The Knowledge, Attitudes, and Practices of Primary Healthcare Physicians in the Al Qassim Region, Saudi Arabia Regarding Travel Medicine: A Cross-Sectional Study.

Background and objective In the age of globalization, diseases associated with travel have emerged as a focal point of public health interest. This has become particularly relevant in Saudi Arabia after the changes in tourism policy in recent years. Primary care physicians are expected to suspect diseases of importance in certain geographic areas. They should dispense pre- and post-travel advice. This study aimed to assess the knowledge, attitudes, and practices of primary care physicians in the Al Qassim region, Saudi Arabia regarding travel medicine. Methods This cross-sectional study was conducted in the Al Qassim region, Saudi Arabia between October and November 2023. We reached out to all primary care physicians in the region regardless of their gender, nationality, and years of experience. The data were collected using a self-administered questionnaire, which was designed based on the available literature and validated by experts. Results A total of 197 physicians participated in the study; 74% were male, 46% were general practitioners, and 48% had 5-10 years of experience. More than half (51%) of the participants reported a weekly patient load of 50-100, while 47% engaged with 5-10 travelers annually; 53% provided travel health advice and a quarter of primary healthcare physicians never attended travel update sessions or conferences. In the last six months, 48% and 43% of the physicians conducted pre- and post-travel consultations respectively. Approximately 49.2% demonstrated a fair knowledge of the topic. Factors associated with fair knowledge included non-Saudi nationality, age below 30 years, minimal traveler exposure, and infrequent conference attendance (p<0.05). A positive attitude was linked to being under 30 years old, having <5 years of experience, seeing <5 travelers yearly, and possessing a fair knowledge of the topic (p<0.05). Conclusions Overall, about half of the physicians in the Al Qassim region engage with travelers and demonstrate good attitudes and practices toward travel medicine. Opening Saudi borders to tourism necessitates the inclusion of travel medicine in continuing medical education programs to prepare primary care physicians to care for travelers more efficiently.

Prevalence of burnout and its impact on self-reported patient care among primary health care physicians at King Abdul-Aziz Medical City in Riyadh region.

Background: Burnout is known worldwide as a work-related syndrome associated with physical illness and mental health problems. It has a significant impact on doctors' health and patient care. Aim: To assess the prevalence of burnout, its associated risk factors, and its impact on self-reported patient care among the doctors of the Family Medicine Department in King Abdul-Aziz Medical City (KAMC), Riyadh. Method: A cross-sectional study was conducted among 150 physicians. Data were collected using the 22-items Maslach Burnout Inventory (MBI) to measure emotional exhaustion, depersonalization, and personal achievement as well as questions about demographic factors, work characteristics, and impact of burnout on self-reported patient care. Results: A total of 150 physicians responded to the questionnaire. In terms of high burnout, 32 doctors (21.3%) had emotional exhaustion, 57 doctors (38%) had depersonalization, and 41 doctors (27.3%) scored low for personal achievement. Staff physicians had high emotional exhaustion (27.8%, P = 0.028), family medicine residents, however, reported higher depersonalization and low personal achievement (42.9%, 45.7%, P = 0.675, P = 0.009, respectively). Being a staff physician, military, with long years in practice, working more than 8 hours per day, and covering ER shifts were strongly associated with a high level of burnout. High-level burnout demonstrated a statistically significant impact on patient care with suboptimal performance among the doctors of this study. Conclusion: Burnout seems to be a common problem in family medicine doctors at KAMC. It was associated with personal and workload indicators affecting their self-reported patient care significantly.

Awareness of Autism Spectrum Disorder Among Pre-School Teachers in Qassim Region, Saudi Arabia.

Background: Autism Spectrum Disorder (ASD) is a lifelong condition that affects children and early intervention to provide an appropriate education for ASD children is necessary. Objective: This study aimed to assess the awareness of ASD among preschool teachers in Qassim region, Saudi Arabia. Methods: A cross-sectional study was carried out from December 2021 to February 2022 among preschool teachers in the Qassim region of Saudi Arabia. A random sampling technique was applied to select teachers through the Ministry of Education website. Results: A total of 164 preschool teachers took part in the questionnaire. The most common age group was 30 - 40 years (58.5%). The total mean score of AKQ was 15.0 (SD 4.97). Nearly three-quarters (74.4%) of the teachers were classified as having a poor level of awareness while 25.6% had a good awareness level. Factors associated with a good awareness level include being a teacher (p=0.034) and having direct contact with autistic children (p=0.016). It is important to note that having more years of experience was significantly associated with knowledge regarding the correct pattern to diagnose children with autism (p=0.049). Conclusion: The awareness of preschool teachers regarding ASD was deficient. Teachers who are in contact with autistic students demonstrated better knowledge than the rest of the preschool teachers. Preschool teachers are expected to maintain high standards in their work to meet the children's abnormal development and to identify them from an early stage, then refer them to diagnosis services.

Habits, Traditions, and Beliefs Associated With the Use of Complementary and Alternative Medicine Among Diabetic Patients in Al-Qassim Region, Saudi Arabia.

Background Since diabetes mellitus (DM) affects every aspect of a person's being, more and more people are using complementary and alternative therapies such as ingesting ginger and cinnamon in addition to conventional medical care and lifestyle changes to manage their condition and enhance their well-being. Although this population uses complementary and alternative medicine (CAM) at a high rate, it is unclear what causes this use. Objective We aim to know the habits, traditions, and beliefs associated with the use of complementary and alternative medicine among type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in the Al-Qassim region of Saudi Arabia. Methods This is an observational cross-sectional study conducted among diabetes patients in Al-Qassim, Saudi Arabia, in 2022. Participants were selected via a non-probability sampling technique. Patients were interviewed in the diabetic clinics using validated questionnaires. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 444 validated responses were received in this study. The average age was 50 ± 16.9 years, and females represented the highest proportion (58.6%). Moreover, we found that most of the participants had type 2 diabetes (79.1%) and 93 (20.9%) had type 1 diabetes. Hypertension was the most reported chronic disease. Our results revealed that the prevalence of CAM usage was 29.1%. Regarding the sources of information on herbal medicines, we found that more than half of the respondents (57.4%) obtained information from friends, relatives, and neighbors. Ginger, vitamins and minerals, and cinnamon were the most frequently used herbals among our participants. Our results found that 38% of CAM users used herbal products on a regular basis. As regards the frequency of using herbal products, 29.5% of the respondents used herbal medicine weekly and 21.7% used it daily. In addition, we found that gender, marital status, and monthly income were significantly associated with the use of CAM (P value = 0.008, 0.011, and 0.011, respectively). The significantly higher CAM use was associated with females, married participants, and participants with a monthly income of 10,000-15,000 Saudi riyal (SAR). Conclusion According to our research, CAM use among diabetes patients in the Al-Qassim region was found to be relatively common. The prevalence of type 2 diabetes mellitus was higher (79.1%) in comparison to type 1 diabetes mellitus (20.9%). Also, the most commonly used herb was ginger (47.66%), followed by vitamins and minerals (44.53%), and cinnamon (42.19%). Patients with diabetes need to be informed of the significance of telling their doctors about their use of CAM.

Hearing loss among patients with type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Hearing loss is an underestimated comorbid condition in type 2 diabetes. OBJECTIVES: Investigate hearing loss as a comorbidity associated with type 2 diabetes mellitus and evaluate the factors associated with hearing loss. DESIGN: Cross-sectional. SETTING: Tertiary care center, diabetes clinic. PATIENTS AND METHODS: Patients with type 2 diabetes, aged 30 to 60 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation. Otoacoustic emission was used to assess inner function, tympanometry to assess middle-ear function, and pure tone air/bone audiometry to assess hearing sensitivity. Risk factors for hearing loss were assessed by multivariate logistic regression. MAIN OUTCOME MEASURE: Frequency, severity and risk factors for hearing loss. SAMPLE SIZE: 157 RESULTS: Of the 157 patients, 77 had hearing loss in both ears (49.0%), 13 in the right ear only (8.3%), 14 in the left ear only (8.9%), and 53 (33.8%) had normal hearing. In the 181 ears with sensorineural hearing loss, 90 had mild loss (49.7%), 69 moderate loss (38.2%), 16 severe loss (8.8%) and 6 had profound loss (3.3%). Disabling hearing loss was observed in 46 (29%) patients. A higher frequency of hearing loss was present in patients with glycated hemoglobin levels ≥8%. In the multivariate logistic regression analysis, the most important factors associated with hearing loss were longer diabetes duration, poor glycemic control and the presence of hypertension. CONCLUSIONS: Hearing loss is an underestimated comorbid condition in type 2 diabetes that warrants frequent hearing assessments and management. Strict glycemic and hypertension control is essential for the minimization of the effects of diabetes on hearing sensitivity. LIMITATIONS: Small sample size, limited age window (30-60 years), which was chosen to eliminate the natural aging effect on hearing. Cross-sectional nature was not ideal for the assessment of causality. CONFLICT OF INTEREST: None.

Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study.

CONTEXT: Diabetes is associated with several potential preventable complications like the efficacy of insulin pump over multiple daily insulin injections (MDI) in glycemic control. AIMS: To assess the outcomes of insulin pump as compared to insulin injection therapy. SETTING AND DESIGN: Case-control study conducted among adult type-1 diabetic patients using insulin pump therapy and alternative insulin injection therapy from the University Diabetes Center (UDC), King Saud University, Riyadh, Saudi Arabia during 1st June-30th October, 2017. MATERIALS AND METHODS: Interview-based questionnaires were used on of 200 subjects using insulin therapy and control (conventional and MDI). Results of each were compared. STATISTICAL ANALYSIS USED: t-test was used for continuous variables and Chi-square test was used for categorical variables. P value less than 0.05 was considered statistically significant. RESULTS: Patients on pump therapy showed a non-significant higher mean of hypoglycemic episodes per week and a lower mean of diabetic ketoacidosis (DKA) episodes per year as compared to the injection therapy patients 1.97 vs. 1.77 and 0.35 vs. 0.37, respectively. However, statistically significant differences were found between the pump and MDI, the pump and conventional, and the MDI and conventional when HbA1c levels were tested. CONCLUSION: Among adult patients with type-1 diabetes, insulin pump as compared to insulin injection was associated with better glycemic control. However, for acute complications, non-significant higher mean of hypoglycemic episodes per week and a lower mean of DKA episodes per year were reported in pump therapy as compared to the injection therapy patients.

Stress Associated Alterations in Dietary Behaviours of Undergraduate Students of Qassim University, Saudi Arabia.

BACKGROUND: Psychological stress associated eating habits among public health have now become a global concern. AIM: This study was undertaken to investigate the levels of psychological stress among undergraduate students of Qassim University and to explore the stress associated alterations in their eating habits. METHODS: This is a cross-sectional survey conducted on 614 undergraduate students of Qassim University, Saudi Arabia. A self-administered questionnaire was used, which included questions on socio-demography and eating habits. Level of stress was measured by a standardised questionnaire highlights the levels of non-chronic stimulation through difficulty relaxing, nervous arousal and being easily upset/agitated, irritable / over-reactive and impatient. RESULTS: Our results show that 28.2% of total participants suffered from some extent of stress. Among stressed participants, 17.3%, 49.1%, 24.8% and 8.7% of participants suffered from mild, moderate, severe and extremely severe stress, respectively. Stressed participants were more preferred to eat junk foods such as fast foods, snacks and beverages as compared with unstressed participants (p < 0.05) and the junk food preference was increased with the increase of stress levels. Moreover, non-stressed participants preferred more healthy foods such as vegetarian food, fresh fruits as compared with stressed participants (p < 0.05). Taste and easy to access were the main reasons for the preference of junk foods by the stressed participants. CONCLUSIONS: This is the first comprehensive study from Saudi Arabia to show stress associated dietary alterations in undergraduates of Qassim University. Data concluded that most of the young adults followed a healthy eating pattern, but a significant number from them were affected by stress. Therefore, specific intervention programs are strongly recommended for the reduction of stress and to improve their quality of life.

Elevated Levels of Protein Carbonylation in Patients With Diabetic Nephropathy: Therapeutic and Diagnostic Prospects.

BACKGROUND: Oxidative stress-induced protein oxidation has been reported in diabetes mellitus; however a relationship between protein carbonylation and diabetic nephropathy remains to be determined. This study was undertaken to investigate a correlation between protein carbonylation and diabetic nephropathy. METHODS: Sera from 153 patients with diabetic nephropathy and 142 healthy humans were selected and protein carbonylation was compared. The glycated hemoglobin (HbA1C), postprandial blood glucose (PPBG), disease duration (DD) and serum creatinine were analyzed and were correlated with the levels of protein oxidation. RESULTS: Protein carbonylation was more pronounced in patients with diabetic nephropathy as compared with healthy humans (P < 0.001). The data showed a positive correlation between protein oxidation and HbA1C (P < 0.001, r = 0.752); the carbonylation was high in those patients with high HbA1C (P < 0.01). The data also showed an important correlation between protein oxidation and PPBG (P < 0.0001, r = 0.680); the carbonyl contents were higher in those patients with higher PPBG (P < 0.001). Results also pointed out a positive correlation of protein oxidation with patients DD (P < 0.001, r = 0.769). Importantly, elevated levels of carbonylation in patients with diabetic nephropathy were also correlated with the elevated levels of serum creatinine. CONCLUSIONS: This is the first study that shows a positive correlation between protein carbonylation and diabetic nephropathy. The higher carbonylation in patients with higher HbA1C, blood glucose, DD or serum creatinine indicate that oxidative modifications in proteins play a key role in the progression of diabetic nephropathy.

Significance of glycated LDL in different stages of diabetic nephropathy.

AIM: The aim of this study was to investigate the role of elevated glycated LDL (low-density lipoprotein) in the progression of diabetic kidney disease among type 2 diabetes (T2D) subjects. MATERIALS AND METHODS: This case-control observational study is a part of Saudi Diabetes Kidney Disease (SAUDI-DKD) study conducted during the period from April 2014 to June 2015. This study cohort is divided into two groups; the first group was T2D patients without diabetic nephropathy (DN) (n = 24) and the second group was T2D with DN (n = 45). Serum glycated LDL levels were determined by ELISA. Pearson's correlation analysis was performed, and the diagnostic accuracy was assessed using the area under the ROC curve. RESULTS: There was a threefold increase of serum glycated LDL level among diabetic subjects when compared with non-diabetic subjects and this level progressively increased with the progression of DN. The glycated LDL was found to have a significant diagnostic accuracy with AUC of 0.685 and 0.775 for cases with microalbuminuria and macroalbuminuria respectively. CONCLUSION: The glycated LDL could play a significant role in predicting diabetic patients who are susceptible to develop DN among T2D patients.

Knowledge, attitudes, and practices of health-care workers regarding hand hygiene guidelines in Al-Qassim, Saudi Arabia: A multicenter study.

INTRODUCTION: Hand hygiene is one of the most important ways to reduce the prevalence of nosocomial infections, morbidity, mortality, and health-care costs among hospitalized patients worldwide. OBJECTIVES: We addressed this study to assess knowledge, attitudes, and practices regarding hand hygiene guidelines among health-care workers. METHODS: A multicenter cross-sectional study conducted from October to December 2015 including three hospitals in Al-Qassim, Saudi Arabia. A total of 354 participants completed a self-administered survey on knowledge, attitudes, and practices of hand hygiene. Analysis of variance was used to compare knowledge level across age, gender, profession, and hospitals. All analyses were performed with SPSS, version 21. RESULTS: Overall, the average knowledge score was 63%. There were significant differences in knowledge level across groups. Health-care workers over the age of 30 had higher scores than those younger than 30. Health-care workers at the tertiary hospital had higher scores than those at the secondary hospitals. Nearly, all reported positive attitudes toward hand hygiene as well as adhering to the guidelines regularly. Further, they reported that soap and water were the most common agents for cleaning hands. CONCLUSION: The study findings indicate that there are gaps in the knowledge, which could be addressed with brief and more frequent training sessions, particularly in the secondary hospitals. However, the hand hygiene guidelines are well-known by the staff and well promoted in the hospitals reflected by the positive attitudes. Further improvements in adherence to the hand hygiene guidelines will continue to decrease the likelihood of nosocomial infections.

Protein Mediated Oxidative Stress in Patients with Diabetes and its Associated Neuropathy: Correlation with Protein Carbonylation and Disease Activity Markers.

INTRODUCTION: Free radicals have been implicated as Diabetes Mellitus (DM) contributors in type 2 DM and its associated Diabetes Mellitus Neuropathy (DMN). However, the potential for protein mediated oxidative stress to contribute disease pathogenesis remains largely unexplored. AIM: To investigate the status and contribution of protein mediated oxidative stress in patients with DM or DMN and to explore whether oxidative protein modification has a role in DM progression to DM associated neuropathy. MATERIALS AND METHODS: Sera from 42 DM and 37 DMN patients with varying levels of disease activities biomarkers (HbA1C, patients' age or disease duration) and 21 age- and sex-matched healthy controls were evaluated for serum levels of protein mediated oxidative stress. RESULTS: Serum analysis showed significantly higher levels of protein carbonyl contents in both DM and DMN patients compared with healthy controls. Importantly, not only was there an increased number of subjects positive for protein carbonylation, but also the levels of protein carbonyl contents were significantly higher among DM and DMN patients, whose HbA1C were ≥8.8 as compared with patients with lower HbA1C (HbA1C<8.8). Similar pattern of protein carbonyls formation was also observed with patients' ages or with patient's disease durations, suggesting a possible relationship between protein oxidation and disease progression. Furthermore, sera from DMN patients had higher levels of protein carbonylation compared with non-neuropathic DM patients' sera, suggesting an involvement of protein oxidation in the progression of diabetes to diabetes neuropathy. CONCLUSION: These findings support an association between protein oxidation and DM or DMN progression. The stronger response observed in patients with higher HbA1C or patients' ages or disease durations suggests, that protein mediated oxidative stress may be useful in evaluating the progression of DM and its associated DMN and in elucidating the mechanisms of these disorders pathogenesis.

Glycemic indices, glycemic load and glycemic response for seventeen varieties of dates grown in Saudi Arabia.

BACKGROUND: Dates are consumed worldwide, and are an important fruit for many individuals in Saudi Arabia. Currently, limited information is available on the glycemic indices of different date varieties. OBJECTIVES: To determine the glycemic index (GI), glycemic load (GL) and glycemic response for 17 common date varieties in Saudi Arabia. DESIGN: Prospective clinical trial on healthy subjects. SETTING: College of Medicine, Qassim University, Buraydah, Saudi Arabia. PATIENTS AND METHODS: The available carbohydrate content of Tamer stage dates was determined using standard laboratory methods. Healthy subjects (ten males and nine females) received 50 g of glucose (on three separate occasions) and 50 g equivalent of available carbohydrates from the seventeen varieties of date (each once). The GI and GL were then calculated. MAIN OUTCOME MEASURE(S): GI, GL, and glycemic response. RESULTS: The mean (SEM) GI of the date samples was 55.2 (7.7) (range, 42.8-74.6). Sellaj and Maktoomi exhibited the highest GI (74.6 [10.1] and 71.0 [11.1]), respectively, whereas Shaqra, Sukkary, and Sag'ai had the lowest GI (42.8 [5.5], 43.4 [4.7] and 44.6 [6]), respectively. The GL of the date samples ranged from 8.5 to 24. Sellaj had a high GL (24), whereas Ajwah and Shaqra had a low GL (8.5 and 9.2). The analyses suggested no significant difference in GI between the date varieties. However, the GL values differed significantly between the 17 date varieties (P < .001). CONCLUSION: The results provide reliable GI and GL values for 17 common date varieties in Saudi Arabia. The identification of date varieties with lower glycemic responses may help lower the GI of the diet of both healthy and diabetic Saudi individuals. LIMITATIONS: We used dates at the Tamer stage, which may not be translatable to all types of dates.