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Objective: This study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: This was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy. Results: The study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50–0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71–3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05–1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39–2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46–11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70–30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05). Conclusions: Polypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. Methods: A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. Results: A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41–50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. Conclusion: Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41–50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control. Methods: We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control. Results: A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: − 0.48 to − 0.24; p < 0.001, respectively). Conclusions: The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases. Method: A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer. Results: Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor's degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only = 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001). Conclusion: Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socioeconomic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms. [ABSTRACT FROM AUTHOR]

In this cross-sectional study, we investigated the prevalence of smoking among medical residents. In addition, we explored the knowledge, risk factors, and cessation attempts related to smoking. This was a cross-sectional study conducted through an online questionnaire in Saudi Arabia from November 2020 to December 2020. All resident physicians in Saudi Arabia were eligible to participate in the study. This study used a convenience sample to recruit the study population. The questionnaire was distributed data among residents via google forms. The forms were sent to residents’ emails that are registered in the Saudi Commission for Health Specialties Fagerstrom Test for Nicotine Dependence and Lebanon Waterpipe Dependence Scale (LWDS-11) were used in this study. Chi-square comparison of categorical data, ANOVA to compare means of continuous variables were used. Multivariate logistic regression was conducted to verify demographic, lifestyle, work-related factors' effect on smoking habit using FTND and/or LWDS-11 scales. A p-value ≤ 0.05 was considered statistically significant. A total of 457 medical residents have participated in this study. Of the 157 participants who reported that they are current smokers, 47.7% reported that they smoke cigarettes. 75.2% of the study sample reported they smoke during working hours. The most commonly reported reasons for starting smoking were to relieve stress and anxiety and/or that it was started as with a trial then continued with 47.1% and 36.9%, respectively. The mean FTND score for the study participants was 0.63 (SD: 1.8). Using multiple linear regression analysis, we found that, older age was associated with having a higher FTND score (p=0.009). Male residents were more likely to have higher FTND scores compared to females (p< 0.001). This study demonstrates that smoking habit is not uncommon among medical residents, despite their perceived social image and role in smoking prevention and cessation. High level of stressors, anxiety and depression are among the most predisposing factors leading to high prevalence of smoking. [ABSTRACT FROM AUTHOR]

Background: High-flow nasal cannula (HFNC) is an essential non-invasive oxygen therapy in acute respiratory distress syndrome (ARDS) patients. Despite its wide use, research assessing the knowledge, practice, and barriers to using HFNC among respiratory therapists (RT) is lacking. Methods: A cross-sectional questionnaire was conducted among RTs in Saudi Arabia between December 19, 2022, and July 15, 2023. Data were analyzed as means and standard deviation or frequency and percentages. A Chi-square test was used to compare the differences between groups. Results: A total of 1001 RTs completed the online survey. Two-thirds of the respondents 659 (65.8%) had received training in using HFNC and 785 (78.4%) had used HFNC in clinical settings. The top conditions for HFNC indication were COVID-19 (78%), post-extubation (65%), and do-not-intubate patients (64%). Participants strongly agreed that helping maintain conversation and eating abilities (32.95%) and improving shortness of breath (34.1%) were advantages of HFNC. Surprisingly, 568 (57%) of RT staff did not follow a protocol for HFNC with ARDS patients. When starting HFNC, 40.2% of the participants started with FiO2 of 61% to 80%. Additionally, high percentages of RT staff started with a flow rate between 30 L/minute and 40 L/minute (40.6%) and a temperature of 37°C (57.7%). When weaning ARDS patients, 482 (48.1%) recommended first reducing gas flow by 5– 10 L/minute every two to four hours. Moreover, 549 (54.8%) believed that ARDS patients could be disconnected from HFNC if they achieved a flow rate of < 20 L/minute and FiO2 of < 35%. Lack of knowledge was the most common challenge concerning HFNC implementation. Conclusion: The findings revealed nuanced applications marked by significant endorsement in certain clinical scenarios and a lack of protocol adherence, underscoring the need for uniform, evidence-based guidelines and enhanced training for RTs. Addressing these challenges is pivotal to optimizing the benefits of HFNC across varied clinical contexts. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients. Methods: An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis. Results: A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41–2.62)), smoking (OR; 1.60 (1.17–2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45–2.71)), Diabetes mellitus (OR; 1.42 (1.04–1.93)), GERD (OR; 2.81 (1.99–3.96)), Ischemic heart disease (OR; 3.22 (2.19–4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38–3.33)), stroke (OR; 4.51 (2.20–9.26))) were predictors of ICU admissions among patients with COPD. Conclusions: Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units. [ABSTRACT FROM AUTHOR]

Background: There is a concerning lack of representative data on chronic obstructive pulmonary disease (COPD) awareness in Saudi Arabia, and a significant proportion of the population is vulnerable to developing a smoking habit, which is a major risk factor for the disease. Methods: Population-Based Survey of 15,000 people was conducted to assess the public knowledge and awareness of COPD across Saudi Arabia from October 2022 to March 2023. Results: A total of 15002 responders completed the survey, with a completion rate of 82%. The majority 10314 (69%) were 18–30 year and 6112 (41%) had high school education. The most common comorbidities among the responders were depression (7.67%); hypertension (6%); diabetes (5.77%) and Chronic Lung Disease (4.12%). The most common symptoms were dyspnea (17.80%); chest tightness (14.09%) and sputum (11.19%). Among those who complains of any symptoms, only 16.44% had consulted their doctor. Around 14.16% were diagnosed with a respiratory disease and only 15.56% had performed pulmonary function test (PFT). The prevalence of smoking history was 15.16%, in which current smokers were 9.09%. About 48% of smokers used cigarette, 25% used waterpipe and around 27% were E-cigarette users. About 77% of the total sample have never heard about COPD. Majority of current smokers (73.5%; 1002), ex-smokers (68%; 619), and non-smokers (77.9%; 9911) are unaware of COPD, p value <0.001. Seventy five percent (1028) of the current smokers and 70% (633) of the ex-smokers have never performed PFT, p value <0.001. Male, younger age (18–30 years), higher education, family history of respiratory diseases, previous diagnosis of respiratory disease, previous PFT, and being an ex-smokers increases the odds of COPD awareness, p-value <0.05. Conclusion: There is a significantly low awareness about COPD in Saudi Arabia, especially among smokers. A nationwide approach must include targeted public awareness campaigns, continued healthcare professional education, community-based activities encouraging diagnosis and early detection, advice on smoking cessation and lifestyle changes, as well as coordinated national COPD screening programs. [ABSTRACT FROM AUTHOR]

Background: Nomophobia is common among students in many healthcare disciplines, and its association with academic performance has been explore before. However, there is no available data on its prevalence and association with academic performance among undergraduate physiotherapy (PT) students in Saudi Arabia.Methods: Between 22 December 2022 and 30 January 2023, a cross-sectional survey was conducted by dissemination using an online platform (Survey Monkey).Results: In total, 806 PT students, with males accounting for 494 (61%), responded to the survey. The prevalence of nomophobia among PT students was 98.4% (793). The mean (±SD) of the total NMP-Q items scores was 49 (± 17), indicating a mild level of nomophobia. Female PT students had significantly higher nomophobia scores than the males (47 (39– 65); 44 (38– 52); (p < 0.001)). Non-smokers had significant higher nomophobia scores than smokers (46 (38– 61); 44 (38– 49); (p = 0.004)). Regarding grade point averages (GPA), the students with a GPA of less than 3.49 had the highest nomophobia score (51 (43– 74); p < 0.001)). Concerning the stage of their studies, bridging students had the highest nomophobia score (51 (34– 76); p = 0.023)). Regarding academic warnings, those who reported no academic warnings had the highest nomophobia score (46 (42– 50); p = 0.023)). Finally, regarding study hours, the students who spent ≥ five hours studying per week had the highest nomophobia score (54 (42– 68); p < 0.001)).Conclusion: Nomophobia is common among PT students, with the majority experiencing a mild level. Being female, non-smoker, and having a higher academic performance were risk factors associated with higher nomophobia levels. [ABSTRACT FROM AUTHOR]

This study aimed to assess the practices and attitudes of the general population towards coronavirus disease-2019 (COVID)-19 after the removal of precautionary and preventive measures in Saudi Arabia.Methods: A cross-sectional study was conducted among the general population in all regions of the Kingdom of Saudi Arabia, from September 2022 to October, 2022 via a virtual survey to evaluate the practices, and attitudes of the general population towards COVID-19. A stratified random sampling technique was applied to collect the sample with inclusion criteria for all individuals who are Arabic language speakers using social media platforms. The individuals selected for this study were 18 years and older.Results: A total of 2406 responses were received for the study questionnaire. Most of participants (66.3%) were females aged 18 to 29 years (61.8%). Half of the participants reported a positive history of COVID-19 infection. Nearly 90% of participants still wear masks, 80% attended a crowded event, and 60% often wash their hands even though the Saudi government has erased the precautions. Females, young (30– 39 years) and elderly (60 years and over) individuals, singles, those with a postgraduate degree, those who are employed, and healthcare workers were more likely to adhere to COVID-19 precautionary measures (p< 0.05).Conclusion: The study's findings indicate that most of the population discontinued practicing precautionary measures after lifting the measures in Saudi Arabia. More public health initiatives should raise the scores of sanitary best practices to prevent the spread of viral illnesses. [ABSTRACT FROM AUTHOR]

Background: Multiple vaccines have been tested in clinical trials for their efficacy and safety. In Saudi Arabia, Pfizer–BioNTech or Moderna were approved for children, however, previous studies to report their safety profile are limited. This research aims to understand the side effect of children's vaccination against SARS-CoV-2 infection in Saudi Arabia. Methods: This was an observational retrospective cross-sectional study was conducted using an online survey in Saudi Arabia from March to May 2022. The inclusion criteria were parents aged 18 years and above who live in Saudi Arabia and have vaccinated their children. The self-reported questionnaire was adopted from published studies to investigate the study objectives Descriptive statistics were used to describe patients' demographic characteristics, continuous data were reported as mean ± S.D., categorical data were reported as percentages (frequencies), and logistic regression was used to identify predictors of persistent post-COVID-19 symptoms. Results: This study had a total of 4,069 participants. Only 41.9% of the participants reported that their child(ren) had been infected with the coronavirus. 2.00 was the median number of children (IQR: 1.00–4.00). More than half of the study participants (64.2%) reported that a family member had been infected with the coronavirus. Both parents received COVID-19 vaccination, according to most participants (88.7%). Most participants (70.5%) stated that all children who met the vaccination criteria had received the vaccine. Most participants (83.5%) said their child or children had two doses of their vaccine, and about half (50.4%) of those who received the vaccine reported experiencing side effects. In addition, the majority (78.9%) reported that the side effects appeared within one day of receiving the vaccine, and nearly two-thirds (65.7%) reported that the side effects lasted between one and three. A total of 11,831 side effects cases were documented. Pain at the injection site, hyperthermia, and fatigue were the most reported side effects, accounting for 15.3%, 14.1%, and 13.2%, respectively. Conclusion: It appears that the side effects of the COVID-19 vaccine for children are minor, tolerable, and like those described previously in clinical trials. Our data should encourage the public about the safety of receiving the COVID-19 vaccine for children. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary rehabilitation (CR) is an effective management approach for heart failure (HF) patients and is delivered by multidisciplinary teams including physiotherapists (PTs). PT attitudes about delivering CR and barriers that might affect referral have not been explored. Thus, this study is aimed to explore PT attitudes about delivering CR programs to patients with HF and identify factors and barriers that might affect referral decisions. Methods: A cross-sectional online survey was disseminated to all PTs in Saudi Arabia between 19 February and 27 June, 2022. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 553 PTs, 289 (52.30%) male and 264 (47.70%) females, completed the online survey. Of these, 360 (65.1%) strongly agreed that CR would improve patients' physical fitness and 334 (60.4%) strongly agreed that CR would reduce breathlessness in patients with HF. The majority of PTs (321, 58%) strongly agreed that CR would improve HF patients' palpitation and fatigue. Out of 553 PTs, 349 (63.1%) strongly agreed that CR would improve patients' ability to perform daily activities. A hospital-supervised program was the preferred mode of delivering CR programs by 499 (90.20%) of the respondents. Apart from the exercise component, stress management was perceived by 455 (82.30%) as an essential component of CR programs. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (42%). A lack of CR centers was reported by 59.90% as the most common referring barrier. Conclusion: PTs perceived CR as a successful strategy for patients with HF. Although a supervised hospital-based program with stress management as an essential component aside from the exercise component was perceived as the preferred mode of delivery, CR was lacking, which caused a significant barrier to CR referral from the PTs' perspective. [ABSTRACT FROM AUTHOR]

Background: Previous studies investigating the impact of social media influencers on food consumption are limited. Therefore, this study explores the influence of social media on people's health choices to understand the consequences of food consumption among the Saudi community. Patients and Methods: A cross-sectional study using an online survey was conducted in Saudi Arabia between 24 June and 20 July 2021. A convenience sample of eligible participants was used to recruit the study participants. A 32-items questionnaire was distributed via social media platforms (Facebook, Twitter, Snapchat, and Instagram). In addition, significant predictors of people being affected by social media to change diet and living with obesity were determined using binary logistic regression. Results: A total of 1124 participants were involved in this study. More than half of them (57.8%) were females and aged below 40 years (57.4%). The study participants' median body mass index (BMI) was 27.4 kg/m2 (IQR: 23.5– 32.5). Around one-third of the study participants (36.6%) reported following influencers on social media. The median attitude score for the study participants was 15.00 (IQR: 1.00– 27.00) out of 72, equal to 20.8%, which highlights that social media influence the diet of around one-fifth of the study participants. Males were less likely to be affected by social media than females (OR: 0.51; (95% CI: 0.40– 0.65). Participants with obesity and participants who had tried a diet to lose weight were more likely to be affected by social media, with odds ratios of 2.14, and 4.83, respectively. Followers of social media influencers were 10-folds more likely to be affected by social media than others. Conclusion: This study showed that social media might influence the food consumption manner in the Saudi population. [ABSTRACT FROM AUTHOR]

Background: Parent's misconceptions or lack of knowledge about childhood urinary tract infections (UTIs) can negatively impact their children's health. Therefore, the present study aimed to determine the childhood urinary tract infections awareness and understanding among parents in Saudi Arabia. Patients and Methods: An online validated cross-sectional survey of parents in Saudi Arabia was conducted from August to September 2021. Study participants who met the inclusion criteria were selected using a convenience sampling technique. A questionnaire with two domains was used to assess parental awareness of childhood urinary tract infection symptoms, complications, treatment, prevention, epidemiology, and diagnosis. The total childhood urinary tract infections awareness scores were classified into three categories: low awareness, moderate awareness, and high awareness. Descriptive statistics were used to determine the data distribution. A chi-square test was used to evaluate the relationship between parental awareness about urinary tract infections in children and other variables. Statistical significance was established at 0.05. Results: Of the 1688 parents who completed the survey, 1289 (76.4%) were female, 1581 (93.7%) were married, and 1161 (68.8) had a university degree. Parent's total awareness scores were high; however, individual domain scores indicate a moderate level of knowledge. Statistically significant relationship were observed between total awareness and gender, occupation, and level of educational level ((P=0.004, P=0.001, P=0.007, respectively). Another statistically significant relationship was noted between the history of urinary tract infections and awareness of disease prevention (P=0.009). Conclusion: In Saudi Arabia, parental knowledge about childhood urinary tract infections is moderate to high. However, future studies are needed to investigate gender, educational, and occupational variations in childhood UTI knowledge among parents in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Large numbers of people infected with COVID-19 developed acute symptoms. Post-COVID-19 conditions have been reported after recovery or discharge from the hospital. However, little is known about the prevalence and possible risk factors of post-COVID-19 conditions in the Saudi community. Here, we describe the incidence of post-COVID-19 conditions among the general population of Saudi Arabia. Methods: We conducted a cross-sectional, nationwide study using an online survey in Saudi Arabia from 1 September 2021 to 28 February 2022. The survey was distributed using social media platforms, such as Twitter, WhatsApp, and Facebook. Patients with SARS-CoV-2 infection were included in the questionnaire adapted from published studies. Result: The study enrolled 7520 individuals who were previously infected with SARS-CoV-2. Most patients in our study were symptomatic and their acute symptoms may persist for more than six days. On the other hand, long-term complications may develop and continue for an extended period (post-COVID-19 conditions). Most of these complications are respiratory, neurological, psychological, or skin related. The proportion of long-term complications reported in this study is 36% among SARS-CoV-2-infected individuals. In addition, being female, old age, number of chronic complications, long-term medication, length of stay in hospital and intensive care unit, and duration of acute symptoms may be significant predictors of post-COVID-19 symptoms. Conclusion: In conclusion, the incidence of post-COVID-19 conditions among the Saudi population was high, which urges further investigation into the risk factors associated with post-COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Background: Nomophobia is a psychological condition caused by a fear of disconnecting from others through mobile phones. Aim: This study aims to determine the prevalence of and predictors of nomophobia and anxiety symptoms among the general population in Saudi Arabia and Jordan. Methods: This study was an observational cross-sectional study using a web-based online survey distributed in two middle eastern countries (Saudi Arabia and Jordan) between Jun 24 and Jul 20, 2021. A convenience sample was used to recruit the study participants. Categorical variables were identified as frequencies and percentages. In addition, a binary logistic regression analysis was used to determine the factors associated with nomophobia symptoms. The Statistical Package for Social Science (SPSS) software, version 27 (IBM Corp, Armonk, NY, USA), analyzed the data. Results: A total of 5,191 responded to the online survey. Around (26.5%) reported that they suffer from an anxiety problem or use a treatment for anxiety. The median daily time spent using a mobile phone (IQR) (minutes) was around 210 min per day. About half of the study sample (51.2%) are diagnosed with dependence syndrome. The binary logistic regression analysis revealed that those within the age group of 30–49 years and 50 years and above) are less likely to have mobile phone dependence compared to those less than 30 years old. Females were 16% at lower risk of developing mobile phone dependence compared to males Married participants were less likely to have mobile phone dependence compared to single participants (OR: 0.62 (95% CI 0.56–0.70)), while divorced participants were at a 46% higher risk of developing mobile phone dependence. Conclusion: Nomophobia prevalence among Saudi Arabia and Jordon's population is 51.2%. Several factors may predict mobile phone dependence including age, gender, marital status, and previous history of anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Influenza vaccination is the primary control measure for severe complications caused by influenza viruses. Moreover, in the face of the COVID-19 pandemic, Saudi Arabia recommends vaccinating people at risk against influenza to minimise co-infection risk with SARS-CoV2. Therefore, this study aims to assess the Saudi population's knowledge, attitude, and practice toward influenza vaccination during the COVID-19 pandemic. Moreover, we evaluate the impact of the COVID-19 pandemic on seasonal influenza vaccination. Methods: This cross-sectional study was conducted using an online survey in Saudi Arabia between July to August 2021. Participants were invited to complete the questionnaire through a survey link sent to social media platforms. Results: A total of 2410 participants were included in this study. Our data demonstrate a lack of practice, attitude, and knowledge, especially on the influenza virus's symptoms, viral transmission, and vaccine efficacy. Moreover, this study showed that the COVID-19 pandemic significantly impacted seasonal influenza vaccination in the Saudi population by 1.5-times compared to the previous years. Conclusion: COVID-19 pandemic has increased the hesitancy of Saudi participants in influenza vaccination due to the lack of knowledge. As the pandemic of COVID-19 is fading, awareness campaigns are needed to encourage the public about the importance of receiving the influenza vaccine, especially for those at high risk each year. [ABSTRACT FROM AUTHOR]

Introduction: Caffeine is the most consumed psychoactive drug worldwide. Nowadays, the introduction of many caffeine-containing products, along with changes in the consumption patterns of both natural and synthetic sources of caffeine, has drawn the attention of health researchers. Information regarding consumption patterns of coffee and caffeinated products among the Saudi population, particularly in different regions, remains unclear. Thus, this study aims to identify the amount and sources of caffeine consumed by the Saudi population and explore its relationship with the consumption patterns. Patients and Methods: This cross-sectional study used an online self-administered questionnaire, including adults who live in the western province of Saudi Arabia and use caffeine products. A 15-item questionnaire was distributed via social media platforms between 1 June and 31 August 2021. Descriptive statistics were used to describe the participants' characteristics, and categorical variables were reported as frequencies and percentages. Chi-square test was used to test the difference between variables. Results: In total, 1,036 participants were included in the study. Females represented 80% of the participants included, and nearly half of participants (58%) received an undergraduate education. Concerning caffeine sources, most participants consumed coffee and tea (97%), followed by OTC medications containing caffeine (21%), energy drinks (17%) and other, such as soft drinks and chocolate (4%). Regarding drinking habits, most participants (89%) replied that they drink coffee/tea only, whereas 8% drink it with sweets and cakes and the rest (3%) have it either with water, fruit or a cigarette. Concerning adverse effects of caffeine intake, most participants experienced sleep disturbance (67%), headache (60%), arrythmia (51%) and stress and anxiety (40%). Sex showed a significant relation with OTC medications containing caffeine (p = 0.025) and adverse effects related to caffeine intake (p = 0.002). Conclusion: The present study provides useful data for multiple stakeholders in Saudi Arabia regarding caffeine consumption. Measures should be implemented to ensure safe caffeine consumption to avoid the occurrence of secondary events associated with a lack of knowledge related to its usage. [ABSTRACT FROM AUTHOR]

This study aimed to assess physicians' attitudes toward delivering pulmonary rehabilitation (PR) to chronic obstructive pulmonary disease (COPD) patients and identify factors and barriers that might influence referral decisions. Between September 2021 and January 2022, a cross-sectional online survey was distributed to all physicians in Saudi Arabia. A total of 502 physicians completed the online survey, of which 62.0% (n = 312) were male. General physicians accounted for 51.2%, while internal-medicine specialists and pulmonologists accounted for 26.9% and 6.6%, respectively. Only 146 (29%) physicians had referred COPD patients to a PR program. The difference in referral rates between all specialties (p = 0.011) was statistically significant. Physicians with more years of experience were more likely to refer COPD patients to PR (p < 0.001). Moreover, a home-based PR program was preferred by 379 physicians (75.5%), and 448 (89.2%) perceived smoking cessation as an essential component of PR. Availability of PR centers (69%) was the most common barrier for not referring patients to PR. The overall referral rate was low among all physicians, owing to a lack of PR centers and trained staff. Home-based delivery was the preferred method of delivering PR, with smoking cessation as an essential component. [ABSTRACT FROM AUTHOR]

aim,8 Abdullah A Alqarni,3 Hassan Alwafi91Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 4UCL Respiratory, University College London, London, WC1E 6BT, UK; 5Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 6National Heart and Lung Institute, Imperial College London, London, UK; 7Department of Pharmaceutical and Biological Sciences, UCL School of Pharmacy, London, UK; 8Department of Computer Science, College of Science and Humanities in Jubail, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 9Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia, Email [email protected] Background: General population knowledge, satisfaction, and barriers to using Seha app have not been evaluated from a large-scale perspective. Therefore, this study aimed to explore current knowledge, satisfaction, and barriers of using Seha app and identify the most common mobile health application used among the general population in Saudi Arabia. Methods: A cross-sectional online survey, consisting of 25 questions, was distributed among the general population of Saudi Arabia. Descriptive statistics were used to describe the respondents' characteristics. Categorical variables were reported as frequencies and percentages. A chi-square (χ 2) test was conducted to assess the statistical difference between respondents' demographic characteristics and their knowledge and use of the app. Results: Overall, 5008 respondents, both Saudi (3723: 74%) and non-Saudi (1285: 26%) as well as male 2142 (43%) and female 2866 (57%), across the Kingdom of Saudi Arabia completed the online survey. A total of 2921 (58%) had heard of the Seha app, although only 1286 (25%) had used the app. Higher percentages of users were from the western region, females and those within the age group of ≥ 51 years old, 388 users (29%: P< 0.001), 804 (28%; P< 0.001) and 67 (35%; P=0.013), respectively. Consulting a doctor was the most frequently utilized service, 576 users (58%). Respondents strongly agreed 402 (41%) that Seha was easy to use, and 538 (54%) strongly agreed that they would recommend Seha to others. The most common barrier of using Seha was a lack of knowledge about the app and its benefits, at 1556 (35%). Overall, the Tawakkalna app was the most utilized mobile health application provided by MOH used 2170 (48%). Conclusion: Utilization of the Seha app is quite low due to a lack of knowledge about the app and its benefits. Thus, the MOH should promote public awareness about the app and its benefits. [ABSTRACT FROM AUTHOR]

Purpose: To explore the impact of the novel coronavirus (COVID-19) pandemic on caregivers' willingness to vaccinate their children against influenza in 2021 in Saudi Arabia and the factors influencing this decision. Patients and Methods: An online survey of 2501 caregivers in Saudi Arabia with children aged 6 months– 18 years was conducted between July 15, 2021, and August 2, 2021. A convenience sample of participants that met the inclusion criteria was used as the study sample. Social Science Package Statistical (SPSS) was used for the statistical analysis. Categorical variables were reported as frequencies and percentages. The Chi-square test was used for categorical variables to assess the difference between the variables and the parents' willingness to vaccinate their children against seasonal influenza after the COVID-19 pandemic. Results: Of the 2501 respondents to the survey, 1185 (47.3%) parents plan to give their children the influenza vaccine next year, which is an increase from 745 (29.8%) in the previous year. The following were the main reasons for not giving children the vaccine: children were less likely to get seasonal flu (617, 24.7%), fear of side effects (491, 19.6%), and fear of needles and syringes (484, 19.4%). Among the parents, 1222 (48.9%) were more likely to receive the seasonal flu vaccine themselves the following year, and 1361 (54.4%), which is more than half, were concerned about their children contracting seasonal influenza. Conclusion: Parents' decision-making to vaccinate their children against seasonal influenza has been influenced by the COVID-19 pandemic. Numerous factors including a caregiver who had received the seasonal influenza vaccine themselves, who had vaccinated or planned to vaccinate their children during the previous or current seasonal influenza season, and/or who had a higher education level were associated with increased willingness to receive the flu vaccine. [ABSTRACT FROM AUTHOR]

Retinoblastoma is the most frequent primary intraocular tumour in childhood. Early detection of retinoblastoma is the key to successful management with a higher chance of survival. This study aims to assess the knowledge of the general population and healthcare providers about retinoblastoma in term of presentation, risk factors, timing for diagnosis, and complications. A cross-sectional study using an online survey was conducted in three Arab countries (Jordan, Saudi Arabia, and Iraq) between 28 August and 16 September 2020. The questionnaire tool was constructed based on an extensive literature review to explore the study's aim and objectives. Logistic regression was used to identify predictors of better knowledge about retinoblastoma. A total of 3676 participants were involved in the study (Jordan = 2654, Saudi Arabia = 604, and Iraq = 418). The average retinoblastoma knowledge score for the whole study population was 6.25 (SD = 4.12) out of 21, representing 29.8% (out of the maximum possible total score). Participants aged above 50 years old, married individuals, those with a secondary education level, those who work as professionals in industry, those who have more than four children, and those who reported that they were not in direct contact with a large number of children were less likely to be knowledgeable about retinoblastoma presentation, risk factors, the timing for diagnosis, and complications (P < .05). Early detection is the cornerstone for decreasing morbidity and mortality among children with retinoblastoma. However, the awareness and knowledge about retinoblastoma are very limited in our study population. Efforts should be directed at increasing awareness of both the general population and healthcare providers regarding retinoblastoma. Policymakers are responsible for improving knowledge and awareness about retinoblastoma to facilitate early detection of the disease by conducting awareness campaigns in addition to improve screening skills of healthcare providers and providing them with proper screening and diagnostic tools. [ABSTRACT FROM AUTHOR]

COVID‐19 and TB coinfection are not common and may occur more in TB endemic countries. However, patients with pre‐COVID‐19 chronic respiratory symptoms should be screened for TB as well. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic is a major strain on health and economic systems, with rapidly increasing demand for in patients' facilities. Disease diagnosis and estimating patients at higher risk is important for the optimal management during the pandemic. This study aimed to identify the predictors of mortality and length of hospital stay in COVID-19 patients. Methods: A retrospective cross-sectional study was conducted between March 2020 and August 2020 at Al-Noor Specialist Hospital in Mecca, Saudi Arabia. All patients who were admitted and had a confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) were included in the study. Descriptive statistics were used to describe patients' demographic characteristics, laboratory findings, and clinical outcomes. Multiple logistic/linear regression analysis was used to identify predictors of death and length of stay at the hospital. Results: A total of 706 patients were hospitalised for COVID-19. The mean age was 48.0 years (SD: 15.6 years). More than half of the patients (68.5%; n= 292) were males. The median duration of stay at the hospital was 6.0 days (IQR: 300– 10:00). The prevalence rate of venous thromboembolism (VTE) among the patients was 3.0% (n= 21). In the multivariate logistic regression analysis, age (AOR: 1.05; 1.02– 1.09), patients with end-stage renal disease (AOR: 6.44; 2.20– 18.87), low Oxygen saturation SPO2 (AOR: 9.92; 4.19– 23.50), D.dimer > 0.5 (AOR: 13.31; 5.45– 32.49), ESR> 10 mm/h (AOR: 4.08; 1.72– 9.68), Ferritin> 400mcg/L (AOR: 18.55; 6.89– 49.96), and Procalcitonin> 0.5ug/L (AOR: 8.23; 1.81– 37.40) were associated with a higher risk of death among patients with COVID-19. Patients with VTE (AOR: 12.86; 3.07– 53.92) were at higher risk of death due to COVID-19. Conclusion: Hospitalised COVID-19 patients have multiple negative consequences in terms of their laboratory findings, signs and symptoms. Age and end-stage renal diseases have a significant impact on the mortality rate and the length of hospital stay among COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global pandemic. The clinical characteristics of COVID-19 have been reported; however, there is limited research investigating the clinical characteristics of COVID-19 in the Middle East. This study aims to investigate the clinical, radiological and therapeutic characteristics of patients diagnosed with COVID19 in Saudi Arabia. Methods: This study is a retrospective single-centre case series study. We extracted data for patients who were admitted to the Al-Noor Specialist Hospital with a PCR confirming SARS-COV-2 between 12th and 31st of March 2020. Descriptive statistics were used to describe patients' characteristics. Continuous data were reported as mean ± SD. Chi-squared test/Fisher test were used as appropriate to compare proportions for categorical variables. Results: A total of 150 patients were hospitalised for COVID-19 during the study period. The mean age was 46.1 years (SD: 15.3 years). The most common comorbidities were hypertension (28.8%, n = 42) and diabetes mellitus (26.0%, n = 38). Regarding the severity of the hospitalised patients, 105 patients (70.0%) were mild, 29 (19.3%) were moderate, and 16 patients (10.7%) were severe or required ICU care. Conclusion: This case series provides clinical, radiological and therapeutic characteristics of hospitalised patients with confirmed COVID-19 in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients' attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events. A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0–4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities. A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients' problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients' problem-solving ability (p < 0.05). Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited., Methods: This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression., Results: Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively., Conclusion: Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Aldhahir, Siraj, Alqarni, Alqahtani, Alyami, Majrshi, Alwafi, Alqahtani, Monshi, Al-Zalabani and Alanazi.)

Background: Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity's impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD., Methods: In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities., Results: A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively)., Conclusion: Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration., Competing Interests: The authors declare no conflict of interest in this work., (© 2024 Alqarni et al.)

Background: Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians' perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions., Methods: Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors., Results: Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% ( n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR., Conclusions: CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians' perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians' and cardiac doctors' perspectives, respectively.

Objectives: To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral., Design: A cross-sectional online survey consisting of nine multiple-choice questions., Settings: Saudi Arabia., Participants: 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists., Primary Outcome Measures: HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia., Results: Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was 'mobility affected by breathlessness' (64%), while the 'availability of PR centres' (61%), the 'lack of trained HCPs' (52%) and the 'lack of authority to refer patients' (44%) were the most common barriers to referral., Conclusion: PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Soon after the COVID-19 pandemic was declared, a pharmaceutical company expressed rapid interest in developing a safe and effective vaccine candidate to contain the spread of SARS-CoV-2 infections. The FDA approved the Pfizer-BioNTech, AstraZeneca, Moderna, and Janssen vaccines. Here, we investigated the attitude and acceptance of using different generic types of COVID-19 vaccines in Saudi Arabia. Methods: This study is a cross-sectional study using an online survey conducted in Saudi Arabia from the 19th of October to the 6th of December 2021. The questionnaire was distributed using social media platforms such as Twitter, WhatsApp, and Facebook. The inclusion criteria to participate in this study were adults who live in Saudi Arabia (Saudis or non-Saudis) and had two doses of COVID-19 vaccinations. Result: 3486 participants were included in this study, and 67.5% of the participants had side effects after the first dose. Similarly, 66.7% of the study participants had side effects after administering the second dose. Our data showed that most participants were unsure if the heterologous COVID-19 vaccination could cause severe side effects. In addition, 47.6% of the participants refused to receive a different generic type of COVID-19 vaccine due to fear of health problems. However, most participants obtained information regarding COVID-19 vaccination from the Saudi Ministry of Health. Conclusions: We found a low level of acceptance for receiving different generic types of vaccines if the participants had a choice. Therefore, plans should focus on increasing the acceptance level among the Saudi population through official platforms such as the Saudi Ministry of Health and private clinics.

Introduction: The management of chronic illnesses commonly includes a long-term pharmacological approach. Although these medications effectively control disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Medication adherence has become a big concern to clinicians and healthcare systems in Saudi Arabia and worldwide because of growing evidence associating nonadherence with adverse outcomes and higher costs of care. Despite it being a well-recognized problem, few studies have investigated medication adherence in Saudi Arabia. Therefore, this study aims to gain a better perspective on medication adherence among patients with chronic diseases in Saudi Arabia. Method: A questionnaire-based cross-sectional study was conducted among patients with chronic diseases in the Makkah region, Saudi Arabia, from 1 May to 31 July 2021. Patients aged 18 years and above who were taking prescribed or over-the-counter medications were included. Descriptive statistics were used to describe the participants’ characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to test the relations between variables. Results: In total, 239 participants were included in the study. Females represented 62% of the participants. In terms of the history of chronic diseases, 44% had hypertension, 40% had diabetes mellitus, 21% had heart diseases and 9% had asthma. Nearly half (49%) of participants did not follow up regularly with a primary healthcare center and 42% said that they had forgotten to take their medications in the past. However, most of the participants (78%) stated that they took their medicine as instructed by their doctor or pharmacist, and 61% took their medications on time. The majority of participants (85%) said that the pharmacist explained the method of using the medications and the instructions for use, while 30% thought that the medications they took were too much. In regard to the reasons for medication nonadherence, having no specific reasons for medication nonadherence was the most common cause for nonadherence in our study. The relationship between patients taking medications as instructed by a healthcare provider (the doctor or pharmacist) and the healthcare provider giving clear instructions to patients about medication use was significant (p < 0.001). Conclusions: Failure to adhere is a significant problem that not only affects the patient but also the healthcare system. Additional research is needed to monitor medication adherence and identify factors contributing to this problem to provide successful strategies to improve medication adherence in Saudi Arabia.

Background: Vaccination against COVID-19 is the key to controlling the pandemic. Parents are the decision makers in the case of children vaccination as they are responsible for them. This study aims to investigate the acceptability of COVID-19 vaccination for children among parents in Saudi Arabia., Methods: This cross-sectional study used an online self-administered questionnaire. A 35-items questionnaire was distributed via social media platforms between June 6 and July 9-2021. Descriptive statistics were used to describe the participants' characteristics. Categorical variables were reported as frequencies and percentages. Predictors of vaccination acceptance were identified using binary logistic regression., Results: A total of 581 parents were involved in this study. A majority of parents 63.9% reported that they will vaccinate their children if the vaccine becomes available. Around 40% of them confirmed that they want their child to be among the first to receive the COVID-19 vaccine. Nearly a quarter, 23.9%, reported that they will vaccinate their child against influenza this year. The most commonly reported reason for hesitancy was poor awareness about the vaccine's effectiveness on children. Adequate information about the COVID-19 vaccine was the most agreed cause to accept the vaccine. Having five or more children was a significant predictor for poor vaccination acceptance (OR: 0.42 (95%CI: 0.21-0.86), p < .05)., Conclusion: An appropriate proportion of parents are willing to vaccinate their children if the vaccine becomes available for children in Saudi Arabia. Public health awareness must be raised to gain public trust in the vaccination and the healthcare system.

Background: Shift work and night shifts are very common in healthcare organisations worldwide. However, healthcare professionals doing shift work and night shifts are exposed to several stressors with psychological, social, physical and sleeping consequences. This study aimed to evaluate the effect of night shifts on the psychosocial, physical well-being and sleeping patterns of healthcare professionals in Saudi Arabia., Methods: We conducted an observational cross-sectional study from July to September 2019 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Convenience sampling technique was used to recruit healthcare providers to participate in the study. The outcomes measured included the effect of working hours of healthcare workers on psychosocial and physical health, substance use, and sleep quality and patterns. Pearson's χ 2 test was used to compare proportions, and Student's t-test/Analysis of variance (ANOVA) was used to examine the mean differences among different demographic groups., Results: A total of 352 healthcare providers were involved in the study, of whom only 272 were night shift workers. The mean level of job satisfaction was higher among day shift workers than night shift workers: the mean scores were 3.82 (SD=0.93) and 3.48 (SD=1.04), respectively, p=0.007. Moreover, social life was more adversely affected among night shift workers compared with day shift workers: 3.95 (SD=1.11) and 3.61 (SD=1.25), respectively, p<0.030. Likewise, family life was more adversely affected among night shift workers than day shift workers, with a mean of 3.92 (SD=1.10) and 3.50 (SD=1.21), respectively, p<0.006. Around 71% of night shift workers reported having poor-quality sleep compared with 50% of day shift workers (p=0.001)., Conclusion: Quality of life is poor among night shift workers than day shift workers, particularly concerning sleep and social and physical outcomes. Further research is needed to investigate factors associated with the quality of sleep and the psychosocial and physical well-being of healthcare professionals working night shifts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Patients with COVID-19 may be at high risk for thrombotic complications due to excess inflammatory response and stasis of blood flow. This study aims to assess the incidence of pulmonary embolism among hospitalized patients with COVID-19, risk factors, and the impact on survival., Methods: A retrospective case-control study was conducted at Al-Noor Specialist Hospital in Saudi Arabia between 15 March 2020 and 15 June 2020. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and confirmed diagnosis of pulmonary embolism by Computed Tomography pulmonary angiogram (CTPA) formed the case group. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and without confirmed diagnose of pulmonary embolism formed the control group. Logistic regression analysis was used to identify predictors of pulmonary embolism and survival., Results: A total of 159 patients participated were included in the study, of which 51 were the cases (patients with pulmonary embolism) and 108 patients formed the control group (patients without pulmonary embolism). The incidence of PE among those hospitalized was around 32%. Smoking history, low level of oxygen saturation, and higher D-dimer values were important risk factors that were associated with a higher risk of developing PE ( p < 0.05). Higher respiratory rate was associated with higher odds of death, and decreased the possibility of survival among hospitalized patients with PE., Conclusions: Pulmonary embolism is common among hospitalized patients with COVID-19. Preventive measures should be considered for hospitalized patients with smoking history, low level of oxygen saturation, high D-dimer values, and high respiratory rate.

Objectives: This study aimed to assess the knowledge and practices of the general public in the Middle Eastern countries during the COVID-19 pandemic. Methods: A cross-sectional study using an online survey was conducted between the 19th of March and the 6th of April 2020 in three Middle Eastern countries (Jordan, Saudi Arabia, and Kuwait) to explore the knowledge and practices of the Middle Eastern population regarding COVID-19. A previously developed questionnaire was adapted and used for this study. Multiple linear regression analysis was used to identify predictors of COVID-19 knowledge. Results: A total of 1208 participants (members of the public) participated from the three countries (Jordan = 389, Saudi Arabia = 433, and Kuwait = 386). The majority of participants ( n = 810, 67.2%) were females aged 30 to 49 years ( n = 501, 41.5%). Participants had moderate overall COVID-19 knowledge, with a mean (SD) score of 7.93 (±1.72) out of 12 (66.1%). Participants had better knowledge about disease prevention and control (83.0%), whereas the lowest sub-scale scores were for questions about disease transmission routes (43.3%). High education level was an important predictor of greater COVID-19 knowledge scores ( p < 0.01). Conclusions: Further public education is needed to address the relatively low level of education regarding the transmission of COVID-19 in the Middle Eastern countries. Policymakers are recommended to develop informative COVID-19 related campaigns that specifically target young people (university students), unemployed individuals, and those with lower levels of education.

Aims: Comprehensive diabetes management may include treatment intensification or the administration of antidiabetic combination therapy. However, this may be associated with an increased risk of adverse events and death. The aim of this study was to understand physicians' perspectives regarding treatment de-intensification, HbA1c goals individualisation, and factors affecting their treatment choice for patients with type 2 diabetes mellitus (T2DM)., Methods: A cross-sectional study was conducted in primary and secondary care units in Saudi Arabia using online questionnaire. Two previously validated questionnaires were used to understand physicians' awareness of, agreement with, and their practices of individualising HbA1c goals and antidiabetic treatment optimisation, and to assess factors affecting physicians' treatment choice when prescribing antidiabetic treatment for patients with type 2 diabetes mellitus. Study population were physicians who are treating patients with diabetes mellitus during the period between October 2017 and May 2018., Results: A total of 205 physicians have participated in the study. Approximately 50% of physicians had family medicine speciality (n = 98, 47.8%). The majority of physicians (n = 183, 89.3%) were familiar with the concept of HbA1c goals individualisation. However, only 66.3% of them (n = 136) reported that they apply it either always or most of the time. 58.5% (n = 120) of physicians reported that they would not initiate conversations about de-intensifying antidiabetic therapy even if their patients had a stable HbA1c values for one year. Physicians showed higher consideration to objective patient clinical data and their assessment of patient's health status, with minor consideration to patient-related factors., Conclusions: Healthcare professionals should focus more on implementing contemporary practices and applying any necessary treatment de-intensification or dose adjustment. Subjective patient factors should be taken into account further, as these factors are associated with better disease management., (© 2020 John Wiley & Sons Ltd.)

Objectives: Considering the transmissible nature of COVID-19 it is important to explore the trend of the epidemiology of the disease in each country and act accordingly. This study aimed to examine the trend of COVID-19 epidemiology in the Kingdom of Saudi Arabia in term of its incidence rate, recovery rate, and mortality rate. Material and Methods: We conducted an observational study using publicly available national data taken from the Saudi Ministry of Health for the period between 3 March and 7 June 2020. The number of newly confirmed cases, active cases, critical cases, percentage of cases stratified by age group [adults, children, and elderly] and gender were extracted from the reports of the Saudi Ministry of Health. Results: During the study period, the total number of confirmed cases with COVID-19 rose from one on 2 March 2020 to 101,914 on 7 June, representing an average of 1,039 new cases per day, [trend test, p < 0.000]. Despite the increase in the number of newly confirmed daily cases of COVID-19, the number of reported daily active cases started to stabilize after 2 months from the start of the pandemic in the country and the overall recovery rate was 71.4%. The mortality rate decreased by 6.4% during the study period. COVID-19 was more common among adults and males compared to other demographic groups. Conclusion: The epidemiological status of COVID-19 in the Kingdom of Saudi Arabia showing promising improvement. Males and adults accounted for the majority of COVID-19 cases in the KSA. Further studies are recommended to be conducted at the patient level to identify other patient groups who are at higher risk of getting infected with COVID-19, and for whom the best pharmacological intervention could be provided., (Copyright © 2020 Alyami, Naser, Orabi, Alwafi and Alyami.)