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Salma S AlSharhan,1 Wasan F AlMarzouq,1 Hamzah K Alshaikh,2 Hussain J Aljubran,3 Rizam Alghamdi,4 Sarah M AlQahtani,4 Aseel F Almarzouq,5 Naheel A AlAmer6 1Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Otorhinolaryngology Head & Neck Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 3College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Otorhinolaryngology Head & Neck Surgery, Dammam Medical Complex, Dammam, Saudi Arabia; 5College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia; 6Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Salma S AlSharhan, Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia, Tel +966505951801, Email ssalsharhan@iau.edu.saPurpose: Otolaryngology has experienced notable advancements and growth in the application of artificial intelligence (AI). However, otolaryngologists’ perception of these tools are lacking. This study aims to assess the knowledge and attitudes of otolaryngologists toward AI.Patients and Methods: A cross-sectional study was conducted among 110 otolaryngologists in the Eastern Province of Saudi Arabia. A piloted questionnaire was used to gather information on knowledge, attitude, and opinions regarding AI. Data analysis was conducted using SPSS version 26.Results: Of the sample, 60% indicated average perceived knowledge of AI, while approximately 44.5% perceived their AI knowledge in the field of otolaryngology to be below average. A significant positive correlation was identified between knowledge and attitude scores. It was found that a higher knowledge score was more closely associated with seeing more than 15 patients per day, while a higher attitude score was more closely associated with being older, being a consultant, and having more years of professional experience. Of the sample, 38.2% strongly agreed that the application of AI in scientific research should be included in the residency training program.Conclusion: These findings underscore the importance of incorporating AI tools into certain aspects of the otolaryngology residency training program, highlighting their significance.Keywords: otolaryngology, artificial intelligence, machine learning, knowledge, attitude

Naheel A AlAmer,1 Reem S AlOmar,1 Shikha M AlKaltham,2 Rawan S AlYami,2 Fatimah N AlRashidi,2 Mai M AlJrri,2 Moataza M Abdel Wahab1 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: Naheel A AlAmerDepartment of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaEmail naalamer@iau.edu.saBackground: As the Saudi Food and Drug Authority (SFDA) has recently requested all food facilities to display the calorie count on their menus, this study aimed to identify the perceived changes in costumers’ eating behaviours in response to the calorie count display (CCD) policy in the Eastern Province.Methods: This was a mixed methods study. The first being quantitative, using a cross-sectional questionnaire which included 400 customers of both genders, aged 10 years and older, and was collected at food facilities from three cities in the Eastern Province. Customers completed a self-administered questionnaire and handed their registered receipts. Collected receipts were used to calculate the total calories ordered per customer. The second method is a qualitative in-depth interview with food facility managers.Results: Customers who reported checking the CCD were 30.5% of the total sample, and 58.2% of them changed their order accordingly. The mean calories ordered were 36 kcal less in customers checking the CCD than those who do not (P=0.674). Customers who exhibit healthy lifestyle habits calculate their daily consumed calories, knowledgeable of the recommended daily caloric intake (RDCI), dining in a dine-in restaurant, and have an educational level of above high school were more likely to check the CCD. This study found that customers who cared to check the CCD were more likely to change their eating behavior. It has been found that only a small percentage (12% to 18%) of customers were knowledgeable regarding the RDCI. After the implementation of the policy, restaurant managers reported a positive change in customers eating behavior, which was more profound in females and athletes.Conclusion: There is a significant association between checking the CCD and positive behavioral changes in customers’ eating behaviors. The results of this study suggest that further enforcement and awareness raising are crucial to increase the number of customers checking and using the CCD.Keywords: calories, energy intake, restaurants, Saudi Arabia, behavior, nutritional

Background: International travel exposes individuals to diverse health risks, necessitating proactive pre-travel health preparations. Saudi Arabia has witnessed increased outbound travel. This study addresses a critical gap in knowledge by investigating the utilization and perceptions of pre-travel health consultations among adults in the Eastern Province of Saudi Arabia., Methods: This cross-sectional study surveyed patients at the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University during January 2024 to explore perceptions of pre-travel health consultations among the Saudi Arabian population. Adults aged 18 years or older in the waiting area were invited to complete a self-administered questionnaire., Results: Of the 772 participants, 624 (80.8%) engaged in international travel within the last year. However, 593 (76.8%) had never sought pre-travel health consultations. Age, gender, and education level significantly influenced the pursuit of pre-travel health advice, with older individuals, females, and those with higher educational attainment more likely to seek consultations. Participants perceived vaccination recommendations (597, 77.4%) and disease prevention information (678, 87.8%) as crucial parts of pre-travel health consultations. However, barriers to seeking advice included perceived low risk (445, 74.8%), lack of awareness (215, 36.3%), time constraints (128, 21.6%), and cost concerns (92, 15.5%)., Conclusion: The low prevalence of pre-travel health consultations among travelers highlights the need for targeted educational campaigns and the integration of travel health services into primary healthcare. Addressing the identified barriers and leveraging preferred information sources are crucial steps towards enhancing the uptake of pre-travel health consultations, ultimately improving the health and safety of international travelers from the region., (© 2024. The Author(s).)

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.)

Background: Obesity is a major health concern that requires accurate diagnosis and management. Body mass index (BMI) commonly used to diagnose obesity, has limitations in accurately assessing body fat. Body fat percentage (BF%) from whole-body dual energy X-ray absorptiometry (DEXA) scans is gaining popularity as a more accurate method in diagnosing obesity., Materials and Methods: This cross-sectional study included 319 adult patients who underwent whole-body DEXA scans in the Eastern Province of Saudi Arabia from May 2016 to December 2021 were recruited from three medical centers, where data for whole-body DEXA were available. Body fat percent was obtained from the whole-body DEXA scan reports and were compared to BMI to evaluate prevalence of obesity. Data was extracted by reviewing patients' records using a structured data collection tool. BMI was defined using WHO criteria, and diagnostic performance was assessed by estimating specificity, sensitivity, likelihood ratios, and predictive values, and by constructing receiver operating characteristic (ROC) curves for BMI to detect obesity by age group., Results: The gender-specific BF% cutoff points revealed a higher prevalence of obesity than BMI cutoff points. BMI misclassified 40.6% of participants, and optimal cutoff points yielding highest area under the curve were 24 kg/m 2 and 24.3 kg/m 2 for males and females, respectively., Conclusion: The study underscores the importance of using accurate and comprehensive diagnostic tools such as whole-body DEXA scans to assess obesity., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family and Community Medicine.)

Background: Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, most commonly caused by Fusobacterium necrophorum., Case Presentation: A 46-year-old woman with no significant medical history presented with generalized neck swelling and fever. Despite seeking medical attention at multiple outpatient clinics for upper respiratory symptoms lasting 10 days, she only received symptomatic treatment for acute viral pharyngitis. A computed tomography (CT) scan of her neck revealed thrombophlebitis in the left internal jugular vein, and subsequent cultures indicated the presence of Klebsiella pneumoniae. The patient's oxygen saturation levels suddenly dropped, and the CT scan identified bilateral peripheral consolidation areas in both lungs, consistent with septic emboli. These findings were consistent with a diagnosis of Lemierre syndrome. The patient was treated with 2 weeks of intravenous piperacillin/tazobactam and vancomycin, as well as anticoagulation therapy using heparin, and her symptoms resolved completely., Conclusion: This report presents an unusual occurrence of Lemierre syndrome caused by K. pneumoniae, a less frequently encountered causative pathogen in patients without diabetes mellitus. The case highlights the significance of timely and appropriate antibiotic use to prevent potential complications., (© 2023. The Author(s).)

(1) Background: Nursing managers as responsible personnel are required to think outside the box in order to make useful decisions using an appropriate style in a creative manner. This study aims to investigate the relationship between nursing managers' decision-making styles and managerial creativity. (2) Methods: A multi-center cross-sectional design was used to collect data from 245 managers in five large government hospitals using self-administered questionnaires on managerial creativity and general decision-making styles. (3) Results: A significant relationship was found between rational, avoidant, and dependent styles and total managerial creativity. A positive correlation was present between the rational style and total managerial creativity and a negative correlation was found between avoidant, dependent, and spontaneous styles and total managerial creativity. According to a regression analysis, the rational style has a positive effect on managerial creativity, whereas the dependent and avoidant styles have a negative effect. (4) Conclusions: The majority of nursing managers in various hospitals throughout the kingdom are creative and almost all use rational and dependent decision-making styles, which are significantly related to managerial creativity. Thus, it is important to continue to conduct training programs on decision-making styles, especially the rational, dependent, and avoidant styles, for the top-, middle-, and low-level managers.

Purpose of the Study: This study aims at identifying the predominant learning approaches by Saudi medical students across Saudi Arabia and assess its possible associations with sociodemographic and educational characteristics., Study Design: A cross-sectional study design using the Approaches and Study Skills Inventory for Students questionnaire. The questionnaire gives rise to three possible learning approaches; deep, strategic and surface approaches. Bivariate analyses were performed through independent samples t-test and χ2 tests where appropriate. A multinominal regression analysis was performed to obtain risk estimates and 95% CIs., Results: A total of 3767 students participated and were included in the analysis. The predominant learning approach was the deep approach, followed by the strategic and surface approaches (40.59%, 37.81% and 21.60%, respectively). Males and students belonging to private medical schools were more likely to adopt a strategic rather than a deep one (relative risk ratio (RRR) 1.22, 95% CI 1.06 to 1.42 and RRR 1.32, 95% CI 1.05 to 1.65, respectively). Students with an A grade point average (GPA) were less likely to adopt a surface approach, whereas those with a C GPA were more likely to adopt it (RRR=0.67, 95% CI 0.54 to 0.83 and RRR=1.29, 95% CI 1.02 to 1.61, respectively)., Conclusion: The findings from this study show that medical students predominantly favour the deep learning approach. Results from this study encourage the continuous adaptation of clinical teaching in medical schools to optimise students' learning experiences., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

Background: Color vision deficiency (CVD) affects approximately one in 12 men and one in 200 women in the world. It is considered a problem in the medical field since the color is often used as a sign in the practice of medicine, in observational assessment, diagnosis, and follow-up. These conditions make the appreciation of color essential in doctors' lives, thus we aimed at finding the prevalence and predictors of CVD in medical students., Materials and Methods: This cross-sectional study included 1115 medical students. A pretested questionnaire consisting of personal data, history of vision problems, familial color vision defect, eye surgery, bad trauma on the head or eyes, drugs taken or chemicals exposed to, other health problems, and whether sufficient amount of Vitamin A is taken was used. This was followed by the screening of the participants for CVD using the Ishihara 15-plates test., Results: A total of 1115 students participated in the study; 52.2% were females and the mean age of the participants was 21.7 years (±1.4). The prevalence of definitive CVD was found to be 2.1%; all of which comprised males. Eighty-seven percent of the affected participants were not aware of their color vision problem. A highly statistically significant association was found between history of vision problems and CVD status (P < 0.008). No association were found for nationality, marital status, family history of CVD, history of eye surgery, and eye trauma., Conclusion: The percentage of CVD in the present study is lower than that reported by previous studies done in other countries. Many medical students with CVD remain unaware of their condition. Therefore, we recommend early screening of all school-age children, and proper counseling of medical students with definite CVD to take care of their own health and wellbeing., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family and Community Medicine.)

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.

Objectives: The objectives of this study were to assess the volunteering of undergraduate health students and interns in the Ministry of Health (MOH) services in the Kingdom of Saudi Arabia (KSA) during the COVID-19 pandemic, its motivational factors and barriers, as well as their risk perception of COVID-19., Design: A cross-sectional study., Participants: From 12 to 21 May 2020, an online survey was sent to all undergraduate health students and interns in the KSA. This included questions on demographics, volunteering status, risk perception of COVID-19, as well as motivations and barriers towards volunteering., Results: In a convenience sample of 6016 students and interns across KSA, 1824 (30.31%) have volunteered with the MOH services during the COVID-19 pandemic. Volunteering was more likely among older participants, from the College of Medicine, those with self-perceived at risk of COVID-19 infection and those with self-perceived healthy participants. Females, those who did not think that students had moral duties to volunteer, those who were at risk of seasonal influenza and those with self-perceived at risk of hospitalisation from COVID-19 were less likely to volunteer. Patriotism, gaining experience, assisting when able and religious rewards all were reported as major motivators to volunteer. Non-volunteering participants reported that lack of interest, protocol and knowledge, as well as issues related to their personal health and transportation were the main barriers to volunteering., Conclusions: About one-third of undergraduate health students and interns volunteered during the first 2 months of the COVID-19 pandemic in KSA. Moral values were the most important motivations among volunteers. Efforts to encourage heath students and interns to volunteer and providing those with appropriate educational programmes are recommended., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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 Mirror writing is unusual handwriting, in which the writing is in the opposite direction to normal, with reversed letters can be effortlessly read using a mirror. Studies reported that the condition can occur temporarily during the normal development of writing skills in children, and can also could occur in children with developmental delays. In adults, it can be acquired after a brain lesion. CASE REPORT A right-handed 19-year-old Saudi woman presented with progressive-onset mirror writing in both hands, and with writing both languages, Arabic and English. The condition was transient and had gradually worsened over the previous 3 years. Recently, it was continuous. She denied a history of alcohol or illicit drug abuse. There was no history of head injury, dyslexia, learning disabilities, or transient mirror writing during writing development in her early school-age years. There was no similar condition in her family. The neuropsychological assessment was normal. Laboratory and imaging were performed to rule out structural lesions, and no underlying etiology was found. After 2 years of follow-up, the patient did not have other associated neuropsychological symptoms, and mirror writing was persistent. CONCLUSIONS Mirror writing in this case was in the right-handed, healthy young woman and was idiopathic. The condition was benign and the 2-year follow-up neuropsychological assessment was normal. The patient lived with the condition, depending on computer typing instead of handwriting, and she had very good academic performance in the university. We suggest that physicians have to diagnose this condition by exclusion and reassure and support the patients to cope with the condition.

Background: To assess the prevalence of depression among medical students in their clinical years (fourth, fifth, and sixth years) in a government university in Eastern Province, Saudi Arabia, and its association with the students' sociodemographic characteristics, academic factors, perceived health problems and their perceived readiness to their future specialties., Methods: A cross-sectional study was conducted among 527 clinical-year medical students. The Patient Health Questionnaire (PHQ-9) and questionnaire designed by the researchers to collect data on sociodemographic and academic variables were used as research instruments. Statistical analyses were conducted using Stata Statistical Software V.15. Descriptive statistics, the χ test, and both an ordered logistic regression and a binary logistic regression analysis were performed., Results: The prevalence of depression was found to be 39.27%, according to the results of the PHQ-9. Both the ordered logistic regression and the binary logistic regression analyses revealed that the odds of severe depression were high among women, and students who perceived that they were not yet ready for their future specialties. The more senior the medical students were, the less likely it is that they have severe depression. A similar association was found for students who perceived that they did not have psychological problems. However, students' grade point average was not statistically significantly associated with depression., Conclusions: The prevalence of depression was high among the medical students examined. Policy makers should establish screening programmes, provide counselling for students who need it and deliver early interventions in detected cases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)