Prevalence of discharge against medical advice and its associated demographic predictors among pediatric patients: A cross-sectional study of Saudi Arabia.

BACKGROUND: Discharge against medical advice (DAMA) occurs when the patient or their caretaker leaves the hospital against the recommendation of their treating physician. DAMA may expose the children to a high risk of inadequate treatment, which may result in readmission, prolonged morbidity, and mortality. The study aimed to identify the predictors of DAMA in the emergency department (ED) within the pediatric age group. METHODS: This was a cross-sectional study. The study used the medical records of pediatric patients (n = 5609) that were admitted to the ED of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, during 2017 and 2018. Descriptive statistics, Chi-square, or Fisher's exact test were used. Unadjusted and adjusted odds ratios with their 95% CI were reported by performing logistic regression modeling. RESULTS: A significant interaction between age and gender was observed in the multivariate analysis after adjusting for the other covariates. The odds of DAMA for a 5-year-old female child were 4.43 times higher than those of a 5-year-old male child (P < 0.1). CONCLUSIONS: The public should be educated about the consequences of DAMA. Continued health education and the promotion of child survival strategies at the community level, combined with an improvement in the socioeconomic conditions of the population, may further reduce DAMA and improve the chances of survival for children. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.

The association between overweight/obesity and psychological distress: A population based cross-sectional study in Saudi Arabia.

OBJECTIVES: The objective of this study was to compare the association between mental well-being between obese (classes 1 and 2), over-weight and non-obese population-based individuals. METHODS: A population-based cross-sectional study was conducted in Al-Kharj, Saudi Arabia. A total of 1019 Saudi nationals aged ≥ 18 years participated in the survey. BMI scores were used to categorize participants into three groups: Obese, overweighted and non-obese/non-overweight. Mental well-being was evaluated by using the validated Arabic version of the General Health Questionnaire version 12 (GHQ-12). RESULTS: We used total GHQ score (Mean=12; SD=5.23) to compare mental well-being between the four BMI class categories. The overall one-way ANOVA model was statistically significant (F = 7.018, d = 6, P < 0.001). In multivariate analysis, after adjusting for sociodemographic variables, diabetes and smoking statuses we found that higher psychological distress (as evident by a higher total GHQ score) was associated with higher BMI. The unstandardized Beta regression coefficient = 2.627; P = 0.034). Females were more likely to have higher psychological distress than males (unstandardized Beta = 1.466, P = 0.003). Job status whether being unemployed or 'civilian' (civil worker) was significantly associated with higher psychological distress (unstandardized Beta = 1.405, P = 0.041). Being diabetic has a 1.6 times higher risk of psychological distress (unstandardized Beta = 1.604, P = 0.027). CONCLUSION: The study highlights the public health implications of psychological distress amongst individuals with overweight and obesity in Saudi Arabia. Future longitudinal studies should explore the temporality of this relationship.

The relationship between chronic pain, prehypertension, and hypertension. A population-based cross-sectional survey in Al-Kharj, Saudi Arabia.

Background: Chronic pain and hypertension are highly prevalent in both developing and developed countries. Although they may appear to be two separate phenomena, several studies in developed countries have found them associated at the population level. Studies in developing countries are scarce and association between pain with prehypertension are rarely explored. The objective of this study was to explore the potential association between prehypertension, hypertension, and chronic pain in a Saudi population.Methods: A cross-sectional general population-based study was conducted on a random sample of employees and university students over a period of 6 months from January 2016 to June 2016 in Al Kharj, Saudi Arabia. A total of 1200 general population adults (aged 18 years and above) were invited to participate in the study.Results: With a response rate of 85.9%, 1031 individuals were included in the final analysis. Among the general population of Al-Kharj, statistically significant association was found between age and chronic pain [Odds ratio (OR) = 1.764 [95% C.I. = 1.391-1.927], P < 0.0001] and between hypertension and chronic pain [(OR) = 1.039 [95% C.I. = 1.018-1.060], P < 0.0001], respectively. The association between prehypertension and chronic pain was not statistically significant [(OR) = 1.211 [95% C.I. = 0.879-1.668, P = 0.243].Conclusion: Results of this survey suggests a statistically significant relationship between hypertension (but not prehypertension) and chronic pain. The temporality of the relationship between hypertension and chronic needs to be explored in future longitudinal studies.

Association between Chronic Pain and Diabetes/Prediabetes: A Population-Based Cross-Sectional Survey in Saudi Arabia.

Background: Diabetes is a debilitating chronic health condition that is associated with certain pain syndromes. The present study sought to evaluate chronic pain and its association with diabetes mellitus at a population level. Methods: A population-based cross-sectional questionnaire survey study was conducted in Al-Kharj, Saudi Arabia, from January 2016 to June 2016. Participants from both private and governmental institutions were selected following a multistage sampling technique and using a cluster sampling method. Anthropometric measurements were taken, including body weight, height, body mass index (BMI) and waist circumference. A blood sample was also drawn from each respondent for fasting blood sugar, HbA1c, and fasting lipid profile. A P value of less than 0.05 indicated statistical significance. Results: A total of 1003 subjects were included for final analysis. Compared to prediabetic and nondiabetic individuals, diabetic subjects had a higher prevalence of lower limb pain (11.1%), back pain (8.9%), abdominal pain (6.7%), and neck pain (4.4%) (X 2 = 27.792, P = 0.015). In a multiple logistic regression model, after adjusting for age, gender, education level, cholesterol, and smoking status, diabetic/prediabetic patients had a significantly higher prevalence of chronic pain ((OR) = 1.931 (95% CI = 1.536-2.362), P = 0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010-1.054, P = 0.004). Conclusion: Results of this study found a significant association between diabetes and prediabetes and chronic pain symptoms. Prospective studies are needed to explore temporality of such association.

The Epidemiology of Migraine Headache in Arab Countries: A Systematic Review.

BACKGROUND: Recurring migraine disorders are a common medical problem, standing among the top causes of disability and sufferings. This study aimed to evaluate epidemiological evidence to report updated estimates on prevalence, risk factors, and associated comorbidities of migraine headache in the Arab countries. Design and Setting. A systematic review was conducted at the College of Public Health and Health Informatics, Riyadh, Saudi Arabia. METHODS: A systematic search in electronic databases, such as PubMed and Embase, as well as manual searches with cross-referencing was performed from 1990 up to 2019. Overall, 23 included papers were rated independently by two reviewers. Studies were eligible for inclusion only if they investigated migraine headache epidemiology in any Arab country and were published in English. RESULTS: Migraine prevalence among the general population ranged between 2.6% and 32%. The estimated prevalence of migraine headache among medical university students ranged between 12.2% and 27.9% and between 7.1% and 13.7% in schoolchildren (6 to 18 years). Females were found more likely to have migraine than males. The duration of migraine attacks became shorter with increasing age, while chronic (daily) migraine showed increasing prevalence with age. The most commonly reported comorbidities with migraine included anxiety, hypertension, irritable bowel syndrome, and depression. Most common headache-triggering factors included stress, fatigue, sleep disturbances, prolonged exposure to excessive sunlight or heat, and hunger. CONCLUSION: The prevalence and risk factors of migraine headache in Arab countries are comparable to reports from western countries. Longitudinal studies are still needed to investigate the prognosis and predictors of chronicity in the arab countries.

The Epidemiology of Celiac Disease in the General Population and High-Risk Groups in Arab Countries: A Systematic Review.

BACKGROUND AND AIMS: Celiac disease (CD) is possibly the most common autoimmune disorder, which may lead to dietary problems in the Arab region. This paper is aimed at exploring the epidemiology of the celiac disease in Arab countries, including its prevalence, associated risk factors, and clinical patterns. METHODS: An extensive search of the literature was conducted from electronic databases such as PubMed, Embase, and Google Scholar. In total, 134 research papers were retrieved. We extracted studies published from January 1996 to December 2019. Our search was limited to studies published in English. Findings. The review included 35 studies with 22,340 participants from 12 countries and demonstrated a wide variation in the prevalence of CD. The highest prevalence among the general population (3.2%) was reported in Saudi Arabia, and the lowest (0.1%) was reported in Tunisia. Women demonstrated a higher prevalence of celiac disease relative to men. The peak age at diagnosis fell between 1 and 3 years and 9-10 years. Most studies focused on type 1 diabetes. Children with type 1 diabetes have a higher prevalence of CD (range from 5.5% to 20%), while the prevalence of CD in Down's syndrome patients was 1.1% and 10.7% in UAE and Saudi Arabia, respectively. Other autoimmune diseases associated with CD are thyroid disease and irritable bowel disease. The most widely recognized clinical presentation was an inability to flourish and poor weight gain, followed by short stature, abdominal pain, abdominal distension, bloating, and chronic diarrhea. CONCLUSION: The prevalence of the celiac disease in Arab countries varies with sex and age. However, we found that celiac disease presented similar clinical characteristics independent of the geographic region. Longitudinal population-based studies are needed to better identify the true burden and determinants of celiac disease.

The Potential of Social Media and Internet-Based Data in Preventing and Fighting Infectious Diseases: From Internet to Twitter.

Health threats due to infectious diseases used to be a major public health concerns around the globe till mid of twentieth century when effective public health interventions helped in eradicating a number of infectious diseases around the world. Over the past 15 years, there has been a rise in the number of emerging and reemerging infectious diseases being reported such as the Acute Respiratory Syndrome (SARS) in 2002, HINI in 2009, Middle East Respiratory Syndrome (MERS) in 2012, Ebola in 2014, and Zika in 2016. These emerging viral infectious diseases have led to serious public health concerns leading to death and causing fear and anxiety among the public. More importantly, at the moment, the prevention and control of viral infectious diseases is difficult due to a lack of effective vaccines. Thus having real-time reporting tools are paramount to alert relevant public health surveillance systems and authorities about taking the right and necessary actions to control and minimize the potential harmful effects of viral infectious diseases. Social media and Internet-based data can play a major role in real-time reporting to empower active public health surveillance systems for controlling and fighting infectious diseases.

The Prevalence of Internet and Social Media Based Medication Information Seeking Behavior in Saudi Arabia.

The internet has become an important resource to help people search for online medication information. This study aims to report the prevalence and profile of Saudi online medication seeking behavior. Conducted via a web-based survey with Twitter participants between January-February, 2015, the primary outcome measures were the self-reported rates of using the internet to search for medication related information. A valid sample of 4847 participants was collected over the period of the study. Out of the total participants, 68.3% (n=3311) were found to seek online medication related information frequently. Most of the social media users were female 83.5% (n=2766). The majority of respondents 63.6% (n= 3081) used Google, followed by Twitter 28.7% (n= 1392), Snapchat 21%, (n=1019), WhatsApp 13.8% (n= 670), Instagram 11.4%, (n= 553), and Facebook 5.5 % (n= 267), with few searching YouTube 1.3% (n=65) to access online medication information. Findings indicate that the Saudi population actively uses the internet and social media to obtain medication information. Further studies are needed to explore the influence of the internet and social media on user perception, attitude, and behavior with the use of online medication information.

Exploring the Impact of Information Seeking Behaviors of Online Health Consumers in the Arab World.

In the Arab world, increasing numbers of people are seeking online health related information for diagnoses, medicine, fitness, pharmaceutical drugs, and smoking cessation programs, among others. Studies exploring the impact of social media channels on health seeking behavior among Arabic users are limited. This study has two goals: (1) describe the prevalence of online health information-seeking behavior in the Arab world, and (2) study the impacts of social media based platforms in helping promote healthy living in the Arab world. In order to gather primary data, a web-based cross-sectional survey with a total of 7013 self-administered questionnaires was sent via SMS messages (n=1278), to Twitter followers of an Arab women's health social media account (n=3630 followers), and WhatsApp messages (n=2105) to participants above 16 years of age representing different socioeconomic groups and within the Arabic speaking world. The findings of this study show high interest among the participants (84.9%) in seeking online health information. Furthermore, reporting online information had an impact on participant health behaviors. Social media can play an important role in strengthening the health care system to provide valuable information, educational programs and interventions to promote healthy life styles among the Arabic people.

Promoting Oral Health Using Social Media Platforms: Seeking Arabic Online Oral Health Related Information (OHRI).

Access to oral health care services around the world is limited by a lack of universal coverage. The internet and social media can be an important source for patients to access supplementary oral health related information (OHRI). Online OHRI presents an opportunity to enhance dental public health education about innumerable oral health issues and promote dental self-care. The aim of this study is to estimate the prevalence of social media users among the Saudi population and identify the preferred social media platform for seeking Arabic OHRI and its impact on seekers' knowledge, attitude, and behavior. A total of 2652 Twitter followers were surveyed, using a web-based self-administered questionnaire to collect data on demographic characteristics and online OHRI seeking behavior More than two thirds, 67.7% (n= 1796), of the participants reported they were seeking Arabic online OHRI, while 41.1% of the participants reported they had no preference for using a specific social media platform. These results emphasize the need and importance of supporting the content of social media with trusted and high quality online OHRI resources to promote a high level of public awareness about oral health and dental health services. Further studies in this regard are highly recommended on a larger scale of nationalities to explore the role of social media platform preference in promoting health promotion and dental public health awareness.

The epidemiology of Dengue fever in Saudi Arabia: A systematic review.

Dengue fever (DF) is the most serious mosquito-borne viral disease worldwide. DF is an acute febrile illness caused by Aedes aegypti and Aedes albopictus, which are endemic in certain cities of Saudi Arabia, such as Jeddah and Makkah (Mecca). An online literature search was conducted using relevant keywords to retrieve DF studies conducted in Saudi Arabia. Forty-five articles were identified initially. After screening for exclusion and retrieving full texts, a total of 10 articles were used for this review. Four studies were cross-sectional, and three observed a seroprevalence ranging from 31.7% to 56.9%, either among clinically suspected cases or among patients visiting the hospital for other reasons. Evidence extracted from risk factors and distribution studies indicated that young males are commonly affected. Fever, vomiting, thrombocytopenia and leukopoenia were the common features of the three studies related to clinical presentation of DF. One cross-sectional study concerning an educational program for DF demonstrated that a positive family history of DF, literate mothers, and age over 17 years were the predictors of a high DF knowledge score. However, the paucity of large epidemiological studies limits the generalizability of such evidence. Future studies in Saudi Arabia should focus upon the expansion of DF to other cities in the Kingdom. Larger epidemiological studies are needed for estimating the true burden and incidence of DF in the Saudi population, as they are limited to seroprevalence among clinically suspected cases and hospital-based patients.

A Social Media Campaign to Promote Breastfeeding among Saudi Women: A Web-based Survey Study.

Prolonged breastfeeding can prevent or limit the severity of a variety of diseases and conditions. Although evidence clearly shows that there are health benefits for breastfeeding, adherence to breastfeeding remains a key challenge facing maternal health providers in Saudi Arabia. The purpose of this study is to evaluate the impacts of a social media platform (Twitter) to promote breastfeeding in Saudi Arabia. Between February 10 and March 25, 2015, a web-based questionnaire was administered to evaluate the impacts of a Twitter based educational campaign on the awareness, knowledge, and adherence to breastfeeding behavior for women in Saudi Arabia. The overall response rate among mothers with a newborn child was 83% (n=484). The results showed an increase in the knowledge and awareness of breastfeeding practices and adherence among Twitter followers. The initiation rate of breastfeeding had slightly increased among women who never had previously breastfed. More women reported their willingness to continue exclusive breastfeeding and to stop bottle-feeding. Results also show that an integration of professional breastfeeding support, public health education programs through social media could be an effective tool in promoting breastfeeding in Saudi Arabia. There is a need for further research on designing and implementing a social media based educational outreach program to increase women's awareness, knowledge, and adherence to breastfeeding behavior in Saudi Arabia.

Exploring the Role of Twitter in Promoting Women's Health in the Arab World: Lessons Learned.

Women's health is a topic that has been largely overlooked within the Arab world. Nevertheless, the constant growth in the use of social media provides an opportunity to improve women's health in the Arab world. In this paper, we discuss our experiences and lessons learned with the development of a women's health promotional campaign in the Arabic language using Twitter, a popular social media platform in the Arab world. We analyzed the combined experiences of five researchers in the development of the Twitter account. Two separate meetings were held, one on March 10 and another on March 25, 2015 with the researchers to review their experiences and lessons learned in developing a Twitter health promotion platform for women's health in the Arab world. The shared experiences were thematically transcribed, coded, matched and grouped under six key themes identified as the main driving forces for the development of a successful health promotion Twitter account. We found that the success of the Twitter account was the result of: defining clear goals, being passionate about the health promotion campaign, being motivated and creative, being knowledgeable about the health promotion area, developing trust between Twitter accounts users and the healthcare provider, and being patient in communicating with Twitter account users. Future research needs to focus on a more detailed analysis of the twitter feeds shared between the users and the health practitioners which can enhance our understanding of the social media based public health educational interventions.

The Role of Social Media in Promoting Women's Health Education in Saudi Arabia.

Social media has the potential to improve women's health in developing countries through health education and promotion. In the Arab world, women's health interventions are lacking. However, with a high penetration rate of social media in the Arab world, there is good opportunity to utilize social media platforms such as Twitter to promote women's health. In this paper, we analyze the Tweet feeds of Saudi-based Twitter account to promote women's health. A total of 5167 Tweets were extracted and analyzed retrospectively, using NVivo Ncapture between June 2014 and March 2015. There were a total number of 3449 followers by March 20, 2015. Results showed that a majority of the Twitter followers (61%, n=2104) were seeking gynecological information, followed by pregnancy related information (27%, n=931), breast-feeding advice (9%, n=310), and other health related information (3%, n=103). Results also showed an increased level of health awareness and comprehension among Twitter followers. Further research is needed to promote women's health in Saudi Arabia and the Arab world through social media platforms such as Twitter and similar platforms including Instagram, Facebook, and YouTube which are also popular in the Arab world.

The Prevalence of Using Social Media among Healthcare Professionals in Saudi Arabia: A Pilot Study.

Keeping up-to-date with new health information is a necessity for healthcare professionals. Today, social media platforms such as Twitter, among others, are important sources for healthcare professionals. Within the Arab world, little is known about how healthcare professionals use social media to update their healthcare information. This study aims to estimate the prevalence of healthcare professionals, primarily physicians, in seeking online health information in Saudi Arabia. We conducted a web-based survey among Twitter participants between February 1 and March 10, 2015. The primary outcome measures were the self-reported rates of Twitter use, perceived effects, and the influence of Twitter information on clinical practice. Our results revealed that the prevalence rate of physician's seeking online health information was 79% (n=166); the majority of them (71.4%, n=150) reported that Twitter had a significant impact in increasing their medical knowledge and in improving their clinical practice. Over half of the survey participates reported the need for investment in establishing trustworthy and credible health Twitter accounts. The participants reported that their preference for social media health accounts that focus on women's health, non-communicable disease and psychotherapy (20%, 18.1% and 14.5% respectively). The findings showed clearly that seeking web-based medical information through social media is popular among physicians, in general, but especially among younger physicians in Saudi Arabia. The study findings indicate to the necessity for further research on designing and implementing a national social media based educational outreach program to provide evidence-based healthcare information and improve healthcare providers' knowledge and skills in Saudi Arabia.

Web-based Health Educational Program in Saudi Arabia.

The purpose of this exploratory study is to provide an overview of a web-based health educational site created by the King Faisal Specialist Hospital and Research Center (KFSH&RC) in the Kingdom of Saudi Arabia (KSA). Sources of data included two interviews with Saudi IT personnel, three health educators, and two medical consultants working at KFSH&RC. The interviews ranged between 45 minutes and 120 minutes. The KFSH&RC website was also searched for the type of health information content posted. Results show that the KFSH&RC web-based health educational site provides health information through a medical encyclopedia, a social networking platform, health educational links, and targeted health information for children, which includes tools such as games and coloring books. Further research is needed on the effectiveness of the KFSH&RC web-based health education site in terms of improving knowledge and changing behavior of Saudi patients. The study recommends that targeted web-based health education strategies should be developed to reach large rural populations which have inadequate computer skills and limited access to the internet.

Electronic Dental Record (EDR) Use in Saudi Arabia: An Exploratory Study.

The purpose of this exploratory study is to provide an overview of the electronic dental records (EDR) systems used at National Guard Health Affair (NGHA) hospitals in the Kingdom of Saudi Arabia (KSA). Different sources of data were collected between February 18 and March 16, 2014. Sources of data included interviews with key informants. Key informants interviews included one 30 minute interview with an information technology specialist working at NGHA; seven 30-40 minute interview with dentists working in both the NGHA hospital and affiliated NGHA Primary Healthcare Clinics (PHCs). Two dental ward clerks were interviewed for 30 minutes and two dental directors were interviewed for 1 hour each. Four main themes emerged as a result of the analysis of the data. The main themes that emerged centered on staff satisfaction and workload, incomplete information, missing files, and adoption of EDRs. There were several challenges identified with the use of EDRs in Saudi Arabia. The challenges related to resistance to use the EDRs by clinical staff; lack of computer skills by clinical staff; usability of the systems; lack of interest in using EDRs; and lack of a clear management change strategy. Moving forward, these issues should be addressed so that more EDRs are implemented in all healthcare institutions in Saudi Arabia.

Are Web-based Surveys the New Epidemiological Mode For Healthcare Research? - The Saudi Perspective.

Web-based surveys (WBS) are gaining popularity as simple, cost-effective and rapid tools for data collection in healthcare research. The purpose of this exploratory study is to summarize the role of website-based survey (WBS) in gathering data for epidemiological research and review challenges facing WBSs in healthcare research. Electronic search in related literature for advantages, characteristics and performance of WBS was conducted. Special focus was placed on WBSs use in the Saudi context. The results indicated that WBSs are being employed increasingly in Healthcare research because of their accessibility, rapidity, reduced cost, less need for human resources and elimination of human errors. However, Paper-based surveys still possess higher response rates, accuracy and are more applicable for probability-sampling methods. Selection bias favoring young, educated and professional participants is associated with WBSs. Most Saudi studies sampled either healthcare professionals or students as the target population. Challenges specific to WBSs include: accessibility, representativeness of sampled population and multiple responses/unintended participants. Although WBSs do appear to be a contemporary alternative to traditional paper-based survey tools, more research is needed to optimize their applicability in different cultural contexts and for diverse pools of participants.

The use of health information technology in saudi primary healthcare centers.

The purpose of this exploratory study is to provide an overview of health information technologies (HITs) used in primary healthcare centers (PHCC) in the Kingdom of Saudi Arabia. Data collection methods included key stakeholder interviews and an academic search using a variety of keyword terms. Evidence shows that the use of health information technologies in Saudi PHCCs is growing although is still in its early stages. Despite the numerous steps undertaken in upgrading and operating the Kingdom electronic health information system (EHIS) as a consequence of the national strategic roadmap of alignment with the electronic health (e-Health) Strategic objectives, yet there is still a mounting need to address realistic approaches in implementing e-health services in Saudi PHCCs. Particularly, tackling barriers that hinder the use of EHIS in PHCCs.

The state public health informatics in saudi arabia.

The purpose of this exploratory study is to provide an overview on the state of Public health informatics (PHI) in the Kingdom of Saudi Arabia (KSA). The study defines PHI and discusses the current status and future challenges which face the Saudi health system. Data collection methods included interviews with public health and PHI experts, and database search, using relevant keyword terms in PubMed. Results of this research show that public health information systems (PHIS) are not well-developed to deliver efficient health care in Saudi Arabia. There are several challenges that need to be addressed with the implementation of PHIS such as the need for readiness assessment, resistant to change, integration of systems, and confidentiality and privacy of health information. Future challenges include profiling users, developing a national PHIS and monitoring the impact of PHIS on healthcare outcomes need to be addressed.