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الملخص: حققت المملكة العربية السعودية تطورات كبيرة في البنية التحتية للرعاية الصحية للأطفال. ومع ذلك، لا تزال هناك فجوات في معالجة السلامة العاطفية للأطفال في المستشفيات، والاحتياجات النفسية، والاجتماعية. على المستوى الدولي، تطورت مهنة ''حياة الطفل'' على مدى عقود من الزمن لتلبية هذه الاحتياجات على وجه التحديد من خلال تدخلات مثل اللعب العلاجي، وتثقيف المريض بلغة تناسب المرحلة العمرية، ودعم الأسرة.تقيم هذه الورقة أهمية ادراج مهنة حياة الطفل في المملكة العربية السعودية لتعزيز جودة الرعاية الصحية للأطفال حيث يكشف تحليل الوضع الحالي عن وجود ثغرات في الرعاية النفسية للأطفال. تم إدراج هذه الفجوات المحددة كأولويات وطنية في برنامج التحول الصحي، الذي يهدف إلى تحسين جودة الرعاية الصحية وتعزيز الرفاهية.مهنة حياة الطفل يمكن أن تساعد في تحقيق هذه الأهداف للأطفال والأسر في المملكة العربية السعودية حيث تم اقتراح استراتيجيات للتنفيذ المرحلي، تشمل مؤسسات الرعاية الصحية، والشركاء الأكاديميين، والشركاء ذوي الصلة غير الربحين، وواضعي السياسات. تؤكد الورقة على الفوائد المتعددة الأوجه لـمهنة حياة الطفل في تحسين تجارب المرضى، وكفاءة تقديم الرعاية الصحية، وجودة الرعاية الصحية للأطفال، والرفاه للأطفال والأسر. Abstract: Saudi Arabia has made substantial advancements in its pediatric healthcare infrastructure. However, substantial gaps persist in addressing hospitalized children's emotional safety, and psychosocial and developmental needs. Internationally, the child life profession has evolved over decades to specifically address these needs, through interventions such as therapeutic play, age-appropriate patient education, and family support.This article evaluates the imperative for integrating the child life profession into healthcare services in Saudi Arabia to transform the quality of pediatric healthcare. An analysis of the current landscape revealed gaps in pediatric psychosocial care. These gaps are listed as national priorities in the health transformation program aimed at improving healthcare quality and enhancing well-being. Integrating the child life profession can help achieve these objectives for children and families in Saudi Arabia.This article highlights the multifaceted benefits of the child life profession in improving patient experiences, healthcare delivery efficiency, pediatric healthcare quality, and the overall well-being of children and families. Strategies for phased implementation, involving healthcare institutions, academic partners, relevant non-profit partners, and policymakers, are proposed.

Abstract Background Test anxiety (TA) is described as a set of psychological and behavioral responses that occur when a person is concerned about the possibility of unfavorable results or failing on an exam. Based on multiple studies, medical education is known for its rigorous curricula, continuous high academic demands, frequent assessments, practical instruction, and mentorship, all of which contribute to a stressful atmosphere that results in elevated rates of depression, anxiety during exams, subpar academic achievement, and a higher number of medical student dropouts. This study aimed to measure the prevalence of test anxiety and predisposing factors among students at Unaizah College of Medicine. Results Our study revealed that 45.4% of responders reported having low anxiety, while 33.2% of them reported having moderate anxiety. A lower but statistically significant percentage (21.5%) expressed high levels of anxiety. Regarding the factors contributing to exam anxiety in medical students such as social support, it was found that the students with poor social support exhibited significant odds of severe test anxiety. Remarkably, there was a decreased likelihood of experiencing severe anxiety when studying all the night before the exam. Conclusion Research results have the potential to impact institutional policies concerning medical students’ well-being. Colleges can create supportive environments that address the factors causing test anxiety and promote mental health and academic success.

BACKGROUND: Functional constipation (FC) is a common condition in children, and information on the clinical characteristics of FC in Saudi children is scarce. OBJECTIVE: Describe the clinical profile of FC in Saudi children. DESIGN: Retrospective SETTING: Hospital that provides primary, intermediate and tertiary care. PATIENTS AND METHODS: All children diagnosed with FC according to the Rome IV criteria were included and had at least one follow-up clinic visit. Demographic and clinical data collected from medical records included the age at onset, duration of constipation, clinical features, treatment modalities, and factors associated with clinical response. Descriptive statistics and Pearson's chi-squared test were used in the statistical analysis to see how categorical study variables were linked to clinical response. A P value of ≤.05 was used to report statistical significance. MAIN OUTCOME MEASURE: Compliance and clinical response to polyethylene glycol (PEG) compared with lactulose. SAMPLE SIZE: 370 children from 0.1 to 13 years of age. RESULTS: The median (IQR) age of onset was 4 (5) years and less than one year in 14%. The median (IQR) duration of constipation was 4 months (11) and less than two months in 93/370 (25%). Abdominal pain was the most commonly associated feature (44%). Screening for celiac disease and hypothyroidism was negative. A Fleet enema was the most common disimpaction method (54%) and PEG was the most common maintenance medication (63.4%). PEG was significantly better tolerated (P=.0008) and more effective than lactulose (P

Abstract Effective dataset management is crucial for enterprises to make informed decisions and remain competitive. However, centralized dataset management approaches often result in poor scalability, unclear governance, inaccessible data silos, and duplication of efforts. This paper proposes a distributed blockchain-based framework inspired by the data mesh architecture to address these challenges. Our proposed framework leverages blockchain’s decentralized nature to enable efficient and transparent dataset sharing across enterprise business domains. By turning datasets into digital assets and business domains into peers, our framework utilizes blockchain smart contracts to allow business domains to view, request, and share datasets. In this paper, we describe the details of our framework, and we analyze it from scalability, accessibility, security, and data governance perspectives. To validate our framework, we provide a proof-of-concept implementation with a publicly available source code.

Background: The kidneys carry out many essential processes. A reduced glomerular filtration rate is the primary cause of renal failure. Patients with chronic kidney disease are significantly increasing all around the world. Patients with varying degrees of renal disease will be seen on the dental chair, and the dentist must be aware of dental considerations when treating such patient. Dental clinicians should carefully evaluate the oral findings and general condition of the renal disease patient. Objective: To increase the awareness of dentists in the dental management of patients with renal diseases or undergoing renal transplant. Methods: This study reviews 56 articles searched on two databases PubMed and Google Scholar with English language. Conclusion: Every dentist should be well-informed regarding dental considerations and oral manifestations when treating a patient with any renal disease. Simple treatment plan modification can prevent the evolution of mild to critical medical or dental complications in renal disease patients.

Academic success in undergraduate programs is indicative of potential achievements for graduates in their professional careers. The reasons for an outstanding performance are complex and influenced by several principles and factors. An example of this complexity is that success factors might change depending on the culture of students. The relationship of 32 factors with the reported academic performance (RAP) was investigated by using a survey distributed over four key universities in Saudi Arabia. A total of 3565 Saudi undergraduate students completed the survey. The examined factors included those related to upbringing, K-12 education, and structured and unstructured activities. Statistical results validate that many factors had a significant relationship with the RAP. Among those factors, paternal's education level and work field, type of intermediate and high schools, and the attendance of prayers in mosques were significantly associated with the reported performance. This study provides important insights into the potential root causes of success so that they can be targeted by educators and policy makers in the effort to enhance education outcomes.

Sentiment analysis is a critical component in understanding customer opinions and reactions. This study explores the application of sentiment analysis using Python on the Amazon Fine Food Reviews dataset to classify customer reviews as positive or negative, enabling businesses to gain valuable insight into customer sentiments. This study used and compared the efficiency of Logistic Regression, Support Vector Machines, Random Forest, XGBoost, LSTM, and ALBERT. The comparison results showed that the LSTM and ALBERT classifiers stand out with remarkable accuracy (96%) and substantial support for positive and negative reviews. On the other hand, although the Random Forest classifier had similar accuracy (96%), it exhibited lower support for positive and negative sentiments.

Introduction The FDA’s ‘The Real Cost’ tobacco prevention campaign aimed to counter tobacco marketing efforts directed toward children and youths. Our objectives were to explore the associations between exposure to the FDA’s campaign and cigarette risk perception among the US adolescent population, and between exposure and cigarette smoking curiosity among adolescents who never smoked cigarettes. Methods We analyzed 3 cycles of National Youth Tobacco Survey (NYTS 2018– 2020, n=53738). Multivariable logistic regression models were fitted to measure the relationship between campaign exposure and cigarettes risk perception (among all), as well as the relationship between campaign exposure and cigarette curiosity (among cigarette never smokers). Results Majority of youths have reported exposure to the campaign 63% between 2018–2020. The odds of youths perceiving cigarettes as risky were 1.6 times higher among exposed compared to those not exposed (adjusted odds ratio, AOR=1.60; 95% CI: 1.43–1.79). There were some racial disparities in risk perceptions among Hispanics and Non-Hispanic Blacks across exposure groups. Exposure was associated with higher cigarettes curiosity odds among Hispanic youths who never smoked (AOR=1.26; 95% CI: 1.10–1.44) compared to their Non-Hispanic White peers. Conclusions The FDA’s ‘The Real Cost’ campaign had exposure levels deemed essential for population-level perceptions change. Exposure was associated with youths having higher risk perceptions about the negative health outcomes related to cigarette smoking. However, students that never smoked were more curious about smoking with campaign exposure. Therefore, future health communication plans should consider both the potential benefits and possible unintended consequences prior to launching such campaigns.

Abstract Background In this study, we aimed to describe patient characteristics and medication adherence among medication access mobile application users and nonusers. Methods This was a cross-sectional study of a randomly selected sample of patients who refilled their medications either through the mobile application ‘MNG-HA Care’ or by phone call to a government-funded multispecialty hospital in Riyadh, Saudi Arabia. Data were collected through an online survey and filed either via WhatsApp or by phone call. Medication adherence was assessed using the five-item Medication Adherence Report Scale (MARS-5). Results A total of 280 respondents were recruited, and their mean age was 48.8 years (standard deviation (SD): 17.8). More than 75% of application users and nonusers were younger (18–64 years) and lived in urban areas, 58% were male, 37.5% held a bachelor’s degree, and 40% were unemployed. The number of respondents who accessed the mobile application (mobile application users) was 212, and 64.2% of them were adherent to their medications. Sixty-eight of the respondents used a phone call for refills (mobile application nonusers), and 77.9% of them were adherent to their medications. The most common self-reported reasons for using the application were to book an appointment and to request a medication refill. The most common self-reported reasons for not using the application were respondents’ lack of knowledge about the availability of the application and preference for speaking directly to the health care provider. Adjusted multivariate logistic regression analysis revealed that medication adherence was not associated with application use (Odds Ratio (OR): 0.65; 95% CI: 0.33–1.29). However, male patients had significantly higher adherence than females (OR 2.68, 95% CI 1.31 to 5.51), and employed patients had significantly lower adherence than unemployed patients (OR 0.37, 95% CI 0.17 to 0.81). Conclusions Providing patients with access to their medication list through a mobile application alone did not significantly impact medication adherence. Further research is needed to explore the potential benefits of incorporating additional features, such as medication instructions and reminders within mobile applications, to improve medication adherence.

The utilization of recycled materials in concrete technology has gained significant attention in recent years, promoting sustainability and resource conservation. This paper investigates the behavior of lightweight self-compacting concrete (LWSCC) with recycled tire steel fibers (RTSFs). The effects of RTSFs on the flowability of the composite material and its density were assessed. The mechanical properties of the developed material were examined and beam tests were performed, aiming to assess its feasibility for structural applications. The compressive and tensile strengths were determined to evaluate the mechanical properties of the developed concrete mixtures. The beam tests were conducted to assess the flexural behavior of the beam specimens. Three different steel fiber contents of 0, 0.5, and 1% volumetric fractions of concrete were used in this study. The test results indicate that incorporating the fibers did not negatively impact the flowability and density of the LWSCC mixtures. In addition, the use of RTSFs enhanced the tensile strength of the developed concrete mixtures, where fibrous concrete showed increases in the splitting tensile strength in the range of 38 to 76% over that of non-fibrous concrete. On the other hand, the compressive strength of the mixtures was not affected. The test beams with RTSFs exhibited improved flexural performance in terms of delaying and controlling cracking, enhancing ultimate load, and increasing ductility. Compared with the control non-fibrous beam, the increases in the cracking load, ultimate load, and ductility index were up to 63.8, 9.3, and 16%, respectively. The test results of the beams were compared with theoretical predictions, and good agreement was found.

Human activity recognition (HAR) is a crucial task in various applications, including healthcare, fitness, and the military. Deep learning models have revolutionized HAR, however, their computational complexity, particularly those involving BiLSTMs, poses significant challenges for deployment on resource-constrained devices like smartphones. While BiLSTMs effectively capture long-term dependencies by processing inputs bidirectionally, their high parameter count and computational demands hinder practical applications in real-time HAR. This study investigates the approximation of the computationally intensive BiLSTM component in a HAR model by using a combination of alternative model components and data flipping augmentation. The proposed modifications to an existing hybrid model architecture replace the BiLSTM with standard and residual LSTM, along with convolutional networks, supplemented by data flipping augmentation to replicate the context awareness typically provided by BiLSTM networks. The results demonstrate that the residual LSTM (ResLSTM) model achieves superior performance while maintaining a lower computational complexity compared to the traditional BiLSTM model. Specifically, on the UCI-HAR dataset, the ResLSTM model attains an accuracy of 96.34% with 576,702 parameters, outperforming the BiLSTM model’s accuracy of 95.22% with 849,534 parameters. On the WISDM dataset, the ResLSTM achieves an accuracy of 97.20% with 192,238 parameters, compared to the BiLSTM’s 97.23% accuracy with 283,182 parameters, demonstrating a more efficient architecture with minimal performance trade-off. For the KU-HAR dataset, the ResLSTM model achieves an accuracy of 97.05% with 386,038 parameters, showing comparable performance to the BiLSTM model’s 98.63% accuracy with 569,462 parameters, but with significantly fewer parameters.

Background:. The therapeutic challenge of managing acute full-thickness burns is significantly ameliorated with the introduction of dermal regeneration templates (DRTs). However, an updated synthesis of evidence-based data on the efficacy and safety of different DRTs is required. Methods:. This systematic review and meta-analysis conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines aims to evaluate the role of various DRTs in comparison with split-thickness skin grafting in managing acute burn injuries after excision and debridement. A total of 28 randomized clinical trials were assessed, encompassing a wide array of DRTs. Results:. The study outcomes pointed to the diverse effectiveness of DRTs, with Integra demonstrating peripheral nerve reinnervation potential and TransCyte promoting rapid re-epithelialization. Some DRTs showed scar formation and skin quality comparable to those of autologous skin grafts. In terms of wound infection, certain treatments, including TransCyte, exhibited a significantly low infection rate. The evaluation of scar quality suggested that various interventions produced acceptable or improved outcomes without hypertrophic scarring. Recovery rates after the interventions displayed a range, with certain treatments showing rapid recovery and satisfactory results. Conclusions:. The current systematic review points to the potential benefits of DRTs in managing burn wounds. Further research is necessary to shed light on the long-term impacts of these interventions on wound healing, scar quality, and patient recovery.

Background Patient safety is of utmost importance and every effort is to be made to reduce the risk of hospital-acquired infection. Contaminated attire is proposed as a mode of hospital infections spread. This study aims to assess the laundering habits, the perception of healthcare workers toward the contamination of their attire, and the effect of coronavirus disease 2019 (COVID-19) pandemic on their cleaning practices in non-operative settings.

OBJECTIVES The demand for orthopedic surgery is expected to increase as the Saudi population grows and ages. Therefore, this study aimed to assess the interest of medical students and interns in orthopedic surgery and the factors that influence their interest. METHODS This cross-sectional study was conducted using a structured questionnaire adapted from a similar study and modified by the authors. The questionnaire was distributed via email to more than 500 medical students from the second year to the internship year. The questionnaire was designed to assess knowledge, interest, and students’ perception of orthopedics. RESULTS Five hundred and ten responses were obtained; 382 (74.90%) were from women. Gender, family orientation, private practice, and perceptions of orthopedic surgery as a stressful specialty or a specialty in crisis were variables that did not influence participants’ perceptions of orthopedic surgery. Further, 13% of participants showed early interest in orthopedic surgery, especially during their third year of medical school. Most of the interested participants recognized that having strong level of knowledge, future academic opportunities, a controllable lifestyle, direct patient care, experience during their clerkship, a high salary, immediate satisfaction, and a prestigious specialty were important aspects that determined their interest in considering a future career in orthopedic surgery. Work preferences that had a significant impact on interest included working with patients not requiring long-term care, working only in the hospital, working outside the hospital, and working only during the day. CONCLUSION There was no difference between genders in terms of interest in orthopedic surgery. This study might serve as a basis for future research assessing the interest of medical students in orthopedic surgery as well as identifying and managing the barriers that prevent students from pursuing careers as orthopedic surgeons.

This research analyzes the content of preschool children's drawings as they reflect on aspects of their preschool environment that they missed most during COVID-19 pandemic-related school closures in Saudi Arabia. Children participated in collaboration with their mothers, who directed and collected their drawings. The participants were limited to a group of 41 children between 3-7 years old. The results revealed that most of their drawings were of people, followed by the school environment; the playground was the most prominent area drawn representing the physical environment. Other categories, from the most to the least drawn, include nature, daily scheduled activities, writing activities, food items, and methods of transportation. Through drawings, children showed their most important needs in the preschool environment, which provides some insight into what educators should plan for when children to return to school.

MERS-CoV belongs to the coronavirus group. Recent years have seen a rash of coronavirus epidemics. In June 2012, MERS-CoV was discovered in the Kingdom of Saudi Arabia, with 2,591 MERSA cases confirmed by lab tests by the end of August 2022 and 894 deaths at a case-fatality ratio (CFR) of 34.5% documented worldwide. Saudi Arabia reported the majority of these cases, with 2,184 cases and 813 deaths (CFR: 37.2%), necessitating a thorough understanding of the molecular machinery of MERS-CoV. To develop antiviral medicines, illustrative investigation of the protein in coronavirus subunits are required to increase our understanding of the subject. In this study, recombinant expression and purification of MERS-CoV (PLpro), a primary goal for the development of 22 new inhibitors, were completed using a high throughput screening methodology that employed fragment-based libraries in conjunction with structure-based virtual screening. Compounds 2, 7, and 20, showed significant biological activity. Moreover, a docking analysis revealed that the three compounds had favorable binding mood and binding free energy. Molecular dynamic simulation demonstrated the stability of compound 2 (2-((Benzimidazol-2-yl) thio)-1-arylethan-1-ones) the strongest inhibitory activity against the PLpro enzyme. In addition, disubstitutions at the meta and para locations are the only substitutions that may boost the inhibitory action against PLpro. Compound 2 was chosen as a MERS-CoV PLpro inhibitor after passing absorption, distribution, metabolism, and excretion studies; however, further investigations are required.

Background: Celiac serology can be transiently elevated in patients with type 1 diabetes mellitus (T1DM) and normalized despite gluten consumption. This study aimed to identify the frequency and predictive factors of spontaneous normalization of anti-tissue transglutaminase (anti-TTG-IgA) antibodies in these patients. Methods: The charts of all patients (≤18 years) with T1DM were retrospectively reviewed from 2012 to 2021 at a tertiary care center in Riyadh, Saudi Arabia. The following data were collected: clinical characteristics of the participants, anti-TTG-IgA-immunoglobulin (Ig) A antibody, and histological findings. The outcome of positive anti-TTG-IgA-IgA in patients with T1DM and the predictive factors for spontaneous normalization were investigated. Results: Of the 1,006 patients with T1DM, 138 (13.7%) had elevated anti-TTG-IgA antibodies, celiac disease was diagnosed in 58/138 (42%) patients, spontaneous normalization of anti-TTG-IgA was observed in 65 (47.1%) patients, and fluctuating anti-TTG-IgA antibodies were seen in 15 (10.9%) patients. The patients with anti-TTG-IgA levels at 3–10 times the upper normal limits (UNL), and those with levels ≥10 times UNL were less likely to have spontaneous normalization of anti-TTG-IgA compared to patients with levels at 1–3 times UNL (hazard ratio [HR] = 0.28, 95% confidence interval [Cl] = 0.13–0.61, P = 0.001, and HR = 0.03, 95% Cl = 0.00–0.19, P < 0.001, respectively). Conclusion: Asymptomatic patients with T1DM with mild elevation of anti-TTG-IgA need not be rushed for invasive endoscopy or exposed to an un-needed gluten-free diet but should rather have a regular follow-up of their celiac serology.

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into ‘pre-COVID-19’ and ‘during COVID-19’ groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83–0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37–0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions.

Background: Anthropometry facilitates the evaluation of risks associated with reduced macular pigment optical density (MPOD). Objectives: To investigate the predictors and anthropometric indices associated with MPOD in healthy adult in Arab population. Design: This is a cross-sectional study. Methods: The MPOD was measured at 0.5° from fovea using a heterochromatic flicker photometer. Healthy participants aged between 20 and 40 years were recruited. The study evaluated the following data of the participants: height, weight, body mass index, body fat percentage, basal metabolic rate, visceral fat level, muscle mass, bone mineral content, and percentage of protein and body water. The correlation between MPOD with anthropometrics and demographic data was evaluated using Spearman’s correlation test. The differences among genders were investigated using the Mann–Whitney U test. The smoking effect on MPOD was analyzed using the Friedman test. Results: In all, 143 participants were recruited. The median ± interquartile range was calculated for age (23 ± 4 years), visual acuity (0.00 ± 0.00 logMAR), and MPOD (0.41 ± 0.18). The average MPOD was higher in males than in females but it was not statistically significant ( p > 0.05); on the other hand, they were statistically significantly different in most of the anthropometric data. A significant relationship was found between MPOD and percentage of body fat, protein, and body water ( r = 0.30, p

Background:. Although many published studies have investigated the benefits of tranexamic acid (TXA) in reducing perioperative bleeding, no large meta-analysis has been conducted to demonstrate its overall benefit. Methods:. A systematic review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Cochrane, Ovid, Embase, Web of Science, ClinicalTraisl.Gov, and Scopus databases were searched for articles reporting the benefit of TXA in reducing perioperative bleeding in craniosynostosis surgery from establishment through October 2022. The results of our meta-analysis were pooled across the studies using a random-effects model, and presented as a weighted mean difference with 95% confidence interval (95% CI). Results:. The database search yielded 3207 articles, of which 27 studies with a corresponding number of 9696 operations were eligible. The meta-analysis included only 18 studies, accounting for 1564 operations. Of those operations, 882 patients received systemic TXA, whereas 682 patients received placebo (normal saline), no intervention, low dose TXA, or other control substances. This meta-analysis demonstrated a significant beneficial effect of TXA in reducing perioperative bleeding, particularly when compared with other controlled substances, with a weighted mean difference of −3.97 (95% CI = −5.29 to −2.28). Conclusions:. To our knowledge, this is the largest meta-analysis in the literature investigating the benefit of TXA in reducing perioperative blood loss in craniosynostosis surgery. We encourage implementing TXA-protocol systems in hospitals after the appraisal of the data presented in this study.

Human errors (HEs) are common problems in manual assembly processes, impacting product quality and resulting in additional costs. Based on expert judgments, this study aims to identify the most significant factors affecting HEs in manual assembly processes and explore the cause-and-effect relationships among those factors. In order to achieve this objective, a proposed model is constructed using two types of Multi-Criteria Decision-Making (MCDM) techniques. Firstly, using two rounds of the fuzzy Delphi method (FDM), twenty-seven factors with an influence score of 0.7 or higher were found to have a major impact on HEs during manual assembly processes, with at least a 75% consensus among experts. After that, the twenty-seven factors affecting HEs were given to experts in a third round to analyze the cause-and-effect relationships among those factors using the fuzzy decision-making trial and evaluation laboratory (DEMATEL) method. In MCDM techniques, symmetry refers to an important property that can be used to find relationships between variables. It is based on the principle that the relative importance or preference between two variables should remain the same regardless of their positions or roles. Therefore, symmetry is a factor that MCDM approaches take into account to ensure that the relationships between variables are accurately represented, leading to more reliable decision-making outcomes. The reliability and normality of the surveying data were examined using the SPSS 22.0 software program. The study results revealed that training level, poor workplace layout, a lack of necessary tools, and experience were the major factors affecting HEs as root causes. Moreover, a failure to address the error-causing problem, unintentional unsafe acts, fatigue, and poor error visual perception were found to be effect (dependent) factors. The findings of this study can help organizations make better-informed decisions on how to reduce worker errors and interest in the factors that contribute to assembly errors and provide a good basis for reaching the quality of final assembled parts.