The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia.

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.

Management of Stroke in Patients With Chronic Liver Disease: A Practical Review.

Chronic liver disease (CLD) is a highly prevalent condition. There is burgeoning recognition that there are many people with subclinical liver disease that may nonetheless be clinically significant. CLD has a variety of systemic aberrations relevant to stroke, including thrombocytopenia, coagulopathy, elevated liver enzymes, and altered drug metabolism. There is a growing body of literature on the intersection of CLD and stroke. Despite this, there have been few efforts to synthesize these data, and stroke guidelines provide scant guidance on this topic. To fill this gap, this multidisciplinary review provides a contemporary overview of CLD for the vascular neurologist while appraising data regarding the impact of CLD on stroke risk, mechanisms, and outcomes. Finally, the review addresses acute and chronic treatment considerations for patients with stroke-ischemic and hemorrhagic-and CLD.

A Case of Leukocytoclastic Vasculitis and Associated Conjunctivitis Following MMR Vaccine Administration.

Introduction: Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by immune complex deposition in the walls of dermal capillaries and venules. With the COVID-19 pandemic, more adults are receiving the MMR vaccine, as it may enhance innate immune responses against COVID-19 infection. Here, we report a case of LCV and associated conjunctivitis arising in a patient secondary to immunization with the MMR vaccine. Methods and Results: A 78-year-old man on lenalidomide therapy for multiple myeloma presented to an outpatient dermatology clinic with a two-day history of a painful rash consisting of scattered pink dermal papules on bilateral dorsal and palmar hands, as well as bilateral conjunctival erythema. Histopathological findings-which revealed an inflammatory infiltrate with papillary dermal edema, as well as nuclear dust within small blood vessel walls with extravasation of red blood cells-were most consistent with LCV. It then became known that the patient had received an MMR vaccine two weeks prior to the onset of the rash. The rash was resolved with the use of topical clobetasol ointment, and the patient's eyes were cleared as well. Conclusions: This is an interesting presentation of MMR vaccine-related LCV occurring only on the upper extremities with associated conjunctivitis. Had the patient's oncologist not known about the recent vaccination, it is likely that the treatment of his multiple myeloma would have been postponed or altered, as lenalidomide can also cause LCV.

Thrombocytopenia and liver disease: pathophysiology and periprocedural management.

Abnormal bleeding in patients with liver disease may result from elevated portal pressure and varix formation, reduced hepatic synthesis of coagulation proteins, qualitative platelet dysfunction, and/or thrombocytopenia. Major mechanisms of thrombocytopenia in liver disease include splenic sequestration and impaired platelet production due to reduced thrombopoietin production. Alcohol and certain viruses may induce marrow suppression. Immune thrombocytopenia (ITP) may co-occur in patients with liver disease, particularly those with autoimmune liver disease or chronic hepatitis C. Drugs used for the treatment of liver disease or its complications, such as interferon, immunosuppressants, and antibiotics, may cause thrombocytopenia. Periprocedural management of thrombocytopenia of liver disease depends on both individual patient characteristics and the bleeding risk of the procedure. Patients with a platelet count higher than or equal to 50 000/µL and those requiring low-risk procedures rarely require platelet-directed therapy. For those with a platelet count below 50 000/µL who require a high-risk procedure, platelet-directed therapy should be considered, especially if the patient has other risk factors for bleeding, such as abnormal bleeding with past hemostatic challenges. We often target a platelet count higher than or equal to 50 000/µL in such patients. If the procedure is elective, we prefer treatment with a thrombopoietin receptor agonist; if it is urgent, we use platelet transfusion. In high-risk patients who have an inadequate response to or are otherwise unable to receive these therapies, other strategies may be considered, such as a trial of empiric ITP therapy, spleen-directed therapy, or transjugular intrahepatic portosystemic shunt placement.

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Management and outcomes of mild hemophiliacs and hemophilia carriers during pregnancy and peripartum period: a hemophilia treatment center experience in the United States.

BACKGROUND: Pregnancy, peripartum management, and outcomes of mild hemophiliacs and hemophilia carriers in the United States are not well established. AIM: To describe the management and outcomes of mild hemophiliacs and hemophilia carriers during assisted conception, pregnancy, peripartum and post-partum period at our hemophilia treatment center (HTC). METHODS: Retrospective review of electronic medical records of pregnant women with mild hemophilia A or B (Factor VIII [FVIII] or Factor IX [FIX] level <0.4 IU/mL) and hemophilia A and B carriers followed at our HTC from January 2008 to October 2020. Demographics, the reason for diagnosis, FVIII and FIX levels at baseline and third trimester, bleeding phenotype and genotype were obtained. Method of conception, factor replacement, iron supplementation, mode of delivery, type of anesthesia, peripartum complications, and offspring outcomes was recorded. RESULTS: There was a total of 18 pregnancies in 12 women (2 with mild hemophilia A, 2 mild hemophilia B, 6 hemophilia A carriers, and 2 hemophilia B carriers). Eleven pregnancies (61%) were conceived naturally and 7 (39%) via in-vitro fertilization (IVF). Eight (44.4%) and 10 (55.6%) pregnancies were vaginal and C-section deliveries, respectively. Neuraxial anesthesia was administered in 17 (94.4%) deliveries without complications. Four pregnancies (22.2%) had bleeding complications, 2 of which were post-partum hemorrhages not requiring transfusion. CONCLUSION: In our case series of pregnant hemophilia carriers and mild hemophiliacs, successful outcomes were achieved with a carefully detailed multidisciplinary-driven approach.

The Association between Tensiomyography and Elastography Stiffness Measurements in Lower Limb Skeletal Muscles.

The objective was to test the measurements association between tensiomyography (TMG) and shear wave elastography (SWE) when evaluating the skeletal muscle stiffness of healthy subjects. The secondary objective was to evaluate the effect of superficial non-muscular tissues thickness on the measurements. A cross-sectional study was conducted with adults who are asymptomatic and had no previous history of musculoskeletal conditions. The vastus lateralis (VL) and biceps femoris (BF) muscle contraction was tested using TMG and SWE. The TMG parameters included time of contraction (Tc), sustain time (Ts), relaxation time (Tr), delay time (Td), and maximal displacement (Dm). The skin, subcutaneous fat, and fascia thicknesses were investigated using ultrasound imaging. A total of 25 participants were enrolled in the study. Six participants were females (24%). The mean age (SD) was 26.5 years (4.7). There was a statistically significant difference (p < 0.001) in SWE between VL (8.1 kPa) compared with the BF (10.8 kPa). As for Dm, which reflects stiffness in TMG, no difference was detected (p = 0.90), as both muscles had a maximum displacement of 3.7 mm. The correlation coefficients failed to detect any significant correlation (r ≤ 0.300, p ≥ 0.1) between SWE and TMG variables. There was no significant difference between male and female participants across all TMG and SWE variables (p > 0.10). Overall, there was no association between TMG parameters and SWE measurements, indicating that each technique might be evaluating a different biomechanical property of skeletal muscle.

Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders.

PURPOSE: To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders. MATERIALS AND METHODS: The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton's guidelines. Patients with lower extremity musculoskeletal disorders (N = 116) were recruited to examine the test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses. RESULTS: Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test-retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS. CONCLUSIONS: The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test-retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders.Implications for rehabilitationRehabilitation specialist can confidently interpret patient's score in the Arabic PSFS to represent the extent of activity limitation.Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time.The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders.The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Annexin A2 in Fibrinolysis, Inflammation and Fibrosis.

As a cell surface tissue plasminogen activator (tPA)-plasminogen receptor, the annexin A2 (A2) complex facilitates plasmin generation on the endothelial cell surface, and is an established regulator of hemostasis. Whereas A2 is overexpressed in hemorrhagic disease such as acute promyelocytic leukemia, its underexpression or impairment may result in thrombosis, as in antiphospholipid syndrome, venous thromboembolism, or atherosclerosis. Within immune response cells, A2 orchestrates membrane repair, vesicle fusion, and cytoskeletal organization, thus playing a critical role in inflammatory response and tissue injury. Dysregulation of A2 is evident in multiple human disorders, and may contribute to the pathogenesis of various inflammatory disorders. The fibrinolytic system, moreover, is central to wound healing through its ability to remodel the provisional matrix and promote angiogenesis. A2 dysfunction may also promote tissue fibrogenesis and end-organ fibrosis.

SPINE20 A global advocacy group promoting evidence-based spine care of value.

PURPOSE: The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. METHODS: The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. RESULTS: The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. CONCLUSIONS: This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.

Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. RESULTS: Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. DISCUSSION: LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

Successful outcome with eculizumab treatment in a patient with antiphospholipid syndrome presenting with an unusual thrombotic storm.

Catastrophic Antiphospholipid Syndrome (CAPS) is a life-threatening complication of APS requiring complex management to optimize patient outcome. We describe a 54-year-old man with APS with history of splanchnic vein thrombosis, a Factor II G20210A heterozygote, autoimmune hemolytic anemia and thrombocytopenia. He developed sudden onset of severe flank pain due to spontaneous bilateral adrenal hemorrhage while on warfarin with a therapeutic INR. Despite unfractionated heparin and initial clinical improvement, severe thrombocytopenia developed requiring dexamethasone, rituximab, and romiplostim. Hospitalization was complicated further by thrombosis of the inferior vena cava, pulmonary embolism, and painful violaceous patches on his neck and ear cartilages. Punch biopsy of lesions revealed C5b-C9 deposition of small vessel thromboses. Although the inciting event for his thrombotic storm remains uncertain, anti-complement therapy with eculizumab provided rapid and durable lesion resolution. Eculizumab was discontinued after 6 months and patient remains in remission without recurrent thrombosis. This case provides insight on the management of CAPS, including the use of eculizumab.

Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population.

BACKGROUND CONTEXT: Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. PURPOSE: To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors. DESIGN: A prospective cohort study. PARTICIPANTS: One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration. MAIN OUTCOME MEASUREMENTS: The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months. METHODS: At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses. RESULTS: The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted. CONCLUSION: The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.

Pain Behaviour Scale (PaBS): An Exploratory Study of Reliability and Construct Validity in a Chronic Low Back Pain Population.

Objectives: To examine the interrater and intrarater reliability and construct validity of the Pain Behaviour Scale during standard physical performance tests in people with chronic low back pain and to confirm the test-retest reliability of the physical performance tests in this population. The Pain Behaviour Scale (PaBS) is an observational scale that was recently designed to uniquely measure both the presence and severity of observed pain behaviours. Methods: Twenty-two participants with chronic low back pain were observed during performance of five physical performance tests by two raters. Pain behaviours were assessed using the Pain Behaviour Scale. The Visual Analogue Scale and Modified Oswestry Disability Index were used to measure pain and disability, respectively. Descriptive statistics were used to report demographic features of participants. Reliability was analyzed using ICCs. Rater agreement was analyzed using the weighted Cohen's kappa. Correlations between PaBS, self-reported measures, and physical performance tests were calculated using Pearson's product-moment correlations. Results: The PaBS demonstrated excellent interrater (ICC2,1 = 1.0, 95% CI: 0.9 to 1.0) and intrarater (ICC3,1 = 0.9, 95% CI: 0.8 to 1.0) reliability. Component physical performance tests (i.e., time and distance) demonstrated good test-retest (0.6-1.0) reliability. Perfect agreement in the reporting of pain behaviours was found (95-100%). Correlations between pain behaviour severity and pain intensity (r = 0.6) and disability (r = 0.6) were moderate. Moderate correlations were found between pain behaviours and physical performance tests in sit to stand (r = 0.5), trunk flexion (r = 0.4), timed up and go (r = 0.4), and 50-foot walk (r = 0.4). Conclusion: The Pain Behaviour Scale is a valid and reliable tool for measuring the presence and severity of pain behaviour, and the physical performance tests are reliable tests.

Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. SUMMARY OF BACKGROUND DATA: CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. METHODS: Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. RESULTS: One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants' age were all found to be associated with disability, accounting for 52.9% (adjusted R = 0.529) of variability. CONCLUSION: This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures. LEVEL OF EVIDENCE: 3.

Validation of an Arabic version of Fatigue Severity Scale.

OBJECTIVES: To develop and test the psychometric properties of an Arabic version of Fatigue Severity Scale (FSS-Ar) that can be used to measure fatigue in Arabic patients with disorders where fatigue is a major symptom.  METHODS: Forward and backward translations of FSS were undertaken to develop an Arabic version. The validity and reliability of the FSS-Ar was then tested on 28 patients with systemic lupus erythematosus (SLE), 24 patients with multiple sclerosis (MS), and 31 healthy subjects. Exploratory factor analysis and hypothesis testing methods were used to examine construct validity. The correlation between FSS-Ar and the vitality domain of the RAND 36-Item Health was examined to test construct validity. The study was conducted at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between February and June 2012. RESULTS: Using a score of ≥4.05 to define fatigue, 39 of 52 (75%) participants were fatigued compared with 10 out of 31 (32%) healthy participants. The correlation between the FSS-Ar and the vitality domain of the RAND-36 was acceptable (r = -0.46). Factor analysis showed that items of the FSS-Ar measured one underlying construct, namely, fatigue. Test-retest reliability and internal consistency of the FSS-Ar was acceptable (intraclass correlation coefficient model 2,1 = 0.80; Cronbach's alpha = 0.84). CONCLUSION: The Arabic version of the FSS demonstrated acceptable psychometric properties and was able to differentiate between patients with SLE or MS, and healthy subjects.

Anthropometric and lifestyle characteristics of active and inactive Saudi and British adolescents.

OBJECTIVES: To compare the anthropometric and lifestyle characteristics of active and inactive adolescents in Saudi Arabia and Britain. METHODS: A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14- to 18-year-olds) were randomly selected using a multistage stratified cluster sampling. Measurements included anthropometric [BMI, Waist circumference (WC), Waist to height ratio], screen time, validated physical activity questionnaire and dietary habits. RESULTS: British males were lighter (P = 0.04, 64.4 vs. 68.2 kg), and had lower values for WC (P = 0.003, 77.1 vs. 78.7 cm) than Saudi males. Males (P = 0.0001) were significantly more active than females but the difference between inactive Saudi and British females was greater than that between inactive Saudi and British males. Being female was significantly (P < 0.001) associated with lower activity levels in both the Saudi and British adolescents. Having lower frequency of fruit intake was significantly (P < 0.001) associated with lower activity levels, whereas increased frequency of consumption of French fries/potato chips was significantly (P = 0.008) associated with increased activity levels in Saudi adolescents. Among British adolescents, lower frequency of breakfast was (P = 0.045) associated with lower activity levels, increased frequency of consumption of sweetened beverages was significantly (P = 0.005) associated with higher activity levels. Higher energy drinks intake frequency was significantly (P = 0.007) associated with higher activity levels. CONCLUSION: The present study identifies crosscultural differences and similarities in lifestyle habits in adolescents from Britain and Saudi Arabia. Activity status (active vs. inactive) appears to play an important role in other lifestyle related behaviors, with active adolescent more likely to engage in healthy dietary behavior than their inactive peers, irrespective of country of origin.

Patterns and determinants of physical activity among Saudi adolescents.

BACKGROUND: Few studies have reported comprehensive and valid physical activity (PA) data for Saudi youth. Therefore, the purpose of this study was to examine patterns and determinants of PA among Saudi adolescents. METHODS: A cross-sectional study was conducted in Saudi secondary schools (15-19 years) during 2009/2010 and used multistage stratified cluster sample (N = 2866, 51.7% females). Weight, height, sedentary behaviors, PA, and dietary habits were assessed. RESULTS: Roughly 44% of males and 20% of females were active (≥ 1 hour/day). Males in public schools were more active than in private schools, whereas the opposite was true for females. Females exercise mostly at home, whereas males exercise at public places. The majority of females exercise alone or with relatives, whereas males largely exercise with friends. Males were active for health and recreation whereas females were active for weight loss and recreation. Lack of time was the primary reason for inactivity in both sexes. The predictors of total PA time were gender, intakes of fruit, milk, energy drinks and vegetables and waist/height ratio (R2 = 0.145). CONCLUSIONS: The high inactivity levels, especially among females, are of great concern. Promotion of active living among youth should be a national public health priority.

Prevalence of overweight, obesity, and abdominal obesity among urban Saudi adolescents: gender and regional variations.

The nutrition transition with associated lifestyle-related non-communicable diseases has rapidly reached many developing countries, including Saudi Arabia. Therefore, the objective of this study was to examine the prevalence of overweight, obesity, and abdominal obesity among Saudi adolescents. This school-based multicentre cross-sectional study was conducted during 2009-2010 in three major cities in Saudi Arabia: Al-Khobar, Jeddah, and Riyadh. Participants included 2,908 students of secondary schools (1,401 males and 1,507 females) aged 14 to 19 years, randomly selected using a multistage stratified cluster-sampling technique. Weight, height, and waist-circumference were measured; prevalence of overweight and obes- ity was determined using age- and sex-specific BMI cutoff reference standards of the International Obesity Task Force (IOTF). Abdominal obesity was determined using waist-to-height ratio (WHtR) cutoffs (above 0.5). The prevalence of overweight was 19.5% in males and 20.8% in females while that of obesity was 24.1% in males and 14% in females. The prevalence of abdominal obesity in males and females was 35.9% and 30.3% respectively. Higher prevalence of obesity was observed among adolescents in private schools. Across all ages, overweight and obesity ranged from 39.9% to 45.6% in males and from 30.4% to 38.7% in females. ANCOVA, controlling for age, showed significant interaction effects (city by gender). It is concluded that the proportions of overweight, obesity, and abdominal obesity, observed among Saudi adolescents were remarkably high. Such high prevalence of overweight and obesity is a major public-health concern.

A cross-cultural comparison of health behaviors between Saudi and British adolescents living in urban areas: gender by country analyses.

This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents. A school-based cross-sectional study was conducted at four cities in Saudi Arabia (Riyadh and Al-Khobar; N = 1,648) and Britain (Birmingham and Coventry; N = 1,158). The participants (14-18 year-olds) were randomly selected using a multistage stratified cluster sampling technique. Measurements included anthropometric, screen time, validated physical activity (PA) questionnaire and dietary habits. The overweight/obesity prevalence among Saudi adolescents (38.3%) was significantly (p < 0.001) higher than that found among British adolescents (24.1%). The British adolescents demonstrated higher total PA energy expenditure than Saudi adolescents (means ± SE = 3,804.8 ± 81.5 vs. 2,219.9 ± 65.5 METs-min/week). Inactivity prevalence was significantly (p < 0.001) higher among Saudi adolescents (64%) compared with that of British adolescents (25.5%). The proportions of adolescents exceeding 2 h of daily screen time were high (88.0% and 90.8% among Saudis and British, respectively). The majority of Saudi and British adolescents did not have daily intakes of breakfast, fruit, vegetables and milk. MANCOVA showed significant (p < 0.05) gender by country interactions in several lifestyle factors. There was a significant (p < 0.001) gender differences in the ratio of physical activity to sedentary behaviors. In conclusion, Saudi and British adolescents demonstrated some similarities and differences in their PA levels, sedentary behaviors and dietary habits. Unhealthy lifestyle behaviors among adolescents appear to be a cross-cultural phenomenon.