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ObjectiveTo identify the approaches and strategies used for ensuring cultural appropriateness, intervention functions and theoretical constructs of the effective and ineffective school-based smoking prevention interventions that were implemented in low-income and middle-income countries (LMICs).Data sourcesIncluded MEDLINE, EMBASE, Global Health, PsycINFO, Web of Science and grey literature which were searched through August 2022 with no date limitations.Eligibility criteriaWe included randomised controlled trials (RCTs) with ≥6 months follow-up assessing the effect of school-based interventions on keeping pupils never-smokers in LMICs; published in English or Arabic.Data extraction and synthesisIntervention data were coded according to the Theoretical Domains Framework, intervention functions of Behaviour Change Wheel and cultural appropriateness features. Using narrative synthesis we identified which cultural-adaptation features, theoretical constructs and intervention functions were associated with effectiveness. Findings were mapped against the capability-motivation and opportunity model to formulate the conclusion. Risk of bias was assessed using the Cochrane risk of bias tool.ResultsWe identified 11 RCTs (n=7712 never-smokers aged 11–15); of which five arms were effective and eight (four of the effective) arms had a low risk of bias in all criteria. Methodological heterogeneity in defining, measuring, assessing and presenting outcomes prohibited quantitative data synthesis. We identified nine components that characterised interventions that were effective in preventing pupils from smoking uptake. These include deep cultural adaptation; raising awareness of various smoking consequences; improving refusal skills of smoking offers and using never-smokers as role models and peer educators.ConclusionInterventions that had used deep cultural adaptation which incorporated cultural, environmental, psychological and social factors, were more likely to be effective. Effective interventions considered improving pupils’ psychological capability to remain never-smokers and reducing their social and physical opportunities and reflective and automatic motivations to smoke. Future trials should use standardised measurements of smoking to allow meta-analysis in future reviews.

The aim of this prospective study was to identify the demographic and clinical variations of keratoconus (KC) in Saudi Arabia.A self-administered survey was completed by patients in Saudi hospitals. The survey included questions on demographics, educational level, treatment options, dry eye, eye rubbing because of allergy, residence, family history, and consanguineous marriage.Six hundred and forty-eight patients (375 - male, 273 - female; mean age: 26.89 [standard deviation: 7.04] years; range: 11-50 years) were conducted at 13 central hospitals in all 13 administrate areas of Saudi Arabia over a 1-year period. Five hundred and forty-three (83.8%) patients had a secondary school diploma or diploma's degree of education and mostly were from the Aseer and Riyadh regions. The geographical distribution rate of KC was highest in the mountainous areas. For dry eye, 21.9% and 44.8% of the patients, respectively, reported frequent or occasional dryness and 13.4% and 48.9% of the patients, respectively, reported frequent or occasional bouts of eye allergy. Furthermore, 17.9% and 61.9% of the patients, respectively, reported that they constantly or sometimes rubbed their eyes. Marriages were endogamous in 53.5% of the patients and the family history was positive by 56.8%. There was a history of ocular disease in 27% of the patients and the systemic disease was 13%.This study is the first to describe the regional demographic and clinical variations of KC in Saudi Arabia. Its findings suggest that the different distribution of keratoconic patients between provinces is attributable to genetic and/or environmental factors.

Pain is one of the most common symptoms experienced by patients with cancer at all stages of the disease, many of whom experience poor pain control. Findings from earlier studies suggest that mobile health (mHealth) approaches may have value in the field of pain management. Currently, development is at an early stage and the needs and preferences of users are not yet well understood. The aim of this study is to report the design and development of a mHealth-based pain recording system for this population to support effective pain management. A user-centred design (UCD) approach with multiple stages, including usability testing, was adopted for achieving this and ensure the system’s clinical utility. Usability testing was conducted on high-fidelity clickable prototypes developed for the system with eleven representative system users. The system was well-received, and all participants found it well-aligned with their needs and easy to use, with only a few addressable usability issues reported. Captured usability metrics indicated that the under-development system has the potential to be effective, efficient and satisfying for users.

Aim of the work: this study aimed to investigate the relationship between the Intraocular Pressure(IOP) readings measured by Goldmaan Tonometry and the amount of corneal astigmatism in healthy young subjects and to assess the reliability of the measurements obtained with the instruments. Method: intraocular pressure measurements were obtained by Goldmann Applanation Tonometer (GAT) (Haag-Streit International, Koeniz, Switzerland), while keratometry readings for corneal curvature were obtained by an Auto-Kerato-Refractometer (ARK-KR.8800, Topcon, Tokyo, Japan). An interval was kept between the keratometric measurements and the IOP measurements. The sequence of measurement was randomized with all participants. Three measurements were taken within ten minutes and the reading was set to one immediately after any measurement were taken. Result: the average age of the volunteers was 22.4 ± 1.5 years (mean age ± SD; range: 20–26 years). Mean Intraocular Pressure (IOP) of the right and left eyes in the first visit (Paired t-test: P = 0.6471) and second visit (Paired t-test: P = 0.5805). The session one means GAT ; IOP was 16.48 ± 3.33 mmHg and 16.59 ±3.47mmHg (right and left eye respectively), while in session two it was15.714±3.10 mmHg and 15.82 ± 2.76 (right and left eye respectively) . The mean corneal astigmatism was -0.24 ± 1.48D, -0.38 ± 1.53 D, right and left respectively in the first visit and -0.34 ± 1.44D, -0.40 ± 1.64D right and left eye second visit respectively. Conclusion: the GAT-IOP was less affected by the amount of corneal astigmatism and GAT-IOP was not significantly higher in eyes with greater corneal astigmatism and the repeatability results, although the differences were stastistically significant, they were not clinically significant.

Summary: Background: The prevalence of childhood vaccine-preventable diseases can be significantly reduced through adherence to confirmed vaccination schedules. However, many barriers to vaccination compliance exist, including a lack of awareness regarding the importance of vaccines, missing due dates, and fear of complications from vaccinations. The aim of this study is to review the existing tools and publications regarding vaccination adherence, and to propose a design for a vaccination adherence application (app) for smartphones. Methods: Android and iOS apps designed for vaccination reminders have been reviewed to examine six elements: educational factor; customizing features; reminder tools; peer education facilitations; feedback, and the language of apps’ interface and content. The literature from PubMed has been reviewed for studies addressing reminder systems or tools including apps. Results: The study has revealed insufficient (n = 6) technology-based interventions for increasing childhood vaccination rates by reminding parents in comparison to the fast growth in technology, out of which are two publications discussed mobile apps. Ten apps have been found in apps stores; only one out of them was designed for the Saudi vaccination schedule in Arabic language with some weaknesses. The study proposed a design for a vaccination reminder app that includes a number of features in order to overcome the limitations discussed in the studied reminders, apps, and systems. The design supports the Arabic language and the Saudi vaccination schedule; parental education including peer education; a variety of reminder methods, and the capability to track vaccinations and refer to the app as a personal health record. Conclusion: The study discussed a design for a vaccination reminder app that satisfies the specific requirements for better compliance to children's immunization schedules based on reviewing the existing apps and publications. The proposed design includes element to educate parents and answer their concerns about vaccines. It involves their peers and can encourage the exchange of experiences and overcome vaccine fears. In addition, it could form a convenient child personal health record. Keywords: Vaccine, Application, Design, Adherence, Child, Reminder

Purpose To assess the prevalence and general knowledge of contact lens (CL) wear among women users and to examine the practice of CL dispensation by non-ophthalmic stores. Method One thousand four hundred and sixty-six female university students, between 16 and 31 years of age, and 1766 registered beauty stores in the region were randomly interviewed using self-administered questionnaires. The questions addressed general care/handling of CLs, CL case and solution hygiene practices by patients, the CL selection available in the shops, the type of instructions given to consumers, and who gives these instructions. Results The prevalence of CL use was 70.2% (1029/1466). Fifty percent were part time users of CLs, and cosmetic reasons were the major reason (63.3%) for CL use. Approximately 38.7% of the respondents used CL without consultation with an eye care practitioner. The main purchasing locations were optical shops (51%), beauty salons (38%), and pharmacies (11%). Concerning contact lens care, 89.4% of the respondents adequately washed their hands before handling CLs and 72.7% changed their solutions daily, while 7.7% admitted to occasional overnight wear of their CL and 27.6% sometimes shared their CLs with friends. Interestingly, 80.3% of the 1327 shops sold CLs with no prescription, and 61.4% gave no instructions to the patients during purchase. Conclusion There is a high prevalence of CL use by female university students in Saudi Arabia, especially for cosmetic purposes. Although, there was good awareness with regard to general lens care practices, some users shared their lenses with friends, and the rate of sale of CLs without prescriptions in ordinary shops was high.

This study is a comparative study of the relationship between corneal structure, morphology, and function in a range of mammalian species. X-ray scattering patterns were gathered at regular spatial intervals over the excised cornea (and in most cases also the scleral rim) of humans, marmosets, horses, cows, pigs, rabbits, and mice. All patterns were analyzed to produce quantitative information regarding the predominant orientation of fibrillar collagen throughout the tissue. The predominant direction of corneal collagen varies between mammals. This variation is not related to the size, shape, or thickness of the cornea or the frequency with which the animal blinks. A relationship does, however, appear to exist between corneal collagen arrangement and visual acuity. An excess of collagen directed toward one or both sets of opposing rectus muscles is a feature of animals that have an intermediate to high level of visual acuity. There is a significant variation in the arrangement of corneal collagen between different mammalian species. This finding may be related to differences in the frequency of action and the forces generated by the various extraocular muscles during eye movement and image fixation.

Purpose. To study the distribution and predominant orientations of fibrillar collagen at different depths throughout the entire thickness of the human cornea. This information will form the basis of a full three-dimensional reconstruction of the preferred orientations of corneal lamellae. \ud \ud Methods. Femtosecond laser technology was used to delaminate the central zones of five human corneas into three separate layers (anterior, mid, and posterior stroma), each with predetermined thicknesses. Wide-angle x-ray diffraction was used to study the gross collagen fibril orientation and distribution within each layer. \ud \ud Results. The middle and posterior parts of the human cornea demonstrated a preferential orthogonal arrangement of collagen fibrils, directed along the superior–inferior and nasal–temporal meridians, with an increase in the number of lamellae toward the periphery. However, the anterior cornea (33% of total corneal thickness) showed no systematic preferred lamellar orientation. \ud \ud Conclusions. In the posterior two thirds of the human cornea, collagen lies predominantly in the vertical and horizontal meridians (directed toward the four major rectus muscles), whereas collagen in the anterior third of the cornea is more isotropic. The predominantly orthogonal arrangement of collagen in the mid and posterior stroma may help to distribute strain in the cornea by allowing it to withstand the pull of the extraocular muscles, whereas the more isotropic arrangement in the anterior cornea may play an important role in the biomechanics of the cornea by resisting intraocular pressure while at the same time maintaining corneal curvature.