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.

Prevalence and Associated Factors of Problematic Use of Smartphones Among Adults in Qassim, Saudi Arabia: Cross-sectional Survey.

BACKGROUND: The Kingdom of Saudi Arabia (KSA) ranks third globally in smartphone use. Smartphones have made many aspects of life easier. However, the overuse of smartphones is associated with physical and psychosocial problems. OBJECTIVE: The aim of this paper is to estimate the prevalence and associated factors of problematic use of smartphones among adults in the Qassim region of KSA. METHODS: We enrolled 715 participants using cluster random sampling for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. RESULTS: We estimated the prevalence of problematic smartphone use among adults at 64% (453/708). Multivariable logistic regression analysis suggested that students are 3 times more likely to demonstrate problematic use compared with unemployed individuals (P=.03); adults using more than five apps are 2 times more likely to demonstrate problematic use compared to those using a maximum of three apps (P=.007). Protective factors against problematic smartphone use include using apps for academic (odds ratio [OR] 0.66; P=.04) or religious needs (OR 0.55; P=.007) and having a monthly family income of 5001-10,000 SAR (Saudi Riyal; US $1300-$2700; OR 0.46; P=.01) or 10,001-20,000 SAR (US $2700-$5400; OR 0.51; P=.03) compared to the <1501 SAR (US $400) income group. CONCLUSIONS: We reported a very high prevalence of problematic use of smartphones in KSA. Considering its negative impact on physical and psychosocial health, public health programs should develop preventive strategies.

Effect of easing lockdown and restriction measures on COVID-19 epidemic projection: A case study of Saudi Arabia.

OBJECTIVES: In this study we compared two predictions of COVID-19 cases in the Kingdom Saudi Arabia (KSA) using pre-and post-relaxation of lockdown period data to provide an insight regarding rational exit strategies. We also applied these projections to understand economic costs versus health benefit of lockdown measures. METHODS: We analyzed open access data on COVID-19 cases from March 6 to January 16, 2021 in the KSA. To understand the epidemic projection during the pre- and post-lockdown period, we used two types of modeling: the SIR model, and the time series model. We also estimated the costs and benefits of lockdown- QALY gained compared to the costs of lockdown considering the payment threshold of the Government. RESULTS: Prediction using lockdown period data suggested that the epidemic might slow down significantly after 109 thousand cases and end on October 6, 2020. However, analysis with latest data after easing lockdown measures suggested that epidemic might be close to an end on October 28, 2021 with 358 thousand cases. The peak has also been shifted from May 18, 2020 to Jun 24, 2020. While earlier model predicted a steady growth in mid-June, the revised model with latest data predicted it in mid-August. In addition, we estimated that 4986 lives would have been saved if lockdown continued but the cost per life saved would be more than $378 thousand, which is way above not only the KSA threshold, but also the threshold of any other highly advanced economies such as the UK and the USA. CONCLUSIONS: Our results suggest that relaxation of lockdown measures negatively impacts the epidemic. However, considering the negative impact of prolong lockdown measures on health and economy, countries must decide on the best timing and strategy to exit from such measures to safely return to normal life with minimum loss of lives and economy considering its economic and health systems' capacity. Instead of focusing only on health, a balanced approach taking economy under consideration is recommended.

The Health Belief Model Predicts Intention to Receive the COVID-19 Vaccine in Saudi Arabia: Results from a Cross-Sectional Survey.

We examined the intention and predictors of accepting the COVID-19 vaccine in Saudi Arabia. We conducted a nation-wide, cross-sectional online survey between February and March 2021. A total of 1387 people (≥18 years) participated. Only 27.3% adults had a definite and 30.2% had a probable vaccination intent; 26.8% and 15.6% had a probable and definite negative vaccination intent. Older people (≥50 years) (p < 0.01), healthcare workers/professionals (p < 0.001), and those who received flu vaccine (p < 0.001) were more likely to have a positive intent. People from Riyadh were less likely to receive the vaccine (p < 0.05). Among the health belief model constructs, perceived susceptibility to and severity of COVID-19 (p < 0.001), and perceived benefit of the vaccine (p < 0.001) were positively associated with vaccination intent, whereas perceived barriers had a negative association (p < 0.001). Individuals were more likely to receive the vaccine after obtaining complete information (p < 0.001) and when the vaccine uptake would be more common amongst the public (p < 0.001).

Tear down the walls: Disseminating open access research for a global impact.

OBJECTIVE: Publications are the cornerstone of the dissemination of scientific innovation and scholarly work, but published works are mostly behind paywalls. Therefore, many researchers and institutions are searching for alternative models for disseminating scholarly work that bypasses the current structure of paywalls. This study aimed to determine whether a self-published open access (OA) journal, the International Journal of Health Sciences (IJHS), has been able to reach a global audience in terms of authorship, readership, and impact using the OA model. METHODS: All IJHS articles were retrieved and analyzed using scientometric methods. Using the keywords from abstracts and titles, unsupervised clustering was performed to map research trends. Network analysis was used to chart the network of collaboration. The analysis of articles' metadata and the visualizations was performed using R programming language. RESULTS: Using Google Scholar as a source, the general statistics of IJHS from inception to 2019 showed that the average citation per article was 11.29, and the impact factor of the journal was 2.28. The results demonstrate the obvious local and global impact of a locally published journal that allows unrestricted OA and uses an open source publishing platform. The journal's success at attracting diverse topics, authors, and readers is a testament to the power of the OA model. CONCLUSIONS: Open source is feasible and rewarding and enables a global reach for research from under-represented regions. Local journals can help the Global South disseminate their scholarly work, which is frequently ignored by commercial and established publications.

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.

Association of cumulative job dissatisfaction with depression, anxiety and stress among expatriate nurses in Saudi Arabia.

AIMS: We aimed to (a) determine the prevalence of depression, anxiety and stress among expatriate nurses in Saudi Arabia, and (b) assess how dissatisfaction with salary, workload and teamwork, individually and in combination, was associated with those conditions. BACKGROUND: Prevalence estimates for depression, anxiety and stress among nurses are higher than those in the general population. Available data on the mental health of expatriate nurses are limited. METHODS: Expatriate nurses (n = 977) from governmental hospitals completed an electronic survey on demography, lifestyle, job factors, depression, anxiety and stress (assessed with DASS-21 scale). Multinomial logistic regressions were used for analyses. RESULTS: Dissatisfaction with workload and teamwork was significantly associated with both mild/moderate and severe depression in adjusted models. Dissatisfaction with workload was significantly associated with both anxiety and stress, but teamwork was not. There was a significant dose-response relationship between the number of domains of dissatisfaction and depression, anxiety and stress (p for trend was < 0.001). CONCLUSIONS: Dissatisfaction with salary, workload and teamwork is associated with depression, anxiety and stress in expatriate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital and nursing administrators should identify specific aspects related to workload and teamwork and offer solutions to reduce mental health distress among nurses.

Establishment of an Accelerated Doctor of Family Medicine Program at Unaizah College of Medicine, Qassim University, Kingdom of Saudi Arabia.

Primary health care is well known to be the cornerstone for the health of the society. Furthermore, efficient health care at the secondary and tertiary levels is entirely dependent on effective primary health care. The Kingdom of Saudi Arabia (KSA) is currently building up a rigorous primary health care system with a large number of well-equipped primary health care centers. However, there is an acute shortage of Saudi family physicians throughout the country; both in urban and rural areas. There is no evidence in the literature supporting the relatively long 7 years' traditional duration of medical programs in the KSA. Rather, several US and Canadian medical schools have established accelerated programs in Internal Medicine and Family Medicine with graduates comparable with those of the traditional curricula in terms of standardized tests, initial resident characteristics, and performance outcomes. In response to the challenges the KSA is facing in primary health care, Unaizah College of Medicine at Qassim University is proposing to establish an accelerated Doctor of Family Medicine Program that would run for total duration of 6 years. Herein, we describe a concise outline of this program.

Comparison between faculty and students perspectives on the qualities of a good medical teacher: A cross-sectional study.

OBJECTIVES: This study aimed to explore faculty and students perceptions on the qualities of good medical teachers, and to determine whether the opinions of faculty and students differed. METHODS: Two quantitative surveys were performed at Qassim University College of Medicine using a pretested self-administered questionnaire distributed to the faculty and students of the college. It captured their opinions about qualities and attributes of good teachers. Each item was measured on a 5-point Likert scale. Data were entered and analyzed using SPSS. RESULTS: A total of 90 faculty and 356 students responded with a response rate of 64%. Overall scores on the performance and personality scales were similar between faculty and students. Faculty and students agreed that "organizes good lectures/use of audiovisual aids" and "expert on the subject/knowledgeable" are important attributes and that telling jokes and the sense of humor or sharing personal experiences are not as important. Students felt it is important for an educator to be respectful, good planner and examiner, whereas faculty members felt that communication skills are of high importance. CONCLUSION: Faculty development programs should be designed to help faculty develop and improve on the identified qualities.

Prevalence and factors associated with anxiety and depression among type 2 diabetes in Qassim: A descriptive cross-sectional study.

OBJECTIVES: To assess the prevalence of anxiety and depression and to identify their associated risk factors among people with type 2 diabetes mellitus. METHODS: A cross-sectional, single-centre study that included 300 adults with type 2 diabetes mellitus was conducted at The Diabetic Center of King Saud Hospital in the Qassim region. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was conducted to evaluate the combined effect of various factors associated with anxiety and depression, adjusting for confounding variables. RESULTS: Overall, 43.6% (95% CI: 37.9-49.3%) and 34.8% (95% CI: 29-40%) of the participants experienced anxiety and depression, respectively. Anxiety was more common among patients who had poor social support (OR 5.35, P 0.001). Anxiety was less common among retired people (OR 0.36, P 0.048) and those having diabetes for more than ten years (OR 0.39, P 0.006). In contrast, depression was more common among patients who had received moderate (OR 2.47, P 0.031) or low social support (OR 6.62, P 0.000) but less common among those having diabetes for more than ten years (OR 0.44, P 0.022). CONCLUSION: This study showed that the prevalence of anxiety and depression is high among adults with type 2 diabetes mellitus. These results should alert clinicians to identify and treat anxiety and depression as part of multidisciplinary diabetes care. Larger community-based studies are needed to identify the magnitude of these problems and their related factors.

Experiences of Barriers and Motivators to Weight-Loss among Saudi People with Overweight or Obesity in Qassim Region - A Qualitative Study.

BACKGROUND: Obesity has become a global health threat. Saudi Arabia ranks among the countries with high obesity and overweight rates. This study aims to explore experiences of Saudi people with overweight or obesity with a particular focus on the perceived barriers and motivators to weight loss. MATERIAL AND METHODS: We used a qualitative approach to recruiting a purposive sample using maximum variation sampling technique. Those who had previously attempted weight loss at least once were included in the study. In-depth interviews were conducted, transcribed and/ or audiotaped. Interviews continued until saturation was reached. The qualitative content analysis was performed. RESULTS: A total of 19 males and 18 females participated in this study with a mean Body Mass Index (BMI) of 32.6 kg/m2. Their main triggers to weight loss were concerns about overall health and the desire to improve their looks. Declining motivation, lack of family support and unhealthy eating during social gatherings were perceived as the main barriers. Motivating factors included concerns about health, family support, and availability of exercise facilities. CONCLUSION: Factors responsible for a successful weight- loss is context-specific. This study has shown several barriers as well as motivators, which play an important role in weight reduction and maintenance.

Parents' perception of children's obesity, in Al-Qassim, Saudi Arabia.

BACKGROUND AND OBJECTIVES: Although the prevalence of childhood obesity has increased significantly in Saudi Arabia, parents are unable to appreciate obesity in their child. The objective of the study was to identify the percentage of parents who misclassify the status of child's weight, and determine whether there is a difference between those parents whose children are overweight and obese and those with children of normal weight. MATERIALS AND METHODS: This cross-sectional study included 601 children aged 6-10 years. The children were recruited from the primary schools located in Al-Qassim, Saudi Arabia. The body mass index of the children was assessed in the school, and their parents responded to a self-administered questionnaire which contained questions on parental perception of the children's weight/obesity status. Data were entered and analyzed using SPSS. RESULTS: Parents with overweight/obese children had significantly more misclassification than those with normal weight children. Ninety percent of parents of the 81 overweight children misclassified and reported that their child had normal weight, while 65% of parents of the 61 obese children, misclassified the child's weight status. CONCLUSIONS: The level of misclassification of children's weight status by parents is high. Saudi parents with overweight and obese children do not recognize their child's weight status. Parents' awareness of childhood obesity and its negative health impact needs to be improved.

Students' perception and experience of intimate area examination and sexual history taking during undergraduate clinical skills training: A study from two Saudi medical colleges.

This study explores the experiences of Saudi undergraduate medical students about intimate-area examination (IAE) and sexual history taking (SHT) skills and assesses the barriers and their impacts on students' learning. This survey-based study was performed at 2 Saudi university medical colleges and revealed that most of the students never performed IAE, that is, female breast, male genital, female genital, female pelvic, male rectal, and female rectal. We found that 42.3% students had never taken any sexual history during their course. Both, male and female students reported barriers of patient refusal, mismatched sex, cultural background, ethical factors, lack of supervision, lack of training, and lack of skills. Among the currently used pedagogical techniques, majority of the students were satisfied with real patient-based learning, followed by video and manikin-based learning. The study indicates that Saudi students do not have sufficient experience of IAE and SHT because of above-mentioned barriers along with religious issues. This study suggests that teachers provide positive support to students and that they develop novel, competent teaching-and-learning techniques to meet the skills training of students without compromising on religious, sociocultural, and ethical values of the kingdom.

Depression among migrant workers in Al-Qassim, Saudi Arabia.

BACKGROUND: Mental disorders are common among migrant workers. There is no data on depression in Saudi Arabia among them; although, they are a third of the population. OBJECTIVE: To determine the prevalence of depression and to assess its relationship with duration of stay and living condition in a sample of migrant workers. METHODS: A cross-sectional survey of 400 migrant workers was conducted in Al-Qassim region of Saudi Arabia. Exposure and covariate factors were assessed with a standardized questionnaire, depression with the CES-D (Center for Epidemiological Studies on Depression) scale, and physical indices (e.g. weight, height, and blood pressure) with a general examination. Logistic regression was used to identify significant correlates of depression. RESULTS: Depression prevalence was 20%; it did not vary by duration of stay or living condition but by age, stress, and self-reported health. In the multivariate model, those who reported 'moderate' or 'high' levels of stress were 1.7 (95% CI: 0.9, 3.1) and 3.9 (95% CI: 1.7, 9.1) times more likely to have depression (reference ='low' level), respectively. Similarly, those who rated their health either 'good' or 'fair to very poor' were 3.4 (95% CI: 1.9, 6.1) and 4.8 (95% CI: 2.3, 10.1) times more likely to have depression (reference ='excellent/very good'), respectively. LIMITATIONS: The data were collected from one company and pertained to only male participants, and the study design could not establish temporal sequence between the exposure and outcome variables. CONCLUSION: Depression is considerably high in this population; a large-scale and nationally representative survey is needed to validate the findings.

Cardiovascular disease risk profile among young Saudi women of Al-Qassim, Saudi Arabia: A cross-sectional study.

STUDY OBJECTIVE: The aim of the study was to assess the level of risk for cardiovascular diseases (CVD) among young Saudi women living in Al-Qassim, Saudi Arabia. METHODS: As part of "The Heart Protection Campaign" in the Al-Qassim region, data were collected from Saudi women using questionnaires as well as objective measurement of height, weight, blood pressure, and blood glucose. Data were analyzed using descriptive statistics. RESULTS: Only 15% of the sample were free of risk factors, the majority had either one (57.5%) or two (20.8%) risk factors. Additionally, 6.7% were considered to be at high-risk with three or more risk factors. The most common risk factors were physical inactivity (74%) and overweight/obesity, (25%/29%). There was a significant increase in the number of risk factors across age groups. Women over the age of 30 were more likely to have a higher number of risk factors than the younger women (20-24 years). CONCLUSIONS: Young women in Al-Qassim, Saudi Arabia have an unusually high risk for CVD. Since the number of risk factors increases substantially between the ages of 20 and 35, there is a need to develop prevention programs to lower the CVD risk through diet and exercise.

Disaster medicine education for medical students: Is it a real need?

BACKGROUND: Disasters are serious public health problems that have increased over the last century. This study evaluated the familiarity and training needs of medical students regarding disaster medicine in Qassim University College of Medicine (QUCOM). METHODOLOGY: A mixed quantitative and qualitative study was conducted in which students in the clinical phase were asked to respond to a questionnaire. Clinical teachers of the college, emergency physicians and health administrators were interviewed for the qualitative part of the study. Data were analyzed using SPSS and relevant tool for the qualitative part. RESULTS: Two-hundred twenty-nine students (91.6%) responded. Familiarity of students with disaster medicine was low with a mean score of 1.65 out of five points. However, male students demonstrated significantly higher mean scores in certain themes of disaster medicine. Students endorsed the idea that a training course is needed with a mean score of 3.66/5 and supported the idea that disaster medicine training should be provided to the general public as well (mean 3.85/5). Qualitative data affirmed inclusion of relevant topics in the curriculum based on students' inputs and needs and as defined by the community. CONCLUSION: Disaster medicine education for medical students is recommended by students and experts, while the applicability and feasibility needs further exploration.

Concordance of obesity classification between body mass index and percent body fat among school children in Saudi Arabia.

BACKGROUND: In Saudi Arabia, where childhood obesity is a major public health issue, it is important to identify the best tool for obesity classification. Hence, we compared two field methods for their usefulness in epidemiological studies. METHODS: The sample consisted of 874 primary school (grade I-IV) children, aged 6-10 years, and was obtained through a multi-stage random sampling procedure. Weight and height were measured, and BMI (kg/m(2)) was calculated. Percent body fat was determined with a Futrex analyzer that uses near infrared reactance (NIR) technology. Method specific cut-off values were used for obesity classification. Sensitivity, specificity, positive and negative predictive values were determined for BMI, and the agreement between BMI and percent body fat was calculated. RESULTS: Compared to boys, the mean BMI was higher in girls whereas the mean percent body fat was lower (p-values < 0.0001). According to BMI, the prevalence of overweight or obesity was significantly higher in girls (34.3% vs. 17.3%); as oppose to percent body fat, which was similar between the sexes (6.6% vs. 7.0%). The sensitivity of BMI to classify overweight or obesity was high (boys = 93%, girls = 100%); and its false-positive detection rate was also high (boys = 63%, girls = 81%). The agreement rate was low between these two methods (boys = 0.48, girls =0.24). CONCLUSIONS: There is poor agreement in obesity classification between BMI and percent body fat, using NIR method, among Saudi school children.

Chronic Venous Insufficiency: prevalence and effect of compression stockings.

INTRODUCTION: Chronic venous insufficiency (CVI) is a common disease affecting mainly lower limbs and significantly influencing the quality of life. This study aims to estimate the prevalence of CVI in the Qassim Region and test the effectiveness of compression stockings as an intervention option. METHODS: A cross sectional study was conducted to assess the prevalence of CVI among patients visiting primary health care (PHC) centers in the Qassim Region. CVI patients were diagnosed and classified using the clinical, etiologic, anatomical, and pathophysiological (CEAP) scale. They were randomly divided into two groups, one using compression stockings and the other standard medical therapy. A clinical follow up was done using multiple scale system including CEAP scale. Data analysis was performed using SPSS. RESULTS: Among the 226 screened patients, 138 (61.1%) were diagnosed as having CVI (69% female and 45% male, p<0.001). Compared to the baseline, both the clinical and venous scores for CVI at the follow-up were significantly lower among patients using compression stockings, p=0.002 and p=0.003, respectively. Regression analysis suggested that, after controlling for age, sex and body mass index, compliance was the main factor responsible for a significant reduction in the clinical score among CVI patients. CONCLUSIONS: Chronic venous insufficiency is very common in the Qassim Region. Compression stockings are highly effective in improving clinical symptoms and signs of CVI. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov(NCT02050061).

Students' perceptions about the family medicine course in Qassim, Saudi Arabia.

BACKGROUND: This study explores students' perceptions and attitudes regarding educational methodology, content and assessment methods in the Family Medicine (FM) Course at Qassim University College of Medicine (QUCOM) with a view to build innovations and improvements on its findings. RESEARCH DESIGN AND METHODS: Three batches of undergraduate medical students attending FM Course - 2011/12 participated in a cross-sectional questionnaire-based study. Data collected through anonymous self-administered questionnaires were analyzed using Statistical Package for the Social Sciences (SPSS). RESULTS: Participation rate was quite high; of the 79 students constituting the course cohort, 68 (86%) responded. Students' perceived problem-based learning (PBL) tutorials positively while both male and female students rated classroom lectures negatively. Primary health care training activities and evidence-based medicine received high positive scores. Male students assigned high positive scores to consultation skills and breaking bad news (BBN) modules, and to a lesser extent the medical audit module. By contrast, female students rated them negatively and gave significantly lower scores. These were the only areas indicating significant differences between opinions of male and female students. CONCLUSION: Although the degree of students' satisfaction with the different learning activities varied, students felt that having a variety of learning and teaching experiences was more appropriate.