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Diabetes is a serious medical condition that may cause blindness, renal failure and amputation of the lower limbs, stroke and myocardial infarction. The global incidence of diabetes increases continuously. The self-management of diabetes can be problematic and burdensome, especially if employed individuals choose not to reveal their illness. The workplace has been highlighted as an important element that may impact how employed individuals, diagnosed with diabetes and managed their illness.To describe the influence of diabetes disclosure on the cognitive, physical ability and diabetes self-management of employed adults with diabetes in Saudi Arabia.A descriptive correlational study.This study used a self-administered questionnaire, including the Checklist Individual Strength and Perceived Diabetes Self-Management Scale, for data collection. The sample size was 250 employed adults with diabetes. The data were analysed using descriptive statistics, Spearman's correlation coefficient and bivariate analysis.A significant correlation was found between diabetes self-management and support from co-workers (r = .55, p .05), and the employees who received more support from their co-workers were able to perform diabetes self-management. The results also indicate that employees who received support at their workplace reported improved concentration, motivation and activity (r = .41, p .05).It is essential for top management and policymakers to implement supportive programmes in the workplace, and considering a constant, not rotating, work schedule.

In response to the disease, multiple companies created coronavirus disease 2019 (COVID-19) vaccinations. These vaccines were developed utilizing a variety of technologies and at an unprecedented rate, leading many people to question their efficacy and safety, as well as what they thought about how well the vaccination may protect them. As a result, the goal of this study was to evaluate the factors and motivators that may affect the Saudi Arabian population's decision to get COVID-19 vaccination.A sample of Saudi citizens from the Central Region completed an electronic questionnaire. This questionnaire assessed a variety of factors, including why people choose to get or not have the COVID-19 vaccination.In total, 526 Saudis responded to the survey, with the average age being 35±11 years. Of the participants, 408 (77.6%) had received COVID-19 vaccination (one or two doses), and 118 (22.4%) had not been vaccinated. Females (n=233, 73%, P=0.002) and the group less than 35 years (n=223, 54.7%, P=0.017) were more likely than the males to get vaccinated. Married (n=256, 80.5%) and employed (n=261, 81.1%) participants had higher vaccination rates than unmarried and unemployed. Major reasons for not being vaccinated were a lack of knowledge about the adverse effects (n=74, 62.7%), concerns about possible side effects (n=70, 59.3%), and a lack of faith in the vaccination (n=45, 38.1%). Receiving flu vaccination was significantly associated with being vaccinated against COVID-19 (P=0.020).Lack of knowledge about the vaccine's side effects and uncertainty were the major deterrents to vaccination, whereas faith in the Ministry of Health's instructions was the key motivator.

Background: Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors. Methods: This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson’s Chi square and binary logistic regression. Results: The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3–3.7] times and younger age groups were 1.5 [1.1–2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P

Scientific medical research involving human samples often leads to improved diagnosis, the discovery of treatment modalities, or the identification of possible risk factors for many diseases. Some findings, including incidental findings, may be important to donors, and some may require intervention. This study aimed to explore the perspectives of health care professionals in their use of stored biological samples for biomedical research regarding the concept of the research results and the challenges of informing donors regarding the results. This qualitative study involved 19 medical researchers doing research with stored biological samples and biobanks. The data were gathered during face-to-face interviews in English using a semistructured interview technique. The participants provided rich and illuminating experiences, framed in the following themes: the professional duty of researchers to return the research results and the right of donors to know; factors affecting informing donors of results (e.g., severity of disease; impact of the provided information; reliability of the research results; and donor approval); challenges to physically returning the results; and the nature of the informed consent, as well as the elements required in the informed consent documentation. Although the majority of researchers agree on the importance of returning research results, some have contradictory views such as that returning research results is not the researcher's responsibility. The study results also support the view that a number of elements should be included in the informed consent, such as the intention of informing the donors of the results as well as the benefits and risks.

Introduction Although the incidence of suicide attempts continues to increase among youth in Saudi Arabia, no risk assessment tool has been established for suicide attempt repetition in the country's youth population. The objective of the study was to develop risk assessment of suicide attempt repetition among youth in Saudi Arabia. Methods This is a retrospective study of youth (10-24 years) with intentional suicide attempt(s) who presented to the emergency departments (ED) at King Abdullah Specialist Children's Hospital (KASCH) and King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia between 1 January 2015 and 31 December 2017. We excluded youth having unintentional suicide attempts. Data were retrieved for the 157 eligible as having attempted suicide. Results Forty-one of 157 (26.1%) had repeated suicide attempts (95% confidence limits: 19.433.7%). Four independent factors were identified that were associated with an increased risk of repeated suicide attempts: age (adjusted odds ratio [aOR] = 1.147, 95% confidence interval (CI) = 11.015-1.297, P=0.028), family problems (aOR = 4.218, 95% CI = 1.690-10.528, P=0.002), psychiatric disorders (aOR = 3.497, 95% CI = 1.519-8.051, P=0.003), and hospitalization (aOR = 5.143, 95% CI = 1.421-18.610, P=0.013). This risk model showed adequate utility with an area under the receiver operating characteristic (ROC) curve (AUC): 77.9%, 95% CI: 69.486.3% with optimism-corrected AUC = 71.8%. Youden index defined a probability of ≥0.38 to predict a high risk of repeated suicide attempts. Conclusion The risk of repeated suicide attempts among Saudi youth was high, compatible with what has been reported among youth in England and in France. Age, family problems, psychiatric disorders, and hospitalization are risk factors for repeated suicide attempts. A prevention program for suicide attempts in youth may take into account family problems, screening for psychiatric disorders, and suicidal behavior.

Background: The newly emerged and highly infectious coronavirus disease (COVID-19), which first broke out in Wuhan, China, has invaded most countries around the globe. As both the daily positive cases and death toll increase, countries have taken aggressive action to halt its spread. Saudi Arabia recognized the danger early and implemented a series of urgent precautions. Thus, this study aims to evaluate public trust and compliance with the precautionary measures implemented by authorities to combat the COVID-19 outbreak. Methods: A cross-sectional study was conducted on a sample of the Saudi public using an electronic questionnaire during the COVID-19 outbreak. The data, which were collected using a validated public trust and compliance tool, were analyzed using the chi-square test, t test, and binary logistic regression. Findings: Of the 1232 participants, there were 655 (53.2%) males and 577 (46.8%) females with 34 ± 10 years as the mean and standard deviation of their age. Participants demonstrated a high level of trust and agreement (98.2%) with the implemented precautionary measures. A positive association between participants’ age and their level of agreement with the government actions (r=˗.082, P=0.004) was observed, with a significant difference between males (97.1±6.2) and females (98.0±4.7) (t=˗2.7, P=0.006). Among the participants, 657 (53.3%) were considered to be practicing poor precautionary measures and 575 (46.7%) good precautionary measures. Males (OR=1.8 times, P

Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals' surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48 h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.

Background: The establishment of a national dental registry provides a great opportunity for the healthcare and criminal investigation systems. Its feasibility would rely mainly upon public knowledge and a willingness to contribute dental profiles. The aim of this study was to evaluate the level of awareness among the Saudi public of forensic odontology and to evaluate their willingness to participate in a prospective national dental registry. Methods: A cross-sectional survey based on a self-administered survey questionnaire was conducted in 2018 at the Al-Janadriyah National Festival in Riyadh, Saudi Arabia. Visitors were questioned about their demographic data and responded to 20 knowledge statements using the alternatives “correct”, “incorrect”, or “don’t know”. Their perception towards registries was assessed using 15 statements and a 5-point Likert scale. The percentage mean score (PMS) of knowledge, the mean positive response rate (MPRR) of participant perception, and their willingness to participate in a prospective dental registry were assessed with respect to their demographic characteristics. Results: Complete surveys were received from 812 study participants (85.5% response rate). The PMS ± standard deviation of knowledge was 39.8 ± 22.5 and the MPRR of perception was 64.7 ± 25.5. More than two-thirds of the responders (n = 548, 67.5%) indicated a willingness to register in a future national dental registry. Differences in knowledge were identified with regard to sex, marital status, education, and occupation, while differences in perception and willingness to enroll were influenced by sex. After adjustment for possible confounders, female participants and employed participants were 1.7 times (95% confidence interval [CI] = 1.2–2.4) and 1.6 times [95% CI = 1.1–2.5] more likely to enroll in the proposed registry (P = 0.004 and P = 0.03, respectively). Higher knowledge and perception scores were associated with more willingness to enroll in the national dental registry (adjusted [adj.] P = 0.03 and adj. P

Objectives: The aim of this study (1) To evaluate the Saudi public's knowledge and attitude on dental stem cells (DSC) for therapeutic/banking purposes, (2) To evaluate the perception of Saudi dentists towards DSC and their attitude towards banking of DSC. Methodology: This was a cross-sectional study based on an electronic survey distributed through the social media nationwide among the Saudi public, and through paper-based surveys among dentists in Riyadh. By convenience, eligible study participants were Saudi adults from the community and dentists from 17 dental centers in different regions of Riyadh. Using SPSS v. 25, descriptive statistics (n,%; PMS ± SD) and bivariate analyses (Pearson's Chi square, Mann Whitney) were conducted to determine factors associated with the study outcomes, with a P value statistically significant at

Background Moral distress is a serious problem in healthcare environments that requires urgent attention and management. It occurs when healthcare providers are unable to provide the care that they feel is right or take, what they believe to be, ethically appropriate actions for their patients. Thus, this study aims to examine moral distress among nurses and physicians working in tertiary teaching hospitals in Saudi Arabia, as well as to evaluate the level of association between moral distress and turnover. Methods This cross-sectional study, which employed an anonymous 21-item Moral Distress Scale, was undertaken at a large medical institution located in different regions of Saudi Arabia. The data were analyzed using bivariate analyses, and logistic regression. Results Of the 342 participants, 239 (69.9%) were nurses/staff physicians and 103 (30.1%) were fellows/consultants. Approximately 24.3% of respondents experienced severe moral distress, whereas 75.7% reported mild moral distress. There was no statistically significant difference between men and women in terms of moral distress. Age was found to be a notable factor: moral distress was significantly higher in those younger than 37 years compared to those 37 years and older (P=0.015). Less than half of the participants (137, 42.8%) indicated their willingness to leave their jobs. A significant association was observed between severe moral distress and leaving the career (OR=3.16; P

Background: Humans process their lifetime experiences internally as mental images that constitute their cognitive maps, which they employ to recall and assess important features in their relative contexts. This study aims to develop a cognitive map of the public's risk perception based on gender and age in the unique Saudi cultural context. Methods: Data were collected using a self-administered survey measuring the public's perceived risk of nine common life hazards. Differences in gender (bivariate analysis) and age (correlation analysis) over each domain were presented. Cognitive mapping was developed. Results: Of the 317 participants, there were 211 (67.6%) females and 101 (32.4%) males with 32.5 ± 10.7 years as the mean and standard deviation of their age. A series of regression models showed that males had a better perception on the knowledge and control domain compared to females about the hazard of nuclear reactors (β = −0.2, adjusted P < 0.001), yet worse perception on the knowledge and control domain about caffeine intake (β = 0.21, adjusted P < 0.001). Males also had a worse perception of the severity and dread domain in regards to caffeine intake (β = −0.16, adjusted P = 0.005) and pesticides (β = −7.54, adjusted P = 0.002) compared to females, yet females had worse perception of the severity and dread domain concerning bicycles (β = 0.31, adjusted P < 0.001) compared to males. Older study participants had a better perception on the dread and severity domain in regards to caffeine intake (β = −0.26, adjusted P < 0.001) compared to younger participants. Conclusion: Gender and age differences in the risk perception toward some life hazards were observed among Saudi adults, which define the structural features of the Saudi cognitive map.

Mostafa A Abolfotouh,1 Adel F Almutairi,2 Zainab Almutairi,3 Mahmoud Salam,2 Anwar Alhashem,1 Abdallah A Adlan,4 Omar Modayfer5 1Research Training and Development Section, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Science and Technology Unit, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Stem Cells Donor Registry, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Bioethics Section, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Division of Mental Health, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia Background: It has been reported that the majority of individuals with mental illnesses (MIs) do not seek help. Few studies have focused on correlates of a positive attitude toward professional help-seeking for MI. This study aimed to determine levels of knowledge, perception, and attitudes toward MI, determine attitudes toward mental health help-seeking, and identify sociodemographic predictors of correct knowledge and favorable attitudes among the Saudi public. Methods: A cross-sectional survey was conducted on 650 Saudi adults aged >18 years who attended the Saudi Jenadriyah annual cultural and heritage festival during February 2016. The previously validated Attitudes to Mental Illness Questionnaire was used. Attitude to professional help-seeking was also assessed, using a tool retrieved from the World Mental Health Composite International Diagnostic Interview part II. Multiple regression analyses were applied, and statistical significance considered at P0.05). Conclusion: The Saudi public reported lack of knowledge of MI and stigmatizing attitudes toward people with MI in relation to treatment, work, marriage, and recovery and toward professional help-seeking. Sociodemographic characteristics predicted correct knowledge and favorable attitudes, while Saudi culture was the likely factor behind negative judgments about mentally ill persons. Efforts to challenge this negative publicity and stigma through antistigma campaigns and public education through schools and media are recommended. Keywords: psychiatric illness, discrimination, people with mental illness, PWMI, stigma, antistigma, negative publicity, judgment of mental issues, professional help-seeking, social distance

Adel F Almutairi,1 Ala’a BaniMustafa,1 Yousef M Alessa,1 Ghiath Alahmad2 1Science and Technology Unit, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 2Biomedical Ethics, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Adel F AlmutairiScience and Technology Unit, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaEmail almutairiad1@ngha.med.saBackground: The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. This pandemic is much more than a health crisis; it has also raised many ethical challenges. The large number of infected patients amid scarce resources has placed healthcare professionals in a critical situation in which they have to make difficult decisions about how to prioritize their patients. Therefore, the aim of this study is to explore the ethical challenges experienced and perceived by healthcare professionals working in healthcare institutions and research centers in Saudi Arabia.Methods: Semi-structured face-to-face interviews were conducted individually with frontline healthcare providers (physicians and nurses), researchers, and decision-makers involved in the management of COVID-19 cases. Each interview lasted up to 90 minutes. The thematic analysis technique was used to analyse the interview data.Findings: The participants’ rich experiences, which revealed a number of ethical challenges concerning the provision of medical care to infected patients, were framed around four main themes: treatment challenges related to COVID-19 patients, uncertainty of the medical outcome, medical care discrimination, and decision to discontinue medical treatment.Conclusion: The COVID-19 pandemic has posed huge ethical challenges for healthcare professionals that might lead to psychological issues given the emotional toll related to making life-and-death decisions.Recommendation: In a situation where no reliable and certain treatment is known or well tested, establishing centralized and responsive ethical committees could help reassure and guide practitioners and address their concerns.Keywords: coronavirus, COVID-19, ethics, medical discrimination, end of life, patients’ rights

The new and dangerous coronavirus disease (COVID-19) has posed a serious challenge to the ability of healthcare systems of many countries to contain the spread of the disease and to mitigate its various consequences. The disease posed many ethical challenges both in itself and in the methods used in its management. Although the ethical principles that healthcare operates under are universal, a thorough understanding of the ethical difficulties it poses necessitates consideration of contextual, societal, and cultural factors. This study provides an in-depth exploration of the ethical challenges related to the COVID-19 pandemic outbreak in relation to healthcare providers, medical researchers, and decision-makers in Saudi Arabia. Four themes were extracted from participants' responses, namely, ethical challenges about disease-control measures, challenges to actions in certain groups, challenges regarding software programs, and finally ethics in research practices. Each theme likewise contained sub-themes. The themes and sub-themes were discussed in light of the ethical principles: autonomy, beneficence, non-beneficence, and justice, as well as other principles, such as protecting confidentiality, privacy, and preventing stigma and discrimination.

Mostafa A Abolfotouh,1– 3 Adel F Almutairi,1– 3 Ala’a Banimustafa,1– 3 Soheir A Hagras,4 Majed Al Jeraisy1– 3 1King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 2King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 4Inaya Medical College, Riyadh, Saudi ArabiaCorrespondence: Mostafa A AbolfotouhKing Abdullah International Medical Research Center (KAIMRC)/King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard- Health Affairs, Riyadh, 11426, Saudi ArabiaTel +966 (11) 429-4460; +966 503659204Fax +966 (11) 429-4440Email mabolfotouh@gmail.comBackground: The behavior of the general public and the adoption of precautionary measures during a pandemic determine the fate of the country in the absence of any specific cure. This study aimed to determine the public attitude and behavior responses to the COVID-19 pandemic in Saudi Arabia during movement restrictions, and the predictors of behavioral responses.Methods: A community-based cross-sectional study of 2470 adult individuals in Saudi Arabia, 17– 29 April 2020 was conducted via Survey Monkey, using an anonymous validated e-questionnaire. Data were collected on demographic characteristics, COVID-19-related attitudes, and behavioral responses in terms of; precautionary measures, preparedness, and self-quarantine activities, to be responded to by 4-point Likert scales. Multiple linear regression analyses were performed to identify the significant predictors of compliance with different behaviors. Significance was considered at p< 0.05.Results: Participants reported positive attitudes towards governmental actions (95%), self-hygiene (93.2%), social distancing (97.1%) and choice of healthy food (89.6%), and negative attitudes towards the current worldwide situation of the pandemic (81.0%) and hearing someone tested positive (77.8%) or died from COVID-19 (83.7%). High rates of compliance to behavior were reported by only 55.8% of participants in terms of precautionary measures (71.3%), preparedness (38.4%), and self-quarantine activities (46.1%). After adjusting for all possible confounders, the total attitude score was a significant predictor of the total scores of precautionary measures (t=12.01, p< 0.001), preparedness (t=9.29, p< 0.001), self-quarantine activities (t=12.05, p< 0.001), and overall behavior response (t=14.09, p< 0.001). Other significant predictors of higher overall behavior response scores were female gender (t=7.22, p< 0.001) and non-Saudi nationality (t=3.40, p< 0.001).Conclusion: This study provides baseline data on the behavioral response to the national COVID-19 pandemic in Saudi Arabia. The levels of compliance to behavior response and attitude to COVID-19 pandemic were less than satisfactory. Socio-demographics influence public behavior and protective health measures. COVID-19 awareness programs are recommended.Keywords: SARS-CoV-2, lockdown, perception, behavior, compliance, preparedness, precautionary measures, self-quarantine

Background: Thrombolysis treatment is a licensed therapy for acute ischemic stroke within 4.5 hours of stroke onset. The International Guideline sets the door-to-needle (DTN) time is

Background Healthcare workers (HCWs) face considerable mental and physical stress caring for patients with Covid-19. They are at higher risk of acquiring and transmitting this virus. This study aims to assess perception and attitude of HCWs in Saudi Arabia with regard to Covid-19, and to identify potential associated predictors. Methods In a cross-sectional study, HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email with an anonymous link, by a concern scale about Covid-19 pandemic during 15–30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern statements in five distinct domains. Multiple regression analysis was used to identify predictors of high concern scores. Results A total of 844 HCW responded to the survey. Their average age was 40.4 ± 9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with others. The majority of participants (72.1%) had overall concern scores of 55 or less out of a maximum score of 96 points, with an overall mean score of 48.5 ± 12.8 reflecting moderate level of concern. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions available. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to and/or from areas affected by Covid-19 (94.7%) and felt safe the government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p p = 0.003), undergraduate education (p = 0.044), living with others (p = 0.003) working in the western region (p = 0.003) and direct contact with patients (p = 0.018). Conclusions This study highlights the high concern among HCWs about Covid-19 and identifies the predictors of those with highest concern levels. To minimize the potential negative impact of those concerns on the performance of HCWs during pandemics, measures are necessary to enhance their protection and to minimize the psychological effect of the perceived risk of infection.

BackgroundCovid-19 was declared by the WHO as a worldwide pandemic on 11 March 2020. As of 11th June, 2020, Saudi Arabia had 112,288 infected cases, with 77,954 recoveries and 819 deaths. Healthcare workers (HCWs) are at higher risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding Covid-19 were evaluated in comparison with their concerns about the previous MERS-CoV outbreak.Methods.HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email, by a concern scale about Covid-19 pandemic during 15–30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern statements in five distinct domains. Multiple regression analyses were used to identify predictors of high concern scores.Results.A total of 844 HCW responded to the survey. Their average age was 40.4 ± 9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with family members and/or others. The majority of participants (72.1%) had an overall concern score of 55 or less out of a maximum score of 96 points. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to/from areas affected by Covid-19 (94.7%) and felt safe government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p

Background The newly emerged and highly infectious coronavirus disease (COVID-19), which first broke out in Wuhan, China, has invaded most countries around the globe. As both the daily positive cases and death toll increase, countries have taken aggressive action to halt its spread. Saudi Arabia recognized the danger early and implemented a series of urgent precautions. Thus, this study aims to evaluate public trust and compliance with the precautionary measures implemented by authorities to combat the COVID-19 outbreak. Methods A cross-sectional study was conducted on a sample of the Saudi public using an electronic questionnaire during the COVID-19 outbreak. The data, which were collected using a validated public trust and compliance tool, were analyzed using the chi-square test, t test, and binary logistic regression. Findings Of the 1232 participants, there were 655 (53.2%) males and 577 (46.8%) females with 34 ± 10 years as the mean and standard deviation of their age. Participants demonstrated a high level of trust and agreement (98.2%) with the implemented precautionary measures. A positive association between participants’ age and their level of agreement with the government actions (r=˗.082, P=0.004) was observed, with a significant difference between males (97.1±6.2) and females (98.0±4.7) (t=˗2.7, P=0.006). Among the participants, 657 (53.3%) were considered to be practicing poor precautionary measures and 575 (46.7%) good precautionary measures. Males (OR=1.8 times, P

Mashael Almuhlafi,1 Khalil Abu Jamilah,1 Adel F Almutairi,2 Mahmoud Salam2 1Department of Family Medicine, North West Armed Forces Hospital, Tabuk, Saudi Arabia; 2Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Obesity and disordered eating (DE) behaviors are serious health concerns, regularly observed among female adolescents, which could progress to adverse psychological and nutritional sequels. Aim: The aim of this study was to determine the prevalence of obesity and the self-reported DE behaviors among high school female students and to evaluate their self-perception of body image, peer pressures, and need for dietary consultation. Methods: This is a school-based cross-sectional study conducted in 2018. Self-administered surveys and anthropometric measurements were obtained from adolescent females, randomly selected from eight schools in northern Saudi Arabia. Sample characteristics were age, menarche, and DE behaviors (binge eating, self-induced vomiting, and usage of laxatives). Body mass index was converted to percentiles using the age-to-gender scale. Self-perception of body image, perceived peer pressures, and the Eating Attitude Test-26 (EAT-26) were scored, summated, and then presented in percentage mean scores (PMSs) and mean scores (MSs). Results: Sample comprised 399 participants. One hundred twenty-eight (32.1%) participants reported early age of menarche (≤12years). Sixty-five (16.3%) participants reported the prevalence of overweight/obesity, 123 (30.8%) participants reported binge eating, 28 (7.0%) participants reported self-induced vomiting, and 21 (5.3%) participants reported usage of laxatives. The PMS of self-perception of body weight and peer pressure was 68.7±27.1 and 41.9±23.5, respectively. One hundred ninety-two (48.1%) participants needed professional dietary help. Students with early age of menarche were 1.7 times more likely to be overweight/obese (adjusted [adj] P=0.018) compared to others. Overweight/obese participants had significantly poorer self-perception of body image (PMS =47.4±25.0) and higher perceived peer pressure (PMS =49.5±23.1) compared to underweight/normal weight students (PMS =72.8±25.6 [P

Adel F Almutairi, Mahmoud Salam, Oraynab Abou Abbas, Maliha Nasim, Abdallah A Adlan King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Human beings may face many circumstances, such as surgery, trauma, and ­anemia, in which they could require an urgent blood transfusion. However, only a few ­studies have examined people’s risk perception of blood transfusion. Therefore, this study aims to evaluate the public’s risk perception of blood transfusion in Saudi Arabia, and to identify factors associated with their risk perception.Methods: Self-reported questionnaires on blood transfusion risk perception were distributed to the public during a Saudi national festival in Riyadh. Data were analyzed using mean, SD, Student’s t-test, and linear regression.Results: The overall percentage mean score±SD of risk perception was 59.8±16.1. Male participants were significantly more likely to perceive blood transfusion negatively, both in terms of the dread/severity domain (β=−0.23, p=0.003) and their overall risk perception score (β=−0.17, p=0.028). Older participants were considerably more likely to have a more negative perception (β=0.12, p=0.041) of the benefits of blood transfusion compared with younger participants. Study participants who received blood in the past had a significantly better perception (β=−0.13, p=0.029) of the benefits of transfusion. Additionally, participants who had previously donated blood had a considerably more positive perception in the dread/severity domain (β=−0.18, p=0.017) and their overall score (β=−0.15, p=0.045).Conclusion: Saudi males are more likely to perceive blood transfusion as a high-risk procedure. Similarly, older Saudis will probably have a more negative perception of the benefits of blood transfusion. Previous recipients and donors will likely have a better perception of the benefits of blood transfusion and a more positive overall risk perception. Keywords: blood transfusion, perception, risk, knowledge, benefit, Saudi

In summer 2015, a Saudi 1000-bed tertiary care hospital experienced a serious outbreak among patients of Middle Eastern Respiratory Syndrome (MERS); during which, some healthcare providers contracted the virus, but none died. The outbreak provoked not only fear and stress; but also professional, emotional, ethical, and social conflicts and tension among healthcare providers and patients alike. Therefore, this study aims to explore what healthcare providers, who survived coronavirus infection, have experienced as a MERS patient and how the infection affected their relationship with their colleagues. Semi-structured, face-to-face interviews were conducted individually with seven survivors (healthcare providers). Each interview lasted up to 90 min, and the data were analyzed using the thematic analysis technique. Within the participants’ rich and illuminating experiences, four themes were identified: caring for others in the defining moments, perceived prejudice behaviours and stigmatization, lived moments of traumatic fear and despair, and denial and underestimation of the seriousness of the disease at the individual and organizational levels. Survivors still suffered as a result of their traumatic experiences, which might negatively influence their performance. As these survivors are vulnerable, it is their organization’s responsibility to provide a system that embraces HCPs during and after disastrous events. Keywords: MERS, Outbreak, Saudi Arabia, Coronavirus, Infection, Survivor, Qualitative research

Objective.The present study aimed to identify the most common learning preferences among the nursing students in Saudi Arabia and to investigate the associations of certain demographic variables with the learning preferences.Methods.All the undergraduate nursing students in the nursing college were requested to participate in this descriptive cross-sectional study. An Arabic version of the Felder-Silverman learning style model (FSLSM) questionnaire was used to examine the learning preferences among undergraduate nursing students.Results.A total of 56 (43%) completed questionnaires were included in the final analysis. Results of the present study indicate that the most common learning preferences among the nursing students were visual (67.9%), followed by active (50%) and sequential (37.5%) learning preferences. The verbal style was the least common learning preference (3.6%) among the nursing students. There was no association between gender and learning preferences (p>.05).Conclusion.The present study concluded that the visual, active, and sequential styles are the commonest learning preferences among the nursing students. The nursing educators should emphasize the use of this information in their teaching methods to improve learning skills among the nursing students.

Safiyyah Asiri,1 Waleed A Altwaijri,1,2 Duaa Ba-Armah,1 Ahmed Al Rumayyan,1,2 Muhammad T Alrifai,1,2 Mahmoud Salam,3 Adel F Almutairi3 1Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children’s Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia; 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Background: Guillain-Barré syndrome (GBS) is a progressive acute form of paralysis most probably secondary to an immune-mediated process. GBS among Saudis has been seldom investigated, which leaves both clinicians and researchers with scarcity in knowledge. Therefore, this study aims to assess the prevalence and clinical prognosis of GBS among pediatrics admitted with acute paralysis at a large healthcare facility in Riyadh, Saudi Arabia. Methods: This retrospective study reviewed patients’ medical records between 2005 and 2015. Eligible cases were children (

Objective The aim of this study was to determine the prevalence of various types of oral parafunctional habits and evaluate its association with the level of anxiety and personality traits among the Saudi adult population. Material and methods It is a cross-sectional study based on an anonymous, Arabic language electronic survey distributed through social media networks among Saudi public community. Eligible cases were 1403. Study participants were Saudi adults who practiced at least one of the five oral parafunctional habits (Nail biting, Grinding, Clenching, Lip/object biting, and daily gum chewing). Level of anxiety was measured using Hamilton Anxiety Scale. The Big Five personality traits were evaluated using the Ten-Item Personality Inventory (TIPI) scale. Descriptive statistics (n,%; Mean ± SD), bivariate analytic statistics (Pearson’s Chi square, T-test) and binary logistic regression analyses were conducted to determine factors associated with the study outcomes. Results The most common reported parafunctional habit was daily gum chewing (86%), followed by lip/object biting (59%). Mild anxiety symptoms were prevalent in 84% of sample. However, very severe anxiety was prevalent in only 2%. The leading personality trait was conscientiousness while extraversion trait had the least mean. A significantly positive relationship was observed between the severity of anxiety levels and most oral parafunctional habits. Conscientiousness and emotional stability traits were significantly related to all oral parafunctional habits. However, extraversion and openness to experience were not significantly associated with any parafunctional habit. Conclusions Oral parafunctions showed in this study a high prevalence and were significantly associated with higher anxiety levels and to conscientiousness and emotional stability personality traits.

Adverse events (AEs) are unfortunate consequences of platelet donation. This study reports the incidence and severity of AEs and the associated risk factors in platelet donation at a major blood donation center in Riyadh, Saudi Arabia.A review of donation records was conducted between 2014 and 2017. Eligible study participants were 5007 platelet donors who had donated 7969 times. Each donation was accounted for as a single study subject. Participants' characteristics were described and analyzed as potential contributing factors to adverse events.The average age of platelet donors was 30.0±7.3 years. First-time donors comprised (n = 3,100, 61.9%) of the sample, and 1907 (38.1%) were multiple donors (periodic/routine). Their average BMI was 28.6 ± 4.9 kg/m2. Most donors have blood type "O" and Rheo "positive". The range of blood volume processed was 0 to 5273 ml, while the procedure duration ranged from 0 to 90 minutes. The average platelet yield was 3.8 ± 3.5 ∗1011 platelets per unit, and the average collected volume was 257.6 ± 86.1 ml. Incidence of AEs was 4.2%, of which 91.3% were mild and 8.7% were severe. AEs were vascular injuries (65.3%), vasovagal reactions (11.6%), and citrate toxicity (5.3%). AEs were associated with first-time donation, adj.OR (95%CI) = 1.5 (1.1-1.8) and lower BMI, adj. OR (95% CI) = 1.4 (1.1-1.8). Citrate toxicity was present in severe forms, unlike vascular injuries and vasovagal reactions that tended to be milder. Donors with hemoglobin levels above 16 g/dl, adj. OR (95% CI) = 1.3 (1.1-1.7) and platelet levels below 250,000, adj. OR (95% CI) = 1.3 (1.1-1.6) were more likely to contract AEs than others.Reporting adverse events is essential to establish a benchmark for the annual incidence rates to be compared against local and international figures. Blood donor centers should also take notice of blood donors characteristics that are associated with higher incidence and more severe forms of AEs during or after platelet donation.

Dentists should have the basic essential skills and knowledge about forensic odontology, to better collaborate with law enforcement and investigations. The objective of this survey was to assess the perceived and actual knowledge toward forensic odontology among dentists and to question their willingness to attend training courses on this specialty. A cross‐sectional survey based on a self‐administered questionnaire was conducted in various districts of Saudi Arabia. Four hundred dentists responded to a questionnaire that tested their actual knowledge of forensic odontology based on answering 15 statements using the alternatives correct, incorrect, do not know. The perceived knowledge was registered as strongly agree, agree, neutral, disagree, and strongly disagree, then assigned scores respectively from four to zero. A willingness to attend a training course in the future was recorded by (yes/no). Scores were summated then subjected to descriptive statistics and regression analyses. Responses were received from 360 study participants (89% response rate). The percentage of correct answers, that is, the actual knowledge, was 67.9 (standard deviation [SD] ± 18.4). About two thirds of the responders (n = 251, 69.7%) indicated a willingness to attend a forensic odontology course in the future. Differences in both actual and perceived knowledge were identified on the basis of gender, work experience, education level, attended a course in forensic odontology, and having previously provided a past bite‐mark examination. The perceived knowledge on forensic odontology among dentists was moderate to low. The gap between perceived and actual knowledge signifies low self‐confidence. Dentists with higher education levels and experience tend to have better knowledge.

This study examined the cultural competence of expatriate nurses using self-reported individual assessment tool, and evaluated if there was an improvement after the educational training provided by nurse educators. Utilizing the Individual Assessment of Cultural Competence tool, questionnaires were administered to nurses (n=584) before the educational training and six months thereafter. A response rate of 90% was obtained. The data revealed that there was no significant difference between pre-test mean score and post-test mean score, (p-value=0.488). However, nurses' self-reported cultural competence was improved, (mean post-test gain = 0.020). Nurses'cultural competence was enhanced through the designed educational training program.

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross-cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC.

In Western forms of health care delivery around the globe, research tells us that nurses experience excessive workloads as they face increasingly complex needs in the populations they serve, professional conflicts, and alienation from leadership in health care bureaucracies. These problems are practical and ethical as well as cultural. Cultural conflicts can arise when health care providers and the populations they serve come from diverse economic, ethnic, and cultural backgrounds. The purpose in this paper is to draw from Almutairiâs research with health care teams in Saudi Arabia to show the complexity of culturally and morally laden interactions between health care providers and patients and their families. Then, I will argue for interventions that promote social justice and cultural safety for nurses, other health care providers, and the individuals, families, and communities they serve. This will include addressing international implications for nursing practice, leadership, policy and research. Keywords: Moral climate, Social justice, Equity, Cultural diversity

Background: Cultural diversity often leads to misunderstandings, clashes, conflicts, ethnocentrism, discrimination, and stereotyping due to the frequent intersection of many variables, such as differences in traditions, behaviours, ethical and moral perspectives, conceptions of health and illness, and language barriers. The root of the issue is related to the way people conceptualise differences and the unique cultural and historical circumstances that have shaped different groups’ heritages. In this study, therefore, we aimed to investigate the perceptions of critical cultural competence (CCC) of registered nurses working in various hospitals across the province of British Columbia, Canada. Method: Data were collected using Almutairi’s Critical Cultural Competence Scale (CCC Scale) with a random sample of 170 registered nurses. This scale measures four essential multidimensional components of the CCC model: critical awareness, critical knowledge, critical skills, and critical empowerment. Data were analysed using descriptive and inferential statistics (Kruskal-Wallis test). Results: The data revealed that participants’ perceptions of CCC were positive with a mean score of 5.22 out of 7.00 for the total number of items (n = 43) and a standard deviation of 0.54. The mean scores for the CCC subscales ranged from 4.76 (for critical skills) to 5.42 (for critical empowerment). The results indicated a statistical difference in CCC perceptions based on participants’ age and country of birth with p = 0.05

Adel F Almutairi,1,2 Mahmoud Salam,1,2 Samiyah Alanazi,1 Manal Alweldawi,1 Najad Alsomali,1 Najla Alotaibi1 1King Saud Bin Abdulaziz University of Health Sciences, 2Science and Technology Unit, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Many studies have discovered a number of factors that can contribute to the risk of developing postpartum depression (PPD), including, but not limited to, life stressors, lack of social support, low economic status, and quality of the marital relationship. However, these studies were conducted in various countries with participants from different cultural backgrounds.Purpose: This study aimed to examine the impact of general help-seeking behavior (GHSB) and partner support (PS) on PPD among Saudi women in primary health care clinics in Riyadh city.Methods: Data were collected by using self-administered measures of the Edinburgh Postnatal Depression Scale (EPDS), General Help-Seeking Questionnaire (GHSQ), and Partner Support Scale (PSS). Frequency distribution was used to analyze the categorical data, and Student’s t-test and one-way analysis of variance were employed to compare the numerical data. Linear regression analysis was used to control for all confounders.Results: The findings showed that 9% and 28% of women had good and poor GHSB, respectively, 16% had poor PS, and 25.7% could be classified as probably depressed. Negative relationships between GHSB versus PPD and PS versus PPD were observed. Adjusting by mode of delivery and controlling for confounders in linear regression showed that women who underwent normal vaginal delivery, with higher para rates (β=0.250, t=2.063) and lower PS scores (β=-0.238, t=-2.038), were more likely to suffer higher depression scores (adjP=0.043 and adjP=0.045, respectively). Women who underwent cesarean-section, with postpartum duration≥6 weeks (β=0.374, t=2.082), were more likely to suffer higher depression scores (adjP=0.045) compared to those with

In summer 2015, a Saudi 1000-bed tertiary care hospital experienced a serious outbreak among patients of Middle Eastern Respiratory Syndrome (MERS); during which, some healthcare providers contracted the virus, but none died. The outbreak provoked not only fear and stress; but also professional, emotional, ethical, and social conflicts and tension among healthcare providers and patients alike. Therefore, this study aims to explore what healthcare providers, who survived coronavirus infection, have experienced as a MERS patient and how the infection affected their relationship with their colleagues. Semi-structured, face-to-face interviews were conducted individually with seven survivors (healthcare providers). Each interview lasted up to 90 min, and the data were analyzed using the thematic analysis technique. Within the participants’ rich and illuminating experiences, four themes were identified: caring for others in the defining moments, perceived prejudice behaviours and stigmatization, lived moments of traumatic fear and despair, and denial and underestimation of the seriousness of the disease at the individual and organizational levels. Survivors still suffered as a result of their traumatic experiences, which might negatively influence their performance. As these survivors are vulnerable, it is their organization’s responsibility to provide a system that embraces HCPs during and after disastrous events.

Purpose: In Saudi Arabia, the health system is mainly staffed by expatriate nurses from different cultural and linguistic backgrounds. Given the potential risks this situation poses for patient care, it is important to understand how cultural diversity can be effectively managed in this multicultural environment. The purpose of this study was to explore notions of cultural competence with non-Saudi Arabian nurses working in a major hospital in Saudi Arabia. Design: Face-to-face, audio-recorded, semistructured interviews were conducted with 24 non-Saudi Arabian nurses. Deductive data collection and analysis were undertaken drawing on Campinha-Bacote’s cultural competence model. The data that could not be explained by this model were coded and analyzed inductively. Findings: Nurses within this culturally diverse environment struggled with the notion of cultural competence in terms of each other’s cultural expectations and those of the dominant Saudi culture. Discussion: The study also addressed the limitations of Campinha-Bacote’s model, which did not account for all of the nurses’ experiences. Subsequent inductive analysis yielded important themes that more fully explained the nurses’ experiences in this environment. Implications for Practice: The findings can inform policy, professional education, and practice in the multicultural Saudi setting.

BackgroundDespite allergic rhinitis (AR) being a highly prevalent disease, according to literature, it is often underdiagnosed or undertreated.AimThis study explored the disease characteristics of AR in the Saudi community and the non-conventional coping measures used to alleviate symptoms.MethodsThe study was a nationwide cross-sectional study, using a self-report electronic survey distributed via social media networks in 2018. The survey included an explanatory letter and consent. The sample size comprised 3,458 participants and 2,849 adults had at least one of the four signs of AR, i.e. watery-nose, sneezing, nasal obstruction, itchy nose, watery eyes, in the past year, not related to cold/flu. The outcomes of the study were the triggers, pattern, severity and the classification of AR (2016 ARIA guidelines) and coping measures. Descriptive statistics, univariate analytic statistics and binary logistic regression analyses were conducted. The P-value was considered statistically significant at ResultsThe leading reported trigger of AR was dust (74%, n = 2118), followed by pollen (17%, n = 477), mold (5%, n = 140) and fur (4%, n = 114). The prevalence of intermittent AR was (54%, n = 1,635), while that of persistent AR was (46%, n = 1,314). Almost one-third (34%, n = 959) complained of mild forms of AR, while others complained of moderate to severe forms (66%, n = 1890). The coping measures were mainly shower/humidification 368(12.9%) and herbal hot drinks 266(9.3%). Older participants (adj.OR = 1.3[1.1-1.5]) and overweight participants, (adj.OR = 1.2[1.1-1.4]) reported more persistent forms of rhinitis compared to their counter groups, (adj.PConclusionThis study presented the disease characteristics of self-reported AR and its associated factors in Saudi Arabia. Special attention should be paid to older age groups and overweight patients who reported persistent forms of AR. Males reported more severe and persistent forms of AR.

This paper reports on a study that demonstrates how to apply pattern matching as an analytical method in case-study research. Case-study design is appropriate for the investigation of highly-contextualized phenomena that occur within the social world. Case-study design is considered a pragmatic approach that permits employment of multiple methods and data sources in order to attain a rich understanding of the phenomenon under investigation. The findings from such multiple methods can be reconciled in case-study analysis, specifically through a pattern-matching technique. Although this technique is theoretically explained in the literature, there is scant guidance on how to apply the method practically when analyzing data. This paper demonstrates the steps taken during pattern matching in a completed case-study project that investigated the influence of cultural diversity in a multicultural nursing workforce on the quality and safety of patient care. The example highlighted in this paper contributes to the practical understanding of the pattern-matching process, and can also make a substantial contribution to case-study methods.