Adherence to Mediterranean-Style Dietary Pattern and Risk of Bladder Cancer: A Case-Control Study in Iran.

Few dietary patterns are related to reduce the Bladder Cancer (BC) risk. One of the well-known dietary patterns is the Mediterranean diet (MD). This case-control study investigated the association between MD and the odds of BC among Iranian population. The present case-control study was performed on 103 eligible cases and 200 controls age 45 to 92 years. Diet of participants was assessed by a validated 168-item food frequency questionnaire (FFQ). Adherence to MD was measured by Mediterranean-Style Dietary Pattern Score (MSDPS). Multivariate logistic regression was used to estimate the relationship between MSDPS and risk of BC. After controlling for potential confounders, a negative association was observed between MSDPS and risk of BC (OR = 0.22; 95%CI = 0.09-0.52; p trend = 0.001). Furthermore, significant negative associations were observed for dairy, fish and other seafood, whole-grain, bread intake and risk of BC (p for trend < 0.05). In contrast, the risk of BC increased for high intake of poultry (OR = 1.09; 95%CI = 1.03-1.15; p trend = 0.003), sweets (OR = 1.24; 95%CI = 1.03-1.48; p trend = 0.018) and egg (p for trend = 0.01). Our results suggested that dietary habit in concordance with the principles of the Mediterranean dietary pattern may protect against BC.

Nutrient Patterns and Bladder Cancer: A Case-Control Study in Iran.

To examine the association between nutrient patterns (NP) and the risk of bladder cancer (BC) in the Iranian population, this Hospital-based case-control study was conducted with 306 participants (106 cases and 200 controls). The cases were newly diagnosed with BC (transitional cell carcinoma). Participants' past year's dietary intake was obtained via a valid 168-item Food Frequency Questionnaire (FFQ). Principal Component Analysis was applied to derive NPs considering the intake of the nutrients. Logistic regression models were used to estimate the odds ratio (ORs) and 95%CIs. Two main NPs were obtained - Mineral Dominant (NP1) and Fat Dominant (NP2). NP1 was characterized by a high loading of folate, total carbohydrate, iron, phosphorus, fiber, total protein, magnesium, potassium, and calcium. NP2 had high loadings of trans-fatty acid (TFA), poly-unsaturated fatty acid (PUFA), total fat, saturated fatty acid (SFA), sodium, and cholesterol. Higher adherence to NP1 pattern significantly decreased the odds of BC (OR = 0.24, 95%CI: 0.09-0.67). In contrast, high adherence to NP2 resulted in almost a five-fold increase in the odds of BC (OR = 5.41, 95%CI: 2.26, 12.95). Variability in nutrient patterns has significant associations with the risk of BC, further highlighting the need to study patterns of nutrient intake rather than single nutrients.

Assessment of the experience of Saudi emergency medical services personnel with acute stroke. On-scene stroke identification, triaging, and dispatch of acute stroke patients.

OBJECTIVE: To assess the knowledge, experience, and the impact of seniority of Saudi emergency services (EMS) personnel in dealing with acute stroke patients. METHODS: We conducted this cross-sectional survey using a 3-part structured questionnaire involving 102 EMS personnel in Riyadh, Kingdom of Saudi Arabia between October and December 2011. We assessed participants` demographic factors, their ability to identify cardinal symptoms of stroke, use of assessment tools, knowledge of tissue plasminogen activator (t-PA), and dispatch of patients. RESULTS: The mean age of participants was 27.6 (+/-4.5) years. Approximately half of the group had experience of up to 2 years. Six percent of participants were not aware of any stroke symptoms, and only 3% identified 5 or more correct symptoms. None of the participants used any stroke specific assessment tools. Around 98% of participants dispatched patients to the nearest hospitals without taking into account availability of stroke treatment facilities. Only 6% of the participants were aware of t-PA and its use in stroke care. CONCLUSION: Most of the EMS personnel lacked knowledge of the cardinal stroke symptoms, t-PA`s principal uses, and its therapeutic time window. Training opportunities coupled with the implementation of screening tools, stroke triage, and dispatch protocols are urgently required.

New Delhi Metallo-Beta-Lactamase Producing Carbapenem-Resistant Gram-Negative Bacilli: Microbiological And Genotypic Analyses At A Tertiary Care Hospital In Pakistan.

BACKGROUND: Metallo-beta-lactamases (MBL) catalyze the hydrolysis of beta-lactam antibiotics including carbapenems. A novel MBL subtype, New Delhi MBL (NDM), poses a serious public health problem. The aims of this study were to determine the frequency of NDM producers among the Carbapenem-resistant gram-negative bacilli (GNB) in hospitalized patients and carrying out the molecular analysis of the NDM genes as reliable data on this is not available in Pakistan. METHODS: We carried out a cross-sectional study on prospectively collected clinical samples from 113 patients hospitalised at Shaikh Zayed Hospital Lahore, Pakistan. All the samples that were carbapenem-resistant on routine sensitivity testing were selected for this study. Various microbiological and genotypic analyses of the samples were performed. RESULTS: The mean age of the patients was 47.8±20.8 years. About a quarter (25.7%) of the samples was from the urology ward and 43% were urine samples. Around two-third of the samples (n=74, 65.5%) tested positive for Non-Enterobacteriaceae GNB. Pseudomonas spp was the most common isolate among the Non-Enterobacteriaceae and E-coli amongst the Enterobacteriaceae. NDM gene was detected in 22 patients (19.5%). We did not find any association of the NDM gene with the demographic and clinical characteristics.. CONCLUSION: NDMpositive GNB are present in our hospitalized patients, which is worrisome as these bacteria can disseminate globally and lead to an extensive and uncontrollable spread of pandemic clones for which efficient antibiotic therapy is currently not available. Systemic surveillance network and infection control strategies should be established to curtail dissemination of NDM-producing GNB in Pakistan.

Impact of Twitter intensity, time, and location on message lapse of bluebird's pursuit of fleas in Madagascar.

BACKGROUND: The recent outbreak of bubonic plague in Madagascar reminds us of the continuing public health challenges posed by such deadly diseases in various parts of the world years after their eradication. This study examines the role of Twitter in public health disease surveillance with special focus on how Twitter intensity, time, and location issues explain Twitter plague message delay. METHOD: We retrospectively analyzed the Twitter feeds of the 2014 bubonic plague outbreak in Madagascar. The analyses are based on the plague-related data available in the public domain between November 19th and 27th 2014. The data were compiled in March 2015. We calculated the time differential between the tweets and retweets, and analyzed various characteristics of the Tweets including Twitter intensity of the users. RESULTS: A total of 6873 Twitter users were included in the study, of which 52% tweeted plague-related information during the morning hours (before mid-day), and 87% of the tweets came from the west of the epicenter of the plague. More importantly, while session of tweet lease and relative location had effect on message lapse, absolute location did not. Additionally, we found no evidence of differential effect of location on message lapse based on relative location i.e. tweets from west or east nor number of following. However, there is evidence that more intense Twitter use appears to have significant effect on message lapse such that as the number of tweets became more intense, time differential between the tweets and retweets increased while higher number of retweets diminished message lapse. CONCLUSION: This study affirms that Twitter can play an important role in ongoing disease surveillance and the timely dissemination of information during public health emergencies independent of the time and space restrictions. Further ways should be explored to embed social media channels in routine public health practice.

Health information sharing on Facebook: An exploratory study on diabetes mellitus.

BACKGROUND: Increasingly, people are using Facebook (FB) to share health information. However, little is known about the type of information sharing and its potential health consequences in the Arabic speaking world. This study attempts to fill this knowledge gap for diabetes mellitus (DM). METHOD: We conducted a retrospective qualitative FB content analysis using predefined eligibility criteria. The analysis was restricted to diabetes related groups in the Arabic speaking world. The data were collected between June 2010 and December 2015. A total of 55 groups were screened of which seven met the eligibility criteria. RESULTS: We found 6107 posts in Arabic related to DM of which 1551 posts were included for further analysis. There were 458 (30%) FB posts from Egypt with no posts from Somalia, Yemen, Comoros, and Djibouti. The majority of the posts, 863 (56%), were from females. The focus of the posts was on sharing personal experiences (n=423, 27%), raising awareness (n=210, 3.5%), providing spiritual support (n=162, 10.4%), sharing latest research (n=147, 9.5%), and providing education (n=110, 7.1%) on DM. A large number of the posts by people in 40-60 year age group were around finding out diagnosis related information due to limited access to care in their home countries. CONCLUSION: Patients with DM are increasingly sharing their health information with other FB users. This study will help inform future research with regard to health information sharing and designing appropriate interventions to harness the power of social media in improving public health.

Clinical manifestations that predict abnormal brain computed tomography (CT) in children with minor head injury.

BACKGROUND: Computed tomography (CT) used in pediatric pediatrics brain injury (TBI) to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative. OBJECTIVES: The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT. MATERIALS AND METHODS: Retrospective cross-sectional study was undertaken in patients (1-14 years) with blunt head injury and having a Glasgow Coma Scale (GCS) of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury. RESULTS: No statistically significant association between parameteres such as Loss of Consciousness, 'fall' as mechanism of injury, motor vehicle accidents (MVA), more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury. CONCLUSION: Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.

The Use of an Adapted Health IT Usability Evaluation Model (Health-ITUEM) for Evaluating Consumer Reported Ratings of Diabetes mHealth Applications: Implications for Diabetes Care and Management.

BACKGROUND: The aim of this paper is to present a usability analysis of the consumer ratings of key diabetes mHealth applications using an adapted Health IT Usability Evaluation Model (Health-ITUEM). METHODS: A qualitative content analysis method was used to analyze publicly available consumer reported data posted on the Android Market and Google Play for four leading diabetes mHealth applications. Health-ITUEM concepts including information needs, flexibility/customizability, learnability, performance speed, and competency guided the categorization and analysis of the data. Health impact was an additional category that was included in the study. A total of 405 consumers' ratings collected from January 9, 2014 to February 17, 2014 were included in the study. RESULTS: Overall, the consumers' ratings of the leading diabetes mHealth applications for both usability and health impacts were positive. The performance speed of the mHealth application and the information needs of the consumers were the primary usability factors impacting the use of the diabetes mHealth applications. There was also evidence on the positive health impacts of such applications. CONCLUSIONS: Consumers are more likely to use diabetes related mHealth applications that perform well and meet their information needs. Furthermore, there is preliminary evidence that diabetes mHealth applications can have positive impact on the health of patients.

Emergency Department Waiting Times (EDWaT): A Patient Flow Management and Quality of Care Rating mHealth Application.

Saudi hospital emergency departments (ED) have suffered from long waiting times, which have led to a delay in emergency patient care. The increase in the population of Saudi Arabia is likely to further stretch the healthcare services due to overcrowding leading to decreased healthcare quality, long patient waits, patient dissatisfaction, ambulance diversions, decreased physician productivity, and increased frustration among medical staff. This will ultimately put patients at risk for poor health outcomes. Time is of the essence in emergencies and to get to an ED that has the shortest waiting time can mean life or death for a patient, especially in cases of stroke and myocardial infarction. In this paper, we present our work on the development of a mHealth Application - EDWaT - that will: provide patient flow information to the emergency medical services staff, help in quick routing of patients to the nearest hospital, and provide an opportunity for patients to review and rate the quality of care received at an ED, which will then be forwarded to ED services administrators. The quality ratings will help patients to choose between two EDs with the same waiting time and distance from their location. We anticipate that the use of EDWaT will help improve ED wait times and the quality of care provision in Saudi hospitals EDs.

Revisiting the impact of mobile phone screen size on user comprehension of health information.

Abstract goes here. This is completion of the research and update of the previous work that was published in 2013[1]. The paper describes our recent experimental study of the impact of mobile screen size on the user comprehension of health information and application structures. An experiment was conducted to measure the impact of screen size on user comprehension and retention. Participants were given the same simple scenario, which consisted of searching from different menus, navigating and reading some contents. They were timed and tracked for correctness. Also, a follow-up survey was given to each participant that consisted of a rating scale to assess usability features, comprehension and retention abilities of the participants based on different mobile screen sizes. Results showed that there was a significant difference between mobile phone screen size and the time taken to read the contents, which was at its highest on small screens (p-value=0.02). Also, reading characters was hardest on a small screen (p-value=0.003). In addition, there was a significant difference between the three screen sizes regarding the organization of the application's information, showing that the smaller the screen size, the more organized the information. On the other hand, there was no significant impact of screen size on user comprehension, retention scores, number of errors or effective task completion but it was generally better if a large screen size was used. This study concludes that the screen size is not the main concern in comprehension of the contents or application structure. However, reading speed improves with the larger screen size and positively influences the task completion and understanding of the application elements.

Impact of computerised provider order entry system on nursing workflow, patient safety, and medication errors: perspectives from the front line.

There is a paucity of research on the impact of computerised provider order entry (CPOE) system on the front line staff. We assessed nurses perspectives of the impact of CPOE system implementation on their workflow, patient safety and medication errors in a Saudi Arabian hospital. We conducted a cross-sectional survey involving 112 nurses between April and May 2012. The workflow was easy to manage for nurses who rated CPOE training as of good quality (p = 0.001) and they found that CPOE helped in reducing medication errors (p = 0.001). The nurses who rated CPOE training as of good quality also stated that patient safety was better with CPOE implementation and its use (p < 0.05). Provision of adequate CPOE training improves nurses' perception of the system's role in their workflow, patient safety and medication errors, and is critical in the success of CPOE use and its long-term adoption.

The impact of mobile phone screen size on user comprehension of health information.

Within the field of mobile health, there is little research conducted on the impacts of mobile health technologies and applications on user comprehension of health content. In this study, we examine the difference between small, medium and large screen mobile phone that affect the user comprehension of health content. We designed an experimental study where 33 users read the contents of a health application on different mobile phone screen sizes. Each participant was timed, tracked for correctness, and gave ratings for both readability and satisfaction on each task. In addition, they were asked some questions about the contents. Results show that there was no significant impact of the screen size on user comprehension of the contents. However, it was found that participants with small screen size took longer to read the health contents.

A case study on the impacts of computerized provider order entry (CPOE) system on hospital clinical workflow.

Computerized provider order entry (CPOE) is a health informatics system that helps health care providers create and manage orders for medications and other health care services. Through the automation of the ordering process, CPOE has improved the overall efficiency of hospital processes and workflow. In Saudi Arabia, CPOE has been used for years, with only a few studies evaluating the impacts of CPOE on clinical workflow. In this paper, we discuss the experience of a local hospital with the use of CPOE and its impacts on clinical workflow. Results show that there are many issues related to the implementation and use of CPOE within Saudi Arabia that must be addressed, including design, training, medication errors, alert fatigue, and system dep Recommendations for improving CPOE use within Saudi Arabia are also discussed.

Nocturnal enuresis among primary school children.

To determine the prevalence and personal and family risk factors for nocturnal enuresis (NE) among primary school children in Al-Mukalla City, Yemen, we conducted a cross-sectional survey using a self-administered, three-part structured questionnaire involving 832 school children aged 6 - 15 years between 2007 and 2008. We assessed participants' socio-demographic factors, family characteristics and factors related to the presence of NE. The mean age of the children was 11.5 (±2.7) years. The overall prevalence of NE was 28.6%, with a predominance of girls, and the prevalence decreased with increasing age (P <0.001). Factors likely to be associated with NE were pattern of sleeping (P <0.001), stressful social and psychological events (P <0.01), positive family history of enuresis (P <0.001), large family size (P >0.002) and a higher number of siblings (P = 0.01). Our findings reveal a high prevalence of NE among children in Al-Mukalla City, Yemen, with a higher prevalence in girls than in boys compared with the other studies. Sleep pattern, stressful life events, family history of NE, large family size and more children in the household may act as a risk factor for NE.

Why is hepatocellular carcinoma less attributable to viral hepatitis in Yemen?

The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, with older individuals having much higher prevalence than younger generations. However, research on the prevalence of viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aim of this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimate the risk of these infections being associated with the development of HCC. A cross-sectional study was conducted on patients attending oncology outpatient in Sana'a, Yemen, through the period 2008-mid 2010 with confirmed diagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan, ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire was also applied and physical examination done to assess the general condition of the patients. Statistical package (SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (± 12.6) with half over 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /no formal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while the rest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of the subjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and use of smoking was associated with HCC diagnosis. Although an association was observed between the occurrence of HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lower than what has been reported elsewhere.