Corrigendum: Fabrication and evaluation of herbal beads to slow cell ageing.

[This corrects the article DOI: 10.3389/fbioe.2022.1025405.].

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment.

OBJECTIVES: To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials. METHODS: We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT). RESULTS: A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014). CONCLUSION: The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

Fabrication and evaluation of herbal beads to slow cell ageing.

Several therapies and cosmetics are available commercially to prevent or delay cell ageing, which manifests as premature cell death and skin dullness. Use of herbal products such as Aloe vera, curcumin, vitamin C-enriched natural antioxidant, and anti-inflammatory biomolecules are potential ways to prevent or delay ageing. Eggshell membrane (ESM) is also a rich source of collagen; glycosaminoglycans (GAGs) also play an essential role in healing and preventing ageing. It is important to use an extended therapeutic process to prolong the effectiveness of these products, despite the fact that they all have significant anti-ageing properties and the ability to regenerate healthy cells. Encapsulated herbal components are therefore designed to overcome the challenge of ensuring continued treatment over time to prolong the effects of a bioactive component after in situ administration. To study their synergistic effects on a cellular level, alginate, Aloe vera, and orange peel extract were encapsulated in bio-polymeric foaming beads and modified with eggshell membrane protein (ESMP) at various concentrations (1 gm, 2 gm, and 5 gm): (A-Av-OP, A-Av-OP-ESMP1, ESMP2, and ESMP3). Analysis of the structural and functional properties of foaming beads showed interconnected 3D porous structure, a surface-functionalized group for entrapment of ESMP, and a significant reduction in pore size (51-35 m) and porosity (80%-60%). By performing DPPH assays, HRBC stabilization assays, and antibacterial tests, the beads were assessed as a natural anti-ageing product with sustained release of molecules effective against inflammatory response, oxidative stress, and microbial contamination. MTT assays were conducted using in vitro cell cultures to demonstrate cytocompatibility (in mouse 3T3 fibroblast cells) and cytotoxicity (in human carcinoma HeLa cells). Our study demonstrates that bio-polymeric ESMP beads up to 2 g (A-Av-OP-ESMP2) are practical and feasible natural remedies for suspending defective cell pathways, preventing cell ageing, and promoting healthy cell growth, resulting in a viable and practical natural remedy or therapeutic system.

Survival, mortality, and related comorbidities among COVID-19 patients in Saudi Arabia: A hospital-based retrospective cohort study.

OBJECTIVES: To assess the survival of COVID-19 patients in Saudi Arabia and to investigate possible mortality predictors. METHODS: This is a retrospective cohort study involving 248 patients with severe acute respiratory syndrome coronavirus-2 who were admitted to the primary COVID-19 referral hospital in Jeddah between March and June of 2020. Socio-demographic characteristics, comorbidities, laboratory investigations, management protocols, complications, treatment options, and mortality data were extracted from electronic medical records. The time analysis began at the first signs of illness thorough discharge or death. RESULTS: Our study showed that in-hospital complications including heart failure followed by acute renal failure had the largest effect size on mortality (p<0.001). Elderly patients and those with comorbid asthma had a higher risk of death. Non-survivors presented more commonly with shortness of breath and fever than survivors. High D-Dimer level was a marginally significant indicator of mortality in the studied population (p=0.05). We did not find a significant benefit in relation to any treatment option. CONCLUSION: Age, asthma, some in-hospital complications are important survival indicators in hospitalized COVID-19 patients. The controllable co-factors should be monitored and managed by healthcare workers to reduce mortality rates in those hospitalized with COVID-19.

Performance, Barriers, and Satisfaction of Healthcare Workers Toward Electronic Medical Records in Saudi Arabia: A National Multicenter Study.

Background Electronic medical record (EMR) systems are nowadays available internationally, including in Saudi Arabia. Nevertheless, there are still many obstacles to overcome before their effective implementation. This cross-national study aimed to investigate the perceptions and practices of healthcare workers toward implemented EMR systems. Methods A cross-sectional study was conducted across selected hospitals in the four cities of Al-Ahsa, Dammam, Medina, and Riyadh in Saudi Arabia. Healthcare workers of all specialties were invited to participate in the study during the six-month study period from August 2019 to February 2020. The questionnaire was submitted online through institutional e-mails. Results The study included a total of 2684 healthcare providers. Almost half of the respondents (47.1%) were aged between 35 and 50 years. High experience with computer use was observed among 38.3% of them, while 54.3% attended EMR training activities. The performance scores of EMR's compared to previous routines had a median of 24 (interquartile range {IQR} = 0-38). The satisfaction scores with EMR's ranged between 16 and 80 with a median of 53 (IQR = 48-61). Older participants (>50 years), non-Saudis, and those who attended EMR training had statistically significant higher scores of both EMR performance and EMR satisfaction, (p<0.001). Those working in other medical specialties (not major) had statistically significant higher scores of EMR performance alone (p<0.001), while general practitioners (p<0.001) and females (p = 0.001) had statistically significant higher scores of EMR satisfaction alone. EMR systems' positive impact on quality of care was the highest agreed-upon benefit reported, while the temporary loss of access to patient records if computers crashed or power failed was the highest agreed-upon barrier. Conclusions The attitude and satisfaction of healthcare workers in Saudi Arabia towards EMR systems are acceptable particularly among those who are older, non-Saudi, and have attended EMR training. Improved quality of care was the main noted benefit of EMR's, followed by improved productivity. The temporary loss of access to patient records if computers crashed or power failed, followed by privacy and security concerns, was the major EMR barrier mentioned.

Association of body dysmorphic disorder with anxiety, depression, and stress among university students.

OBJECTIVES: This study aims to estimate the prevalence of body dysmorphic disorder (BDD) and identify its association with depression, anxiety, and stress. METHOD: We conducted a cross-sectional study in Jeddah, KSA. In 2019, a validated questionnaire with items on sociodemographic characteristics and body dysmorphic disorder, as well as the Depression, Anxiety, and Stress Scale - 21 items (DASS 21) was distributed to 1,112 students of King Abdulaziz University. SPSS version 23 was used for data analysis, which included descriptive statistics, chi-square tests, and binary logistic regression models. The association was presented as an odds ratio (OR) along with its 95% confidence Interval (CI). RESULTS: The overall prevalence of BDD was 13.9% (95% CI of 11.8-16.2.) with the highest reported sites being the skin (81.6%) and waist (68.8%). BDD was found to be a significant predictor of depression with an OR of 4.2 (95% CI 2.9-6.1), anxiety OR of 2.2 (95%1.6-3.2), and stress OR of 3.2 (2.2-4.7). Females were significantly associated with anxiety, OR of 1.4 (95% CI 1.1-1.9) and stress, OR of 1.5 (1.1-2). Affiliation to the administration, arts, humanities, and social colleges was also a significant predictor of anxiety as reflected by an OR of 1.4 (95% CI 1.1-1.8). CONCLUSIONS: Our study shows that BDD is relatively common among university students in Jeddah and associated with depression, anxiety, and stress.

Seroprevalence of SARS-CoV-2 Binding and Neutralizing Antibodies in Healthcare Workers during the Epidemic Peak in Referral Hospitals and Quarantine Sites: Saudi Arabia.

Healthcare workers (HCWs) are at high risk for SARS-CoV-2 infection compared to the general population. Here, we aimed to evaluate and characterize the SARS-CoV-2 seropositivity rate in randomly collected samples among HCWs from the largest referral hospitals and quarantine sites during the peak of the COVID-19 epidemic in the city of Jeddah, the second largest city in Saudi Arabia, using a cross-sectional analytic study design. Out of 693 participants recruited from 29 June to 10 August 2020, 223 (32.2%, 95% CI: 28.8-35.8) were found to be confirmed seropositive for SARS-CoV-2 antibodies, and among those 197 (88.3%) had never been diagnosed with COVID-19. Seropositivity was not significantly associated with participants reporting COVID-19 compatible symptoms as most seropositive HCW participants 140 (62.8%) were asymptomatic. The large proportion of asymptomatic SARS-CoV-2 cases detected in our study demands periodic testing as a general hospital policy.

Factors associated with non-urgent visits to the emergency department in a tertiary care centre, western Saudi Arabia: cross-sectional study.

OBJECTIVES: To explore magnitude and factors associated with non-urgent visits to the emergency department (ED) in a tertiary care centre, western Saudi Arabia. DESIGN: A cross-sectional study. SETTING: ED of a tertiary care hospital in western Saudi Arabia. PARTICIPANTS: 400 patients, both men and women. INTERVENTIONS: An interview-based questionnaire was administered to a consecutive sample of patients who visited the ED during morning shifts, where primary healthcare centres (PHCs) and outpatient clinics were available. PRIMARY OUTCOME MEASURE: ED visits classified as non-urgent versus urgent (excluding life-threatening conditions) based on the Canadian Triage and Acuity Scale (CTAS). Levels IV and V were classified as non-urgent. RESULTS: Majority of the cases were adult (97.3%) and half of them were women (54.8%). Non-urgent visits represented 78.5% among non-life-threatening cases. One-third of the patients (33.8%) had three visits or more to the ED during the past year. Main reasons for visiting the ED were perception that the condition was urgent (42.0%), easy access (25.5%) and limited resources and services at the PHCs (17.8%). Patients 40-50 years old were more likely to have non-urgent visits (OR=3.21, 95% CI 1.15 to 8.98). However, likelihood of non-urgent visits was significantly lower among patients with cancer (OR=0.37, 95% CI 0.19 to 0.72) and cardiovascular disease (OR=0.43, 95% CI 0.23 to 0.83), and those who live near the hospital (OR=0.49, 95% CI 0.28 to 0.88). CONCLUSIONS: The current study reported overuse of the ED. Enhancement of the primary care services, in concordance with community awareness, is an important component to reduce burden due to non-urgent use of the ED.

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Burden of Middle East respiratory syndrome coronavirus infection in Saudi Arabia.

MERS-coronavirus infection is currently responsible for considerable morbidity and mortality in Saudi Arabia. Understanding its burden, as an emerging infectious disease, is vital for devising appropriate control strategies. In this study, the burden of MERS-CoV was estimated over 31months period from June 6, 2012 to January 5, 2015. The total number of patients was 835; 528 (63.2%) patients were male, 771 (92.3%) patients were ≥25 years of age, and 210 (25.1%) patients were healthcare workers. A total of 751 (89.9%) patients required hospitalization. The median duration between onset of illness and hospitalization was 2 days (interquartile range, 0-5). The median length of hospital stay was 14 days (IQR, 6-27). The overall case fatality rate was 43.1%. Basic reproductive number was 0.9. Being Saudi, non-healthcare workers, and age ≥65 years were significantly associated with higher mortality. In conclusion, MERS-CoV infection caused a substantial health burden in Saudi Arabia.

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study.

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

Global Mortality From Firearms, 1990-2016.

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

Hepatitis C virus infection in Jeddah city, Saudi Arabia: Seroprevalence and knowledge.

The infection rate of the hepatitis C virus (HCV) in Saudi Arabia is among the lowest in the world. However, it is likely that poor knowledge and awareness of HCV infection could minimize the effectiveness of prevention and control programs in the kingdom. Thus, the study objective was to estimate the prevalence of HCV infection, and to assess current knowledge about it, in the targeted population. Data on 5482 Saudi people attending primary healthcare centers in Jeddah City in 2014/2015 were analyzed in this cross-sectional study. Questions that covered the natural history, risk behavior, and prevention, and treatment of HCV were collected using a predesigned questionnaire. HCV seroprevalence was assessed using an enzyme-linked immunosorbent assay. HCV prevalence of 0.38% (95% confidence interval: 0.22-0.54) was found. The level of knowledge of the natural history, risk behavior, and prevention and treatment of HCV was poor among the participants. The lowest level of knowledge for all participants pertained to its prevention and treatment. The prevalence of HCV was low in Saudi Arabia (0.38%). However, adequate knowledge of HCV was lacking. Thus, the need to increase knowledge and awareness of HCV in the Saudi population is warranted.

Assessment of perceived needs and preferences with regard to the education of residents in Medical Ethics in King Abdulaziz University Hospital.

INTRODUCTION: Medical ethics is the branch of ethics that deals with moral issues in medical practice. Many postgraduate training programs have developed educational interventions in ethics to meet accreditation standards and prepare learners for certification examinations and clinical practice. The aim of this study was to assess the attitude of residents in King Abdulaziz University Hospital (KAUH) toward the need for ethics education and identify the most effective methods of teaching ethical issues. MATERIALS AND METHODS: A cross-sectional study of residents in different specialties at KAUH was conducted using a self-administered questionnaire. The questionnaire consisted of four parts: demographic data, assessment of the educational need for ethics education, assessment of the impact of various learning methods, and assessment of the need for ethically important practices and behavior. SPSS version 16.0 was used for data entry and analysis. Descriptive analysis included frequency distribution, percentages, mean, and standard deviation (SD); Chi-square test and t-test were employed to determine statistical significance. RESULTS: Eighty-eight of the 102 residents invited to participate in the study returned completed questionnaires, providing a response rate of 86.3%. Their ages ranged between 24 and 38 years with a mean of 27.7 (standard deviation 2.8) years. Approximately two-thirds of the residents (65.9%) agreed that medical ethics can be taught and learned while only 19.3% of them disagreed. The most effective methods of ethical education according to the residents were discussion groups of peers led by a knowledgeable clinician (78.4%), clinical rounds (72.7%), and an incorporation of ethical issues into lectures and teaching rounds (69.3%). CONCLUSION: This study documents the importance residents placed on ethics education directed at practical, real-world dilemmas and ethically important professional developmental issues.

Discrepancies between dental and medical records of cardiac patients in AlHada Armed Forces Hospital, Taif, Saudi Arabia.

AIMS AND OBJECTIVES: This study aims to estimate the prevalence of medical information discrepancies between dental and medical records of cardiac patients at AlHada Armed Forces Hospital in Taif and to identify the factors contributing to these information discrepancies. MATERIALS AND METHODS: The study applied a descriptive retrospective medical and dental records review of a stratified proportional sample of 289 cardiac patients, which was extracted from 1154 cardiac patients who visited both the cardiology and dental clinics at the AlHada Armed Forces Hospital between 2007 and June 2012. Data were analyzed using the Statistical Package for the Social Sciences version 19. RESULTS: The main results of this study are the following: The mean and standard deviation of patient's age was 56 ± 16.9, female patients represented 47.8% of the study population. A total of 78.5% of dental records were documented by dental residents whereas 48.4% of the dentists had more than 6 years of experience. Two hundred and seventy-nine (96.5%) of the 289 dental records had medical information discrepancies compared to the corresponding medical records. One hundred percent of systemic lupus erythematosus and rheumatic fever cases were not documented in the dental records followed by 93% of medications, 92% of stroke, and 88.5% of hyperlipidemia, whereas the least prevalent were cardiac disease (26%) and diabetes mellitus (22.2%). CONCLUSION: Approximately 75% of the patients who directly or indirectly accessed the dental services showed discrepancies. The researcher concludes that critical information gaps exist between dental and medical records that mostly attributed to system level problems. A well-established model for efficient communication among medical and dental care providers caring for cardiac patients does not appear to exist. The absence of such a model can threaten the overall health of patients.

Prevalence and predictors of hepatitis B in Jeddah City, Saudi Arabia: a population-based seroprevalence study.

INTRODUCTION: Despite solid preventive strategies to reduce the risk of hepatitis B virus (HBV) infection, recent reports about its prevalence and predictors are lacking in several Saudi cities at the community level. This study aimed to assess the seroprevalence of HBV and to identify the most important predictors among the Saudi population in Jeddah city, Saudi Arabia. METHODOLOGY: A cross-sectional study was conducted among 5,584 Saudi people attending primary health-care centers in Jeddah city during 2012/2013. Sociodemographic and hepatitis-related data were collected. HBV was diagnosed by ELISA test. The seroprevalence of HBV was estimated, and appropriate statistical analyses were performed, including univariate and multivariable regression analyses. RESULTS: The seroprevalence of HBV was 2.2% (95% CI = 1.82-2.58) in the studied participants. The prevalence was higher among non-governmental workers (3.5%), male participants (3.4%) and those aged ≥ 25 years (2.4%). The most important predictors for increasing the risk of HBV in this study were HBV contacts, male sex, history of dental procedures and blood transfusion. The significant positive risks associated with these predictors were 3.3, 2.5, 2.0 and 1.65, respectively. HBV vaccination, on the other hand, was associated with a significant risk reduction of 88% (OR = 0.12; 95% CI = 0.03-0.51). CONCLUSIONS: The seroprevalence of HBV was relatively low among the Saudi population in Jeddah city reflecting the actions taken by health authorities to control HBV infection. However, more efforts, particularly in relation to health education programmes, strict control of blood banks and dental clinics, are still needed.

The Prevalence of Diabetes and Prediabetes in the Adult Population of Jeddah, Saudi Arabia--A Community-Based Survey.

BACKGROUND: Type 2 (T2DM) is believed to be common in Saudi Arabia, but data are limited. In this population survey, we determined the prevalence of T2DM and prediabetes. MATERIALS AND METHODS: A representative sample among residents aged ≥ 18 years of the city of Jeddah was obtained comprising both Saudi and non-Saudi families (N = 1420). Data on dietary, clinical and socio-demographic characteristics were collected and anthropometric measurements taken. Fasting plasma glucose and glycated hemoglobin (HbA1c) were used to diagnose diabetes and prediabetes employing American Diabetes Association criteria. Multiple logistic regression analysis was used to identify factors associated with T2DM. RESULTS: Age and sex standardized prevalence of prediabetes was 9.0% (95% CI 7.5-10.5); 9.4% (7.1-11.8) in men and 8.6% (6.6-10.6) in women. For DM it was 12.1% (10.7-13.5); 12.9% (10.7-13.5) in men and 11.4% (9.5-13.3) in women. The prevalence based on World Population as standard was 18.3% for DM and 11.9% for prediabetes. The prevalence of DM and prediabetes increased with age. Of people aged ≥50 years 46% of men and 44% of women had DM. Prediabetes and DM were associated with various measures of adiposity. DM was also associated with and family history of dyslipidemia in women, cardiovascular disease in men, and with hypertension, dyslipidemia and family history of diabetes in both sexes. DISCUSSION: Age was the strongest predictor of DM and prediabetes followed by obesity. Of people aged 50 years or over almost half had DM and another 10-15% had prediabetes leaving only a small proportion of people in this age group with normoglycemia. Since we did not use an oral glucose tolerance test the true prevalence of DM and prediabetes is thus likely to be even higher than reported here. These results demonstrate the urgent need to develop primary prevention strategies for type 2 diabetes in Saudi Arabia.

Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia.

AIM: The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. METHODS: An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. RESULTS: Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P < 0.001), absence of the internet and computer access (P < 0.001), unavailability of laboratory services (P = 0.004), reagents (P = 0.001), X-ray equipment (P = 0.027), ultrasound equipment (P < 0.001), an electronic medical records system (P < 0.001), insufficient laboratory tests (P = 0.0001), and poor building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). CONCLUSION: MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

Utilization of the Emergency Department and Predicting Factors Associated With Its Use at the Saudi Ministry of Health General Hospitals.

Overuse of emergency rooms (ER) is a public health problem. To investigate this issue, a cross-sectional survey was conducted at the ERs of King Abdul-Aziz Hospital, King Fahd Hospital, and Al-Thaghor Hospital in November 2013 with the aims of estimating emergency service utilization for non-urgent cases, identifying the predictors of ER utilization for non-urgent cases, and measuring patients' knowledge of primary healthcare centers (PHCCs). Patients were interviewed using a structured questionnaire and the data were analyzed using the Statistical Package for the Social Sciences. We recruited 300 patients; males comprised 50.7% of the sample. A higher proportion of patients with non-urgent cases visited the ER three to four times a year (P=0.001). A higher proportion of patients without emergencies had not attempted to visit an outpatient clinic before the ER (P=0.003). Most patients without emergencies thought the ER was the first place to consult in case of illness. Most patients who visited the ER were single, <15 years, and had lower incomes. Patients requested ER services for primary care-treatable conditions because of limited services and resources as well as limited working hours at PHCCs. Most patients (90.0%) were knowledgeable about PHCCs, with those of lower education being more knowledgeable. Patients reported long ER waiting times (≥3 hours), no organization (85.9%), and lack of medical staff. Overall, overuse of ER services is high at the Ministry of Health hospitals in Jeddah. The risk factors for ER overuse are age<15 years, singlehood, and low incomes. Policy makers and health providers have a challenging task to control ER overuse. We recommend developing strategies to implement policies aimed at reducing non-urgent ER use as well as making healthcare services more available to the population.

Risk factors for falls in a longitudinal cohort study of Saudi postmenopausal women: the Center of Excellence for Osteoporosis Research Study.

OBJECTIVE: This study aims to identify possible risk factors for falls among Saudi postmenopausal women in a population-based study. METHODS: Seven hundred seven postmenopausal women aged 50 years or older were followed in a prospective cohort study. Participant demographic characteristics, medical history, lifestyle factors, past-year history of falls, and physical activity (PA) scores were assessed. We recorded single and multiple falls, anthropometric parameters, five special physical performance tests, hormone levels, and bone mineral density measurements. Data on knee osteoarthritis (OA), lumbar spondylosis, and osteopenia were collected. Knee and lower back pain were assessed by interview, and cognition was assessed with Mini-Mental State Examination. RESULTS: During the mean (SD) follow-up of 5.2 (1.3) years, 164 women (23.2%) reported at least one fall, of whom 73 women (10.3%) reported multiple falls. Six independent predictors of all falls were identified: PA score of 12.61 or lower (lowest quartile; odds ratio [OR], 4.10; 95% CI, 1.82-8.90); past-year history of falls (OR, 2.44; 95% CI, 2.30-2.90); age 65 years or older (OR, 2.16; 95% CI,1.30-3.12); presence of knee OA (OR, 1.56; 95% CI,1.03-2.34); handgrip strength of 13.88 kg or lower (lowest quartile; OR, 1.33; 95% CI,1.09-1.64); and 8-ft walk test of 3.94 s or longer (highest quartile; OR, 1.18; 95% CI, 1.07-1.35). CONCLUSIONS: Poor PA score, past-year history of falls, age 65 years or older, presence of knee OA, poor handgrip strength, and prolonged time on the 8-ft walk test are risk factors for all falls among Saudi postmenopausal women.