Nonadherence to antiseizure medications: what have we learned and what can be done next?

INTRODUCTION: Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs. AREAS COVERED: This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed. EXPERT OPINION: Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.

Improving medication dispensing and counselling for patients with vision impairment: a qualitative study of pharmacist-reported barriers and facilitators.

BACKGROUND: People with vision impairment encounter many difficulties when it comes to medicines use. However, evidence indicates that there are major gaps in pharmaceutical care service provision worldwide and limited research on interventions to optimise medication use for this patient population. The Theoretical Domains Framework (TDF) provides a method for theoretically understanding individuals' behaviour and informing development of interventions. The aim of this research was to (a) identify the barriers and facilitators to the provision of medication dispensing and counselling services by pharmacists to patients with vision impairment, and (b) identify key TDF domains to be targeted in a future intervention. METHODS: Semi-structured interviews were conducted with pharmacists from different pharmacy practice settings/areas in Saudi Arabia. The 14-domain TDF was utilised as the theoretical lens through which pharmacists' behaviours were examined. Interviews were conducted in Arabic or English, either face-to-face or over the telephone based on the participant's preference. Following transcription, interviews conducted in Arabic were translated into English before analysis. Data analysis involved using the framework method and content analysis to identify important barriers and facilitators to the provision of dispensing and counselling services to those with vision impairment. Key TDF domains that could be targeted in a future intervention were then identified using a consensus-based approach. RESULTS: Twenty-six pharmacists were interviewed. Pharmacists' experience in pharmacy practice ranged from two to 28 years. A range of barriers and facilitators were highlighted as important in providing services to those with vision impairment. Eight domains were identified as 'key domains' including: 'Knowledge', 'Skills', 'Beliefs about capabilities', 'Goals', 'Memory, attention, and decision processes', 'Environmental context and resources', 'Social influences', and 'Behavioural regulation'. CONCLUSIONS: Barriers and facilitators identified by pharmacists will inform the development of an intervention to ensure its applicability to everyday practice. Future research will focus on the process of developing the proposed intervention through targeting key TDF domains to improve medication dispensing and counselling by pharmacists to patients with vision impairment.

Quality of Life, Fatigue, and Physical Symptoms Post-COVID-19 Condition: A Cross-Sectional Comparative Study.

The magnitude of post-COVID-19 syndrome was not thoroughly investigated. This study evaluated the quality of life and persistence of fatigue and physical symptoms of individuals post-COVID-19 compared with noninfected controls. The study included 965 participants; 400 had previous COVID-19 disease and 565 controls without COVID-19. The questionnaire collected data on comorbidities, COVID-19 vaccination, general health questions, and physical symptoms, in addition to validated measures of quality of life (SF-36 scale), fatigue (fatigue severity scale, FSS), and dyspnea grade. COVID-19 participants complained more frequently of weakness, muscle pain, respiratory symptoms, voice disorders, imbalance, taste and smell loss, and menstrual problems compared to the controls. Joint symptoms, tingling, numbness, hypo/hypertension, sexual dysfunction, headache, bowel, urinary, cardiac, and visual symptoms did not differ between groups. Dyspnea grade II-IV did not differ significantly between groups (p = 0.116). COVID-19 patients scored lower on the SF-36 domains of role physical (p = 0.045), vitality (p < 0.001), reported health changes (p < 0.001), and mental-components summary (p = 0.014). FSS scores were significantly higher in COVID-19 participants (3 (1.8-4.3) vs. 2.6 (1.4-4); p < 0.001). COVID-19 effects could persist beyond the acute infection phase. These effects include changes in quality of life, fatigue, and persistence of physical symptoms.

Genetic recombination among tomato yellow leaf curl virus isolates in commercial tomato crops in Kuwait drives emergence of virus diversity: a comparative genomic analysis.

OBJECTIVE: Whitefly-transmitted tomato yellow leaf curl virus (TYLCV) continues to be a major constraint to tomato production in Kuwait. However, very limited information is available about the population structure and genetic diversity of TYLCV infecting tomato in Kuwait. RESULTS: Whole genome sequences of 31 isolates of TYLCV, collected from commercial tomato crops grown in northern (Abdally) and southern (Al Wafra) parts of Kuwait, were deciphered. Eighteen isolates of TYLCV are identified as potential genetic recombinants. The isolates Abdally 6A and Abdally 3B reported in this study were identified to be potential recombinants. Compared to the 15 isolates from the Abdally area, and the three previously reported KISR isolates of Kuwait, six out of sixteen Al Wafra isolates showed an insertion of 19 extra nucleotides near the 5'-end. There are also four nucleotide variations before the 19-extra-nucleotides. The additional 19 nucleotides observed in nine isolates indicate that these isolates might have resulted from a single gene recombination/insertion event. Molecular phylogeny based on complete genome sequences of TYLCV isolates suggests transboundary movement of virus isolates due to geographic proximity. The information presented herein is quite useful for the comprehension of TYLCV biology, epidemiology and would aid in the management of disease in the long run.

The Role of the Ferroelectric Polarization in the Enhancement of the Photocatalytic Response of Copper-Doped Graphene Oxide-TiO2 Nanotubes through the Addition of Strontium.

To evaluate the potential role of in situ formed Sr-Ti-O species as a ferroelectric component able to enhance the photocatalytic properties of an adjacent TiO2 semiconductor, Cu-doped/graphene oxide (GO)/TiO2 nanotubes (TiNTs) composites (with 0.5 wt % Cu and 1.0 wt % GO) have been synthesized while progressive amounts of strontium (up to 1.0 wt %) were incorporated at the surface of the composite through incipient wetness impregnation followed by post-thermal treatment at 400 °C. The different resulting photocatalytic systems were then first deeply characterized by means of N2 adsorption-desorption measurements, X-ray diffraction (XRD), UV-vis diffuse reflectance (UV-vis DR), Raman and photoluminescence (PL) spectroscopies, and scanning electron microscopy (SEM) (with energy-dispersive X-ray (EDX) spectroscopy and Z-mapping). In a second step, optimization of the kinetic response of the Sr-containing composites was performed for the formic acid photodegradation under UV irradiation. The Sr-containing Cu/GO/TiNT composites were then fully characterized by electrochemical impedance spectroscopy (EIS) for their dielectric properties showing clearly the implication of polarization induced by the Sr addition onto the stabilization of photogenerated charges. Finally, a perfect correlation between the photocatalytic kinetic evaluation and dielectric properties undoubtedly emphasizes the role of ferroelectric polarization as a very valuable approach to enhance the photocatalytic properties in an adjacent semiconductor.

Patient preferences for epilepsy treatment: a systematic review of discrete choice experimental studies.

BACKGROUND: This review aimed to 1) identify and assess the quality of discrete choice experiments (DCEs) examining preferences related to epilepsy treatment; 2) summarize the attributes and attribute levels measured in these studies; 3) identify how researchers selected and developed these attributes; and 4) identify which attributes are most important for epilepsy patients. METHODS: A systematic literature review using PubMed, Web of Science and Scopus databases from database inception to February or April 2022. We included primary discrete-choice experiments eliciting preferences for various attributes of pharmacological and surgical interventions in patients diagnosed with epilepsy or the parents/carers of children with epilepsy. We excluded non- primary studies, studies assessing preferences for nonpharmacological treatment and studies that elicit preferences using methods other than discrete choice experiments. Two authors independently selected studies, extracted data and assessed risk of bias of studies. The quality of the included studies was assessed using two validated checklists. Study characteristics and findings were summarized descriptively. RESULTS: A total of seven studies were included in the review. The majority of studies explored patients' preferences, and two compared the preferences of patients with physicians. The majority (n = 6) compared two medications, and one compared two surgical options to continuing medication options. The studies examined 44 attributes in total, including side effects (n = 26), efficacy expressed as being seizure free or have fewer seizures (n = 8), costs (n = 3), dosing frequency (n = 3), duration of side effects (n = 2), mortality (n = 1), long-term problems after surgery (n = 1) and surgical options (n = 1). The findings indicate that people with epilepsy have strong preferences for improving seizure control, which was ranked as the top priority in all studies. Patients also have a strong preference for the reduction of adverse effects and may be willing to make trade-offs between improved seizure control and reduction of long-term side effects that may impact their quality of life. CONCLUSIONS: The use of DCEs in measuring patients' preference for epilepsy treatment is accumulating. However, inadequate reporting of methodological details may reduce decision-makers' confidence in the findings. Suggestions for future research are provided.

Reducing Violence in Riyadh's Emergency Departments: The Critical Role of Healthcare Providers.

Emergency department staff are at high risk of experiencing violence and aggression from patients and visitors, which can have negative impacts on healthcare providers in the ED. The aim of this study was to explore the role of healthcare providers in addressing local violence in Riyadh EDs and investigate their preparedness for managing violent incidents. We used a descriptive, correlational design with survey methodology to collect data from a convenience sample of nurses, ED technicians, physicians, and advanced practice providers in Riyadh city's EDs. To examine the associations, we used an analysis of variance (ANOVA) for unadjusted relationships and an analysis of covariance (ANCOVA) for adjusted associations. Measures included a demographic survey, and clinicians responded to an online survey. A total of 206 ED staff participated in the questionnaire, and 59% reported experiencing physical violence during an ED shift, with 61% of incidents being caused by relatives. Additionally, 32% of the participants witnessed workplace violence. Our findings revealed that male healthcare workers, physicians, and those working in the governmental sector were at the highest risk of experiencing violence. We also found a statistically significant association between the rate of patients seen in the ED and the frequency of assault (physical or verbal) in the ED. Our results suggest that the rate of workplace violence in Riyadh EDs is high, and more efforts are needed to protect the health and well-being of healthcare providers. Senior management should take a position against ED domestic violence and reinforce managerial and healthcare provider resources by adopting policies and procedures that protect healthcare workers' safety. This study provides valuable insights into the nature and prevalence of violence in Riyadh EDs and highlights the critical role of healthcare providers in reducing violence in EDs.

Economic evaluation of interventions to improve medication adherence among patients with chronic diseases: an overview of systematic reviews.

INTRODUCTION: This overview aimed to find, assess, and synthesize systematic reviews that compared the cost-effectiveness of interventions designed to improve medication adherence among patients with chronic disease. AREAS COVERED: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Center for Review and Dissemination were searched. The quality of the included reviews was assessed using two validated checklists. The review characteristics and findings were summarized narratively. A total of 9 systematic reviews were included. Interventions reported to be cost-effective were simplification of the medication regimen, financial incentives, improved coverage or reduced out-of-pocket spending, and pharmacist care. The most common interventions were patient education and counseling, with mixed results of cost-effectiveness. This evidence comes from economic evaluations with varying degrees of quality. EXPERT OPINION: Future evaluations of adherence interventions' cost-effectiveness will be improved in quality as our understanding of the reasons behind intentional and unintentional nonadherence and factors associated with this behavior advances. The development of criteria for the value assessment of medication adherence-enhancing interventions will contribute to improving the quality of adherence intervention cost-effectiveness research.

Prevalence and factors associated with dyslipidemia among adolescents in Saudi Arabia.

Dyslipidemia is a major risk factor for atherosclerosis. Screening for dyslipidemia at an early age is essential to prevent and control its consequences. This study aimed to determine prevalence of dyslipidemia and its correlates among adolescents in Saudi Arabia. Data of 5854 adolescents aged 10-19 years from all 13 regions of Saudi Arabia were obtained from the Jeeluna study; a national cross-sectional, multistage stratified cluster sample survey. Dyslipidemia was defined based on the National Heart Lung and Blood Institute and National Cholesterol Education Program guidelines for adolescents. We found that a quarter of Saudi adolescents have dyslipidemia (males: 33.3%, females: 17.9%). Significant variation was observed by region (p < 0.001). Prevalence of abnormal Total Cholesterol was 6.7%, LDL-C 7.1%, HDL-C 12.8%, Non-HDL-C 8.3%, and Triglycerides 9.6%. Factors independently associated with dyslipidemia were male gender (OR = 2.19, 95% CI 1.78-2.70, p < 0.001), BMI (underweight OR = 0.80, 95% CI 0.69-0.94, overweight OR = 1.76, 95% CI 1.50-2.06, obese OR = 2.80, 95% CI 2.34-3.34, p < 0.001, vs. normal) and serum ferritin (high OR = 7.02, 95% CI 1.49-34.79, low OR = 0.82, 95% CI 0.67-1.01, p = 0.04 vs. normal) and ≥ 1 daily intake of carbonated beverage (OR = 1.10, 95% CI 1.00-1.20, p = 0.03 vs. no or not daily intake). Public health interventions for improving lipid profile of adolescents are urgently needed.

Glucose-independent racial disparity in HbA1c is evident at onset of type 1 diabetes.

OBJECTIVE: Higher levels of HbA1c, independent of blood glucose levels, have been described in Blacks compared to Whites patients with established diabetes. The goal of this study was to determine if glucose-independent racial disparity in HbA1C is evident at diabetes onset. RESEARCH DESIGN AND METHODS: We conducted a retrospective single-center chart review of 189 youth with new onset Type 1 diabetes (T1D) 60 % Whites and 40 % Blacks. HbA1c, glucose and other biochemistry measures were obtained at presentation in the Emergency Department before initiation of any therapy. HbA1c levels were adjusted for presenting glucose, self-identified race, age, gender, hematocrit, and RDW-CV. RESULTS: Blacks with T1D had statistically significant higher unadjusted HbA1c (11.9 ± 1.9 vs 11.04 ± 2.0 %, p = 0.004), initial glucose (530.6 ± 230.4 vs 442 ± 211.3 mg/dL, p = 0.0075) and lower pHs (7.28 ± 0.15 vs 7.33 ± 0.12, p = 0.02) compared to white patients. Least squares means of HbA1c remained higher in Black patients even after statistical adjustment for presenting glucose, age, gender, RDW-CV, and pH. In a multiple variable model (R2 = 0.38, p < 0.0001) c-peptide was influenced by HCO3 (p = 0.0035), gender (p = 0.0092), BMI (p < 0.0001), but not race or glucose. CONCLUSIONS: HbA1c at initial presentation of T1D is higher in young Black patients compared to Whites even after adjustment for glucose, age, gender, and RDW-CV. This racial disparity is consistent with other studies in individuals without diabetes and patients with long-standing diabetes under treatment.

Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings.

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well as preference for continuing professional education in community pharmacy settings. This study aimed to investigate community pharmacists' management of an over-the-counter (OTC) product request and feasibility of immediate SP feedback in Jordan. Four trained SP visited a sample of pharmacies in three main urban cities in Jordan requesting an antacid. Information request and professional behavior as well as content of information were evaluated. The SP provided structured immediate feedback. The pharmacy staff views on the visit and usefulness of the feedback were collected. A total of 57 visits were conducted. The average duration of SP visits was 1.55 min. The average score (±SD) for information seeking behavior was 16% (±7) and for professional behavior was 56% (±15). The average score for information provision provided spontaneously was 17.1% (±12). Upon demand by the SP; the average score for information improved to 47.6 (±18). Non-pharmacological advice was not offered often; only 6 (10.5%) visits. Written information was provided in 10 (17.5%) visits. Immediate feedback was accepted by all visited pharmacies. Participants expressed positive views about the SP visit and usefulness of the feedback. Community pharmacists supplied OTC drug without carful screening of symptoms and essential information. The SP approach with immediate feedback was shown feasible and well accepted. Further potential for use of SP with feedback formally in practice and professional development should be explored in future studies.

High Occurrence Among Calves and Close Phylogenetic Relationships With Human Viruses Warrants Close Surveillance of Rotaviruses in Kuwaiti Dairy Farms.

Rotavirus, one of the main pathogens causing morbidity and mortality in neonatal dairy calves worldwide, is responsible for 30-44% of cattle deaths. It is considered to be the most common etiologic agent of diarrhea in neonatal dairy calves and children, the dominant type being group A. Two hundred seventy animals from 27 farms from 2 regions of Kuwait were tested for the presence of Rotavirus serogroup A (RVA) using latex agglutination test (LAT) and reverse transcription-polymerase chain (RT-PCR) testing. RVA non-structural proteins NSP1-2, NSP4-5 and capsid protein genes VP1-7 were characterized by next generation sequencing. LAT was positive in 15.56% of the animals, and RT-PCR in 28.89%. Using RT-PCR as a reference method, LAT was 100% specific but only 83.33% sensitive. ANOVA analysis showed correlation only with the location of the farms but no significant correlation with the age and sex of the animals. Although there was a tendency of clustering of RVA positive animals, it did not reach statistical significance (p = 0.035 for LAT). The phylogenetic analysis showed that Kuwaiti isolates of group A rotavirus clustered with human rotaviruses. Taken together, it seems that rotavirus was present in most of the dairy farms in Kuwait. The high occurrence of the virus in calves in Kuwaiti dairy farms and the close phylogenetic affinity with human isolates warrants urgent action to minimize and control its spread between calves in farms.

Association of genetic polymorphisms in DNA repair genes ERCC2 Asp312Asn (rs1799793), ERCC2 Lys 751 Gln (rs13181), XRCC1 Arg399 Gln (rs25487) and XRCC3 Thr 241Met (rs861539) with the susceptibility of lung cancer in Saudi population.

This study demonstrated the association of polymorphisms in ERCC2 (Asp312Asn) rs1799793, ERCC2 (Lys751Gln) rs13181, XRCC1 (Arg399Gln) rs25487 and XRCC3(Thr241Met) rs861539 polymorphisms with a susceptibility of lung cancer (LC) onset in the Saudi population. The study was performed on 134 LC patients and 270 controls. The data revealed that there was no significant association of LC with subtype squamous cell carcinoma (SCC), small cell lung cancer (SCLC) and adenocarcinoma with the ERCC2 rs1799793 polymorphism. The data showed that the CC genotype for ERCC2 rs13181, the AA genotype for XRCC1 rs25487, and the genotype TT for XRCC3 rs861539 were significantly associated with SCC susceptibility (p < 0.05). Similarly, the CC genotype for ERCC2 rs13181 and the AA genotype for XRCC1 rs25487 were significantly associated with adenocarcinoma susceptibility (p < 0.05). Whereas, the TT genotype for XRCC3 rs861539 was significantly associated with SCLC susceptibility (p = 0.005). In total, significant association of LC susceptibility was found in the following combination models of recessive genotypes: AC heterozygous for ERCC2 rs13181 + AA homozygous for XRCC1 rs25487, CC homozygous for ERCC2 rs13181 + GA heterozygous for rs25487, CC homozygous for rs13181 + AA homozygous for XRCC1 rs25487, CC homozygous for ERCC2 rs13181 + TT homozygous for XRCC3 rs861539, GA heterozygous for XRCC1 rs25487 + CT heterozygous for XRCC3 rs861539, GA heterozygous for XRCC1 rs25487 + TT homozygous for XRCC3 rs861539, AA homozygous for XRCC1 rs25487 + CT heterozygous for XRCC3 rs861539, AA homozygous for XRCC1 rs25487+ TT homozygous for XRCC3 rs861539. These data clearly demonstrated that the combination of recessive genotypes may be associated with susceptibility of LC onset (p < 0.05). In short, the data indicated that DNA repair genes increase LC risk via gene-gene interaction rather than independent variants.

Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study.

OBJECTIVES: To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content. METHODS: A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated. RESULTS: A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively. CONCLUSIONS: Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.

Impact of COVID-19 on the 937 Telephone Medical Consultation Service in Saudi Arabia.

The impact of COVID-19 on healthcare services has been profound. One major impact has been underutilization of traditional healthcare services by patients. In 2020, the Saudi Ministry of Health (MoH) started offering general COVID-19 enquiries, education, and medical and psychological consultations around the clock via their 937-Call Center. Given this major change, there was a need to understand the impact of the COVID-19 pandemic on Call Center services, specifically medical consultations, to suggest future recommendations for patient care optimization. This descriptive study analyzed routinely collected data on the 937-Call Center service between March 2020 and September 2020. Data were reviewed, coded, verified, and analyzed using SPSS v22. There was a 296% increase in the number of calls received by the 937-Call Center in 2020 compared to the same period in 2019. The majority of calls received in 2020 were general medical enquiries (98.41%), but about three million COVID-19-specific enquiries were also received in 2020. The increased number of calls was managed by accepting volunteers to handle calls: an average of 236 volunteers per month, handling about 20% of the total call volume. The majority of volunteers were physicians but with the presence of pharmacists, psychologists, and specialized healthcare workers such as nutritionists. Utilization of the 937-Call Center increased during the COVID-19 pandemic, suggesting that it has been an effective strategy for combatting the COVID-19 pandemic in Saudi Arabia. Further research is recommended to investigate the impact of COVID-19 on public awareness of the 937-Call Center and other health-related mobile apps.

High Rate of Depression among Saudi Children with Type 1 Diabetes.

Saudi Arabia ranks among the top ten in type 1 diabetes (T1D) prevalence. The psychological burden, including depression, among T1D children, affects short-term and long-term outcomes. In Saudi Arabia, studies on depression among T1D children are limited. We determined the prevalence of depression among T1D children and adolescents in the Saudi Arabia-Qassim region and investigated risk factors for depressive symptoms. This quantitative cross-sectional study was conducted among T1D children and adolescents in the outpatient clinic of Maternity and Children Hospital, Buraydah, Saudi Arabia, between October 2020 and April 2021. Using a validated questionnaire translated into Arabic, we interviewed patients during clinic appointment. Questionnaires on sociodemographic characteristics, clinical data, and Clinical Depression Inventory scale were used to measure depression. There were 148 T1D respondents (children: 58.1%; adolescents: 41.9%). More than half were females (53.4%), with most Saudis (94.6%). Depression prevalence among children and adolescents was 27%. Mild, moderate, and severe depression occurred in 80%, 12.5%, and 7.5% of depressed patients, respectively. Factors significant for depression were female sex (p = 0.014), uncontrolled HbA1c level (p = 0.037), and longer diabetes duration (p = 0.013). Depression among children and adolescents was more prevalent in this study than in previous reports. Early detection of depression will improve diabetes control and quality of life.

Cancer Impacts on Out-of-Pocket Expenses, Income Loss, and Informal (Unpaid) Care: A Cross-Sectional Study of Patient Perspective.

A paper-based questionnaire was used to measure out-of-pocket expenses, income loss, and informal (unpaid) care from the cancer patient's perspective. A total of 181 adult solid cancer patients on chemotherapy for at least 3 months were recruited from 1 teaching hospital in Riyadh, Saudi Arabia. The majority were female (66%) and 41% were 60 years of age or older. A total of 107 respondents used their own car for transport to and from the hospital to receive chemotherapy (median distance 42 km). Over the last 4 weeks, 21% purchased medications, 18% visited a physician, and 8% visited a physiotherapist, spending a median amount of $47, $220, and $793, respectively. A total of 47 participants were employed at the time of their cancer diagnoses, and 32% of them reported some loss of income. A total of 85% of respondents were escorted by a carer during chemotherapy sessions. Approximately 64%, 31%, 61%, 43%, and 28% reported getting help from a carer for housework, child care, shopping, medicine taking, and personal care, respectively. The carer spent on average 50 h per week looking after the patient.

ATP2B1 genotypes rs2070759 and rs2681472 polymorphisms and risk of hypertension in Saudi population.

This study examined an association of ATP2B1 gene polymorphism and hypertension in the Saudi population. The 246 hypertensive cases and 300 healthy human controls were genotyped. The results showed that genotypes rs.207075 (CA + AA) [p = 0.05; OR: 95% CI, 1.5:(1.0 to 2.4) and p = 0.001, OR: 95% CI, 2.4: (1.5 to 4.0) and rs2681472 (CT + TT) [p = 0.05; OR: 95% CI, 1.5 (1.0 to 2.4) and p = 0.006 OR: 95% CI, 2.0 (1.2 to 3.1) respectively] associated with the risk of hypertension. Cases carrying the recessive models: [(CA + AA)/(CT + TT)] and [(AA)/(TT)] genotypes confer a strong susceptibility risk of hypertension [p = 0.002; OR: (95%CI) 1.8 (1.2 to 2.6) and p = 0.001; OR: (95%CI) 2.6 (1.5 to 4.7) respectively]. However, cases with body-mass-index (BMI)<25, carrying homozygous mutant genotypes [AA, rs2070759, p = 0.007; OR: (95%CI) 2.75(1.37 to 5.5) and (TT, rs2681472, p = 0.05; OR: (95%CI) 1.96 (1.03 to 3.72)] as well as A allele of rs2070759 [p = 0.006; OR: (95%CI) 1.62 (1.16 to 2.25)] and T allele of rs2681472, p = 0.04, 1.43(1.03 to 1.98)] showed a significant association with high risk of hypertension. In short, a significant association between ATP2B1 gene polymorphism and risk of hypertension was noticed. In addition, individuals carrying recessive genotypes have greater risk in developing hypertension than those carrying dominant genotypes. Moreover, cases with high-risk BMI associated with ATP2B1 variants may play a critical role in developing hypertension.Supplemental data for this article is available online at https://doi.org/10.1080/15257770.2021.1973034 .

The Impact of Quarantine on Sleep Quality and Psychological Distress During the COVID-19 Pandemic.

PURPOSE: We investigated the impact of isolation on sleep quality and psychological distress during the COVID-19 pandemic in Saudi Arabia. METHODS: An online survey was conducted on 353 (88 isolated and 265 not isolated) individuals from May to June 2020. Subjective sleep quality was determined using the Pittsburgh sleep quality index (PSQI), and psychological distress measured using the Kessler psychological distress scale (K10). RESULTS: The mean age of the isolated group was 28.6 years versus 27.5 years for the non-isolated group, with male participants accounting for 37% in both groups. The mean PSQI score was 8.5±3.6 and 8.4±3.5 for the isolated and non-isolated groups, respectively (P= 0.92). The mean K-10 score was 27.6± 9.4 and 25.3± 9.5 for the isolated and non-isolated groups, respectively (P= 0.04). Poor sleep (PSQI ≥6) was reported in 235 (66.6%) and psychological distress (K-10 ≥20) in 244 (69.1%) participants. Isolation was not associated with poor sleep (OR: 0.73 (95% CI: 0.41-1.3), P=0.29), but was statistically significant with psychological distress (OR: 2.12 (95% CI: 1.10-4.08), P=0.03). CONCLUSION: Poor sleep and psychological distress symptoms were highly prevalent in our study population. Isolation may influence psychological distress but not sleep quality during the COVID-19 pandemic.

The Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) and the Medical Consumption Questionnaire (iMCQ): Translation and Cognitive Debriefing of the Arabic Version.

The aim of this study was to translate the Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) and the Medical Consumption Questionnaire (iMCQ) from English into Arabic and perform cognitive debriefing in a Saudi Arabian setting. We conducted the translation according to guidelines, including two independent forward translations and a backward translation. Cognitive debriefing was carried out in two stages. First, the pre-final translated versions of the two questionnaires were tested on a group of respondents (n = 5) using face-to-face or telephone interviews. The participants completed a copy of the questionnaires, identified items or questions that were confusing or misunderstood, and then answered a series of open-ended questions about their understanding of each instruction, question and response option. Second, another group of participants (n = 17) completed the questionnaire and circled any word that was confusing or difficult to understand and provided comments on the questionnaires. The Arabic translation and linguistic validation were realized without any major difficulties. The few changes made after cognitive debriefing generally related to changing one word to a more appropriate Arabic word. The final Arabic translation needs to be validated for psychometric properties such as validity and reliability before being recommended for use in future research.