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Reem S AlOmar,1 Nouf A AlShamlan,1 Wejdan M Al-Johani,1 Ali H Almayyad,1 Hadeel K Alotaibi,1 Sarah I Alsamin,1 Naif Y Alfrayyan,2 Leila A Boubshait,1 Layla M Alghamdi,1 Malak A Al-Shammari1 1Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 2Internal Medicine Department, Psychiatry Division, Security Forces Hospital, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Reem S AlOmar, Email rsomar@iau.edu.saBackground: Attention deficit hyperactivity disorder (ADHD) among the youth and university students differs internationally. This study aims to assess the prevalence of ADHD positivity from a validated screening test among medical students across the Kingdom of Saudi Arabia (KSA) and its associated sociodemographic and family-related factors and the impact of ADHD on students’ academic performance. Also, to highlight the implications of the current findings on epidemiologists and family physicians in the region.Methods: This cross-sectional study utilised the Adult ADHD Self-Report Scale (ASRS) symptom checklist along with several questions on sociodemographic, siblings and personal academic achievement. Multivariable logistic regression models were performed to obtain the Odds Ratios (ORs) of risk of ADHD screening positivity and their 95% confidence intervals (CIs) against potential predictors.Results: The overall prevalence of positively screened medical students was 38.86%. After adjustment, a statistically significant increased risk of ADHD positivity was observed for students who had one sibling (OR = 1.70, 95% CI = 1.09– 2.64). Also, upon examination of birth order, a significant increased risk was observed for students who were firstborn (OR = 1.22, 95% CI = 1.02– 1.47). With regard to academic achievement, both before and after adjustment, students who screened positive had a 14% increased risk of obtaining an F GPA (OR = 1.14, 95% CI = 0.99– 1.30).Conclusion: A considerable number of medical students are potentially positive for ADHD. Albeit not diagnostically confirmed – this indicates that a substantial number of people have displayed symptoms akin to ADHD, but were not clinically diagnosed. Research into ADHD in the region is still in its infancy, and epidemiologists would benefit from high-quality databases to address this condition. Also, primary care physicians should develop skills in detecting and managing ADHD in children at an earlier age to improve symptoms in adulthood.Keywords: attention deficit hyperactivity disorder, epidemiology, family physicians, cross-sectional study, Kingdom of Saudi Arabia

Nouf A AlShamlan, Malak A Al Shammari, Reem S AlOmar, Danya Gari, Assim M AlAbdulKader, Sameerah Motabgani, Abdulaziz Farea, Magdy A Darwish Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nouf A AlShamlanDepartment of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966504901406Email nashamlan@iau.edu.saBackground: Understanding the distribution of blood groups and blood donation willingness in a population is crucial in managing blood banks and transfusion services. Moreover, awareness of one’s own blood group is essential especially in emergencies that mandate blood donation. This study aimed to determine the distribution of ABO and Rhesus (Rh) blood groups among health students, the students’ knowledge about their blood group, and their willingness to donate blood.Methods: This cross-sectional study included all newly accepted health students in a large university in the Eastern Province of Saudi Arabia (N=1145) during August 2020. The data included a self-administered questionnaire and the serology results of ABO and Rh factors. Chi-squared and Fisher’s exact tests were performed followed by a multivariable binary logistic regression analysis which identified the predictors of willingness of blood donation.Results: Blood group O was the most frequent type among students (51.1%), followed by group A (24.5%) and B (20.4%). The majority (93.3%) of students had Rh-positive factor. When we compared students’ answers with their sample results, most students (75.5%) correctly reported their ABO and Rh blood groups. Male students and those with a previous history of blood donation correctly reported their blood group more than others. Of the total sample, 47.3% were willing to donate blood within the next year. Positive predictors of the willingness of student to donate blood included being male, and those with a history of blood donation. Interestingly, students with a family member in the healthcare field were significantly less likely to donate blood.Conclusion: Blood group O and Rh positive were the most frequent blood groups. Most students had a good knowledge about their blood groups, and about half of students were willing to donate blood. Efforts to encourage the young population to participate in blood donation are crucial.Keywords: ABO blood group, Rh factor, blood donation, Saudi, students

Nouf A AlShamlan,1 Reem S AlOmar,1 Omar Y Almukhadhib,2 Saad A Algarni,2 Askar K Alshaibani,2 Sara A Elmaki,3 Malak A Al Shammari,1 Abdulaziz M Sebiany1 1Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Radiology at Family and Community Medicine Center, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nouf A AlShamlanDepartment of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966504901406Email nashamlan@iau.edu.saBackground: Breast masses are common among females presenting to primary health care (PHC) facilities. The family physician’s role is crucial in detecting breast disease. Utilization of breast ultrasonography has been increasing recently as a diagnostic tool.Objective: This study aims to determine the characteristics of masses detected on breast ultrasound, their associations with characteristics of females attending the PHC setting and explore the management of these cases by family physicians.Methods: This registered based, cross-sectional study included 321 females who were referred for diagnostic breast ultrasound in the PHC center of the University hospital, Eastern province, Saudi Arabia (2017– 2019). t-test, Chi-squared and Fisher’s Exact tests were performed to assess associations between the presence of breast masses in the ultrasound and patients’ characteristics. Moreover, to compare the breast masses in two groups of patients (< 40 years and ≥ 40 years) regarding their characteristics, ultrasound findings, and further management performed. P < 0.05 was considered statistically significant.Results: Approximately 24% patients had a breast mass and 70.92% of cases were detected among females ≥ 40 years old. The odds of having a breast mass were highest among overweight, females complaining from a breast lump, and who had early menarche. Grand multiparous had lower odds of a breast mass. Females < 40 years old had higher rates of breastfeeding, increasing parity, and obesity than older females. Sonographic examined masses were larger in young females, and posterior enhancement of the mass was more reported in older. BI-RADs of the masses were not associated with the patient’s age.Conclusion: Breast masses were prevalent among females who underwent breast ultrasound. The results support referral for investigation when a female complains of a breast lump. Family physicians have a vital role in encouraging protective behaviors from developing breast masses such as maintaining normal weight and breastfeeding.Keywords: breast, mass, ultrasound, primary care, family physician

Nouf A AlShamlan,1 Reem S AlOmar,1 Malak A Al Shammari,1 Reem A AlShamlan,2 Abeer A AlShamlan,2 Abdulaziz M Sebiany1 1Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nouf A AlShamlanDepartment of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +00966504901406Email nashamlan@iau.edu.saBackground: Anxiety disorders are a significant global health concern with destructive morbidity and mortality. Medical school is a stressful environment worldwide. This study measures the prevalence of anxiety symptoms among clinical-year medical students in Saudi Arabia. As well as to explore its association with students’ sociodemographic factors, academic performance, issues experienced by them during the study of medicine, and their perceived readiness for their future specialties.Methods: The generalized anxiety disorder (GAD-7) tool along with a sociodemographic questionnaire was distributed to 523 clinical-year medical students (fourth, fifth and sixth years) from the Imam Abdulrahman Bin Faisal University, Saudi Arabia, in this cross-sectional study. Data analysis was performed with SPSS version 23 and it included the Chi-Square or Fisher’s exact tests for bivariate analysis, and the multivariable logistic regression to account for confounders.Results: The prevalence of anxiety symptoms as measured by the GAD-7 was found to be 31.7%. Of these, 14.3% had severe symptoms. Only 4.4% students went to a healthcare professional and were diagnosed with psychiatric problems. Logistic regression analysis revealed that the odds of anxiety was higher among females and students who had perceived psychological problems. However, students’ grade point average (GPA) and perceived readiness for their future specialty were not statistically significant with anxiety symptoms.Conclusion: Anxiety was highly prevalent among clinical-year medical students included in this study. This urges periodic mental health screening, proper diagnosis of high-risk individuals in medical schools, and early interventions through confidential access to mental health services.Keywords: prevalence, generalized anxiety disorder, medical students, Saudi

Nouf A AlShamlan, Malak A Al Shammari, Magdy A Darwish, Abdulaziz M Sebiany, Amr A Sabra, Sameeh M Alalmaie Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nouf A AlShamlanDepartment of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966504901406Email nashamlan@iau.edu.saBackground: There are few data on assessment methods in the field of family medicine in Arab countries. Imam Abdulrahman Bin Faisal University (IAU) in 2017 established the family medicine clerkship rotation for the fifth-year medical students. The objective of the study is to evaluate the multifaceted assessment of family medicine clerkship and their correlation to each other among fifth-year medical students in IAU.Methods: We examined the performance of 455 fifth-year medical students from two batches (2018 and 2019) in the continuous course assessment, Objective Structured Clinical Examinations (OSCE), extended matching questions (EMQ), and multiple-choice questions exams (MCQ).Results: The students’ total mark range was 55.16 to 95.64. Batch 2018 and females had significantly higher marks (p=0.000). On the other hand, no significant associations were seen between the total marks and the semester in which the clerkship was taken or the order of group in each semester (p= 0.464 and 0.980 respectively). Significant positive correlations were seen between all forms of assessment during the family medicine clerkship (p=0.000).Conclusion: This study demonstrates that different assessment methods used to evaluate medical students during the family medicine clerkship were correlated. The performances of the female and the first batch were superior. This finding is the basis for introducing a platform for developing modern learning and the improvement of the assessment standards in family medicine clerkship rotation.Keywords: family medicine, clerkship, medical students, assessment

Nouf A AlShamlan,1 Reem S AlOmar,1 Assim M AlAbdulKader,1 Marwa Mahmoud Shafey,1 Faisal A AlGhamdi,2 Abdullah A Aldakheel,2 Saud A AlShehri,2 Lyana A Felemban,3 Shahad A AlShamlan,2 Malak A Al Shammari1 1Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3College of Medicine, Fakeeh College of Medical Sciences, Jeddah, Saudi ArabiaCorrespondence: Nouf A AlShamlan, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Tel +966504901406, Email nashamlan@iau.edu.saBackground: Epidemiological evidence has shown that human papillomavirus (HPV) is the most frequent cause of sexually transmitted infection, and vaccination is an essential measure to prevent associated diseases and complications. This study aimed to assess the HPV vaccine uptake and its associated factors as well as HPV vaccine hesitancy by female healthcare workers (HCWs) in Saudi Arabia.Methods: This online, questionnaire-based, cross-sectional study involved female HCWs in Saudi Arabia between July and October 2022. The study tool included questions about sociodemographic, occupational, and reproductive characteristics, uptake of HPV vaccination, and reasons of hesitancy. Chi-squared and t-tests were used for bivariate analyses, and multivariable logistic regression was used to adjust for confounders.Results: The total number of participants was 1857. Around 20% of HCWs received at least one dose of the HPV vaccine, and around 45% were willing to take it this year. Lower odds of vaccine uptake were reported among older participants and those with a higher level of education. However, nurses, HCWs with a previous HPV infection, those with a family history of cervical cancer, or those with a previous cervical cancer screening test had higher odds of receiving the vaccine. On the other hand, older participants and diploma degree holders were less willing to take the HPV vaccine. Higher odds of willingness were reported in married HCWs, those with a previous HPV infection, those who received a previous HPV vaccine dose, or those who were screened for cervical cancer. Lack of knowledge and some misconceptions were the most reported reasons for hesitancy.Conclusion: Certain factors that affect HCWs personal decisions to take the vaccine were identified. By targeting these issues, epidemiologists, public health officials and women’s health care providers can work to increase HPV vaccine uptake and reduce the burden of HPV-related diseases in this population.Keywords: HPV vaccine, epidemiology, public health, women’s health, healthcare worker, uptake

Nouf A AlShamlan,1 Reem S AlOmar,1 Assim M AlAbdulKader,1 Faisal A AlGhamdi,2 Abdullah A Aldakheel,2 Saud A Al Shehri,2 Lyana Atif Felemban,3 Marwa Mahmoud Shafey,1 Malak A Al Shammari1 1Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3College of Medicine, Fakeeh College of Medical Sciences, Jeddah, Saudi ArabiaCorrespondence: Nouf A AlShamlan, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Tel +966 504901406, Email nashamlan@iau.edu.saPurpose: Epidemiologically, cervical cancer is the fourth most commonly diagnosed cancer among females globally and the third most commonly diagnosed gynecological cancer in Saudi Arabia. Screening is an important measure to prevent it. The current study aimed to assess, epidemiologically, female healthcare workers’ (HCWs) utilization of cervical cancer screening services and its association with their beliefs about cervical cancer and the screening test, as well as their personal characteristics.Methods: This cross-sectional study included female HCWs in Saudi Arabia. A predesigned, self-administered survey was used to collect data, and it included questions about sociodemographic and reproductive characteristics, self-utilization of cervical cancer screening services, and the Health Belief Model (HBM) scale. Regression analyses were conducted to identify predictors of cervical cancer screening service utilization.Results: A total of 1857 females participated. The cervical cancer screening test uptake was 24.6% of ever-married females. However, 45% of the participants were willing to have the test. The odds of utilizing a screening were significantly higher among older participants, those with a higher level of education, and those with a higher number of pregnancies. Furthermore, HCWs with a history of HPV infection, cervical cancer in the family, hormonal contraception, or immunocompromised diseases were more likely to have the screening. An increase in the mean scores of the perceived benefits and motives subscales of HBM was associated with an increase in the uptake of screening. However, an increase in perceived barrier scores was significantly associated with a lower likelihood of cervical cancer screening uptake.Conclusion: Low cervical screening uptake and slightly higher intentions to have the test exist among HCWs. Certain personal factors and health beliefs significantly affect the utilization of the screening test. Approaches that target perceived benefits, health motivation, and perceived barriers to improve the screening rates of cervical cancer among HCWs are recommended.Keywords: cervical cancer screening, health belief model, Pap smear, healthcare worker, utilizations, Saudi Arabia

Background: In the Kingdom of Saudi Arabia (KSA), little is known about the adoption of virtual consultations (VCs), with most studies being survey-based leading to varying results. This study aims to utilise secondary collected data on the use of both kinds of VCs currently available, and to epidemiologically describe the adoption of these consultations., Methods: This retrospective study analysed data provided by the Ministry of Health between January 1st 2021 and June 30th 2022. For both the home-based and the hospital-based consultations, variables included the age and sex of patients, date of consultation, duration in minutes, closure status for the appointment and the governorate in which the patient is residing. A heat map was drawn to present patterns of utilisation across the country., Results: The total number of VCs for both types were 1,008,228. For both types, females were higher adopters (54.73%). Of the total number of consultations, 751,156 were hospital-based. Of these consultations, family medicine consultations were the most common (20.42%), followed by internal medicine. Maternity follow-up clinics were higher in home-based clinics. The proportion of patient no-shows was high overall (48.30%). Utilisation was high in urban governorates, and low in rural ones., Conclusion: Findings have several implications on health policy. It provides further evidence of the importance of family medicine, where it was the most common speciality even in hospital-based settings. The high variability in the adoption of consultations across rural and urban areas as well as the extremely high number of patient-no-shows warrants further investigation., (© 2024. The Author(s).)

Background: Herpes Zoster (HZ), also known as Shingles, is a commonly occurring infection especially among the elderly. It is due to the reactivation of the dormant virus in the sensory ends that were present since the primary infection with the virus., Objective: Our study aims at assessing the knowledge, attitudes practices beliefs and current barriers towards the Shingrix vaccine to fully understand where we stand and come up with proper recommendations to services these at-risk individuals and ultimately have a positive impact on the healthcare system., Methods: Questionnaire based cross sectional study using a translated version of a previously developed and tested questionnaire., Results: more than 8000 participants responded to the survey. The vast majority had chicken pox before and did hear about the vaccine from different sources. Most of the participants had minimal knowledge regarding the vaccine and were willing to take it regardless of some safety concerns., Conclusion: more efforts need to be conducted to enhance vaccine uptake in at risk populations in Saudi Arabia., Competing Interests: The authors declare no conflicts of interest., (© 2024 Nouf F. Bin Rubaian, Nada Alghamdi, Nada Alquorain, Serene R. Almuhaidib, Nouf A. AlShamlan, Assim M. AlAbdulKader, Moataza M. Abdel Wahab, Malak A. Al-Shammari.)

Background: The coverage of the seasonal influenza vaccine has always been sub-par. Understanding the motivators of receiving vaccines, especially during pandemics, could enhance and increase the coverage rates. The Saudi Ministry of Health launched its annual influenza vaccination campaign during the 2021 influenza season and provided vaccinations in primary healthcare settings. This study aims to explore public motivators to receive influenza vaccination, particularly during the coronavirus disease 2019 global pandemic., Materials and Methods: This cross-sectional study enrolled 783 participants who attended the influenza vaccination campaign. All persons who received the influenza vaccine in the influenza vaccination campaign held in Dammam, Saudi Arabia, from October to November 2021, were interviewed and completed a self-administered questionnaire. Odds ratio with a 95% confidence interval were estimated using the full model fit. The significance level was set as α = 0.05., Results: The majority of the participants had more than high school education (81%), were males (66.2%), and married (59.6%), and 50.6% were below 35 years of age. Participants with higher education, health-care workers, and those who had been previously counseled on influenza vaccination were less likely to have started taking the influenza vaccination, whereas smokers and persons who do not have routine checkups were more likely to start influenza vaccination. The main motivator to take the influenza vaccine was the establishment of a vaccination campaign near the participant's workplace (62.2%), followed by advice from their physician (30.3%), and fear of having influenza disease (29.6%)., Conclusion: Accessibility to the vaccination campaigns was the main motivator for receiving the vaccine followed by the advice from physician. Advice from physician and increasing mobile vaccination campaigns and mobile clinics would substantially increase influenza vaccine uptake., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family and Community Medicine.)

Introduction: H5N1 is a highly pathogenic avian influenza virus that can infect humans and has an estimated fatality rate of 53%. As shown by the current situation of the COVID-19 pandemic, emerging and re-emerging viruses such as H5N1 have the potential to cause another pandemic. Thus, this study outlined the hub genes and pathways associated with H5N1 infection in humans., Methods: The genes associated with H5N1 infection in humans were retrieved from the NCBI Gene database using "H5N1 virus infection" as the keyword. The genes obtained were investigated for protein-protein interaction (PPI) using STRING version 11.5 and studied for functional enrichment analysis using DAVID 2021. Further, the PPI network was visualised and analysed using Cytoscape 3.7.2, and the hub genes were obtained using the local topological analysis method of the cytoHubba plugin., Results: A total of 39 genes associated with H5N1 infection in humans significantly interacted with each other, forming a PPI network with 38 nodes and 149 edges modulating 74 KEGG pathways, 76 biological processes, 13 cellular components, and 22 molecular functions. Further, the PPI network analysis revealed that 33 nodes interacted, forming 1056 shortest paths at 0.282 network density, along with a 1.947 characteristic path length. The local topological analysis predicted IFNA1, IRF3, CXCL8, CXCL10, IFNB1, and CHUK as the critical hub genes in human H5N1 infection., Conclusion: The hub genes associated with the H5N1 infection and their pathways could serve as diagnostic, prognostic, and therapeutic targets for H5N1 infection among humans.

Background: Decreasing the number of Emergency Department patient visits for treatment, especially in non-urgent cases, is an international healthcare goal. The same applies for pediatric emergency rooms where the utilization of ED is much more than adults., Objective: We aim to measure the length of stay for all pediatric patients and examine the factors influencing it., Methods: A retrospective chart review study was conducted at the pediatric ED of King Fahd Hospital in the Eastern Province of Saudi Arabia. The study included all patients presented to the pediatric ED, between January 1, 2018, and December 31, 2018, aged from 1 day to < 14 years old. Data included patient's age, sex, season in which the patient presented in, chief complaint, time of presentation, and whether admission to the hospital ward was collected., Results: The total number of patients was 37,613. The median LOS was 100, interquartile range (IQR) = 53 - 272 minutes. Male pediatric patients were (55.12%). Among all patients, (32.04%) were toddlers, followed by school aged children (25.05%). The ER received more patients during the winter months followed by summer (32.92% and 24.72%, respectively). Fever was the most common complaint for all patients combined. For prolonged LOS patients, the most common complaints were respiratory related (23.44%). Pre-school children and school aged children were found to have a 5.49% and a 7.93% increased LOS when compared to toddlers (95% CI = 2.52 - 8.53, and 95% CI = 5.01 - 10.93, respectively). Summer was associated with a statistically significant increased LOS (% change = 28.92, 95% CI = 25.53 - 32.40). Morning shift was found to have a 7.89% increased LOS when compared to the evening shift. The highest increase in LOS was attributed to haematology related complaints (% change = 108.32, 95% CI = 85.69 - 133.71)., Conclusion: Several pediatric LOS predicting factors have been identified; morning arrival, and presentation during summertime. Systemic factors such as staffing, and infrastructure can be modified and may affect the length of stay of patients. The implementation of these strategies and the evaluation of their impact on the length of stay in the pediatric emergency department require further investigation., Competing Interests: There are no conflicts of interest., (© 2023 Abdullah A. Yousef, Mohammed H. Al Qahtani, Abdullah K. Al-Mutairi, Faisal O. AlQurashi, Reem S. AlOmar, Nouf A. AlShamlan, Malak A. Al Shammari, Hannen A. Yousef.)

Background: Palliative care (PC) is a new concept in Iraq, and there is no training for health care specialists or the public. The lack of education and training programs is the most important barrier for PC. Intermediate training is needed for nurses who regularly manage patients with life-threatening diseases. The End-of-Life Nursing Education Consortium for pediatric palliative care (PPC) program is intended for nurses who are interested in providing care to children with life-limiting diseases or providing support in the event of an accident or unexpected death., Objective: Our trial aims to evaluate the effect of a web-based training course, using the Normalization Process Theory. It focuses on how complex interventions become routinely embedded in practice and on training of a sample of academic nurses in the application of PPC in routine daily practice. It hypothesizes that nurses will be able to provide PC for the pediatric population after completing the training., Methods: This is a multicenter, parallel, pragmatic trial in 5 health care settings spread across a single city in Babylon Province, Iraq. Participants will be recruited and stratified into 2 categories (critical care units and noncritical care units). In the experimental condition, 86 nurses will be trained in the application of PPC for 2 weeks through a web-based training course powered by the Relais Platform. The nurses will be invited to participate via email or instant messaging (WhatsApp, Telegram, or Viber). They will provide end-of-life care in addition to usual care to children and adolescents with life-limiting conditions. In the control condition, 86 nurses will continue usual care. The program's effectiveness will be assessed at the level of nurses only. We will compare baseline findings (before the intervention) with postintervention findings (after completing the training course). A further assessment will be performed 3 months after the course. As numerous unidentified factors can influence the effect of the training, we will perform a progressive evaluation to assess sample selection, application, and intervention value, as well as implementation difficulties. The nursing staff will not be blinded to the intervention, but will be blinded to the results., Results: The study trial recruitment opened in July 2020. The first outcomes became available in December 2020., Conclusions: The trial attempts to clarify the delivery of PC at the end of life through the implementation of a web-based training course among Iraqi nurses in the pediatric field. The study strengths include the usual practice setting, staff training, readiness of staff to participate in the study, and random allocation to the intervention. However, participants may drop out after being transferred to another department during the study period., Trial Registration: ClinicalTrials.gov NCT04461561; https://clinicaltrials.gov/ct2/show/NCT04461561., International Registered Report Identifier (irrid): PRR1-10.2196/23783., (©Moustafa A Al-Shammari, Amean Yasir, Nuhad Aldoori, Hussein Mohammad. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.11.2022.)

Background: Social Anxiety disorder (SAD) is common worldwide. However, data from Saudi Arabia is deficient. This study aims to determine the prevalence of SAD across Saudi medical students and its associations with sociodemographic factors and their academic performance., Methods: The main outcome was presence/absence of SAD and the secondary outcome was its level of severity. These were assessed from the Social Phobia Inventory. Associated factors included sociodemographic variables, as well as educational characteristics of students. Descriptive statistics were reported as counts and percentages, and unadjusted and adjusted odds ratios (OR) and their 95% confidence intervals (CIs) were computed through bivariate and multivariate logistic regression., Results: Of 5896 Saudi medical students who participated in the study, the prevalence of SAD was almost 51%. While 8.21% and 4.21% had reported severe and very severe SAD, respectively. Older age students were at lower risk of developing SAD (OR = 0.92, 95% CI = 0.89 - 0.96). In contrast, females (OR = 1.13, 95% CI = 1.01 - 1.26), students enrolled in private colleges and colleges implementing non-problem-based learning (OR = 1.29, 95% CI = 1.09 - 1.52 and OR = 1.29. 95% CI = 1.15 - 1.46 respectively) were at higher risk. A significant elevated risk of SAD was found among students who had previously failed, and had a low GPA., Conclusion: SAD is prevalent among the sampled population, and different associated factors were identified. Current results could raise the awareness of faculty members and healthcare providers towards early detection and management of these cases., (© 2022. The Author(s).)

Introduction/objectives: The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University., Methods: This registry-based cross-sectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods., Results: The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function., Conclusions: Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease.

The Journal of Family and Community Medicine (JFCM) is a peer-reviewed open access journal published by the Saudi Society of Family and Community Medicine. This review is aimed to analyze the scientometric attributes of manuscripts published over 27 years from 1994 to 2020 using scientometric technique. The bibliographic records of manuscripts published from 1994 to 2020 were retrieved from the Web of Science and Medline-PubMed databases. The data were analyzed by using VOSviewer, CiteSpace, and Biblioshiny software. A total of 648 manuscripts were included; these were written by 1442 authors, with an average of 2.22 authors per manuscript and 24 manuscripts per year. All manuscripts gained 2,693 citations with a mean ratio of 4.15 citations per manuscript. All the top-20 contributing authors belonged to Saudi Arabia, and 48% of the manuscripts were in the single-author pattern; the multiauthored manuscripts received a higher ratio of citations. The review highlighted the most contributing institutions and countries.Bibliographic coupling of countries, institutions, keywords co-occurrence, and co-citation of journals were also presented. The JFCM is an important journal of Saudi Arabia that has provided a platform to family medicine researchers to share their scholarly and scientific communication for the past 27 years. Over the years, the frequency and number of publications in the journal have improved. Although the journal has received manuscripts from all over the world, most contributions were from Saudi Arabia., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family and Community Medicine.)

Objectives: To assess the seroprevalence of Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among newly admitted health track students in a large university in the Eastern Province of Saudi Arabia, and determine the students' immunity against HBV, and bloodborne viral infection risk factors or practices among them., Methods: Information about the 1145 students, vaccination history, and exposure to bloodborne viral infections risk factors/practices were collected using a structured questionnaire during August 2020. The results of serological data were obtained from students' electronic files., Results: All students tested negative for HBV, HCV, and HIV infections. The seroprevalence of positivity against HBV was 25.8%, and the frequencies of students with protective levels of anti-HBV were inversely related to their age. The majority (70.8%) of students had 1 or 2 identifiable risk factors for bloodborne diseases, and the most frequent risk factor was history of dental intervention. Female students were more than four-times likely to be in the high-risk group for bloodborne infections than males (OR = 4.4; 95% CI: 3.3-5.9). Being from the Central Province of Saudi Arabia (OR = 1.9; 95% CI: 1.2-3.1) and having a mother's educational level of master or doctorate (OR = 3.0; 95% CI: 1.3-6.7) were found to be independent predictors of being in the high-risk group. On the other hand, having a family member in the healthcare field was found as a predictor of being in the low-risk group for bloodborne diseases (OR = 0.7; 95% CI: 0.5-0.9)., Conclusion: About three-fourth of students in this study were susceptible to HBV. Our findings stress the need to develop policies to raise awareness regarding bloodborne infectious diseases, in addition to expanding access to HBV vaccination for healthcare staff, especially in older ages.

Background: The Emergency Repartment (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia., Methods: This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome., Results: The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57-5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85-89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65-51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70-133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23-0.38)., Conclusions: A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Introduction: Primary care plays an integral role in modern healthcare systems. More so in a country that is currently undergoing a reform of its health system. Their remains barriers that hinder patients from seeking medical assistance from primary physicians. This study aims to examine the overall satisfaction of patients toward Primary Healthcare Centers (PHCs) in Saudi Arabia, as well as its association with potential barriers from a sample of patients who presented at the emergency department (ED) for non-urgent cases., Methods: This cross-sectional study sampled 403 patients from King Fahd Hospital of the University. A piloted questionnaire was utilized that included questions on sociodemographics, satisfaction of PHCs, as well as organizational, socioeconomic, access, and patient-doctor relationship barriers using a Likert-scale item response. Chi-squared and Fisher's Exact tests were used to compare categorical variables, and multivariable logistic regression was used to assess the association between overall satisfaction and all factors and barriers., Results: The sample consisted of 48.1% males and 51.9% females. Only 5.2% of the patients were hospitalized. Of the total sample, 28.3% reported being always satisfied with PHC services. The most reported barriers were organizational barriers and socioeconomic barriers. The regression analysis found that being a female, highly educated, have high organizational, and patient-doctor relationship were independent predictors for low overall satisfaction with PHCs., Conclusion: Findings from this study should allow healthcare planners and policy makers to reduce the impact of these barriers by finding solutions that would target them. This may include strictly implementing policies such as proper implementing of triaging in EDs as well as promoting services that are being provided free of charge at these centers.

Background: Family Medicine was introduced as a major undergraduate clinical rotation in 2016 after the medical college at Imam Abdulrahman Bin Faisal University revised its curriculum., Objective: Assessing how students' medical knowledge has improved post Family Medicine introduction to the revised medical school curriculum., Study Design: This was a cross-sectional epidemiological study among fifth year clinical medical students (n = 219). A pretest and post-test was distributed to all fifth year clinical medical students voluntarily during the period of October 2017 to May 2018. They were asked to rate the exam as well., Results: The mean exam grades were 25.52 (SD = 4.44) and 34.16 (SD = 5.76) for pre-rotation and post-rotation, respectively. There was a statistically significant difference between post and pre rotation exam grade for the overall sample ( t (218) = 23.73, P  < .0001) indicating that students had a statistically significantly higher exam grades post-rotation (M = 34.16, SD = 5.76) than pre-rotation (M = 25.52, SD = 4.44). Females had a statistically significantly larger difference in post-rotation and pre-rotation exam grade than males indicating that they improved more in the post rotation exam. It was found that nearly 60% (59.36%) of subjects considered the exam difficult before the rotation; however, only around 40% (40.18%) considered the exam difficult after the rotation., Conclusion: Students benefited after taking the course of family medicine. This helps in advocating for both the importance of this specialty and for the university's decision in incorporating family medicine as a major clinical rotation for undergraduates.

Background: Sleep is often challenging for medical students because of the considerable amount of learning they have to do. The aim of this study was to identify the patterns of sleep quality and daytime sleepiness among medical students in Saudi Arabia and to identify the possible factors associated with poor quality of sleep and daytime sleepiness., Materials and Methods: This cross-sectional questionnaire-based study was conducted at College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia. The questionnaire included the prevalidated Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality and the Epworth Sleepiness Scale (ESS) to measure daytime sleepiness. Covariates included sociodemographic characteristics and academic performance. Bivariate and multivariate logistic regression analyses were used to obtain adjusted and unadjusted odds ratios (ORs)., Results: The sampled population comprised 36.7% males and 63.30% females. The mean global PSQI score was (standard deviation (SD)=4.66), while the mean global ESS score was 8.03 (SD=4.66). Further analysis showed that 80.60% had poor sleep quality and 37.80% of the students suffered from excessive daytime sleepiness. Multivariate regression showed that poor sleep quality was significantly associated with poor academic achievement (adjusted OR = 3.33, 95% confidence interval [CI] = 1.28-8.63). Furthermore, excessive sleepiness significantly increased the odds of poor academic performance (adjusted OR = 4.58, 95% CI = 1.09-20.81)., Conclusions: The results on daytime sleepiness were found to be within the ranges reported worldwide; poor sleep quality was found to be among the highest ever reported. Both sleep quality and daytime sleepiness significantly affect academic achievement., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family and Community Medicine.)

Background: Although lipoplasty is the most frequently performed aesthetic surgical procedure, ultrasound-assisted lipoplasty (UAL) has not been widely adopted because of its increased potential for complications, complex and bulky instrumentation, additional cost, and steep learning curve., Objective: We report on the use of the VASER ultrasound device in lipoplasty procedures and compare the clinical outcomes obtained by means of VASER-assisted lipoplasty with those of other UAL devices., Methods: A superwet technique was used, and the wetting solution was uniformly distributed in the intended treatment area. Skin protection measures included use of specially designed skin ports to protect the incision edges and wet towels adjacent to the port locations. Access incisions were 3 to 4 mm in length. The VASER device was used in VASER (pulsed ultrasound) mode by 2 investigators (P.B.F. and M.L.J.); the continuous ultrasound mode was used by these investigators only if tissue emulsification was not readily achieved by using the VASER mode. A third investigator (E.B.d.S.P.) primarily used the continuous mode. Effective fat fragmentation in either mode was achieved by a maximum of 1 minute of treatment time per 100 mL of infused wetting solution., Results: In a series of 77 patients treated by 3 different clinicians, satisfactory results were obtained with no major complications. This contrasts with an incidence of complications of 7.9% (median, 4.9%) for first- and second-generation UAL devices as determined by statistical analysis of the literature., Conclusions: The initial clinical experience with VASER-assisted lipoplasty indicates that it is a safe and efficient technique for body-contouring surgery. (Aesthetic Surg J 2002;22:131-146.).