Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy.

Background: The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT. Purpose: To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests. Results: The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001). Conclusion: The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

Association Between Multi-Morbidities and Polypharmacy Among Older Adults at an Academic Medical Center in Saudi Arabia.

Background: Polypharmacy, or the routine use of five or more medications, can result in impacting patients' quality of life. Objective: to examine the association between multi-morbidities and polypharmacy, and to examine prescription practices in the elderly. Methods: This is a retrospective cross-sectional study. Data were gathered from electronic medical records (EMR) at King Fahad University Hospital (KFHU) and the Family & Community Medicine Center (FCMC) of Imam Abdulrahman bin Faisal University (IAU), between January 1, 2019, and December 31, 2020. We included individuals aged 60 and above with at least one dispensed prescription in 2019 and 2020. Of the 76,216 patient records reviewed, 5,060 met the inclusion criteria. Polypharmacy was defined as a monthly average of five or more prescribed medications. The prevalence of polypharmacy was calculated by year, sex, and age group, and findings were summarized using mean medication numbers and standard deviations for each stratum. An app using R programming language was developed to help visualize patients' medication histories through interactive plots. Results: Polypharmacy prevalence was 46% in 2019 and 44.6% in 2020. The mean and standard deviation of medications per person was 5.17 (3.42) in 2019 and 5.04 (3.37) in 2020. Females had a higher average number of medications than males, 5.17 (3.47) vs 5.04 (3.32). The age group of 80-85 had the highest number of medications at 5.6 (3.6), while those aged 90 and above had the lowest number at 4.48 (2.64). The presence of comorbidities was positively associated with the mean monthly medication count (P value < 0.01). Conclusion: Our study revealed a high prevalence of polypharmacy among elderly patients at KFHU/FCMC, and a positive association with multi-morbidities. Consequently, measures must be taken to mitigate this globally emerging issue's impact and rapid progression.

Arabic Translation and Cross-Cultural Adaptation of the Victorian Institute of Sport Assessment Questionnaire for Patellar Tendinopathy.

Background: The Victorian Institute of Sport Assessment questionnaire for patellar tendinopathy (VISA-P) is currently not available in the Arabic language. Purpose: To translate and culturally adapt the VISA-P questionnaire into Arabic and to evaluate its reliability and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Translation of the VISA-P questionnaire was implemented in compliance with international guidelines. In total, 111 participants (53 with patellar tendinopathy and 58 healthy controls) were recruited to validate the Arabic-language version of the VISA-P (VISA-P-Ar). The patients with patellar tendinopathy completed the 36-item Short Form Health Survey (SF-36) and rated their knee pain using the numeric pain rating scale (NPRS). They completed the VISA-P-Ar twice (within a week) to assess test-retest reliability. Scores between the patients and controls were compared with the Mann-Whitney U test, construct validity was assessed with Spearman rank-order correlation, internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Results: There was a significant difference in VISA-P-Ar scores between the patellar tendinopathy group (mean, 41.35 ± 13.56) and the control group (mean, 95.22 ± 8.22) (P < .001). In addition, scores on the VISA-P-Ar were significantly positively correlated with the SF-36 (r = 0.630; P < .001) and significantly negatively correlated with the NPRS (r = -0.681; P < .001). The items in the VISA-P-Ar had good internal consistency (α = 0.709) and showed high test-retest reliability (ICC, 0.941; P < .001). Conclusion: The results of this study indicated that the VISA-P-Ar is a valid and reliable tool for assessing symptoms of patellar tendinopathy in the Saudi population and can be used in clinical and research settings.

An extended DeLone and McLean's model to determine the success factors of e-learning platform.

Due to the COVID-19 pandemic, all Saudi universities have adopted e-learning systems to ensure that educational activities continue. Shaqra University adopted a platform called the Shaqra University e-learning platform. This study aimed to identify the factors contributing to the success of that platform in Shaqra University, based on students' responses. This research has proposed an extension of well-known DeLone and McLean's Information Systems Success (D&M ISS) model to check and validate the success factors of the Shaqra University platform. The questionnaire was adopted in this study to collect data from students currently enrolled at Shaqra University. One thousand online links to the questionnaire were randomly distributed among current students enrolled in Shaqra University. The results revealed that the instrument adopted in this study was valid and reliable. Also, the results showed that the model was a good fit for the Saudi context. The proposed factors of instructor's quality, learner quality, and perceived usefulness positively impacted the e-learning platform. On the other hand, the factors information quality, system quality and service quality had no positive impact on the use of the e-learning platform.

Association Between Nap Duration and Cognitive Functions Among Saudi Older Adults.

Purpose: Current evidence of whether napping promotes or declines cognitive functions among older adults is contradictory. The aim of this study was to determine the association between nap duration and cognitive functions among Saudi older adults. Methods: Old adults (> 60 years) were identified from the Covid-19 vaccine center at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia between May and August 2021. Face-to-face interviews were conducted by a geriatrician or family physicians. Data collected for each participant included sociodemographic, sleep patterns, health status and cognitive functions. St. Louis University mental status (SLUMS) was used to assess the cognitive functions. A multi-Linear regression model was used to determine the association between cognitive functions and nap duration. Results: Two-hundred participants (58 females) aged 66 ± 5 years were recruited. Participants were categorized according to their nap duration into non-nappers (0 min), short nappers (> 0- ≤ 30 min), moderate nappers (> 30-≤ 90 min), and extended nappers (> 90 min). The mean duration of the nap was 49.1 ± 58.4 min. The mean SLUMS score was 24.1 ± 4.7 units. Using the multi-linear regression model, the mean total SLUMS score for extended nappers was, on average, significantly lower than non-nappers [-2.16 units; 95% CI (-3.66, -0.66), p = < 0.01] after controlling for the covariates (age, sex, education level, sleep hours, diabetes mellitus, hypertension, pain). Conclusions: Extended napping was associated with deterioration in cognitive function among Saudi older adults.

Effect of nocturnal hypoxemia on glycemic control among diabetic Saudi patients presenting with obstructive sleep apnea.

Background: Obstructive sleep apnea (OSA) is a prevalent disease that is associated with an increased incidence of type II diabetes mellitus (DM) if left untreated. We aimed to determine the association between glycosylated hemoglobin (HbA1c) levels and both nocturnal hypoxemia and apnea-hypopnea index (AHI) among a Saudi patients with OSA. Methods: A cross-sectional study that enrolled 103 adult patients diagnosed with DM and confirmed to have OSA by full night attended polysomnography between 2018 and 2021. Those who presented with acute illness, chronic obstructive pulmonary disease (COPD)/restrictive lung diseases causing sleep-related hypoxemia, or no available HbA1c level within 6 months before polysomnography were excluded from the study. Univariate and multivariate linear regression analyses between HbA1c levels and parameters of interest were tested. Results: Sixty-seven (65%) of the studied population had uncontrolled DM (HbA1c ≥7%). In univariate regression analysis, there was a significant positive association between HbA1c, and sleep time spent with an oxygen saturation below 90% (T90), female gender, and body mass index (BMI) (p<0.05) but not AHI, or associated comorbidities (p>0.05). In the multivariate analysis, HbA1c was positively associated with increasing T90 (p<0.05), and ODI (p<0.05), but not with AHI (p>0.05). Conclusion: Nocturnal hypoxemia could be an important factor affecting glycemic control in patients with OSA suffering from DM irrespective of the severity of both diseases.

The impact of baseline incidence rates on burden of disease assessment of air pollution and onset childhood asthma: analysis of data from the contiguous United States.

PURPOSE: Burden of disease (BoD) assessments typically rely on national-level incidence rates for the health outcomes of interest. The impact of using a constant national-level incidence rate, versus a more granular spatially varying rate, remains unknown and understudied in the literature. There has been an increasing number of publications estimating the BoD of childhood asthma attributable to air pollution, as emerging evidence demonstrates that traffic-related air pollution (TRAP) leads to onset of the disease. In this study, we estimated the burden of incident childhood asthma cases which may be attributable to nitrogen dioxide (NO2), a criteria pollutant and a good marker of TRAP, in the contiguous United States. We used both a national-level and newly generated state-specific asthma incidence rates and compared results from the two approaches. METHODS: We estimated incident childhood asthma cases which may be attributable to NO2 using standard BoD assessment methods. We combined child (<18 years) counts with 2010 NO2 exposures at the census block level, concentration-response function, and state-specific asthma incidence rates. NO2 concentrations were obtained from a previously validated land-use regression model. We sourced the concentration-response function from a meta-analysis on TRAP and risk of childhood asthma. We estimated incidence rates using raw data collected in the 2006-2010 Behavioral Risk Factor Surveillance System and Asthma Call-back Surveys. We stratified the estimated BoD by urban versus rural status and by median household income, explored trends in BoD across 48 states and the District of Columbia, and compared our results with a published BoD analysis which used a constant national-level incidence rate across all states. RESULTS: The overall mean (min-max) NO2 concentration(s) was 13.2 (1.5-58.3) ug/m3 and was highest in urbanized areas. The estimated national aggregate asthma incidence rate was 11.6 per 1000 at-risk children and ranged from 4.3 (Montana) to 17.7 (District of Columbia) per 1000 at-risk children. The 17 states that did not have data to estimate an incidence rate were assigned the national aggregate asthma incidence rate. Using the state-specific incidence rates, we estimated a total of 134,166 (95% confidence interval: 75,177-193,327) childhood asthma incident cases attributable to NO2, accounting for 17.6% of all childhood asthma incident cases. Using the national-level incidence rate, we estimated a total of 141,931 (95% confidence interval: 119,222-163,505) incident cases attributable to NO2, accounting for 17.9% of all childhood asthma incident cases. Using the state-specific incidence rates therefore reduced the attributable number of cases by 7,765 (5.5% relative reduction), compared with estimates using the national-level incidence rate. Across states, the change in the attributable number of cases ranged from -64.1% (Montana) to +33.8% (Texas). California had the largest absolute decrease (-6,190) in attributable cases, whereas Texas had the largest increase (+3,615). Stratifying by socioeconomic status and urban versus rural status produced new trends compared with the previously published BoD analysis showing high heterogeneity across the states. CONCLUSIONS: We estimated new state-specific asthma incidence rates for the contiguous United States. Using state-specific incidence rates versus a constant national incidence rate resulted in a small change in the NO2 attributable BoD at the national level, but had a more prominent impact at the state level.

Therapeutic regimens for vitamin D deficiency in postmenopausal women: a systematic review.

INTRODUCTION: We reviewed the most effective vitamin D3 regimen for vitamin D deficiency in postmenopausal women. MATERIAL AND METHODS: We searched for studies and clinical trials conducted on healthy postmenopausal women published on PubMed from 2000 to 2018 using the term "Vitamin D deficiency" combined with the following terms: "dose", "supplement", "supplementation", "cholecalciferol" or "cholecalciferol dose". We identified 1376 articles which matched the search criteria. Based on reviewing the title and abstract, 17 articles were eligible for a full-text review. Of those, 12 manuscripts were ultimately included. RESULTS: A majority of the studies (75%) reported using daily maintenance doses which were predominantly administered orally (83.3%). Two studies reported favorable results following therapy with a single oral dose of 300,000 IU. After one month, however, 25-hydroxy vitamin D [25(OH)D] was satisfactory; both studies failed to maintain adequate responses after 60 and 90 days. One study found that loading oral doses of 50,000 IU/day for 2 weeks followed by the same doses every 2 weeks for one year were effective. Five studies employed oral doses of 800 IU/day but none of them reported that this dose was adequate. Three studies used doses of 1000 IU/day but only two of them reported positive results. Three trials examined oral doses of 2000 IU/day and another 3 studies tested oral doses of 4000-4800 IU/day. All of them reported acceptable responses that lasted with continued treatment. CONCLUSIONS: Oral maintenance doses of 2000-4800 IU/day satisfactorily corrected vitamin D deficiency and maintained 25(OH)D levels in postmenopausal women with continuous therapy.

Traffic related air pollution and the burden of childhood asthma in the contiguous United States in 2000 and 2010.

BACKGROUND: Asthma is one of the leading chronic airway diseases among children in the United States (US). Emerging evidence indicates that Traffic Related Air Pollution (TRAP), as opposed to ambient air pollution, leads to the onset of childhood asthma. We estimated the number of incident asthma cases among children attributable to TRAP in the contiguous US, for the years 2000 and 2010. METHODS: The number of incident childhood asthma cases and percentage due to TRAP were estimated using standard burden of disease assessment methods. We combined children (<18 years) counts and pollutant exposures at populated US census blocks with a national asthma incidence rate and meta-analysis derived concentration response functions (CRF). NO2, PM2.5 and PM10 were used as surrogates of TRAP exposures, with NO2 being most specific. Annual average concentrations were obtained from previously validated land-use regression (LUR) models. Asthma incidence rate and a CRF for each pollutant were obtained from the literature. Estimates were stratified by urban or rural living and by median household income. We also estimated the number of preventable cases among blocks that exceeded the limit for two counterfactual scenarios. The first scenario used the recommended air quality annual averages from the World Health Organization (WHO) as a limit. The second scenario used the minimum modeled concentration for each pollutant, in either year, as a limit. RESULTS: Average concentrations in 2000 and 2010, respectively, were 20.6 and 13.2 µg/m3 for NO2, 12.1 and 9 µg/m3 for PM2.5 and 21.5 and 17.9 µg/m3 for PM10. Attributable number of cases ranged between 209,100-331,200 for the year 2000 and 141,900-286,500 for 2010, depending on the pollutant. Asthma incident cases due to TRAP represented 27%-42% of all cases in 2000 and 18%-36% in 2010. Percentage of cases due to TRAP were higher (1) in urban areas than rural areas, and (2) in block groups with lowest median household income. Online open-access interactive maps and tables summarizing findings at the county level and 498 major US cities, are available at [https://carteehdata.org/l/s/TRAP-burden-of-childhood-asthma]. Assuming that pollutants did not exceed WHO air quality recommendations, the number of incident cases that could have been prevented ranged between 300 and 53,400, depending on the pollutant and year. Assuming that pollutant levels were limited to the minimum modeled concentration, the number of childhood asthma incident cases that could have been prevented ranged between 127,700 and 317,600, depending on the pollutant and year. CONCLUSION: This is the first study to estimate the burden of incident childhood asthma attributable to TRAP at a national scale in the US. The attributable burden of childhood asthma dropped by 33% between 2000 and 2010. However, a significant proportion of cases can be prevented.

Therapeutic and maintenance regimens of vitamin D3 supplementation in healthy adults: A systematic review.

Studies carried out assessing the effect of different doses of cholecalciferol (vitamin D3) on correcting serum 25-hydroxyvitamin D deficiency in healthy adults are limited and review studies are lacking. Moreover, the maintenance dose and its duration offered by these few studies are inconsistent. We performed a systematic review of randomized clinical controlled trials (RCTs) that assessed the effect of different doses of vitamin D3 on serum 25(OH)D in healthy adults. PubMed database was searched from 2010 to 2018 using the following search terms: "vitamin D deficiency", "Cholecalciferol", "vitamin D3 dose", "vitamin D supplement", "vitamin D therapy". RCTs and original articles that evaluated different doses of vitamin D3 were identified. A total of sixteen (out of 3016) acceptable studies fulfilling our inclusion criteria were included in the current systematic review. Our results revealed that supplementation with vitamin D3 had a significant positive effect in raising serum 25(OH) D concentrations. Our findings indicated that the best regimen of vitamin D3 supplement consisted of an initial large bolus dose either IM injection of 600.000 IU monthly or oral dose of 200.000 IU monthly or 50.000 IU weekly for 8 weeks, followed by a maintenance dose of 50.000 IU monthly or bimonthly. A large bolus therapeutic dose of vitamin D3, frequently or infrequently for 8 weeks, followed by long-term oral maintenance dose of 50.000 IU monthly or bimonthly optimiz and manitain vitamin D serum levels year round.