Assessing Public Awareness, Utilization and Satisfaction with Community Pharmacy Services.

Background: The Saudi Community pharmacy sector has been changing towards patient-centred care rather than depending solely on dispensing medications. Accordingly, pharmacies can now provide many services that they previously could not offer. The aims of this study were to identify all pharmacy services provided in a community setting and to assess public awareness and utilization of and satisfaction with these services. Methods: This was a cross-sectional study in which the authors first purposively visited community pharmacies to identify the services offered. Pharmacists were asked about pharmacy services currently provided to community. Fieldnotes were used to document pharmacists' responses. After identifying pharmacy services, a questionnaire was desgined and reviewed by experts in the field, piloted and approved by the Ethics Committee at King Faisal University, then disseminated via Google Forms. The satisfaction level with pharmacy services was assessed using a five-point Likert scale. Data were collected from 24 January 2023 to 2 March 2023. Results: Eighteen community pharmacies offering 17 different services were visited across Alahsa Governorate. The number of participants who completed the questionnaire was 350. Of those (232 [66.3%]) were female, and the majority of the sample (80.5%) were younger than 40 years old. The majority of the participants were unaware of pharmacy services. Out of 17 services, six received a score of 50% or higher regarding participant awareness. The most utilized services were the medication dispensing service "Wasfaty" (250 [71.4%]), medication counselling provided by pharmacists (232 [66.3%]) and minor ailment service (231 [66%]). The overall satisfaction score for pharmacy services was 87.2%. Conclusion: The majority of the participants were unaware of the full range of available pharmacy services. There is a potential for community pharmacists to fill the capacity gap in the healthcare system since, overall, the participants rated the pharmacies' clinical services as satisfactory. Commissioners of pharmacy services may consider extending the scope of community pharmacies to include services that best utilize the expertise of clinical pharmacists.

Performance of Recycled Polylactic Acid/Amorphous Polyhydroxyalkanoate Blends.

Blends of polylactic acid (PLA) with amorphous polyhydroxyalkanoate (aPHA) are less brittle than neat PLA, thus enabling their use as biodegradable packaging. This work investigated the impact of recycling on the properties of neat PLA and PLA/aPHA blends with 90 and 75 wt. % PLA. After the materials were subjected to five heat histories in a single-screw extruder, the mechanical, rheological, and thermal properties were measured. All recycled compounds with 100% PLA and 75% PLA had similar decomposition behavior, whereas the decomposition temperatures for the blends with 90% PLA decreased with each additional heat cycle. The glass transition and melting temperatures were not impacted by reprocessing, but the crystallinity increased with more heat cycles. The complex viscosity of the reprocessed PLA and PLA/aPHA blends was much lower than for the neat PLA and increasing the number of heat cycles produced smaller reductions in the complex viscosity of 100% PLA and the blend with 90% PLA; no change in complex viscosity was observed for blends with 75% PLA exposed to 2 to 5 heat cycles. The tensile properties were not affected by reprocessing, whereas the impact strength for the 75% PLA blend decreased with reprocessing. These properties suggest that users will be able to incorporate scrap into the neat resin for thermoformed packaging.

Predictors of Hand Grip Strength in Adults Without Sarcopenia: Data From the NHANES, 2013-2014.

Background: Grip strength measurement is used to estimate muscle strength and predict health status; yet, an accurate examination of grip strength predictors from body composition variable is lacking. Objectives: This study aimed to examine the association of grip strength with lumbar bone mineral density (BMD) and total lean mass in adults without sarcopenia. Methods: Adults without sarcopenia (N = 3100) were included from the NHANES, 2013-2014, in this cross-sectional study. Body mass (kg), body height (cm), body mass index (kg/m2), grip strength (kg), total percent fat (%), lumbar BMD (g/cm2), and total lean mass excluding bone mineral content (BMC, kg) were obtained and tested as predictors of grip strength. Results: The regression analysis yielded a significant model [F(2,343732) = 71,284.2; R2 = 0.713; P < 0.001], with all predictors explaining ∼71.3% of the variance in grip strength. Age [ß: -0.043; 95% confidence interval (CI): -0.040, -0.036], sex (ß: -0.296; 95% CI: -6.431, -6.270), total percent fat (ß: -0.245; 95% CI: -0.315, -0.308), lumbar BMD (ß: 0.037; 95% CI: 2.529, 2.806), and total lean mass (ß: 0.482; 95% CI: 0.001, 0.001) were all significant predictors of grip strength. Conclusions: The predictive value of the BMD and total lean mass can serve as a useful measure in predicting grip strength and overall health status in adults without sarcopenia.

Multifaceted associations between walking performance, physical fitness, extremity function, health status, and depression in individuals with COPD.

BACKGROUND/OBJECTIVE(S): Chronic obstructive pulmonary disease (COPD) can precipitate a deterioration of an individual's physical performance and overall health. Evidence suggests that, along with pulmonary functions, several other factors are related to the significant impairment of walking performance in individuals with COPD. This study compared the depressive symptoms, health status, upper and lower extremity functions, and peak oxygen uptake (VO2peak) in a group of individuals with COPD based on walking performance using a cutoff distance of 350 m in the six-minute walking test (6MWT). The study also investigated the associations between these factors and walking performance. MATERIALS AND METHODS: Participants performed the 6MWT according to the guidelines and were classified into high (>350 m; n = 40) or low (<350 m; n = 30) walking performance groups according to distance. The forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were recorded. Participants completed the Patient Health Questionnaire-9 (PHQ-9), St. George's Respiratory Questionnaire (SGRQ), and the Upper and Lower Extremity Functional Index (UEFI/LEFI). Predicted VO2peak was measured using the Duke Activity Status Index (DASI). RESULTS: Seventy participants with a mean age of 63 ± 11 years (20% female) were enrolled in this study. Patients with high walking performance demonstrated significantly better health status than those with low walking performance (SGRQ: 49 ± 25 vs. 56 ± 21, p = 0.03). Participants with low walking performance had lower predicted VO2peak compared to their higher performing counterparts (p = 0.002). The overall model was significant (F(8, 61) = 7.48, p = 0.0006), with PHQ-9, SGRQ, UEFI/LEFI, VO2peak, and FEV1/FVC explaining approximately 49.5% of the variance in the 6MWT distance. CONCLUSION: This study shed light on the association of depressive symptoms, health status, extremity function, and VO2peak with walking performance, providing valuable insights that may impact the management and care of individuals with COPD.

COPD is a global health issue that significantly impairs physical performance, particularly walking.Depressive symptoms, health status, extremity function, and predicted peak oxygen uptake can predict walking performance in patients with COPD, offering insight into potential interventions.

Fat-free mass mediates the association between body mass and jump height in healthy young adults.

BACKGROUND: The countermovement jump (CMJ) is a reliable and valid test of lower-extremity (LE) muscle power and neuromuscular performance. Body mass is positively associated with CMJ performance in young adults, warranting the examination of the influence of body composition on jump height (JH). This study examined the mediation effects of body composition on CMJ performance in young adults. The hypothesis was that fat-free mass and percent fat mass would significantly mediate the association between body mass with JH in young adults. METHODS: Healthy young adults (N.=81; 47 female; mean age 25.1±3.4) completed this study and underwent body composition assessment using a bioelectrical impedance analysis device. Participants performed three CMJ trials to measure average JH using an electronic jump mat. Mediation analysis models were performed to examine the hypothesis of this study. RESULTS: The mediation analyses indicated that the indirect effects of fat-free mass on the association between body mass with JH were significant (indirect effect [IE]=-0.23, 95% CI -0.315, 0.767; IE=0.76, 95% CI 0.334, 1.272; respectively), after controlling for sex and percent fat mass. CONCLUSIONS: The association between body mass with JH in young adults with normal BMI was mediated by fat-free mass. Clinicians, trainers, and coaches should potentially target increasing fat-free mass when improving LE power and neuromuscular performance in rehabilitation and sports settings in this population, but further studies are needed.

Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review.

BACKGROUND: Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. OBJECTIVE: We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. METHODS: We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality. RESULTS: Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH. CONCLUSIONS: In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).

Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial.

BACKGROUND: Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. OBJECTIVE: The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. METHODS: This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure-66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. RESULTS: The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. CONCLUSIONS: The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/53728.

Moderate-to-Vigorous Physical Activity and Response Inhibition Predict Balance in Adults with Attention Deficit/Hyperactivity Disorder.

Background: Some evidence indicates that adults with attention deficit hyperactivity disorder (ADHD) may have balance impairments. This study examined the associations between moderate-to-vigorous physical activity (MVPA), response inhibition (RI), and static balance in this population while off and on psychostimulant medication (PS). Methods: Participants (n = 40; 30 females; M age = 29.0; SD = 6.3 years) wore an ActiGraph GT9X-link around their waist to estimate MVPA levels (minutes/day). To assess RI, participants completed the Delis-Kaplan Executive Function System (D-KEFS) subtests Trail-Making Test (TMT) and Color-Word Interference Test (CWIT). To evaluate static balance, participants completed postural sway area (cm2) assessments in four conditions: feet-apart eyes-open (FAEO), feet-apart eyes-closed (FAEC), feet-together eyes-open (FTEO), and feet-together eyes-closed (FTEC). Participants also completed the single-leg standing tests (seconds) with eyes open (SLEO) and with eyes closed (SLEC). Results: When off medication, MVPA significantly predicted SLEC (ß = 0.30; p = 0.017). MVPA and TMT significantly predicted FTEO, explaining ~19% of the variance in FTEO; both MVPA and TMT were significant predictors (ß = -0.33, p = 0.027 and ß = -0.31, p = 0.039, respectively). When on medication, TMT significantly predicted FAEC (ß = 0.17; p = 0.047). Conclusions: MVPA and RI may be effective parameters in predicting static balance in adults with ADHD when off medication only.

A survey of drive-thru pharmacy services: Evaluating the acceptance and perspectives of community pharmacists in Saudi Arabia.

Background: The practice of dispensing drugs in primary healthcare centers has shifted to community pharmacies in Saudi Arabia. These changes increase demand and mandate improving their services; one such is establishing pharmacy drive-thru services. To explore the effects of drive-thru services on the pharmacy profession, this study aimed to measure community pharmacists' acceptance, perception, and satisfaction regarding drive-thru services. Methods: This cross-sectional study design was conducted in Saudi Arabia between January 2023 and May 2023-comparing the perception, acceptance, and satisfaction of pharmacists who work in a community pharmacy that provides a drive-thru service versus no drive-thru service. Community pharmacists were invited to complete an online questionnaire consisting of four sections developed from previous studies with some modifications. Descriptive statistical analysis and an independent t-test were utilized to test the difference between the two groups (providing drive-thru service vs. non) in their responses. Results: This study included 380 community pharmacists, of whom 33 % provided drive-thru services and 67 % did not. Pharmacists' perceptions of drive-thru services differed significantly. Those with drive-thru services perceived lower convenience for delivering drug information and patient counseling, and they were concerned about the potential impact on their health effects (M = 3.15, SD = 1.34) compared to those without (M = 3.58, SD = 1.10), t (3 7 8) = -3.32, p < 0.01). However, they recognized the convenience of serving sick patients, the elderly, disabled individuals, and mothers with children in cars (M = 3.71, SD = 1.17), which was higher than those without (M = 4.04, SD = 1.21), t (3 7 8) = -2.70, p < 0.01). Regarding the current pharmacy layout suitability, pharmacists with drive-thru services found it more suitable (M = 3.13, SD = 1.14) than those without (M = 2.49, SD = 1.14), t (3 7 8) = 5.1, p < 0.01). However, the two groups had no significant difference in overall satisfaction. Conclusion: Pharmacists working in pharmacies offering drive-thru services recognized certain benefits but also expressed concerns about health effects and decreased convenience for counseling. These findings provide valuable insights for policymakers and pharmacy management, highlighting the nuanced views of pharmacists in adopting drive-thru services.

The Association between Self-Care Activities and Depression in Adult Patients with Type 2 Diabetes in Saudi Arabia: A Cross-Sectional Web-Based Survey Study.

This study examined the level of adherence to self-care behaviors among individuals with type 2 diabetes in Saudi Arabia and its connection with depression and demographic factors. A cross-sectional survey was conducted among diabetes patients using the Patient Health Questionnaire (PHQ-9) to measure depression and the Summary of Diabetes Self-Care Activities (SDSCA) to evaluate diabetes self-care activities. Among the 252 participants who completed the survey, 43.2% were older than 55 and 59% were men. The ordinal regression model showed an association between the PHQ-9 and SDSCA scores with an OR of 0.83 (95% CI: 0.71 to 0.96, p = 0.013). The PHQ-9 score was significantly associated with blood sugar monitoring (OR: 0.90 [95% CI: 0.82 to 0.99, p = 0.003]), exercise (OR: 0.88 [95% CI: 0.79 to 0.98, p = 0.002]), and diet (OR: 0.94 [95% CI: 0.85 to 1.03, p = 0.045]). Of all the diabetes-related factors, only a history of hospitalization and receiving diabetes education were found to be associated with improved self-care behaviors. In conclusion, a negative association was found between PHQ-9 scores and the SDSCA mean score and most daily diabetic self-care behavior components.

Effect of psychostimulant medications on physical function in children with cerebral palsy: scoping review.

The aim of this scoping review is to examine the extent and depth of the literature on effects of central nervous system (CNS) stimulant medications on physical function in children with cerebral palsy (CP). A systematic search for relevant peer-reviewed studies was conducted of PubMed, CINAHL, Cochrane, SPORTDiscus, Embase, & Scopus (January 2002 & August 2022). We included studies that examined the effects of CNS stimulants on physical function in children with CP. Four studies met our selection criteria. All studies explored the effect of Modafinil on physical function outcomes. Three studies of the four included studies reported positive effects of Modafinil on spasticity, motor performance, and gait, whereas one study reported no significant effects of Modafinil. Our findings suggest that there is very low-quality evidence that suggests that Modafinil may enhance physical improvements in body structure and function, including reduction in spasticity and improvements in gait parameters. IMPACT: Central nervous system stimulants were examined for efficacy on physical function and spasticity in children with cerebral palsy. The evidence on the effects of central nervous system stimulants on physical function in children with CP is limited and inconsistent.

E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis.

INTRODUCTION: Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS: Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS: The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS: Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use.

Knowledge, Attitude, and Perception of Health Care Providers Providing Medication Therapy Management (MTM) Services to Older Adults in Saudi Arabia.

INTRODUCTION: Medication Therapy Management (MTM) is identified as a group of services provided to the patient in order to optimize the medication use in order to mitigate adverse drug reactions (ADRs), drug-drug interaction (DDI), and polypharmacy. Elderly populations above 60 years old are at high risk for Medication-related Problems (MRPs) due to several factors. Therefore, MTM programs showed good contributions globally regarding enhancing medication use in the elderly population. Thus, evident information regarding its implementation in Saudi Arabia is lacking in the literature. OBJECTIVE: Our objective is to assess community pharmacists' knowledge, attitude, and barriers to providing MTM services to the older adult population in Saudi Arabia. METHODOLOGY: A cross-sectional study has been conducted among community pharmacists across the Kingdom. It was survey-based research that was designed and conducted through (QuestionPro). The survey was distributed for the community pharmacists from Feb-May 2023 via (QuestionPro). Descriptive analysis was performed using SAS OnDemand to analyze the categorical variables and test it with the outcome of interest. RESULTS: Out of the 528 participants who have viewed our questionnaire, 319 participants have completed the survey in 5 min average time. Most of our participants were male, holding a bachelor's degree, and had an average working load of more than 40 h a week, respectively (84.95%, 92.48%, and 76.18%). In addition, the participants were from different regions of the Kingdom, which enhanced the generalizability of our findings. Moreover, 65.52% have reported a higher level of knowledge, while 34.48% have reported a moderate to low level of knowledge regarding MTM service. Most of those with a higher level of knowledge maintain a positive attitude regarding MTM service, its implementation, and dealing with older adult patients in the community pharmacy. In addition, lacking the time, training, and presence of a private consultation room were the top barriers to provide MTM services in the community pharmacy in Saudi Arabia. CONCLUSION: Educational sessions regarding MTM services among the older adult population are highly recommended for community pharmacists before its implementation.

The Burden of Skin Cancers in Saudi Arabia Through 2011-2022.

Introduction Skin cancers are classified into melanoma and non-melanoma or keratinocyte cancers. No recent data are found about the epidemiology of skin cancers in Saudi Arabia. The current study aims to determine the burden of skin cancer in the last 11 years from 2011 to 2022. Methods Patients who were diagnosed with any type of skin cancer were enrolled in the study. The diagnosis was conducted based on histopathology and immunohistochemistry. Different variables like age, type of cancer, type of lesions, and treatment approach used were measured. Results A total of 91 patients were diagnosed with skin cancers during the study period. The head and neck were the most common sites for skin cancers. Only 4/91 cases reported invasive melanoma. Both squamous cell carcinoma (SCC) (34/91) and basal cell carcinoma (BCC) (28/91) were found to be the most reported skin cancers. Other cancers including mycosis fungoides (MF) (10/91), Kaposi's sarcoma (6/91), and dermatofibrosarcoma protuberans (DFSP) (5/91) were also detected. The rest of the detected tumors were rarely detected. Aggressive CD4+/CD4+/CD8+ MF was more prevalent than CD3+/CD4+/CD8- MF cancer cases. CD34+ /S100- DFSP cancers were evident in most of the DFSP cases. Human herpes virus 8 was detected in all Kaposi's sarcoma cases and all of them were HIV-confirmed cases. Surgical treatment was the most frequently used approach to treat skin cancers, followed by phototherapy (9.9%), surgical/radiotherapy (5.5%), surgical/chemotherapy (4.4%), chemotherapy (3.3%), and then chemoradiotherapy immunotherapy (1.1%). Conclusion The incidences of SCC and BCC are relatively high in comparison to other types of skin cancers with the surgical intervention being most frequently used.

Pharmacists' perceptions about providing COVID-19 vaccines in community settings.

Background: Community pharmacists were underutilized in Saudi Arabia. At the start of the coronavirus disease 2019 (COVID-19) outbreak, global healthcare systems experienced significant pressure. To combat the pandemic effectively, there was a need to involve other healthcare providers, such as community pharmacists. As a result, community pharmacists were enlisted to provide vaccines. Objectives: This study aims to explore community pharmacists' perceptions about providing COVID-19 vaccines in Saudi community settings. Methods: Ethical approval was granted by the Research Ethics Committee of King Faisal University in January 2022. A qualitative methodology was used to explore the opinions of community pharmacists. Semi-structured interviews were conducted via face-to-face qualitative interviewing. Participants were recruited purposively and represented different types of community pharmacy settings. Results: A total of 15 face-to-face individual interviews were conducted. The cohort included pharmacists who provided the service (n = 5) and those who did not (n = 10). The results showed that providing the service in a community setting was advantageous to patients, community pharmacy sector, and healthcare system. Moreover, the participants identified several barriers to providing the service. Conclusion: Although providing the service had several advantages to several parties, the identified barriers need to be considered for the service to be provided appropriately.

The relationship between chronic lung disease diagnosis and the susceptibility to e-cigarette use in adults: The mediation effects of psychosocial, cognitive influences, and the moderation effect of physiological factors.

INTRODUCTION: There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and whether the relationship between CLD and e-cigarette use is conditional on the presence of respiratory symptoms. METHODS: We recruited adults aged ≥18 years in Alabama with CLD from university medical clinics (n=140) and individuals without CLD (n=123 as a reference group). Information on sociodemographics, susceptibility to e-cigarette use, psychosocial factors, and cognitive factors were collected. Mediation analysis was used to assess whether the psychosocial factors or cognitive factors explained the association between CLD and susceptibility to using e-cigarettes, and moderation analysis was conducted to determine if respiratory factors would change the association between CLD and susceptibility to e-cigarette use. RESULTS: Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were notably high among individuals with CLD. Having CLD was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, being a smoker, boredom, taste/sensorimotor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes among individuals with CLD. Mediation analysis indicated a statistically significant indirect effect of CLD on the susceptibility to using e-cigarettes through stress and boredom reduction. We did not find a statistically significant interaction between CLD and respiratory symptoms affecting susceptibility to using e-cigarettes. CONCLUSIONS: Individuals with CLD often exhibit stress, depression, and a positive view of e-cigarettes but are generally less inclined to use them. Stress, smoking habits, boredom, taste, and social influence can increase their susceptibility to e-cigarette use. Our findings call for further exploration to evaluate the temporal relationship between CLD status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov, on 5 November 2019. Identifier: NCT04151784.

Public Awareness About Sexually Transmitted Diseases in Taif, Saudi Arabia.

INTRODUCTION: Islamic culture does not tolerate homosexuality and extramarital sex. This may result in ignorance of safe sex practices and a lack of proper public health education by the authorities and parents; this includes knowledge and awareness about sexually transmitted diseases (STDs), modes of transmission, protection methods, and sources of information about STDs. METHODS: This is a cross-sectional study, a Quick Response (QR)-code-based survey. A standard web-based questionnaire was electronically delivered to our enlisted sample. The statistical analysis started by transferring data from the Excel spreadsheet (Microsoft Corporation, Redmond, Washington, United States) to the SPSS software program. We used one-way ANOVA to compare mean scores between the various groups. And we used the Pearson correlation coefficient to assess the association of age with the score. Significance was established at a p-value of 0.05 or less with a 95% confidence interval. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). RESULTS: The study analysed the sociodemographic characteristics and STD knowledge of 608 participants. Findings revealed a balanced gender distribution, 52.8% male and 47.2% female, the majority being single (72.0%) and with a university education (72.0%). Knowledge gaps were identified, such as confusion between genital herpes and HIV, limited understanding of chlamydia transmission, and misconceptions about human papillomavirus (HPV) and HIV. No significant differences were found based on sex, age, marital status, or father's education. However, higher education of mother correlated with significantly higher knowledge scores (p < 0.0001). CONCLUSION: This study shed light on the limited knowledge and misconceptions surrounding STDs in Taif city. The findings highlighted knowledge gaps, including confusion between different STDs and misconceptions about transmission modes. The results revealed a positive correlation between higher maternal education and increased knowledge scores. These findings underscore the urgency for health authorities to develop awareness campaigns and educational initiatives to promote accurate information and foster healthier attitudes toward sexual activity in these regions.

Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia.

BACKGROUND: Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students. MATERIALS AND METHODS: A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables. RESULTS: The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS. CONCLUSION: The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Effects of backward walking exercise using lower body positive pressure treadmill on knee symptoms and physical function in individuals with knee osteoarthritis: a protocol for RCT.

OBJECTIVES: The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status. METHODS: The study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures. RESULTS: Not applicable. CONCLUSION: Using lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making. TRIAL REGISTRATION: This study was registered in ClinicalTrails.gov (ID: NCT05585099).