launched mobile clinics to facilitate access to PHC and increase access to healthcare. This study aims to assess the accessibility of MHCs in rural areas of Saudi Arabia measuring four dimensions of access from the patient's perspective: physical accessibility, availability, financial affordability, and acceptability. Methods: A quantitative cross-sectional survey in the form of an interviewer-administered questionnaire was performed on patients who attended mobile clinics between August and October 2020. All these people have been targeted to be interviewed as a nonprobability sample. Data was collected through a survey filled out by the interviewer. Results: Five hundred participants were interviewed in nine mobile clinics in the nine cities of the Kingdom. The majority were men (82.4%) and from Makkah city (13.6%) and 94.2% of the participants were Saudi nationals. In total, 98.3% of the respondents were satisfied with the overall mobile clinic services and 11.4% of the participants had difficulties with the mobile clinics' work schedules. There was a positive correlation between access to mobile clinics and satisfaction. Conclusions: The mobile clinics in rural and remote areas in Saudi Arabia during the study period were accessible to the respondents and met patient satisfaction. Most participants accept the work schedule for mobile clinics. However, it requires further improvements to meet all access dimensions of the study.

Estimating Implicit and Explicit Gender Leadership Bias among Primary Healthcare Professionals in Saudi Arabia.

(1) Background: Women have become more influential and powerful; however, implicit bias continues to plague organizations when it comes to women in leadership positions. This study examines the implicit and explicit biases that favor men as leaders among Saudi Arabian primary healthcare professionals. (2) Methods: A secure, web-based survey was administered to primary healthcare professionals. The survey included questions about leadership as well as an Implicit Association Test (IAT) for implicit gender bias. (3) Results: Out of 690 eligible, 448 respondents completed the survey, representing a response rate of 65%. Male residents had a mean IAT score of 0.27 (SD 0.31) and females 0.12 (SD 0.29), both favoring males in leadership roles, and the difference was statistically significant. There was a significant association between gender and gender IAT. In the explicit bias, gender, education, gender of the current manager, and being manager were associated with the gender explicit bias. Explicit bias favoring males in leadership roles was associated with increased implicit bias favoring males in leadership roles. (4) Conclusions: This study found that explicit and implicit gender bias is present among primary healthcare professionals favoring men in leadership positions held by both men and women.

National COVID-19 Vaccine Program and Parent's Perception to Vaccinate Their Children: A Cross-Sectional Study.

Vaccinating children against COVID-19 is an essential public health strategy in order to reach herd immunity and prevent illness among children and adults. Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. In this study, we aimed to investigate parents' perceptions and acceptance of the COVID-19 vaccine for their children in Saudi Arabia. A well-designed, pre-validated, Google questionnaire was distributed to parents through social media websites. The selection of the participants was based on the simple random sample technique. The study sample size was 1304 participants, with 342 males (26.2%), and 962 females (73.8%). The personal information, perception about COVID-19, and their children's vaccination status were obtained. Among the participants, 602 (46.1%) were willing to get the COVID-19 vaccination for their children, whereas 382 (29.3%) were hesitant to inoculate their children for COVID-19 and 320 (24.4%) were unsure. Age (p = 0.004), gender (p = 0.001), occupation (0.004), income (p = 0.030), and vaccination status (p = 0.001) had an influence on the parents' acceptance of COVID-19 vaccination of their children. On the other hand, education level, number of children, and having been previously infected with COVID-19 had no statistically significant effect on the parent acceptance. The correlation of parents' knowledge about COVID-19 and their agreement to the vaccination of their children was statistically significant, along with gender (males were more knowledgeable, with p < 0.001), occupation, income (higher income showed a statistical difference, with p < 0.001), and vaccination status (p < 0.001). There was a decrease in parents' acceptance toward the COVID-19 children vaccine in Saudi Arabia, which requires more attention and focus from health providers to eliminate fear and anxiety among the parents through additional educational programs and events to decrease the resistance toward the vaccination of children. More emphasis is required to increase the awareness of parents and convey the importance of the vaccine for children. In addition, more studies are needed to ensure the vaccine's safety.

Stress and turnover intention among healthcare workers in Saudi Arabia during the time of COVID-19: Can social support play a role?

The turnover intention of healthcare workers is a threat to the competence of health services, especially during COVID-19 time. This study aimed to investigate the association between stress and turnover intention among healthcare workers in Saudi Arabia and whether social support could affect this association. In this cross-sectional study, healthcare workers in primary healthcare centers in Saudi Arabia responded to an online questionnaire assessing their sociodemographic and occupational history, stress levels using the Perceived Stress Scale-10 (PSS-10), social support using the Multidimensional Scale of Perceived Social Support (MSPSS), and turnover intention within the next few months. Path analysis was conducted to assess the mediating effect of social support on the association between stress and turnover intention. A total of 1101 healthcare workers (242 physicians, 340 nurses, 310 paramedics, and 209 administrative workers) participated in this study. The path between stress and support had a significant standardized regression weight (-.34, p < .05). The path between support and turnover had a significant standardized regression weight (.08, p < .05). The standardized total effect of stress on turnover without the impact of support was significant (-.39, p < .05). The direct effect of stress on turnover with the presence of support was significant (-.36, p < .05). The indirect effect of stress on turnover with the presence of support was significant (-.03, p < .05). Thus, there is evidence to show that support mediates the relationship between stress and support. Stress is associated with turnover intention among healthcare workers in Saudi Arabia. Social support had a mitigating effect on the relationship between stress and turnover intention.

The role of Cyperus alopecuroides Rottb. sedge in monitoring water pollution in contaminated wetlands in Egypt: a phytoremediation approach.

Many macrophytes have heavy metal phytoremediation potential from contaminated watercourses. Therefore, the present study investigated the seasonal potential of the sedge plant Cyperus alopecuroides to remediate heavy metals from contaminated water bodies. Water, sediment, and plant samples were collected from four contaminated watercourses and the uncontaminated Nile River. Summer was the blooming season of C. alopecuroides with the highest shoot density, leaf size, fresh production, and dry biomass, while winter represented the lowest growth season. The photosynthetic pigments were distinctly decreased in plants growing in contaminated compared to the uncontaminated sites. Plant roots accumulated concentrations of all measured heavy metals, except Ni, Cu, Zn, and Pb, more significant than the shoot. The maximum concentrations of Al, Ni, and Pb were recorded during spring, while the highest Cd, Cr, Fe, and Mn were recorded during summer. The bioconcentration factor (BCF) of all investigated metals (except Al) was > 1, while the translocation factor (TF) of all elements (except Pb) was ˂ 1. These results indicated the capability of C. alopecuroides for metal phytostabilization and considered the target species a powerful phytoremediator for monitoring water pollution in contaminated wetlands. In this context, the above- and belowground parts of C. alopecuroides should be harvested in summer for efficient phytoremediation.

Work-Related Challenges among Primary Health Centers Workers during COVID-19 in Saudi Arabia.

This study aimed to identify certain occupational risk factors for stress among healthcare workers (HCWs) during the COVID-19 pandemic. Using a multistage random sampling approach, an online questionnaire was applied to collect data on role conflict and ambiguity, self-esteem and social support from 1378 HCWs working in primary health centers (regular and fever clinics; clinics specialized in managing patients with COVID-19 symptoms) across Saudi Arabia. The results showed that stress correlated positively with role conflict and ambiguity and negatively with social support. HCWs in fever clinics exhibited significantly more stress and role conflict and ambiguity than those who were working in regular primary healthcare centers. In conclusion, role conflict and ambiguity and social support were determinants for stress among HCWs, especially those working in fever clinics.

Factors Affecting COVID-19 Vaccination among the General Population in Saudi Arabia.

Vaccine refusal or hesitancy is one of the significant issues that can have an adverse impact on people's health and their countries' economy. Additionally, vaccine acceptance or refusal could have a decisive role in controlling the COVID-19 pandemic. This study aims to investigate the factors affecting COVID-19 vaccine refusal and hesitancy among the general population in Saudi Arabia. The method is a cross-sectional survey using an online questionnaire, and data were collected from 1935 participants between 18 February 2021 and 1 April 2021. Out of 1935 participants aged ≥18 years and residing in Saudi Arabia, 46.9% reported their intention to receive the COVID-19 vaccine, 22.4% had received the vaccine, 9.5% did not intend to receive the vaccine, and 21.2% had not made their decision. In the multinomial logistic regression models, vaccine refusal was associated with age (OR: 0.961), nationality (OR: 0.182), monthly income of more than SAR 18,000 (OR: 2.325), chronic diseases (OR: 0.521), knowledge about the vaccine (OR: 0.937), and concerns about the vaccine (OR: 1.5). The hesitancy was associated with age (OR: 0.977), nationality (OR: 0.231), monthly income between SAR 6000 to 12,000 (OR: 0.607), chronic diseases (OR: 0.640), knowledge about the vaccine (OR: 0.907), and concerns about the vaccine (OR: 1.3). The main concerns about the vaccine were "COVID-19 vaccines are not tested enough on people", "drug companies are interested in COVID-19 vaccine sales only", and "COVID-19 vaccines have serious adverse effects". Awareness programs and vaccination campaigns should consider people's concerns and correct their misinformation.

Association between role conflict and ambiguity and stress among nurses in primary health care centers in Saudi Arabia during the coronavirus disease 2019 pandemic: A cross-sectional study.

ABSTRACT: This study aimed to assess the association between role conflict and ambiguity among nurses in primary healthcare centers (PHCs) in Saudi Arabia and their stress levels during the coronavirus disease 2019 (COVID-19) pandemic.In this online cross-sectional study, sociodemographic and occupational characteristics, role conflict, and ambiguity of 432 nurses were assessed using the Bowling Scale for Role Conflict and Ambiguity and stress was assessed using the 10-item Perceived Stress Scale from September 27 to October 17, 2020. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for above-median stress levels of nurses with average and high (2nd and 3rd tertiles) role conflict and ambiguity compared with nurses with low role conflict and ambiguity (1st tertile).The mean (standard deviation) age of the nurses was 36.5 ±â€Š6.6 years, and 25.9% of them were males. After adjusting for PHC type and working hours, nurses with average and high role conflict had significantly higher stress rates than those with low role conflict, with ORs (95% CIs) of 2.69 (1.62-4.46) and 6.31 (3.78-10.53), respectively. Similarly, nurses with average- and high-role ambiguity had significantly higher stress than those with low role ambiguity, with ORs (95% CIs) of 2.15 (1.30-3.55) and 7.68 (4.54-13.01), respectively. Increasing stress rates were detected across increasing categories of role conflict and ambiguity (P values for trend <.001).We found that role conflict and ambiguity were associated with stress among nurses in PHCs in Saudi Arabia during the COVID-19 pandemic.

Metal uptake capability of Cyperus articulatus L. and its role in mitigating heavy metals from contaminated wetlands.

Wetland plants are biological filters that play an important role in maintaining aquatic ecosystem and can take up toxic metals from sediments and water. The present study investigated the seasonal variation in the accumulation potential of heavy metals by Cyperus articulatus in contaminated watercourses. Forty quadrats, distributed equally in 8 sites (six contaminated sites along Ismailia canal and two uncontaminated sites along the River Nile), were selected seasonally for sediment, water, and plant investigations. Autumn was the flourishing season of C. articulatus with the highest shoot density, length, and diameter as well as aboveground biomass, while summer showed the least growth performance. The photosynthetic pigments were markedly reduced under contamination stress. C. articulatus plants accumulated concentrations of most heavy metals, except Pb, in their roots higher than the shoots. The plant tissues accumulated the highest concentrations of Fe, Cd, Ni, and Zn during autumn, while Cu and Mn during spring, and Cr and Co during winter. It was found that Cd, Cu, Ni, Zn, Pb, and Co had seasonal bioaccumulation factor (BF) > 1 with the highest BF for Cd, Ni, and Zn during autumn, Co, Cu, and Pb in winter, spring, and summer, respectively. The translocation factor of most heavy metals, except Pb in spring, was <1 indicating potential phytostabilization of these metals. In conclusion, autumn is an ideal season for harvesting C. articulatus in order to monitor pollution in contaminated wetlands.

Coordinating the Bidding Strategy in Multiissue Multiobject Negotiation With Single and Multiple Providers.

This paper addresses the problem of flexible procurement of multiple distinct services characterized by multiple nonfunctional characteristics, i.e., quality-of-service attributes. We consider the one-to-many negotiation approach as a flexible method for procuring multiple different services by a buyer agent. We address the problem of coordinating the bidding strategy amongst multiple concurrent negotiations and propose novel dynamic negotiation strategies. The proposed strategies consider the behaviors of the opponents of the current negotiation encounter in managing the local reservation values of the common negotiation issues (attributes) of different services. Most previous works consider the problem of negotiation over a single object characterized by one or more issues. We extend our previous work and investigate a more complex situation where a buyer agent negotiates over multiple distinct services given that each service has multiple negotiation issues and multiple possible providers. The experimental results show evidence for the effectiveness and robustness of our dynamic negotiation strategies under various negotiation environments.

Diphenylcyclopropenone-induced vitiligo in a patient with alopecia universalis.

Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune comorbidities. Many studies show colocalization of these diseases at the same anatomical site. Here, we have a case where both disorders were reported to present in the same patient. Diphenylcyclopropenone (diphencyprone, DCP) is used in the treatment of alopecia areata and may induce vitiligo in some patients. We report on one case of vitiligo that was induced by DCP during therapy for alopecia universalis. Alopecia areata and vitiligo share many susceptibility genes. Follicular melanocyte destruction may represent the link between the two diseases.

Reactivation of Tuberculosis in Three Cases of Psoriasis after Initiation of Anti-TNF Therapy.

New biological therapies for disabling diseases such as psoriasis may carry both short- and long-term risks. Tuberculosis (TB) reactivation is a frequent complication of anti-tumor necrosis factor (TNF) therapy. We present 3 cases of psoriasis that were treated with different types of anti-TNF and developed TB infection (TBI) during therapy. One of the cases was diagnosed as active pulmonary TB and the other 2 cases as latent TBI. All cases received appropriate anti-TB treatment, and the anti-TNF therapy was interrupted and then resumed according to various clinical considerations.