Zinc status or supplementation and its relation to soil-transmitted helminthiasis in children: A systematic review.

Soil-transmitted helminths (STHs) parasitic infection is known as one of the most common infections around the world affecting more than a quarter of the world's population. The relationship between STH infections and micronutrient deficiencies are closely related and often coexist among the affected population. The study, therefore, aimed to summarise the available literature focusing on the effect of zinc status/deficiency or supplementation on STH infection or reinfection in children. For this purpose, we adopted a systematic approach and searched the existing literature on PubMed, Scopus, and Cochrane Library databases. A search term was entered to retrieve the available data. A total of 12 articles were included in this review after applying the inclusion/exclusion criteria. Most of the included studies reported a lower zinc status in children affected with any parasitic infection. Regarding the effect of zinc status and supplementation on parasitic infection in children, we found only a few studies (n = 4) with inconsistent result findings. This review reported that children infected with STH have lower zinc levels; however, a limited number of studies showed the effect of zinc supplements on the risk of STH warrants the need for further studies in this regard.

Physical activity and health-related quality of life among adults living in Jeddah city Saudi Arabia.

Background: Physical activity can improve health-related quality of life (HRQoL) in adults. However, the effect of physical activity on quality of life is unclear among the Saudi adult population. The study aimed to determine the association between physical activity and HRQoL in apparently healthy adults in Jeddah, Saudi Arabia. Methods: This cross-sectional study was conducted among visitors of shopping malls, walking tracks/fitness centres/gyms and governmental hospitals in Jeddah from March to September 2022. Physical activity was measured with the electronic template of the general practice physical activity questionnaire (GPPAQ), while the HRQoL was measured using the 36-Item Short Form Survey (SF-36) questionnaire. A multiple linear regression model investigated the relationship between physical activity and HRQoL. Results: A total of 693 individuals participated in this study, with a mean age of 36 (±11). Individuals who fall in the active category of the physical activity level were mostly younger men (37% vs 21%), were non-smokers (30% vs 10%) and had no comorbid condition (29% vs 15%). After adjusting for covariates, men (adjusted ß 4.43, 95% CI [1.44-7.41]) with higher physical activity levels (active-adjusted ß 10.11, 95% CI [5.44-14.77]) had better scores on the physical component summary (PCS). Similarly, mental component summary (MCS) scores for men (adjusted ß 6.51, 95% CI [3.40-9.63]) and physical activity levels (active-adjusted ß 9.77, 95% CI [4.90-14.64]) were high. Conclusion: The article reinforces how physical activity contributes towards each dimension of HRQoL. Physical inactivity is a growing public health challenge in Saudi Arabia, affecting all age groups. Investing in innovative strategies and establishing targeted health education programs for academic institutions and communities are required to enhance healthy habits. Additionally, constructing more local sports facilities and concession packages, especially for the females at the gyms, can motivate individuals and promote physical activity.

Spirulina, an FDA-Approved Functional Food: Worth the Hype?

Spirulina, a blue-green microalga is an eminent functional food due to its unique nutritional and disease-mitigating properties. The main objective of this article is to present an overview of the nutritional composition of Spirulina. Along with its therapeutic potential and applications in the food industry. Studies included in this review have suggested spirulina to be a rich source of complete proteins, essential fatty acids (EFAs), vitamins, minerals and various bioactive compounds like carotenoids, chlorophyll, and xanthophylls. This makes Spirulina a promising functional food for the treatment of ailments like diabetes, cancer, cardiovascular disorders (CVDs), COVID-19, neuroinflammatory conditions and gut dysbiosis. Additionally, data from numerous studies suggest its use in food formulations, primarily in sports supplements, bakery products, beverages, dairy products, snack sources and confectionaries. It has also been used by the National Aeronautics and Space Association (NASA) for astronauts on space missions to the Moon and Mars. Furthermore, spirulina's use as a natural food additive possesses enormous potential for further research. Owing to its high nutritional profile and disease-fighting potential, it lends itself to numerous food formulations. Therefore, based on the findings of previous studies, further progress can be made considering spirulina's application in the food additive industry.

Effect of inulin, galacto oligosaccharides and iron fortification on iron deficiency anemia among women of reproductive age; a randomized controlled trial.

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value < 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 µg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 µg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

Nutrition competence of primary care physicians in Saudi Arabia: a cross-sectional study.

OBJECTIVES: Primary care physicians have an opportunity to support healthy dietary behaviours of patients by providing nutrition care. However, it is unclear whether primary care physicians in the Kingdom of Saudi Arabia (KSA) are sufficiently competent in nutrition. This study aimed to assess the nutrition competence of primary care physicians in KSA and identify whether nutrition competence is associated with the provision of nutrition care to patients living with diet-related chronic disease. DESIGN: A cross-sectional study. SETTING: Chronic disease clinics across 48 primary care centres under the Ministry of Health in the city of Jeddah, KSA. PARTICIPANTS: 90 primary care physicians completed the survey (response rate: 98%). General practitioners and family medicine residents, specialists, and consultants actively working in chronic disease clinics between February and May 2019 were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was nutrition competence of primary care physicians measured via the validated NUTCOMP (nutrition competence) questionnaire. RESULTS: Primary care physicians perceived themselves as competent in nutrition care but their reported provision of nutrition care was limited. Confidence in their nutrition knowledge and skills elicited the lowest mean scores of 25.8 (±5.4) out of 35 and 29 (±5.2) out of 40, respectively. The reported provision of nutrition care was closely correlated with physicians' confidence in their nutrition knowledge (r=0.57) and communication (r=0.52). Three factors were identified as predicting whether physicians provide nutrition care to patients: confidence in counselling about nutrition (p<0.001), having previous nutrition education (p=0.005) and a higher professional qualification (p=0.008). CONCLUSIONS: Primary care physicians felt confident in providing nutrition care to patients living with diet-related chronic disease. Primary care physicians would benefit from higher levels of nutrition knowledge and skills to effectively support patients to improve their dietary behaviours and health conditions, leading to a positive impact on public health.

High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia.

BACKGROUND: Tuberculosis (TB) remains a major global public health problem in many developing countries including Kingdom of Saudi Arabia (KSA). Patient compliance with anti-tuberculosis treatment is a determining factor in controlling the spread of TB. This study compares the default rate and the perception of their treatment among TB patients being treated by means of a community mobile outreach approach, with those of patients being treated by means of a facility-based Directly Observed Treatment Short course (DOTS) in the Jeddah region of Saudi Arabia. METHODS: A comparative cross-sectional study of 200 TB patients who presented at the Madain Alfahd Primary Health Care Center (PHCC) Jeddah, between January 2018 and November 2018 was undertaken. In one group, randomly assigned patients were served by mobile outreach teams who administered oral anti-TB treatment under the DOTS regime. In the other group, the patients were treated by means of the traditional facility-based DOTS treatment. A questionnaire measuring patient attitudes and understanding of the disease and their treatment modes was completed by patients at the beginning of their treatment, and again after 3 months. The results were analysed by means of independent and Paired T Tests, along with chi square analysis. RESULTS: We found that the overall default rate among those patients served by our mobile outreach team was only 3%, compared with a 22% default rate among non-mobile team treated patients (p = < 0.001). A major change in the attitude and understanding scores of patients was noted in both groups after 3 months. A significant difference was also noted in the mean compliance scores (mobile team served =58.43 and facility-based =55.55, p < 0.001) after 3 months of treatment. CONCLUSION: Our study indicated that treatment by means of our mobile outreach DOTS can offer an effective strategy for the treatment of TB patients. A reduced patient default rate and a better understanding of the disease and its treatment confirmed a positive impact of mobile outreach teams on these patients. Treating TB patients by means of mobile outreach teams can thus be recommended as a means for the cure and prevention of the further spread of the disease.

Challenges faced by marginalized communities such as transgenders in Pakistan.

INTRODUCTION: Stigmatization, social exclusion and consequent banishment from the society makes transgender's life even tougher; isolating, pushing and forcing them into inappropriate conducts/habits like selling sex. This study investigates the association of social exclusion/victimization with high-risk behaviors among transgender community of Rawalpindi and Islamabad (Pakistan). METHODS: Through a cross-sectional study design, a sample of 189 transgender community living in twin cities of Rawalpindi and Islamabad was selected using snowball sampling technique. A validated close ended questionnaire was used to estimate the high-risk behaviors. Multivariate logistic regression was used to explore the competing outcomes associated with suicidal risk, selling sex and substance abuse. RESULTS: Majority study participants 77.8% experienced physical attacks with institutional discrimination even higher (91.5%). Commercial sex work and drug abuse was reported in 39.2% and 37.6% respectively. The prevalence of suicide ideation was high (38.6%) however, suicide attempted rate was less (18.5%). In the multivariate logistic regression, compared to those with no risk, being physically attacked increased the odds of both attempting (OR=2.18) and contemplating suicide and selling sex (OR=4.10). Nevertheless, the relative impact of institutional victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression (AOR = 6.20, CI = 1.58-24.29, p=0.009). CONCLUSION: The transgender community is socially excluded by the Pakistani society where they experience high levels of physical abuse and face discriminatory behavior in daily life. Such attitudes make them vulnerable for risky behaviors; forcing them to become commercial sex workers, begging, drugs use and even suicidal ideation.

Epidemic of Kala Pathar(Paraphenylene Diamine) Poisoning: an Emerging Threat in Southern Punjab.

OBJECTIVE: To assess cases of the spectrum of Kala Patharpoisoning in all age groups. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Combined Military Hospital (CMH) Bahawalpur and Bahawal Victoria Hospital (BVH), Bahawalpur, from January 2016 to April 2017. METHODOLOGY: All the cases of Kala Pathar(Paraphenylene diamine (PPD)) poisoning, admitted and treated at the study places during said period were included in the study. The assessed variable included gender, age, education status, socioeconomic status, reason of poisoning and mortality. Chi-square was applied for qualitative variables with p-value less than 0.05 was considered significant. RESULTS: A total of 1,258 cases of PPD poisoning were included in the study; 814 (64.7%) females and 444 (35.3%) males. Their age ranged from 5 - 63 years, with median age 21 (IQR 4). Sixty-six (5.2%) were children and the rest 1,192 (94.8%) were adults. In adults 1,125 (94.37%) cases of PPD poisoning were suicidal and 62 (5.20%) accidental cases; only 5 (0.42%)adults were intentionally poisoned. On the other hand, only one child took it with suicidal intent, 54 (81.81%) ingested it accidentally and 11 (16.66%) children were given poison deliberately with the intent to murder. The overall mortality was 24.08% - 22.81% in adults, and 46.96% in children. CONCLUSION: Kala Pathar(PPD) is a lethal substance when ingested. PPD poisoning is not limited to adults; many cases of pediatric poisoning are also being reported in Southern Punjab. Mortality due to Kala Patharis high. Tracheostomy should be done immediately in all such cases; and high intensive multidisciplinary approach is required.

Professional satisfaction of family physicians working in primary healthcare centers: A comparison of two Saudi regions.

INTRODUCTION: As a new healthcare market force and first point of contact, family physicians (FPs) play a key role in healthcare delivery system. It is vital to understand issues that affect performance and satisfaction with their practices and working environment. The objectives of this study are to assess the level of professional satisfaction and to compare and identify the factors potentially associated with professional satisfaction/dissatisfaction among FPs of two regions. MATERIALS AND METHODS: A comparative cross-sectional study on FPs working in primary healthcare centers under Ministry of Health was conducted in two regions (Jeddah and Eastern region) to assess job satisfaction and dissatisfaction among them. Validated close-ended questionnaire was emailed. Overall satisfaction along with the associated factors was identified. Chi-square and multivariate regression analyses were performed to test the association between job satisfaction and predictors. RESULTS: A total of 237 FPs completed the survey and an overall 62% of them were satisfied. Male doctors were less in number yet more satisfied (71%). FPs of eastern region were slightly more satisfied (63.4%) when compared with 59.2% of Jeddah. Factors significantly associated with professional dissatisfaction included FPs having the opinion that they were not respected by community members [odds ratio (OR) 2.7, confidence interval (CI): 1.24-5.97, P = 0.012] and FPs' own perception of being inferior to other specialties (OR 13.59, CI: 4.98-37.07, P < 0.001). CONCLUSION: More than half of the FPs were professionally satisfied; however, the majority had perception of being inferior to other specialties. Improving self-esteem, working environment, and addressing other identified factors for dissatisfaction can help FPs overcome their stresses, leading to better healthcare delivery.

Factors Associated with Consuming Junk Food among Saudi Adults in Jeddah City.

Introduction Junk food (JF) consumption trend is increasing in all parts of the world. The transition in lifestyle and dietary habits is leading to many non-communicable diseases. The objectives of this study are twofold: (1) To examine the prevalence of junk food consumption and factors associated with consuming junk food among Saudi adults in Jeddah; and (2) to compare the trends of junk food consumption among males and females in Jeddah. Methodology This cross-sectional study was conducted in five different Primary Health Care centers (PHCCs) of Jeddah working under Ministry of Health. The subjects were men (n = 146) and women (n = 254) aged 18-67 years visiting these centers. Structured validated close ended questionnaire was filled by all the participants. Data analysis was done using SPSS. Chi-square was applied to analyze the difference between male and female JF consumption and multivariate logistic regression analysis was done to examine the risk factors. Results Overall the JF consumption in subjects with mean age 33.69 ± 12.29 years was highly prevalent in both genders (86.5%); (men = 85.6% and women = 87.4%). Controlling for some demographic and socioeconomic variables, increased junk food consumption was independently associated with education (OR = 2.47, 95% CI: 1.088-5.605, p = 0.031), individuals who had limited time (OR = 3.82, 95% CI: 1.690-8.642, p < 0.001), for the change of routine and taste (OR = 7.64, 95% CI: 3.145-18.563, p < 0.001 and OR = 11.031, 95% CI: 4.219-28.843, p < 0.001, respectively). Conclusion The study findings provide evidence on the high prevalence of junk food consumption among Saudi adults. Junk food has influence in the dietary patterns of Saudi adults and this trend is likely to rise. This growing widespread use of junk food is of concern which may cause obesity-related non-communicable diseases.

Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia.

Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p <0.001), unorganized patients flow to clinics (p=0.021), more paperwork (p<0.001), and less co-operative colleague doctors (p=0.045) were the significant predictors for high emotional exhaustion. A positive correlation was noted between the number of patients per day and burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

KNOWLEDGE, ATTITUDES AND PRACTICES OF HEPATITIS B AND C AMONG BARBERS OF URBAN AND RURAL AREAS OF RAWALPINDI AND ISLAMABAD.

BACKGROUND: Hepatitis B and Hepatitis C are serious global public health problems with a prevalence of 10-15% with majority of the cases seen in the developing countries including Pakistan. It is a blood borne infection transmitted by infected blood and blood products through transfusions, contaminated needles, vertical transmission, unsafe sex and reuse of razors by barbers. The literature search so far did not reveal any study comparing knowledge, attitude and practices of hepatitis B & C in barbers working in Urban and rural areas. METHODS: A comparative cross sectional survey was carried out among barbers of urban and rural areas of Rawalpindi and Islamabad. A structured close ended questionnaire was filled from total of 202 barbers by non-probability convenience sampling technique. Comparative data analysis was done including variables like age, education, knowledge about hepatitis B & C, mode of transmission, role of the blades and media etc. RESULTS: Knowledge about hepatitis B & C was good in urban areas (92%) as compared to those working in the rural areas (68%). Using new blade for every customer was seen in urban (100%) and rural (93%) area. However barbers knowledge about symptoms of the disease (urban 81% & rural 93%) and vaccination trend of Hepatitis B was low. CONCLUSION: This study showed a marked difference in the knowledge, attitude and practices of the barbers working in the urban and the rural areas. Main focus should be on launching Health education programs and behaviour change communication campaigns for the barbers. Strict regulatory monitoring must be done against unlicensed street barbers.