Publications by authors named "Ashraf Metwally"

71 Publications

Acceptability of COVID-19 vaccination in Saudi Arabia: A cross-sectional study using a web-based survey.

Hum Vaccin Immunother 2021 Oct 8;17(10):3338-3347. Epub 2021 Jul 8.

College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.

The success of COVID-19 vaccination depends on individual's vaccine acceptance. There has been misinformation on the media that doubts its effectiveness, safety, and long-term risk. Such controversy could affect the acceptance toward the uptake of the COVID-19 vaccine. The objective of this study was to assess the factors influencing the acceptance and hesitancy toward the COVID-19 vaccine in Saudi Arabia. A cross-sectional study was conducted. An online survey was conducted with four parameters: Demographics, medical history, knowledge and information sources about COVID-19 and vaccine, and hesitancy/acceptance of vaccinations. Bivariate analysis between several survey items and the acceptance of COVID-19 vaccine was conducted using Chi-square test. Logistic regression was used to assess to what degree each variable affects the acceptance and the hesitancy toward the COVID-19 vaccine. Approximately 64% show a desire to accept the vaccine while 18.3% were extremely hesitant to take the vaccine. Non-demographic factors that were associated with the acceptance toward the COVID-19 vaccine were the source of health information about COVID-19 (OR:1.63; 95% CI:1.07-2.47), perception toward whether the vaccine is effective on other variants of the virus (OR:7.24; 95% CI:4.58-11.45), previous uptake of the influenza vaccine (OR:1.62; 95% CI:1.07-2.47), and potential mandatory of vaccination in order to travel internationally (OR:16.52; 95% CI:10.23-26.68). This study provides an insight into factors - other than the sociodemographic - influencing the acceptance of the COVID-19 vaccine in Saudi Arabia. The government should address the COVID-19-related misinformation and rumors to increase acceptance of COVID-19 vaccination.
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http://dx.doi.org/10.1080/21645515.2021.1936869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437496PMC
October 2021

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

Saudi J Biol Sci 2021 May 16;28(5):2783-2788. Epub 2021 Feb 16.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 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.
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http://dx.doi.org/10.1016/j.sjbs.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116972PMC
May 2021

Psychological predictors of chronic pain in Al Kharj region, Saudi Arabia.

Ann Gen Psychiatry 2021 Mar 26;20(1):23. Epub 2021 Mar 26.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.

Background: Psychological distress is one of the major determinants for the experience progression, and recovery of chronic pain. However, it is unclear whether physical pain in specific body sites could be predictive of psychological illness. In this study, we aim to investigate the link between chronic pain in specific anatomical sites and psychological distress represented in the General Health Questionnaire-12 (GHQ-12 items).

Methods: A population-based cross-sectional study was conducted in Al Kharj region of Saudi Arabia. We included 1003 participants. Data were collected using the GHQ-12, and a subjective report on eight anatomical pain sites. Data analysis used statistical software SPSS version 26.0 for Windows statistical package.

Results: Chronic musculoskeletal pain in the neck and head regions was significantly associated with higher psychological distress. Other sites (back, lower limb, chest, abdominal and upper limb pain) were not associated with psychological distress. In multiple regression analysis, chronic 'general' pain was significantly associated with higher psychological distress (unstandardized Beta regression coefficient = 2.568; P < 0.0001). The patients with younger age were more likely to develop negative psychological disorders (unstandardized Beta = - 3.137; P = 0.038). Females were more likely to have higher psychological distress than males (unstandardized Beta = 2.464, P = 0.003). Single (not-married) people have a higher risk of psychological distress than married people (unstandardized Beta = 2.518, P = 0.025). Also, job type/status whether being unemployed (not working) or 'civilian' (civil servant/worker) was positively and significantly associated with an increased probability of psychological distress (unstandardized Beta = 1.436, P = 0.019).

Conclusion: Chronic 'general' pain was significantly associated with negative psychological disorders. The government of Saudi Arabia needs to focus on patients with chronic 'general' pain, females, young and unmarried individuals as potentially 'high-risk' population subgroups for adverse psychological disorders, and subsequent long-term complications.
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http://dx.doi.org/10.1186/s12991-021-00345-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004409PMC
March 2021

The Prevalence of Headache and Associated Factors in Al-Kharj, Saudi Arabia: A Cross-Sectional Study.

Pain Res Manag 2021 4;2021:6682094. Epub 2021 Mar 4.

Family & Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.

Background: Only few studies have investigated the prevalence and risk factors of headaches among the Saudi population. The study aimed to estimate the prevalence of headache and to explore its associated risk factors Al-Kharj, Saudi Arabia.

Methods: The multistage sampling technique was used to enroll 1200 population-based participants who were asked to complete a self-administered questionnaire about headaches, demographics, and several other parameters such as smoking status and different chronic and psychological illnesses. The chi-square test and multivariate logistic regression analysis were used to test the association.

Results: The overall prevalence of headaches in this study was 3%. The multiple logistic regression analysis showed that females were more likely to have headaches than males (odds ratio (OR) 0.735, 95% confidence interval (CI) = 0.612-1.341; =0.024). Being a current smoker was also significantly associated with higher "odds" of having headache (OR = 1.319, 95% CI = 0.932-2.462; =0.037). Participants who were overweight had a significantly higher risk of headache (OR = 1.631, 95% CI = 1.48-1.854; =0.037). Nonmarried people were significantly more likely to have headache pain, compared to married individuals (OR = 0.875, 95% CI = 0.646-2.317; =0.047).

Conclusion: The prevalence of headaches was 3%, and four significant associated factors were identified: females, nonmarried, smoking, and overweight. The temporality of the relationship between these factors and headache cannot be confirmed in this cross-sectional study; so future longitudinal studies are needed to confirm these potential causal relationships.
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http://dx.doi.org/10.1155/2021/6682094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952183PMC
June 2021

The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey.

BMC Cardiovasc Disord 2021 01 7;21(1):22. Epub 2021 Jan 7.

Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.

Background: Hypercholesterolemia (HC) is an important precursor to many cardiovascular, cerebrovascular, and peripheral vascular diseases. A report conducted by the American Heart Association showed the prevalence of HC to be 11.9%, with around 28.5 million adults age ≥ 20 years having high cholesterol levels. This study aimed to evaluate the prevalence of HC and its associated risk factors among the general population of Al-Kharj, Saudi Arabia.

Method: A cross-sectional study was conducted on the general population of Al-Kharj, Saudi Arabia in 2016. The representative sample consisted of 1019 individuals, who all participated on a voluntary basis. The statistical analysis was performed using SPSS version 25.

Results: The results of this study showed the prevalence of HC in the sample to be 12.5%. There was a significant moderate positive association between increasing age and the prevalence of HC (r = 0.240, P < 0.0001). Males had a significantly higher prevalence of HC (56.7%) compared to their female counterparts (43.3%) (X = 23.093, P ≤ 0.0001). BMI was positively and significantly associated with high cholesterol status. Participants in the overweight category had a significantly higher risk of HC (OR = 1.727; 95% CI = 1.58-1.914; P = 0.046). The non-obese (< 25 kg/m) participants had an inverse significant association with the risk of hypercholesterolemia. (OR = 0.411; 95% CI = 0.216-0.783; P = 0.007).

Conclusion: In this population-based study, the predominant risk factors of HC in Al-Kharj region were being of a Saudi nationality, male, having obesity, being unemployed, and being a civilian worker. There is a clear need for future screening studies of HC, as most previous studies have reported contradictory prevalence data (because they were conducted in different regions of KSA). Furthermore, well-designed prospective cohort studies are needed in the future to assess how the association between lifestyle behavioural factors such as dietary intake patterns and levels of physical activity may affect the relative risk of HC status.
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http://dx.doi.org/10.1186/s12872-020-01825-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792200PMC
January 2021

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

Postgrad Med 2021 Apr 31;133(3):345-350. Epub 2020 Dec 31.

Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

: 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.: 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.: 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].: 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.
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http://dx.doi.org/10.1080/00325481.2020.1863716DOI Listing
April 2021

Dental and Orofacial Barotraumas among Saudi Military Naval Divers in King Abdul Aziz Naval Base Armed Forces in Jubail, Saudi Arabia: A Cross-sectional Study.

J Int Soc Prev Community Dent 2020 Sep-Oct;10(5):643-651. Epub 2020 Sep 28.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

Background: The aim of this study was to assess dental as well as orofacial pain under atmospheric pressure in military divers.

Materials And Methods: Cross-sectional study was conducted in King Abdulaziz Naval Base Armed Forces (KANB) in Jubail, Saudi Arabia involving 216 Saudi military divers. Questionnaire was formulated to assess the prevalence and factors associated with dental as well as orofacial pain among divers.

Results: Of total 216 participants, 35.6% participants dive 10-50times/year; whereas 52.8% dive in more than 20 m depth and 67.2% dive in the atmospheric pressure of >1.5bar. Majority (81.9%) used compressed air when diving. Sudden pain during or after diving was experienced by 67.1% in head or facial area, 69.2% in nose and paranasal sinuses, and 52.3% have experienced dental injury. Statistically significant associations were found between pain during diving with a frequency of diving, diving depth, and atmospheric pressure with < 0.001, 0.001, and 0.011, respectively.

Conclusion: Through this study, we concluded that dental and orofacial pain were experienced by more than half of the military divers at least once during their dive. Factors like increased frequency of diving, deep divers, and increased atmospheric pressure increases the extent of pain. Findings of this study suggested that more studies focusing on diving centers should be performed to realize the complete range of the issue.
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http://dx.doi.org/10.4103/jispcd.JISPCD_165_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685277PMC
September 2020

Familial aggregation of multiple sclerosis: Results from the national registry of the disease in Saudi Arabia.

Mult Scler J Exp Transl Clin 2020 Oct-Dec;6(4):2055217320960499. Epub 2020 Oct 12.

King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia.

Background: Multiple Sclerosis (MS) is a chronic CNS inflammatory disease commonly affecting young adults. Both genetics and environmental factors have been reported to have a role in pathophysiology of the disease.

Objective: This article aims to report familial nature and aspects of MS in Saudi Arabia.

Method: The study utilized data collected by the National Saudi MS Registry between 2015 and 2018; especially data relevant to the familial history of MS. SPSS 22 was used for all analysis and reporting. Statistical significance was set at p-value < 0.05.

Results: The registry included 20 hospitals and a total of 2516 patients from the different regions of Saudi Arabia with median age 32.00 (Range: 11-63) and 66.5% being female. About 12.8% of all registered patients reported a family history of MS (95%CI: 11.2-13.9). Reported parental consanguinity was significantly higher among patients with family history (FMS) (56.3%) compared to non-FMS patients (27.9%). 42.53% of FMS patients reported having siblings affected with MS (95%CI: 37.01-48.21), with more female siblings affected than males (63.4% vs 36.6% respectively).

Conclusion: Our Findings suggested that FMS was less prevalent than what was reported previously; however, parental consanguinity was significantly more prevalent among FMS patients than non-FMS. Our findings were in line with those reported in recent studies in the region, but lower than those reported by western countries indicating that increasing prevalence of MS in Saudi Arabia could be multifactorial and other environmental factors should be considered for understanding this recent rise in the prevalence of MS in Saudi Arabia.
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http://dx.doi.org/10.1177/2055217320960499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556172PMC
October 2020

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

Pain Res Manag 2020 24;2020:8239474. Epub 2020 Jun 24.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 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 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%) (  = 27.792, = 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), = 0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010-1.054, = 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.
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http://dx.doi.org/10.1155/2020/8239474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333061PMC
November 2020

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

ScientificWorldJournal 2020 16;2020:4790254. Epub 2020 Jun 16.

Ministry of Health, Riyadh, Saudi Arabia.

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. . 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.
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http://dx.doi.org/10.1155/2020/4790254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315321PMC
June 2021

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

Biomed Res Int 2020 3;2020:6865917. Epub 2020 Jun 3.

King Abdulaziz Medical City, National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

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. . 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.
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http://dx.doi.org/10.1155/2020/6865917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292982PMC
March 2021

Demographic Variations of MERS-CoV Infection among Suspected and Confirmed Cases: An Epidemiological Analysis of Laboratory-Based Data from Riyadh Regional Laboratory.

Biomed Res Int 2020 19;2020:9629747. Epub 2020 Feb 19.

Department of Virology and Cytogenetics, Riyadh Regional Laboratory, Riyadh, Saudi Arabia.

. Middle East respiratory syndrome coronavirus was first recognized in September 2012 in Saudi Arabia. The clinical presentations of MERS and non-MERS SARI are often similar. Therefore, the identification of suspected cases that may have higher chances of being diagnosed as cases of MERS-CoV is essential. However, the real challenge is to flag these patients through some demographic markers. The nature of these markers has not previously been investigated in Saudi Arabia, and hence, this study aims to identify them.

Methods: It was a surveillance system-based study, for which data from a total of 23,646 suspected patients in Riyadh and Al Qassim regions were analyzed from January 2017 until December 2017 to estimate the prevalence of MERS-CoV among suspected cases and to determine potential demographic risk factors related to the confirmation of the diagnosis.

Results: Of 23,646 suspected cases, 119 (0.5%) were confirmed by laboratory results. These confirmed cases (67.2% of which were males) had a mean age of 43.23 years (SD ± 22.8). Around 42.2% of the confirmed cases were aged between 41 and 60 years and about 47% of confirmed cases had their suspected specimen tested in the summer. The study identified three significant and independent predictors for confirmation of the disease: an age between 41 and 60 years, male gender, and summer season admission.

Conclusion: The study provides evidence that the MERS-CoV epidemic in the subject regions has specific characteristics that might help future plans for the prevention and management of such a contagious disease. Future studies should aim to confirm such findings in other regions of Saudi Arabia as well and explore potential preventable risk factors.
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http://dx.doi.org/10.1155/2020/9629747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049846PMC
September 2020

The status of zinc in type 2 diabetic patients and its association with glycemic control.

J Family Community Med 2020 Jan-Apr;27(1):29-36. Epub 2020 Jan 13.

Department of Internal Medicine and Family Medicine, King Abdullah Bin Abdul-Aziz University Hospital, Riyadh, Saudi Arabia.

Background: Zinc (Zn) is a trace element that carries antioxidant properties. Deficiency of Zn increases oxidative stress, especially in diabetes. The objective of this study was to assess the relationship between the level of Zn and glycemic control in type 2 diabetes.

Materials And Methods: A cross-sectional study was carried out in the Department of Medicine at King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia, from March 2018 to September 2018. A total of 440 participants were included in the study; 252 of these had type 2 diabetes and 188 were controls. All participants had laboratory investigations including fasting blood sugar (FBS), glycosylated hemoglobin, and lipid profile and Zn levels. These two groups (diabetics and controls) were further divided into Zn deficient group and normal Zn group according to their Zn levels. Data were analyzed by using SPSS software.

Results: The mean Zn level was 11.7 + 1.5 in the control group, whereas it was significantly low (9.3 + 1.6) in the diabetic group ( < 0.001). Zn deficiency in the control group was only 6.4%, while in the diabetic group, it was 67.9%, ( ≤ 0.001). The mean ages for the low Zn group and normal Zn group were 40.9 + 12.5 and 37.5 + 10.1, respectively, and the Zn deficient group was higher in age ( = 0.003). There was no significant statistical difference between genders regarding Zn deficiency. Obesity was associated with significantly low Zn levels ( = 0.016). The serum Zn level was significantly negatively associated with FBS and glycated hemoglobin in diabetic participants ( < 0.001).

Conclusion: Diabetic patients have Zn deficiency compared to normal individuals and poor glycemic control is associated with low Zn levels.
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http://dx.doi.org/10.4103/jfcm.JFCM_113_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984028PMC
January 2020

Discharge against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia.

Emerg Med Int 2019 28;2019:4579380. Epub 2019 Nov 28.

King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: The discharge against medical advice (DAMA) in the Emergency Department (ED) is an issue of great concern because it may result in adverse consequences at a later stage. The reported worldwide prevalence of DAMA ranges from 0.07 to 20% for emergency admissions. The outcomes of DAMA can have significantly damaging effects, causing possible relapses of disease, readmission, and increases in medical costs for the patient. Therefore, it is imperative to identify the predictors of DAMA in ED.

Methods: It was a cross-sectional study. The medical records used were those of all the patients ( = 11513) admitted to the Emergency Department (ED) of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, between 2017 and 2018. A thorough analysis was performed using IBM SPSS Statistics version 22. Descriptive statistics were reported for quantitative and categorical variables and assessed by independent -test/chi-square/ANOVA (analysis of variance), where appropriate. Unadjusted and adjusted odds ratios with their 95% CI (confidence interval) were reported by performing logistic regression. A value of ≤0.05 was considered statistically significant throughout the study.

Results: The prevalence of DAMA in our study was 1%. In a multivariable analysis, after adjusting for the other covariates, we observed a significant interaction between age and gender. It was observed that the odds of DAMA for ≤40-year-old males were 3.12 times higher than those of a ≤40-year-old female ( value < 0.1). To further investigate this interaction, men and women were modeled separately in multivariable models using the same covariates. We found that, for men, the effect of age (≤40 years) was significant (OR = 3.94, 95% CI 1.31-11.80, =0.014), while, for women, the effect of age (≤40 years) was not as pronounced (OR = 1.27, 95% CI = 0.66-2.42, =0.27).

Conclusions: Our study concluded that DAMA was more likely among younger male patients (≤40 years of age). Most of the patients with DAMA were presented to the urgent care of the Emergency Department. We recommend that patients be given some financial support to bear the expenses of the hospital stay from the healthcare facility or from the state. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.
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http://dx.doi.org/10.1155/2019/4579380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906859PMC
November 2019

Epidemiology of Alzheimer's Disease and Dementia in Arab Countries: A Systematic Review.

Behav Neurol 2019 29;2019:3935943. Epub 2019 Oct 29.

Epidemiology and Biostatistics Section, Health Sciences Research Centre, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Background/objectives: Contrary to popular belief, the condition of dementia is not an actual discrete disease, but rather a group of symptoms, most notable of which is the disturbance of memory and social ability, often severe enough to impair daily functioning. As a result, it has been a major cause of functional deterioration among varying populations in the world. This study is aimed at reviewing the epidemiology of dementia in Arab countries in terms of its prevalence, distribution, and risk factors.

Methods: A systematic literature review was conducted using articles published in PubMed, Embase, Scopus, and other local journals between 1990 and 2018. After applying the inclusion and exclusion criteria, a total of 18 studies were concluded to be eligible for the review.

Results: Prevalence studies demonstrated that dementia is indeed a prevalent condition in Arab countries, ranging between 1.1% and 2.3% among age groups of 50 years and older, as well as between 13.5% and 18.5% among age groups of 80 years and above. However, these results are not different from those of many other countries in the world. Moreover, prevalence was found to vary depending on sociodemographic characteristics. Major risk factors of dementia included hypertension, low income, and low education, while the risk of developing dementia is increased by obesity, diabetes mellitus, and cardiovascular risk factors. Despite the growing evidence regarding the epidemiological distribution and determinants of dementia worldwide, studies from the Arab region remain scarce.

Conclusion: This systematic review highlights the need for population-based studies to provide necessary information for developing preventive and curative strategies specific to the Arab region.
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http://dx.doi.org/10.1155/2019/3935943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854962PMC
April 2020

The epidemiology of domestic violence in Saudi Arabia: a systematic review.

Int J Public Health 2019 Nov 18;64(8):1223-1232. Epub 2019 Oct 18.

College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guards - Health Affairs, Riyadh, Saudi Arabia.

Objectives: The aim of this study is to review the prevalence, risk factors, and outcomes of domestic violence (DV) in Saudi Arabia.

Methods: Systematic review utilizing PRISMA guidelines conducted on articles focusing on research related to the epidemiology of domestic violence in Saudi Arabia between 2009 and 2017 were identified through electronic databases (PubMed and Embase) and supplemented by cross-referencing and local journal searches.

Results: Eleven studies were conducted in six cities (Riyadh, Jeddah, Madina, Taif, Arar, and Al-Ahsa). Several screening questionnaires were utilized; four studies used the WHO multi-country study questionnaire and found that the lifetime prevalence of DV ranged between 39.3 and 44.5%. The most frequently reported risk factors for DV were the level of education of both the victim and the spouse and alcohol or drug addiction of the spouse.

Conclusions: One in every three women in Saudi Arabia is a victim of domestic violence. Strategies to reduce risk factors, prevent DV, care for victims, and mitigate the effects of DV must be adopted by health care agencies in Saudi Arabia.
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http://dx.doi.org/10.1007/s00038-019-01303-3DOI Listing
November 2019

Prevalence of Prediabetes, Diabetes and Its Predictors among Females in Alkharj, Saudi Arabia: A Cross-Sectional Study.

Ann Glob Health 2019 07 22;85(1). Epub 2019 Jul 22.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SA.

Background/objective: The prevalence of prediabetes and diabetes is reaching epidemic proportions across the globe. Therefore, this study aims to determine the prevalence of prediabetes and diabetes, together with its accompanying risk factors, among young females.

Methods: An exploratory cross-sectional survey was conducted with 638 Saudi females in Alkharj, Saudi Arabia. Statistical analysis was carried out using STATA version 14. Odds ratios for the risk of diabetes and associated factors were calculated using log-binomial and multinomial logistic regression. Standardized prevalence and strata-specific prevalence of diabetes and prediabetes for different risk factors were also calculated.

Findings: The study revealed that nondiabetics and prediabetics were more prevalent between the ages of 18 and 24 years, while diabetic patients were consistently between 25 to 44 years of age. The average value for HbA1c in females was 5.44. Regression analysis shows that being older, married, obese, a smoker or less educated significantly increases the risk for both prediabetes and diabetes. Mutivariable analysis revealed obesity had a significant association with both prediabetes and diabetes. Prediabetics were 2.35 times more likely to be obese as compared to nondiabetics, with 95% CI (1.38-3.99). Similarly, diabetics were 6.67 times more likely to be obese compared to nondiabetics 95% CI (1.68-26.42).

Conclusion: Our study shows the prevalence of diabetes and prediabetes among females from Al Kharj was 3.8% and 18.8%, respectively. The diabetic and prediabetic female participants had higher mean BMI and waist circumference, were older in age, were married, and smoked as compared to nondiabetics. In the context of the findings of our study, and keeping in view the the burden of this disease globally and in our population, it has now become extremely important to understand these factors and encourage health-promoting behaviors to construct effective interventions.
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http://dx.doi.org/10.5334/aogh.2467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659578PMC
July 2019

Antimicrobial consumption in three pediatric and neonatal intensive care units in Saudi Arabia: 33-month surveillance study.

Ann Clin Microbiol Antimicrob 2019 Jul 3;18(1):20. Epub 2019 Jul 3.

Neonatal Intensive Care, King Abdullah Specialized Children's Hospital, MNGHA, Riyadh, Saudi Arabia.

Background: Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities.

Objectives: To calculate overall and type-specific antimicrobial consumption.

Methods: A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption.

Results: During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively).

Conclusion: Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.
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http://dx.doi.org/10.1186/s12941-019-0320-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607581PMC
July 2019

Cross-cultural adaptation and validation of the Arabic version of the Index of Dental Anxiety and Fear (IDAF-4C).

J Oral Sci 2019 ;61(2):229-237

College of Public Health and Health Informatic, King Saud Bin Abdulaziz University for Health Sciences.

This study aimed to investigate cross-cultural adaptation and validation of the Arabic version of the Index of Dental Anxiety and Fear (IDAF-4C). A total of 167 participants completed the questionnaire with a response rate of 72.6%. The participants were asked to complete the adapted Arabic version of the IDAF-4C and the modified dental anxiety scale (MDAS). The participants were asked to complete the second form of the Arabic version of the IDAF-4C over a period of 1 week to determine the reproducibility of the index. The internal consistency of the IDAF-4C was high (Cronbach's alpha, 0.94). The intraclass correlation coefficients for total score and each item were high (range, 0.98-0.99). In addition, the Kappa statistics for the total score and each item were high (range, 0.83-0.97). The Spearman's correlation coefficients between the IDAF-4C total and the component scores were high (r = 0.86-0.92, P < 0.001). In addition, the IDAF-4C total and the component scores were significantly associated with the MDAS score (r = 0.67-0.71). The adapted Arabic version of the IDAF-4C demonstrated suitable psychometric properties. The current study indicates that the Arabic version of the IDAF-4C might be a suitable index to measure dental anxiety and fear in Arabic-speaking populations.
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http://dx.doi.org/10.2334/josnusd.18-0097DOI Listing
November 2019

The prevalence of chronic pain and its associated factors among Saudi Al-Kharj population; a cross sectional study.

BMC Musculoskelet Disord 2019 Apr 25;20(1):177. Epub 2019 Apr 25.

Family & Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.

Background: Chronic pain (CP) can be a symptom of many underlying health issues. The consequences of CP may vary from slight discomfort to disruption of quality of life and normal functioning. In this study, we aim to investigate the prevalence of CP and its associated factors in Al Kharj, Saudi Arabia.

Methods: This was a cross-sectional study conducted in Al Kharj, Saudi Arabia. We recruited 1031 participants for our study. Data was collected on socio-demographic, health predictors and anthropometric measurements (such as weight, height and waist circumference). The data analysis was performed on JMP®, Version 12. SAS Institute Inc., Cary, NC, 1989-2007.

Results: The prevalence of self-reported chronic pain in Al Kharj population was 19% with a mean age of 26.4 (SD = 8.6) years. The most common locations of pain included; back pain (30%), abdominal pain (26%), headache (13%), and any musculoskeletal pain (56%). Multiple logistic regression revealed that presence of a chronic disease (OR = 3.8; 95% CI = 2.3-6.2), psychological disease (OR = 2.3; 95% CI = 1.2-4.3), high General Health Questionnaire (GHQ)-12 score (OR = 1.06; 95% CI = 1.03-1.1), and pack-years of smoking (OR = 1.05; 95% CI = 1.01-1.08) were significantly related to chronic pain in Al Kharj population.

Conclusions: Our study results found a high burden of chronic pain in this selected Saudi population. The most prevalent pain was low back pain. The presence of chronic and psychological diseases were strongly related to chronic pain. Future prospective studies are needed to establish the temporal relationship of chronic pain with these factors.
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http://dx.doi.org/10.1186/s12891-019-2555-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485157PMC
April 2019

Predictors and Level of Job Satisfaction among the Dental Workforce in National Guard Health Affairs.

J Int Soc Prev Community Dent 2019 Jan-Feb;9(1):89-93. Epub 2019 Jan 23.

College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Objective: To assess the level of job satisfaction among the dental workforce in the National Guard Health Affairs (NGHA) in Saudi Arabia and to explore any predictors that have impact on the level of satisfaction.

Materials And Methods: A cross-sectional study targeted dentists, dental assistants, dental hygienists, and dental lab technicians who are workers for the NGHA. A cluster random sampling procedure was conducted from seven dental centers. Data were collected through a self-reported questionnaire that was previously published. Satisfaction questions were related to (a) professional and personal life, (b) income and job security, (c) quality of service, and (d) prestige and self-perception domains. Data analysis included frequency distributions, and a comparison of mean using -test was conducted using SPSS software.

Results: The response rate was 55.5%. The mean satisfaction score was 65.7 out of 112 (2.9 out of 5). Of the four domains pertaining to job satisfactions, the highest mean score was obtained for quality of service (4.2 out of 5), followed by prestige and self-perception (2.8 out of 5), professional and personal life (2.8 out of 5), and income and job security (2.6 out of 5). Non-Saudis were found to be significantly more satisfied in professional and personal life; however, Saudi dentists were more satisfied for income and job security and quality of services.

Conclusions: In general, the dental workforce practicing in NGHA experience a low level of job satisfaction. Professional and personal life, income and job security, and quality of services are all important factors affecting the level of job satisfaction.
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http://dx.doi.org/10.4103/jispcd.JISPCD_418_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402258PMC
January 2019

Quality of life among home healthcare patients in Saudi Arabia: household-based survey.

Health Qual Life Outcomes 2019 Jan 25;17(1):21. Epub 2019 Jan 25.

Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.

Background: The need for home healthcare programs is an increasingly becoming important common component of healthcare worldwide, as an alternative to hospitalization, owing to the growing elderly population, chronic and acute diseases that need continuous monitoring and care. The overall aim of this study was to describe and assess the quality of life (QOL) and associated determinants among patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia.

Methods: This cross-sectional study was conducted among patients enrolled at the HHC program. The World Health Organization QOL questionnaire (WHOQOL-BREF) was used to collect data about the different domains of patients' QOL. Logistic regression models were fitted to determine factors associated with QOL low score.

Results: The study included 253 patients. Mean age was 67.05 (± 20.0). The overall QOL for HHC patients was significantly affected by both socio-demographic and morbid characteristics. In the final Multivariate logistic regression models, marital status, and having psychological problems, stroke and number illness were independently associated with the overall QOL of HHC patients (p = .022, p = .002, p = .031, .057 respectively). The physical health domain score was significantly associated with education level, having psychological problems and stroke (p = .028, p = .002, p = .007 retrospectively) whereas the psychological domain score was significantly associated with age (p = < 0.001) and three types of chronic diseases: pulmonary (p = .002), psychological problems (p = < 0.001). The social domain score was significantly associated only with the marital status (p = .026). The environmental domain was significantly associated with the education level and having stroke (p = .017 vs .027).

Conclusions: The overall QOL and its domains are significantly associated with several different factors. Many of these factors can be monitored and enhanced by improving quality of HHC services, thus improving the QOL of patients.
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http://dx.doi.org/10.1186/s12955-019-1095-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347790PMC
January 2019

Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study.

Antimicrob Resist Infect Control 2018 21;7:156. Epub 2018 Dec 21.

1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

Background: Estimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption.

Objectives: To quantify service-specific antimicrobial consumption using different metrics.

Methods: A surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as defined daily dose (DDD), days of therapy (DOT) per 1000 patient days, and frequency of daily consumption.

Results: A total of 43,970 DDDs and 46,940 DOTs were monitored during 54,116 patient-days. For the most frequently consumed antimicrobials, the consumption of carbapenems, piperacillin/tazobactam, vancomycin, and colistin (respectively) in all ICUs combined were 255.9, 134.3, 98.2, and 13.6 DDDs per 1000 patient-days and 235.7, 145.9, 129.5, and 117.5 DOTs per 1000 patient-days. For the frequency of daily consumption, carbapenems were the most frequently consumed antimicrobial group in medical/surgical, burn, and step-down ICUs while piperacillin/tazobactam was the most frequently consumed antimicrobial in neuro-surgical and cardio-thoracic ICUs.

Conclusion: High consumption of broad-spectrum antimicrobial agents such as meropenem and piperacillin/tazobactam is observed in multiple ICUs in a tertiary care hospital. Meropenem consumption is considerably higher than similar ICUs internationally. Future studies focusing on concurrent monitoring of antimicrobial resistance and identifying patient and physician characteristics associated with specific prescription patterns may help in improving judicious antimicrobial consumption.
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http://dx.doi.org/10.1186/s13756-018-0451-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302414PMC
September 2019

Prevalence of hypertension and prehypertension and its associated cardioembolic risk factors; a population based cross-sectional study in Alkharj, Saudi Arabia.

BMC Public Health 2018 Nov 29;18(1):1327. Epub 2018 Nov 29.

College of Public Health and Health Informatics, King Saud Bin AbdulAziz University for Health Sciences, Mail Code 2350, P.O. Box 3660, Riyadh, 11481, Saudi Arabia.

Background: Hypertension and prehypertension pose significant public-health and clinical challenges for both economically developed and developing nations. Prevalence of these conditions are frequently underreported because of its often-silent nature. Population-based studies that explore the occurrence and correlates of these conditions are scarce in Saudi Arabia. This study aimed at estimating the prevalence and associated factors of hypertension and prehypertension on a representative sample of males and females living in Al-Kharj town in Saudi Arabia.

Methods: Cross-sectional analysis was performed from January 2016 until June 2016 by recruiting a representative sample (n = 1019; aged 18 to 67 years) of the Al Kharj population. All participants completed a self-administered questionnaire, followed by a physical examination and blood test. Statistical analysis was carried out using SPSS version 24.0 for Windows.

Results: The prevalence of prehypertension was 66.1, 48.1 and 54.9% in male, female and all subjects, respectively. The prevalence of hypertension was 6.0, 4.2 and 4.9% in male, female and all subjects, respectively. Being overweight was associated with the highest risk of hypertension (OR = 4.98 [95% C.I. = 1.98-12.52], P = 0.001). People who were classified as class I obese had 3.5 times the risk of hypertension compared with the non-obese group (OR = 3.49 [95% C.I. = 1.42-8.63], P = 0.007). Risk of pre-hypertension was significantly lower in females (OR = 0.48 [95% C.I. = 0.32-0.71]) and tends to increase with obesity status. Gender-specific analyses found that males in the lowest education attainment level had a significantly increased risk of pre-hypertension (OR = 6.56 [95% C.I. = 1.27-33.85], P = 0.003).

Conclusion: This population-based study in Saudi Arabia shows that hypertension and prehypertension are common conditions particularly among males. Overweight and obesity was associated with both conditions. In addition, lower education attainment was a significantly associated factor among males. Future prospective studies are needed to confirm the etiological nature of such associations.
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http://dx.doi.org/10.1186/s12889-018-6216-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267095PMC
November 2018

The factor structure of the general health questionnaire (GHQ12) in Saudi Arabia.

BMC Health Serv Res 2018 08 2;18(1):595. Epub 2018 Aug 2.

Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.

Background: The General Health Questionnaire-12 (GHQ-12) is one of the most unique and extensively used self-report instruments for evaluating psychological disorders and strains. However, the factor structure of GHQ-12 has not been fully explored. The current study aims to assess the factorial structure of GHQ-12 in a large cross-sectional data-set extracted from Al Kharj central region of Saudi Arabia.

Methods: Population based cross sectional data was extracted from January 2016 to June 2016 from Al Kharj population recruiting 1019 respondents aged 18 and above. Exploratory factor analysis (EFA) was applied together with multiple regression analysis to extract and retain factors. Mean GHQ-12 score for demographic and health-related traits were used for assessing this association. Statistical analysis was carried out using STATA version 12.1.

Results: Three factors, including social dysfunction, anxiety, and loss of confidence were extracted from the factor structure. 55% of the overall variance was obtained through these factors. Total score of GHQ-12 ranged from 0 to 32 with a mean score of 12.

Conclusion: Investigation of the factor structure of GHQ-12 demonstrated that GHQ-12 is a good measure for evaluating the general health of Saudi population. Future studies based on a larger sample size of non-clinical respondents will be useful to evaluate the practical effectiveness of GHQ-12 factors.
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http://dx.doi.org/10.1186/s12913-018-3381-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472711PMC
August 2018

Current status, and future prospects of pharmaco-epidemiology and post-marketing surveillance in Saudi Arabia: A review of literature.

Saudi Pharm J 2018 Jul 6;26(5):629-633. Epub 2018 Mar 6.

Epidemiology & Biostatistics Department, College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

Background: Pharmacoepidemiology is the concept used for evaluating the impact of drugs among a large number of people in the post-marketing phase The use of this concept makes it increasingly necessary to detect the recurrence of drug-related anomalies that mostly occur through health care professionals or patients themselves. Pharmacoepidemiology is important since it helps to provide the right balance of benefits versus risks of the drug products while remaining an excellent tool to prepare the risk/benefit balance profile.

Aim: The objective of this study is to review and explore the current status and future prospects of pharmacoepidemiology and post-marketing surveillance in Saudi Arabia.

Methods: A literature review has been conducted using keywords such as pharmacoepidemiology'; 'post-marketing'; 'surveillance'; 'Saudi Arabia'; 'ADRs'; and 'pharmacovigilance'. The study refines its focus on 13 pharmacoepidemiology and post-marketing surveillance research studies conducted in Saudi Arabia using the databases; Embase, PubMed, EBSCOhost, MEDLINE, and AMED.

Results: Pharmacoepidemiology and post-marketing surveillance creates a body of research in Saudi Arabia, but within a restricted scope. The studies that were reviewed assessed the challenge from various perspectives. Lack of knowledge, post-marketing surveillance, ADR reporting, and increased use of generic products were reported.

Conclusion: The current level of research may be widened and increased through improving the process of ADRs reporting system. More research needs to be conducted based on nation-wide observational studies. Collaboration among medical professionals, academics and industries should continue to establish a more efficient and consistent post-marketing surveillance system.
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http://dx.doi.org/10.1016/j.jsps.2018.02.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035327PMC
July 2018

A finite and stable exponential growth-adjusted indirect cost of cancer associated with discounted years of life lost in Saudi Arabia.

Heliyon 2018 May 31;4(5):e00637. Epub 2018 May 31.

Oncology Department, King Abdulaziz Medical City, National Guard Health Affairs Hospital, Riyadh, Saudi Arabia.

Background: The risk of getting cancer before full life expectancy and mortalities per year are on the rise in Saudi Arabia. Yet, evidence of economic burden of cancer in the country remains largely unknown. In order to provide evidence, we attempted to estimate the economic burden in terms of indirect cost associated with premature cancer deaths among the active or potentially economically active population aged 15-60 years in Saudi Arabia.

Method: Within the framework of the World Health Organization guide of identifying the economic consequences of disease and injury, our method employs cost-of-illness approach. This approach is based on a macroeconomic model that estimates the indirect cost of cancer in terms of total non-health gross domestic product resource loss associated with a disease. We used epidemiological, health system, and macroeconomic data for our estimation. We discounted the net loss at 3% and computed an extension of the loss with a finite and stable upper limit proxied by non-health gross domestic product per capita. We carried out separate analyses for male and female. We conducted sensitivity analyses to account for uncertainties of epidemiological and economic factors on the robustness of the estimated economic burden. We varied the proportion of total cancer deaths, discount rate, and value of health expenditure per capita by ±20%. We further determined which of these factors or parameters had the greatest uncertainty or variation on the net present value total non-health gross domestic product resource loss per Capita.

Results: Our results indicate the indirect cost associated with cancer deaths among Saudi population aged 15-60 years to be Int$ 2.57 billion of which Int$ 1.46 billion (57%) was accounted for by females. The total indirect loss of cancer deaths increased by 8% to Int$ 2.77 billion when the loss is allowed to grow with a finite and stable upper limit proxied by non-health gross domestic product per capita over the discounted years of life lost per a death among female and male respectively. Much of the uncertainty in the determination of the value of the loss was accounted for by the proportion of total cancer deaths and discount rate, while health expenditure per capita was responsible for the least variability.

Conclusion: Our findings reveal evidence of indirect cost associated with cancer premature deaths in Saudi Arabia. In order to develop cancer control actions, the results of this study can inform health system policymakers not only of the extent of the enormous economic burden but also drawing attention to epidemiological and economic factors that explain the variability of the burden.
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http://dx.doi.org/10.1016/j.heliyon.2018.e00637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986542PMC
May 2018

Prevalence of overweight and obesity based on the body mass index; a cross-sectional study in Alkharj, Saudi Arabia.

Lipids Health Dis 2018 Jun 5;17(1):134. Epub 2018 Jun 5.

Docent of Epidemiology, School of Health Sciences, University of Tampere, Tampere, Finland.

Background: Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia.

Methods: Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. SPSS 24.0 was utilized for statistical analysis of the data.

Results: Majority of respondents in this study were overweight and obese (54.3%) compared with 45.7% being non-obese. A linear positive association of increasing BMI with older age groups was present in males and females. Men had larger waist circumference, weight and height measures as compared with their female counterparts. Regression analysis showed increasing age, being married and high serum cholesterol to be the significant predictors of overweight and obesity while gender, education level, job status, and having diabetes were not.

Conclusions: The obesity-overweight prevalence in the Saudi population is high mainly across both genders. However, the associated factors are potentially preventable and modifiable. The regional barriers to lifestyle modifications and interventions to encourage active lifestyles, especially among adolescents to limit the occurrence of obesity and ultimately promote health and wellbeing, are warranted. Furthermore, prospective studies are needed in future to confirm the aetiological nature of such associations.
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http://dx.doi.org/10.1186/s12944-018-0778-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989365PMC
June 2018

Prevalence of Prediabetes, Diabetes, and Its Associated Risk Factors among Males in Saudi Arabia: A Population-Based Survey.

J Diabetes Res 2018 24;2018:2194604. Epub 2018 Apr 24.

Department of Epidemiology, School of Health Sciences, University of Tampere, Tampere, Finland.

Objectives: The study aims at determining the prevalence of prediabetes and diabetes and at ascertaining some concomitant risk factors among males in Saudi Arabia.

Methods: A population-based cross-sectional study including 381 Saudi adult males from different institutions was recruited. Odds ratios for diabetes risk and risk factors were calculated using log-binomial and multinomial logistic regression, using STATA version 12.

Results: The participants included 381 diabetic males with a median age of 45 years, average body mass index of 25 ± 40 kg/m, whereas waist circumferences ranged from 66 to 180 cm in the male study population. In addition, 27.82% had normal BMI, 32.28% were overweight, and 36.22% were obese. Around 36% had higher waist circumference, that is, >102 cm. Age, BMI, marital status, and educational attainment were statistically significant predictors for prediabetes and diabetes.

Conclusion: This study found that the prevalence of diabetes and prediabetes was 9.2% and 27.6%, respectively, for male Al-Kharj study population. The factors that increase the risk of diabetes and prediabetes include older age, obesity and overweight, being married, smoker, and having a civilian job and less education. All these factors were found statistically significant except smoking status and job type. In order to evaluate the causal relationship of these factors, prospective studies are required in future.
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http://dx.doi.org/10.1155/2018/2194604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941814PMC
October 2018

The Prevalence of Phenylketonuria in Arab Countries, Turkey, and Iran: A Systematic Review.

Biomed Res Int 2018 18;2018:7697210. Epub 2018 Apr 18.

Newborn Screening and Biochemical Genetics Lab, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.

Background/objectives: This paper seeks to identify the prevalence of Phenylketonuria (PKU) in Arab countries, Turkey, and Iran. The study reviewed the existence of comprehensive national newborn screening programs and reported consanguinity rates.

Methods: A computer based literature search was conducted using relevant keywords to retrieve studies conducted on PKU. A total of 34 articles were included. Prevalence was categorized based on the type of screening method used for PKU diagnoses.

Results: The prevalence of classical PKU diagnosed through a comprehensive national newborn screening program ranged from 0.005% to 0.0167%. The highest prevalence was reported in Turkey at 0.0167%, whereas the lowest prevalence was reported in the UAE, 0.005%.

Conclusion: The findings of this review emphasize the need for the establishment of more efficient reporting systems in these countries that would help measure Disability-Adjusted Life Year (DALY) in order to estimate the overall societal burden of PKU.
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http://dx.doi.org/10.1155/2018/7697210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932526PMC
October 2018
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