ABSTRACT
Background: The Saudi Food and Drug Authority (SFDA) requires marketing authorization holders to submit a PIL in both Arabic and English language. However, the readability of imprinted and disseminated Patient information leaflets (PILs) was not assessed extensively in Saudi Arabia. This study aims to assess the readability of PIL of antihypertensive drugs in both Arabic and English languages. Method: This study was a descriptive quantitative analysis conducted in Saudi Arabia in August 2021. PILs of all oral antihypertensive medications in Saudi Arabia were included in the study. The Arabic and English PILs were extracted from the Saudi Drugs Information System (SDI) and pharmaceutical companies' registration documents. The study used Flesch-Kincaid grade level to assess the readability of English and sentence length to assess the Arabic texts. Descriptive analyses were used to assess the readability scores and the mean differences. Results: It was found that almost 88% of English PILs were above recommended readability level compared to 79% of Arabic PILs. About 89% of English PILs of generic and 86% of brand-name medications were above the readability cutoff point compared with 83% of Arabic PILs of generic and 68% of brand-name medications. The means of grade level for readability of PILs for the widely used antihypertensive medications including angiotensin II receptor blockers (ARBs), antiadrenergic, diuretics, Beta-blockers (BBs), calcium channel blockers (CCBs), and combination antihypertensive medications, and CCBs were higher than the recommended readability level (p < 0.05). The highest mean grade level for readability among English PILs was for combinations of antihypertensive agents (9.35 ± 1.38, p 0.01) and among Arabic PILs was for ARBs (6.15 ± 1.62, p < 0.01). Conclusions: The majority of PILs of antihypertensive medications were above the recommended readability level that can be understood by the majority of the public, especially among generic medications and the most widely used antihypertensive medications. The study findings highlight the need of implementing guidelines to improve the readability of information imprinted in PILs and adopt new regulations requiring readability assessment for manufactures before submitting the PILs to the SFDA.
ABSTRACT
BACKGROUND: Previous meta-analyses suggest that users of proton pump inhibitors (PPIs) have a higher risk of developing enteric infections compared with nonusers. These previous meta-analyses have considerable heterogeneity, and it is not clear whether the effect of PPIs is different for different types of microorganisms. OBJECTIVE: The aim of this study is to update previous meta-analyses, concentrating on enteric infection in community settings and exploring potential sources of heterogeneity. METHODS: A systematic search was conducted on electronic databases (all available years until November 2017). PubMed, EMBASE, Cochrane, and Web of Science were searched using specific keywords related to PPI therapy and community-acquired enteric infection. Eligible studies were selected based on prespecified criteria. RESULTS: A total of 9 observational studies evaluating community-acquired enteric infection were eligible, including 12 separate analyses. The meta-analysis showed that PPI users have an increased risk of developing community-acquired enteric infection (pooled odds ratio [OR] = 4.28; 95% CI = 3.01-6.08). There was significant heterogeneity between the studies ( I2 = 85%; P < 0.001), which was partly explained by type of microorganism. The strength of the association was similar for Salmonella (pooled OR = 4.84; 95% CI = 2.75-8.54; I2 = 58.7%; P = 0.064) and Campylobacter (pooled OR = 5.09; 95% CI = 3-8.64; I2 = 81%; P < 0.001) but lower for studies that combined all bacteria (pooled OR = 2.42; 95% CI = 0.96-6.14; I2 = 94.3%; P < 0.001). CONCLUSION: PPI users have an increased risk of developing community-acquired enteric infections compared with nonusers. The heterogeneity was partially explained by type of microorganism; the association is stronger for Salmonella and Campylobacter than for all bacteria combined.
