Physical function trajectory after wrist or lower arm fracture in postmenopausal women: results from the Women's Health Initiative Study.

Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older. INTRODUCTION: Physical functioning trajectory following lower arm or wrist fracture is not well understood. PURPOSE: This study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age. METHODS: We performed a nested case-control study of prospective data from the Women's Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical functioning trajectory groups: stable, improving, and declining. RESULTS: Mean (SD) number of physical functioning measurements was 5.2 (1.5) for cases and 5.0 (1.4) for controls. Declining physical functioning was observed among 20.4% of cases and 16.0% of controls. Compared to women without lower arm or wrist fracture, women with lower arm or wrist fracture were 33% more likely to experience declining physical functioning (adjusted odds ratio [aOR] 1.33 95% confidence interval [CI] 1.19-1.49, reference group stable or improving physical functioning trajectory). Associations varied by age: age ≥ 80 years aOR 1.56 (95% CI 1.29-1.88); age 70-79 years aOR 1.29 (95% CI 1.09-1.52); age < 70 years aOR 1.15 (95% CI 0.86-1.53) (pinteraction = 0.06). Associations between lower arm or wrist fracture and odds of declining physical functioning did not vary by baseline physical functioning or physical activity level. CONCLUSIONS: Women with lower arm or wrist fracture, particularly those aged 80 and older, were more likely to experience declines in physical functioning than women without such fractures, independent of baseline physical functioning level.

Prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia: A cross-sectional study.

BACKGROUND: Professional drivers in Saudi Arabia may be at increased risk for mental illness because of their expatriate status, long driving hours, and unhealthy lifestyles. OBJECTIVE: To assess the prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia, most of whom are expatriates. METHODS: Professional drivers (n = 324) were interviewed after convenient sampling of transportation companies. The Depression Anxiety Stress Scale-21 (DASS-21) was used to screen for depressive symptoms. Correlates of depressive symptoms were identified using Cox regression with a fixed follow-up time. RESULTS: Of the drivers, 20.4% had moderate to severe depressive symptoms. Sleep quality was found to be a significant independent correlate of depressive symptoms. Drivers with poor and fair sleep quality had higher risk of depressive symptoms than drivers with excellent sleep quality (poor: OR = 5.8, CI: 1.95-17.11; fair: OR = 4.5, CI: 1.68-11.96). CONCLUSION: The frequency of depressive symptoms among professional drivers in Saudi Arabia is high (one out of five). Companies should consider screening for depressive symptoms and sleep disorders among employees and should provide referrals as needed.

Mental illness stigma as a moderator in the relationship between religiosity and help-seeking attitudes among Muslims from 16 Arab countries.

BACKGROUND: Determining the potential barriers responsible for delaying access to care, and elucidating pathways to early intervention should be a priority, especially in Arab countries where mental health resources are limited. To the best of our knowledge, no previous studies have examined the relationship between religiosity, stigma and help-seeking in an Arab Muslim cultural background. Hence, we propose in the present study to test the moderating role of stigma toward mental illness in the relationship between religiosity and help-seeking attitudes among Muslim community people living in different Arab countries. METHOD: The current survey is part of a large-scale multinational collaborative project (StIgma of Mental Problems in Arab CounTries [The IMPACT Project]). We carried-out a web-based cross-sectional, and multi-country study between June and November 2021. The final sample comprised 9782 Arab Muslim participants (mean age 29.67 ± 10.80 years, 77.1% females). RESULTS: Bivariate analyses showed that less stigmatizing attitudes toward mental illness and higher religiosity levels were significantly associated with more favorable help-seeking attitudes. Moderation analyses revealed that the interaction religiosity by mental illness stigma was significantly associated with help-seeking attitudes (Beta = .005; p < .001); at low and moderate levels of stigma, higher religiosity was significantly associated with more favorable help-seeking attitudes. CONCLUSION: Our findings preliminarily suggest that mental illness stigma is a modifiable individual factor that seems to strengthen the direct positive effect of religiosity on help-seeking attitudes. This provides potential insights on possible anti-stigma interventions that might help overcome reluctance to counseling in highly religious Arab Muslim communities.

Symptoms of depression and stress among migrant workers in Al Qassim, Saudi Arabia.

BACKGROUND: Migrant workers make up a third of the population of Saudi Arabia, approximately 13 million. Mental health disorders among this population are common, but very limited data exist currently. AIMS: To assess the prevalence of moderate to severe symptoms of depression and stress among a sample of migrant workers in Saudi Arabia. To identify whether migrant-specific factors, such as occupation, nationality, duration of migration, and work characteristics, are associated with depressive and stress symptoms. METHODS: A cross-sectional study of 2,123 migrants was conducted in Al Qassim, Saudi Arabia. Depressive and stress symptoms were assessed with the Depression, Anxiety, and Stress Scale (DASS-21). The outcomes were categorized into two levels (i.e. mild or no symptoms versus moderate to severe symptoms). Univariate and multivariate binary logistic regressions were used to assess the relationship with potential covariates. RESULTS: The prevalence of moderate to severe depressive and stress symptoms was 7.3% and 3.6%, respectively. These did not vary by the duration of stay in the country or weekly work hours. However, there was substantial variance in the symptoms by participants' nationality and occupation. Participants from Bangladesh were 3.8 (95% CI [1.50, 9.62]) times more likely, and hospital cleaners were 6.5 (95% CI [2.12, 20.07]) times more likely to have depressive symptoms. Similarly, auto-repair workers were 6.3 times more likely to have symptoms of stress (95% CI [1.55, 25.90]). CONCLUSION: The prevalence of depressive and stress symptoms varied significantly depending on occupation and country of origin. It would behoove employers to screen for these mental health conditions and refer employees to the relevant healthcare services. Future studies could examine the feasibility of mental health screening programs among migrant employees.

Suicide literacy mediates the path from religiosity to suicide stigma among Muslim community adults: Cross-sectional data from four Arab countries.

BACKGROUND: The majority of research attention has been devoted to the link between religiosity and suicide risk, and a considerable amount of studies has been carried out on how stigma impacts individuals with mental health problems of different kinds. However, the interplay between religiosity, suicide literacy and suicide stigma has seldom been empirically researched, especially quantitatively. We sought through this study to redress the imbalance of research attention by examining the relationship between religiosity and suicide stigma; and the indirect and moderating effects of suicide literacy on this relationship. METHOD: A cross-sectional web-based survey was conducted among Arab-Muslim adults originating from four Arab countries (Egypt: N = 1029, Kuwait: N = 2182, Lebanon N = 781, Tunisia N = 2343; Total sample: N = 6335). The outcome measures included the Arabic Religiosity Scale which taps into variation in the degree of religiosity, the Stigma of Suicide Scale-short form to the solicit degree of stigma related to suicide, and the Literacy of Suicide Scale explores knowledge and understanding of suicide. RESULTS: Our Mediation analyses findings showed that literacy of suicide partially mediated the association between religiosity and stigmatizing attitude toward suicide. Higher religiosity was significantly associated with less literacy of suicide; higher literacy of suicide was significantly associated with less stigma of suicide. Finally, higher religiosity was directly and significantly associated with more stigmatization attitude toward suicide. CONCLUSION: We contribute the literature by showing, for the first time, that suicide literacy plays a mediating role in the association between religiosity and suicide stigma in a sample of Arab-Muslim community adults. This preliminarily suggests that the effects of religiosity on suicide stigma can be modifiable through improving suicide literacy. This implies that interventions targeting highly religious individuals should pay dual attention to increasing suicide literacy and lowering suicide stigma.

Effect of a WhatsApp walking trial on daily steps among female Saudi Arabian university students.

Objective: Physical inactivity in Saudi women is high, even among young women (60% of university students are physically inactive). We aimed to investigate the effect of a physical activity intervention on daily walking among female students at a Saudi university. Methods: Two hundred and seven female students (mean age: 22.6 ± 1.3; body mass index: 24.6 ± 5.9) participated in a parallel-group randomized trial. The intervention group wore pedometers and received health-promotion messages for 12 weeks through WhatsApp®; the control group received a similar number of messages unrelated to health. Average daily steps and self-reported activity were assessed at baseline and after 3 months. Analysis followed an intention-to-treat approach. Group differences in average daily steps were assessed using a two (group) by 2 (time) ANOVA. F-tests for main effects and the interaction were evaluated; P < 0.05 was considered significant. Results: There was a significant group-by-time interaction, that is, the intervention group had a significantly higher change in daily steps compared to the control group (+576 vs. -525; F = 4.33, P = 0.04). Self-reported daily activity was not significantly different by group. Conclusions: The intervention was effective at improving the number of daily steps in young women. Future studies could test this intervention among other student groups.

Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals.

BACKGROUND: There is evidence that culture deeply affects beliefs about mental illnesses' causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking. METHODS: We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public. RESULTS: More than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p < .001), knowledge (F = 88.7, p < .001), and help-seeking attitudes (F = 32.4, p < .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants. CONCLUSION: Interventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.

Knowledge of and attitude toward venous thromboembolism among professional drivers in Saudi Arabia.

Evidence suggests that professional drivers are at risk for venous thromboembolism (VTE), a life-threatening yet preventable disease. Awareness of VTE among this population has not been assessed in the Middle East. The study aimed to assess professional drivers' awareness of VTE and attitudes toward VTE preventive measures. We used a validated VTE awareness questionnaire to interview 324 drivers in Saudi Arabia during February-March 2020. Knowledge about VTE was the lowest compared to other medical conditions. Less than a third (31.8%) of the drivers were aware of VTE. Only 15.7% of those with prior awareness correctly identified all four deep vein thrombosis symptoms, and only 7.4% correctly identified all five pulmonary embolism symptoms. A significant proportion believed in unrelated practices for VTE prevention. Health promotion campaigns are urgently needed to raise awareness and to promote healthy behaviors.

Effect of interactive vs. passive virtual reality on pain threshold and tolerance.

OBJECTIVES: Scientific evidence suggests that virtual reality (VR) could potentially help patients tolerate painful medical procedures and conditions. The aim of this study was to evaluate the efficacy of virtual reality on pain tolerance and threshold. METHODS: A within-subjects experimental study design was conducted on 53 female students at Qassim University in Saudi Arabia. Each participant completed three rounds of assessment: one baseline (no VR) and two VR immersion (passive and interactive) in random order sequence. During each round, participants submerged their non-dominant hand into an ice bath; pain threshold and tolerance were measured as outcomes and analyzed using repeated measures ANOVA. RESULTS: Participants had both higher pain threshold and tolerance during interactive and passive VR rounds in comparison to the non-VR baseline assessment (p<0.05). Participants had greater pain tolerance during the interactive VR condition compared to the passive VR condition (p<0.001). CONCLUSIONS: VR experiences increase pain threshold and tolerance with minimal side effects, and the larger effects were demonstrated using interactive games. Interactive VR gaming should be considered and tested as a treatment for pain.

Gain in growth after surgical repair of congenital heart disease among children with Down syndrome.

Down syndrome (DS) is a common genetic disorder among Saudi children, for which limited data is available on growth for those who undergo surgery for congenital heart disease (CHD). We assessed the magnitude of growth over time following surgery and the factors associated with growth change. Eighty-eight children with DS and CHD who underwent surgery between 2009 and 2017 at the tertiary children's hospital in Al-Qassim, Saudi Arabia, were eligible. Information on gender, height, and weight (at surgery, 6 and 12 months), age at surgery, and type of CHD were abstracted from the medical records. Repeated measure analysis of variance (ANOVA) was used for data analysis. The sample's mean age (SD) was 16.2 months (20.1); 47% were male. Height, weight, and body mass index (BMI) increased significantly at both follow-up points. There was a significant interaction between age at surgery, type of heart disease, and time for all three physical indices (p-values <0.001). The increase in height, weight, and BMI was significantly greater for children ≤8 months old with acyanotic CHD compared to children >8 months with cyanotic CHD. Overall, the gain in growth was greater for the children with DS who had had surgery at a younger age.

Gender Differences in Sleep and Mental Health among Saudi Adolescents.

Among adolescents, mental health issues (i.e., stress and depressive symptoms) negatively affect sleep. We assessed whether the association between mental health and sleep varied between genders among Saudi adolescents. A total of 2206 school students (grades 7-12) from 40 randomly selected schools in four cities of Al-Qassim province in Saudi Arabia participated in this cross-sectional study. The survey assessed demography, lifestyle, sleep (12-item Medical Outcomes Study Sleep Scale), depression (Depression, Anxiety, Stress Scale (DASS-21)) and stress (10-item Perceived Stress Scale). Adjusted associations with sleep were tested with linear and logistic regressions. Of the sample, 55% were girls, and their average sleep score was lower than that of the boys (58.7 vs. 63.4, p < 0.001). Girls had worse mental health than boys; the proportion of girls with both severe stress and severe depressive symptoms was three times higher than that of the boys (12% vs. 4%, p < 0.001). For both boys and girls, those with severe depressive symptoms only or both severe depressive symptoms and severe stress had significantly lower sleep scores than those who had neither of the two conditions (reference group). On the other hand, among those who had severe stress only, the sleep score was significantly lower for the girls (p = 0.002) than for the boys (p = 0.19). Overall, girls had a significantly lower sleep score and worse mental health than boys. The association between mental health and sleep significantly differed between the sexes. Severe stress was negatively associated with sleep in girls but not in boys.

Internet addiction in Gulf countries: A systematic review and meta-analysis.

BACKGROUND AND AIMS: The prevalence of internet addiction (IA) varies widely in the Gulf Cooperation Council (GCC) countries (4%-82.6%). We aimed to assess the quality of IA studies from the GCC and pool their data to get an accurate estimate of the problem of IA in the region. METHODS: A systematic review of available studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane Controlled Register of Trials were systematically searched; studies conducted in GCC countries (i.e., Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) with a validated instrument for internet addiction assessment were eligible. Ten studies were eligible for the systematic review, all of which were included in the meta-analysis. The Newcastle Ottawa Scale was used for quality assessment. RESULTS: Nine out of ten of the included studies had either adolescent and/or young adult participants (age < 25). Two studies were of 'good' quality, six were of 'satisfactory' quality, and two were of 'unsatisfactory' quality. The pooled internet addiction prevalence was 33%; it was significantly higher among females than males (male = 24%, female = 48%, P = 0.05) and has significantly increased over time (P < 0.05). DISCUSSION AND CONCLUSIONS: One in every three individuals in GCC countries was deemed to be addicted to the internet, according to Young's Internet Addiction Test. A root cause analysis focusing on family structure, environment, and religious practices is needed to identify modifiable risk factors.

The associations of religiosity and family atmosphere with lifestyle among Saudi adolescents.

There have been gradual sociocultural changes in Saudi Arabia due to globalization. This allows a unique opportunity to examine religiosity and family atmosphere in relation to lifestyle among Saudi adolescents. In this cross-sectional study, 2067 school students (grades 7-12) from 32 randomly selected schools in Al-Qassim, Saudi Arabia were enrolled. Perceived religiosity, family atmosphere, lifestyle (e.g., physical activity, diet, screen time, obesity, and smoking), demography, parental attributes, and religious practices were assessed with validated scales and questions. A risk profile was created from the lifestyle variables (none, one, two, or ≥ three), and the students were grouped into low versus high religiosity and low versus high family atmosphere using a median split. Multinomial regressions were used to model the lifestyle risk profile. The mean age ±standard deviation was 15.5 years ±1.7, and 35% were girls; 28% had no risk factors, 32% had one, 25% had two, and 15% had ≥3. After adjustment, both low religiosity and low family atmosphere were significant correlates of the lifestyle risk profile (e.g., ≥3 risk factors: religiosity OR = 2.9, 95% CI: 2.1, 4.0; family atmosphere OR = 2.0, 95% CI: 1.5, 2.8). Those with both low religiosity and low family atmosphere were more likely to have a higher lifestyle risk profile than those who scored high in religiosity and better in family atmosphere (e.g., ≥3 risk factors: OR = 5.9, 95% CI: 3.7, 9.5). Hence, higher religiosity and better family atmosphere are associated with less risky lifestyles among Saudi adolescents.

Assessment of nationally representative dietary studies in the Gulf Cooperation Council: a scoping review.

BACKGROUND: Obesity is at a record high in Gulf Cooperation Council (GCC) countries and is expected to continue increasing. Diet is a major contributor to this disease, but there is inadequate nationally representative dietary research from these countries. The aim was to quantify the number dietary studies using food frequency questionnaires (FFQs) that have been conducted in individual GCC countries and to assess the quality of eligible studies. METHODOLOGY: Four databases (PubMed, Web of Science, MEDLINE, and DOAJ) were searched for keywords; records were screened for eligible studies and data were abstracted on study characteristics (publication year, geographical locations, sample size, units of measurement, number of foods examined, number of Arab foods and key findings). Quality was assessed using an adapted Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies. RESULTS: Only seven studies were eligible from four of six GCC countries (Saudi Arabia, Bahrain, Kuwait and Qatar). All eligible studies used FFQs, but only 29% used a validated questionnaire, one being in Arabic, and none of the studies used any additional tools to measure diet. Fifty-seven percent of studies made an effort to include local foods. The majority of studies (71%) either measured frequency or quantity of food consumed, but only 29% attempted to account for both frequency and quantity. CONCLUSIONS: The quality of studies varied and major weaknesses of FFQ validity and adaptability have been highlighted. More dietary investigations are needed using validated FFQs that have been adapted to the local GCC diets. Using reference tools will allow for better dietary estimations.

Saudi women's physical activity habits during pregnancy.

BACKGROUND: Despite many benefits of physical exercise to women during pregnancy, the majority of Saudi women do not engage in an adequate amount of activity because of common barriers such as fatigue, lack of motivation, and childcare. The purpose of this study was to estimate the proportion of Saudi women who get adequate exercise during pregnancy as well as to evaluate their knowledge of, attitude toward, and barriers to physical exercise during pregnancy. METHODS: This study had a cross-sectional design. Data were collected retrospectively (average time: 1 year after the birth), using translated questionnaires (English to Arabic), from primary health care centers and from the Maternity and Children Hospital in Qassim, Saudi Arabia. Logistic regression was employed to assess the a priori correlates of adequate exercise during pregnancy (primary outcome). RESULTS: The sample included 274 women, who had a mean age of 31.9 years. A majority of the women thought that physical exercise during pregnancy was necessary and had high knowledge levels (mean = 77; median = 75) about types and amount of physical activity. Less than half of the women were either walking (26%) or exercising (42%) adequately (i.e. ⩾150 min/week). Age (odds ratio: 1.79), number of pregnancies (odds ratio: 2.41), attitude toward exercise (odds ratio: 2.71), and self-rated health (odds ratio: 2.50) were significant correlates of adequate exercise during pregnancy. Among those who reported no physical exercise during pregnancy (n = 68), the following barriers were most common: tiredness (25.0%), fear (18.1%), dislike of exercise (16.7%), and lack of information (16.7%). CONCLUSION: For Saudi women, interventions are needed during pre-natal checkups to promote and maintain adequate physical activity levels during pregnancy.

Substance use disorders in Saudi Arabia: a scoping review.

BACKGROUND: Substance use disorders (SUD) are mental health conditions that arise from chronic drug use. There is an increased recognition of this problem in Saudi Arabia. OBJECTIVE: Conduct a comprehensive review of published literature on SUD to identify knowledge gaps and to guide future research. METHODS: PubMed, Embase and Cochrane databases were searched with suitable keywords for SUD publications up to June 10, 2019. Eligible studies (primary research conducted in Saudi Arabia) were organized into three broad domains: (1) risk (or protective) factors of SUD, (2) perspectives on drug use of people who use drugs, and (3) impact on family. The quality of the included studies was assessed with the Newcastle-Ottawa Scale. RESULTS: Of the 113 search records, 23 were eligible for analysis (19 cross-sectional and 4 case-control). All studies were conducted in clinical settings; all but two included males only. There were 4 studies about SUD risk factors, 6 studies about the perspectives of people who use drugs, and none about family impact. None of the cross-sectional studies (0%) and 25% of case-control studies were of good quality. CONCLUSIONS: The available studies were few in number, weak in methodology, and poor in quality. Quantitative as well as qualitative studies about SUD are warranted in each domain and should represent both genders.

Gaming addiction and perceived stress among Saudi adolescents.

INTRODUCTION: Adolescents (age: 10-19 years) make up 15% of the Saudi population and have easy access to electronic gadgets and the Internet, yet data on gaming addiction among adolescents are negligible. We aimed to determine the prevalence of gaming addiction and its association with stress among Saudi school students. METHODS: In this cross-sectional survey, 2675 school students (grades 7-12) from 40 randomly selected schools in four main cities of Al-Qassim province in Saudi Arabia participated. The questionnaire inquired about demography, lifestyle, gaming addiction (7-item Game Addiction Scale), and stress (10-item Perceived Stress Scale). Multinomial logistic regression assessed the association between gaming addiction (yes, no) and stress (high, moderate, low). RESULTS: Participants' mean age was 16.1 (SD = 1.6) years; 50% were female; 64% reported >3 h of daily screen time; 5% were addicted to gaming; 11.4% had high-level stress. Addiction to gaming was strongly associated with stress in the adjusted analysis (moderate OR = 6.7, 95% CI = 2.9-15.5; high OR = 11.9, 95% CI = 4.7-30.1). Additionally, those who were older, female, had poor grades, unhealthy dietary habits, an inactive lifestyle, and smoked were more likely to experience high stress. CONCLUSIONS: Gaming addiction is strongly associated with stress among Saudi adolescents.

Job insecurity, fear of litigation, and mental health among expatriate nurses.

The objective was to assess whether job insecurity and fear of litigation were correlates of depression, anxiety, and stress among expatriate nurses in Saudi Arabia. The participants included 977 expatriate nurses working in Al-Qassim, Saudi Arabia who completed an online survey that assessed depression, anxiety, and stress (using DASS-21) as well as demography, lifestyle, and job characteristics. Mean age was 32 years and 60% of nurses were from India/Pakistan. Twenty-four percent of nurses reported job insecurity, and 18% reported a fear of litigation. Severe depression, anxiety, and stress were significantly higher among nurses who always felt insecure about their job (compared to never) and among those who always feared litigation (compared to never). We concluded that job insecurity and fear of litigation were significant correlates of severe depression, anxiety, and stress among expatriate nurses.