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Charbel El Bcheraoui,1 Mohammed Basulaiman,2 Mohammad A AlMazroa,2 Marwa Tuffaha,1 Farah Daoud,1 Shelley Wilson,1 Mohammad Y Al Saeedi,2 Faisal M Alanazi,2 Mohamed E Ibrahim,2 Elawad M Ahmed,2 Syed A Hussain,2 Riad M Salloum,2 Omer Abid,2 Mishal F Al-Dossary,2 Ziad A Memish,2 Abdullah A Al Rabeeah,2 Ali H Mokdad1 1Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; 2Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia Background: Dietary risks were the leading risk factors for death worldwide in 2010. However, current national estimates on fruit and vegetable consumption in the Kingdom of Saudi Arabia (KSA) are nonexistent. We conducted a large household survey to inform the Saudi Ministry of Health (MOH) on a major modifiable risk factor: daily consumption of fruits and vegetables. Methods: The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. It includes questions on sociodemographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions. We used a backward elimination multivariate logistic regression model to measure association between the Centers for Disease Control and Prevention (CDC)-recommended daily consumption of fruits and vegetables and different factors. Results: Between April and June 2013, a total of 10,735 participants completed the survey. Overall, 2.6% of Saudis aged 15 years or older met the CDC guidelines for daily consumption of fruits and vegetables. The likelihood of meeting the CDC guidelines increased with age; among women; among persons who graduated from elementary or high school or had a higher education; among residents of Makkah, Al Sharqia, Ha’il, or Jizan; among those who consumed at least two servings of meat or chicken per day; among those who visited a health care facility for a routine medical exam within the last 3 years; and among those who have been diagnosed with hypertension. Conclusion: We have showed that KSA is in dire need of improving the diet of its population. Our findings call for urgent research to understand the reasons for low fruit and vegetable consumption, focusing on price or preference in order to develop and implement culturally and country-relevant solutions to increase the consumption of fruits and vegetables. Keywords: Kingdom of Saudi Arabia, fruits, vegetables, dietary risks, diet

Cancer is a major health problem in both developed and developing countries. This study was designed to evaluate the referral system for cancer patients, and to assess the information which is received by cancer patients about their disease in tertiary hospitals in Riyadh, KSA. A cross sectional study was conducted on 73 cancer patients who received treatment in two tertiary hospitals in Riyadh; King Fahd Medical city and King Khalid University Hospital in March 2012. The study included any man or woman above 15 years old, who had been diagnosed with any type of cancer, and received treatment in the tertiary hospital for any time period. All the participants were recruited from the chemotherapy department and outpatient clinic. Data was collected through questionnaire interview with all patients or their relatives by the study investigator. QLQ-INFO25 questionnaire was used. There were 30 (44.8%) patients who had been referred to KFMC or KKUH, and 37 (55.2%) patients who had been admitted without referral. The main cause of referral was to confirm the diagnosis 76.7%, then to receive chemotherapy 16.7%. Time duration to the acceptance was 40% less than one week, 36% one to two weeks, 3.3% three to four weeks, 13.3% one to two months, and 6.7% more than two months. 70% of cancer patients gave their case report by hand to the tertiary hospital, 23.3% sent their case report by fax, and 3.3% sent the case report by email. 25 (83.3%) cancer patients were satisfied with the referral system of cancer patients in Saudi Arabia. The global score of the information module "QLQ-INFO25" was 67. The mean score was 31.3 (46.8) and standard deviation was 12.1. From this study, we conclude that, the referral system for cancer patients in Saudi Arabia needs to be electronic, unified in all hospitals, fair with all cancer patients, time effective, connect all tertiary hospitals and have a two way direction between secondary and tertiary hospitals. All medical facilities should provide the disease information to cancer patients by transparency and honesty. Health educators and social workers have an important role in psychological support to cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR)., Methods: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs)., Results: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries., Conclusions: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: No recent original studies on the pattern of diet are available for Saudi Arabia at the national level. The present study was performed to describe the consumption of foods and beverages by Saudi adults., Design: The Saudi Health Interview Survey (SHIS) was conducted in 2013. Data were collected through interviews and anthropometric measurements were done. A diet history questionnaire was used to determine the amount of consumption for eighteen food or beverage items in a typical week., Setting: The study was a household survey in all thirteen administrative regions of Saudi Arabia., Subjects: Participants were 10 735 individuals aged 15 years or older., Results: Mean daily consumption was 70·9 (se 1·3) g for fruits, 111·1 (se 2·0) g for vegetables, 11·6 (se 0·3) g for dark fish, 13·8 (se 0·3) g for other fish, 44·2 (se 0·7) g for red meat, 4·8 (se 0·2) g for processed meat, 10·9 (se 0·3) g for nuts, 219·4 (se 5·1) ml for milk and 115·5 (se 2·6) ml for sugar-sweetened beverages. Dietary guideline recommendations were met by only 5·2 % of individuals for fruits, 7·5 % for vegetables, 31·4 % for nuts and 44·7 % for fish. The consumption of processed foods and sugar-sweetened beverages was high in young adults., Conclusions: Only a small percentage of the Saudi population met the dietary recommendations. Programmes to improve dietary behaviours are urgently needed to reduce the current and future burden of disease. The promotion of healthy diets should target both the general population and specific high-risk groups. Regular assessments of dietary status are needed to monitor trends and inform interventions.

Background: Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10-24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors., Methods: The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories., Findings: The leading causes of death in 2013 for young people aged 10-14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15-19 years (14·2%) and 20-24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20-24 years (17·1%) and the fourth highest for girls aged 15-19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15-19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20-24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20-24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20-24 years. Alcohol and drug use in those aged 10-24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs., Interpretation: Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems., Funding: Bill & Melinda Gates Foundation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: We conducted a large household survey in 2013 to determine the current status of oral health practices and use of oral health services in the Kingdom of Saudi Arabia (KSA)., Methods: The Saudi Health Information Survey is a national multistage survey of individuals ≥ 15 years of age. We used a backward elimination multivariate logistic regression model to measure the association between having been to a dental clinic during the last year, and sex, age, marital status, education, time since last routine medical examination, history of diagnosis with a cardiovascular chronic condition, brushing or flossing teeth and use of Miswak (a chewing stick)., Results: Between April and June 2013, 10,735 participants completed the survey (89.4% of the households contacted). An estimated 1.5 million (11.5%) and 6.3 million (48.6%) Saudi Arabian people, ≥ 15 years of age, had visited a dental clinic for a routine check-up and for a complaint during the last year, respectively. In total, 16.3%, 85.0% and 52% of Saudi Arabian people never brush their teeth, never floss their teeth or never use Miswak, respectively. The probability of visiting a dental clinic increased with education, among individuals who brushed or flossed their teeth and who used Miswak., Conclusions: Oral hygiene practices are not common among Saudi Arabian people, and use of health care for prevention of oral disease is limited. Hence, the need for oral health promotion is pressing. The KSA Ministry of Health should develop and implement programmes, through its primary health clinics, to increase the awareness of the importance of good oral health., (© 2016 The Authors. International Dental Journal published by John Wiley & Sons Ltd on behalf of World Dental Federation.)

Background: The health status of the young people is an important indicator for future health and health care needs of the next generation. In order to understand the health risk factors of Saudi youth, we analyzed data from a large national survey in the Kingdom of Saudi Arabia., Methods: The Saudi Health Information Survey sample included 2382 youths aged 15 to 24 years old. The questionnaire included information on socio-demographic characteristics, risk factors, risky behaviors, chronic conditions, functional status, health care utilization, and anthropometric and blood pressure measurements., Results: Only 45.9% of men and 48.4% of women had normal body mass index (BMI). Men were more likely than women to smoke cigarettes or shisha. The prevalence of daily consumption of at least five servings of fruits and vegetables was 6.6%. The prevalence of no or insufficient physical activity was 41.8% in men and 75.6% in women (P < 0.001). Around 40% of men and 25% of women had abnormal blood pressure. Mean BMI and prevalence of insufficient physical activity, current smoking, and hypertension washigher in 20-to 24-year-olds than younger ages. Women were more likely to report that they never use seatbelts (82.2% vs. 65.4%)., Conclusions: The prevalence of modifiable risk factors and risky driving behaviors is very high among Saudi youth. If these current behaviors are not reversed during this crucial age period, the burden of disease and injuries will rise in the future. Our findings call for developing health prevention programs for youths in Saudi Arabia.

Background: With the lack of appropriate data, we conducted a large household survey in 2013 to determine current rates of physical activity in the Kingdom of Saudi Arabia (KSA)., Methods: The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. We used a multivariate logistic regression model to measure association between sociodemographic and selected characteristics and meeting the recommended levels of moderate and vigorous weekly physical activity., Results: Of a total of 12,000 households contacted, 10,735 (89.4%) participants completed Saudi Health Interview Survey. An estimated 4.5 million (34.5%) Saudis aged 15 years or older reported no weekly physical activity, while only 1.7 million (12.9%) meet the recommended levels of moderate physical activity (MPA). The likelihood of meeting MPA decreased with age, education, among women, those with a history of diagnosis of select chronic conditions, including diabetes. Similar results were found for the likelihood of meeting the recommended levels of vigorous weekly physical activity., Conclusions: We found very low levels of physical activity in KSA. Perhaps, KSA can challenge communities or employers to devise solutions and reward those with the best results. These solutions would be of great value to other Gulf countries, as well.

Purpose: Chronic diseases and their risk factors are believed to be common in the Kingdom of Saudi Arabia (KSA). Most of them require long-term management through medications. We examined patterns of medication use for chronic health conditions (CHC) in KSA based on a national survey., Methods: The Saudi Health Interview Survey was a cross-sectional nationally representative household survey of 10,735 individuals aged 15 years or older in 2013. The survey consisted of a detailed health questionnaire. Current medications for CHC were assessed and classified based on the Anatomical Therapeutic Chemical classification., Results: Among the respondents, 11.8% (standard error = 0.4) reported taking at least one medication for CHC with a mean number of 2.05 (standard error = 0.05) medication items. In addition to older age (odds ratio = 1.94 per each decade, 95%CI: 1.83-2.05) and male gender (odds ratio = 1.22, 95%CI: 1.06-1.41), those with higher income were more likely to take medication. The most common medicines were drugs used for diabetes (A10 Anatomical Therapeutic Chemical code). The top 20 drugs accounted for about 80% of all medications. Only 32.7% of medications were reported to be used exactly as prescribed., Conclusions: Compared with the prevalence of CHC in KSA, our study indicates a potential underuse of medications as well as non-adherence to the directions for use. Interventions such as improved clinical guidelines for healthcare providers to increase utilization of necessary medication and educational programs to improve patients' adherence are needed., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: Vitamin D deficiency has been correlated with several diseases and injuries including diabetes, osteoporosis, fractures, and falls. In the Kingdom of Saudi Arabia (KSA), current data on vitamin D status are lacking., Aims: To inform Saudi public health authorities on the current status of blood levels vitamin D deficiency, we analyzed data from the Saudi Health Interview Survey., Materials and Methods: The Saudi Health Interview Survey (SHIS) is a cross-sectional national multistage survey of individuals aged 15 years and above on sociodemographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions. A total of 10,735 participants completed a health questionnaire and were invited to the local health clinics for biomedical exams., Results: 62.65% of female Saudis and 40.6% of male Saudis aged 15 years and above are deficient in vitamin D. Out of them, less than 1% males and less than 2% females consume vitamin D supplements. Women who have never married and obese individuals are more likely to be deficient in vitamin D, compared to men who were currently married and nonobese individuals. Those consuming vitamin D supplements are less likely to be deficient in vitamin D., Conclusions: Our study showed a high prevalence of vitamin D deficiency among Saudi men and women, and the results call for an increased awareness to ensure adequate levels of vitamin D for better health in Saudi Arabia. Moreover, our findings are certainly relevant for other countries in the Gulf region or countries with similar cultures, clothing, and religions.

Self-rated health reflects a person's integrated perception of health, including its biological, psychological, and social dimensions. It is a predictor of morbidity and mortality. To assess the current status of self-rated health and associated factors in the Kingdom of Saudi Arabia, we analyzed data from the Saudi Health Interview Survey. We conducted a large national survey of adults aged 15 years or older. A total of 10,735 participants completed a standardized health questionnaire. Respondents rated their health with a five-point scale. Data on socio-demographic characteristics, chronic diseases, health-related habits and behaviors, and anthropometric measurements were collected. Associated factors of self-rated health were analyzed using a backward elimination multivariate logistic regression model. More than 77% of respondents rated their health as excellent/very good. Female sex [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.24-1.88], decades of age (OR 1.35, 95% CI 1.25-1.46), diagnosed diabetes mellitus (OR 1.54, 95 CI 1.22-1.93), diagnosed hypercholesterolemia (OR 1.37, 95% CI 1.06-1.79), diagnosed hypertension (OR 1.55, 95% CI 1.22-1.96), number of other diagnosed chronic diseases (OR 1.69, 95% CI 1.41-2.03), limited vigorous activity (OR 3.59, 95% CI 2.84-4.53), need for special equipment (OR 2.62, 95% CI 1.96-3.51), and more than 3 h of daily television/computer screen time (OR 1.59, 95% CI 1.11-2.29) were positively associated with poor/fair health. Smoking, obesity, and physical inactivity were not associated with self-reported health. We found that preventable risk factors are not associated with Saudis' self-rated health. This optimistic perception of health poses a challenge for preventive interventions in the Kingdom and calls for campaigns to educate the public about the harm of unhealthy behaviors.

Background: There are not enough data on the epidemiology of asthma in the Kingdom of Saudi Arabia (KSA). We analyzed data from a national household survey conducted in KSA in 2013 to estimate prevalence, associated risk factors and control measurements of asthma., Methods: The Saudi Health Interview Survey was a cross-sectional national multistage survey of 10,735 individuals aged 15 years or older. The survey included a detailed household questionnaire and a physical exam. We used self-reported clinical diagnosis of asthma to assess prevalence of asthma., Results: The prevalence of asthma in KSA was 4.05 % (95 % confidence interval [CI]: 3.54-4.62 %). Asthma was less frequent in individuals with higher education but higher in former smokers and obese individuals. Around 76.7 % of asthma patients (95 % CI: 70.6-82.0 %) experienced an asthmatic attack, and 61.6 % (95 % CI: 54.4-68.4 %) visited a hospital/emergency room because of asthma during the past year. Asthma attack was less frequent in older patients (odds ratio [OR] = 0.78, 95 %CI: 0.59-0.96 for each decade of life). Current use of medication for asthma was highly associated with asthma attacks (OR = 9.14, 95 % CI: 3.29-25.38). Asthma attack was also more frequent in individuals who were exposed to secondhand smoking (OR = 2.17, 95 %CI: 1.05-4.45) and those who were obese (OR = 3.01, 95 %CI: 1.34-6.78)., Conclusion: Saudi Arabia has a relatively low prevalence of diagnosed asthma; however, many of the patients with known asthma do not have it under good control. Our study calls for programs to inform patients about the importance and proper means of controlling their condition. Implementing and monitoring of clinical guidelines can also help to improve asthma control among patients as well as identify undiagnosed cases.

Background: Tobacco consumption is a major risk factor for morbidity and mortality. The Saudi Ministry of Health started a national tobacco control program in 2002 with increased and intensified efforts after joining the World Health Organization Framework Convention for Tobacco Control in 2005., Methods: In order to assess the status of tobacco consumption in the Kingdom of Saudi Arabia (KSA), we conducted a survey on 10735 individuals aged 15 years or older (5253 men and 5482 women) which was performed between April and June 2013. The Saudi Health Interview Survey had a multistage sampling and was nationally representative. Data were collected through face-to-face interviews. The survey included questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions., Results: Overall prevalence of current smoking was 12.2 % and males were more likely to smoke than females (21.5 % vs. 1.1 %). Mean age of smoking initiation was 19.1 years (±6.5 years) with 8.9 % of ever smokers starting before the age of 15 years. Daily shisha smoking was reported by 4.3 % of the population (7.3 % of men and 1.3 % of women). Around 1.4 % of population (2.6 % of men and 0.1 % of women) were daily smokers of cigarette/cigar and shisha. Receiving advice for quitting smoking by health care professionals during the last 12 months was reported by 53.2 % (95 % confidence interval [CI]: 49.8-56.5) of ever smokers. Among ever smokers, 51.3 % of individuals reportedly attempted to quit smoking during the last 12 months. Of those, 25.3 % were successful by the time of the survey. Around 23.3 % of the entire population, 32.3 % of men and 13.5 % of women, were exposed to secondhand smoke for at least one day during the past 7 days at home, work, or school., Conclusions: Although the indicators of tobacco consumption in KSA are better than most of the countries of the Middle East region and high-income countries, there are many potential areas for improvement. Our findings call for the development and implementation of programs to prevent smoking initiation and encourage quitting. To achieve its health goals, KSA may consider increasing taxation on tobacco products as well as other measures.

Introduction: It is unknown whether Saudis receive health examinations periodically. To inform health authorities on the health-seeking behavior of the Saudi population, we investigated patterns of periodic health examination (PHE) use by Saudis., Materials and Methods: We conducted a nationally representative multistage survey of individuals aged 15 years or older on sociodemographic characteristics, healthcare utilization, and self-reported chronic conditions. We used a backward elimination multivariate logistic regression model to measure associations between PHE and sociodemographic, behavioral, and health characteristics., Results: Between April and June 2013, a total of 12,000 households were contacted, and 10,735 participants completed the survey (response rate of 89.4%). Among participants, 2542 (22.9%), representing more than 2.7 million Saudis aged 15 years or older, received a PHE during the past 2 years. Moreover, 7463 (73.5%) participants, representing 9.1 million Saudis, visited a healthcare setting in the past 2 years due to illness or injury. The likelihood of receiving a PHE in the past 2 years increased with age, education, being married, consumption of five servings of fruits and vegetables per day, diagnoses of prediabetes, diabetes, or hypercholesterolemia, and a visit to a healthcare setting within the last 2 years due to an illness or an injury., Discussion: This is the first national study to investigate the use of PHE in Kingdom of Saudi Arabia (KSA) where healthcare is freely available. Few Saudis seek preventive healthcare and most healthcare visits are for injuries or sickness. KSA may reduce its health expenditures by routinizing PHE and detecting chronic conditions at early stages.

Introduction: Mammography ensures early diagnosis and a better chance for treatment and recovery from breast cancer. We conducted a national survey to investigate knowledge and practices of breast cancer screening among Saudi women aged 50 years or older in order to inform the breast cancer national health programs., Materials and Methods: The Saudi Health Interview Survey is a national multistage survey of individuals aged 15 years or older. The survey included questions on socio-demographic characteristics, tobacco consumption, diet, physical activity, health-care utilization, different health-related behaviors, and self-reported chronic conditions. Female respondents were asked about knowledge and practices of self and clinical breast exams, as well as mammography., Results: Between April and June 2013, a total of 10,735 participants completed the survey. Among respondents, 1,135 were women aged 50 years or older and were included in this analysis. About 89% of women reported not having a clinical breast exam in the past year, and 92% reported never having a mammogram. Women living in Al Sharqia had the highest rate of mammography use. Women who were educated, those who had received a routine medical exam within the last two years, and those who were diagnosed with hypertension were more likely to have had a mammogram in the past two years., Discussion: Our results show very low rates of breast cancer screening in the Kingdom of Saudi Arabia, a country with free health services. This calls for educational campaigns to improve breast cancer screening. Addressing the barriers for breast cancer screening is a public health imperative.

Introduction: Road traffic injuries are the largest cause of loss of disability-adjusted life years for men and women of all ages in the Kingdom of Saudi Arabia, but data on driving habits there are lacking. To inform policymakers on drivers' abilities and driving habits, we analyzed data from the Saudi Health Interview Survey 2013., Methods: We surveyed a representative sample of 5,235 Saudi males aged 15 years or older on wearing seat belts, exceeding speed limits, and using a handheld cell phone while driving. Male and female respondents were surveyed on wearing seat belts as passengers., Results: Among Saudi males, 71.7% reported having had a driver's license, but more than 43% of unlicensed males drove a vehicle. Among drivers, 86.1% engaged in at least one risky behavior while driving. Older and unlicensed drivers were more likely to take risks while driving. This risk decreased among the more educated, current smokers, and those who are physically active. Up to 94.9% and 98.5% of respondents reported not wearing a seat belt in the front and the back passenger seats, respectively., Discussion: The high burden of road traffic injuries in the Kingdom is not surprising given our findings. Our study calls for aggressive monitoring and enforcement of traffic laws. Awareness and proper education for drivers and their families should be developed jointly by the Ministries of Health, Interior Affairs, and Education and provided through their channels.

Objectives: In the Kingdom of Saudi Arabia (KSA), current data on diabetes are lacking, and a rise of the epidemic is feared, given the epidemiologic transition in the country. To inform public health authorities on the current status of the diabetes epidemic, we analyzed data from the Saudi Health Interview Survey (SHIS)., Methods: Saudi Health Interview Survey is a cross-sectional national multistage survey of individuals aged 15 years or older. A total of 10,735 participants completed a health questionnaire and were invited to the local health clinics for biomedical exams., Results: 1,745,532 (13.4 %) Saudis aged 15 years or older have diabetes. Among those, 57.8, 20.2, 16.6, and 5.4 % are undiagnosed, treated uncontrolled, treated controlled, and untreated, respectively. Males, older individuals, and those who were previously diagnosed with hypertension or hypercholesterolemia were more likely to be diabetic., Conclusions: Our findings call for increased awareness of pre-diabetes, diabetes, and undiagnosed diabetes in KSA. Combatting diabetes and other non-communicable diseases should be the task of the Ministry of Health and other ministries as well, to offer a comprehensive socio-cultural approach to fighting this epidemic.

Purpose: To assess the prevalence of hypercholesterolemia and its associated factors in the Kingdom of Saudi Arabia., Methods: A national multistage representative sample of Saudis aged 15 years or older was surveyed through face-to-face interviews. Data on sociodemographics, risk factors, and health information were collected, and blood sample analysis was performed. Data were analyzed using SAS 9.3 to account for the sample weights and complex survey design., Results: Between April and June 2013, a total of 10,735 participants completed the survey. Overall, 8.5% of Saudis had hypercholesterolemia. Another 19.6% had borderline hypercholesterolemia. Among hypercholesterolemic Saudis, 65.1% were undiagnosed, 2.3% were treated uncontrolled, 28.3% were treated controlled, and 4.3% were untreated. The risk of being hypercholesterolemic increased with age and among individuals who reported consuming margarine, obese individuals, and those who have been previously diagnosed with hypertension or diabetes., Conclusions: More than a million Saudis have hypercholesterolemia, and 700,000 of them are unaware of their condition which can be controlled through early detection campaigns and lifestyle change and medication. An urgent awareness and screening campaign is needed in Kingdom of Saudi Arabia to prevent and avoid disease progression toward more serious stages., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The objective of this study was to assess the accuracy of x-ray film interpretation by nonradiologist physicians. This was a cross-sectional study based on data collected using a structured check-list from a sample of 863 x-ray films requested and interpreted by physicians working in the outpatient departments of Dammam Central Hospital, and in five primary health care centers in Dammam city, Saudi Arabia. The check-list was used to compare the physicians' interpretations of x-ray films requested with those made by an experienced consultant radiologist. Physicians' interpretations were classified as concordant or discordant with those of the radiologists. Factors affecting those interpretations were assessed. Physicians from both the hospital and primary health care centers were discordant with the radiologist in 20.0% and 22.2% of x-ray films interpreted. There were significant positive correlations of physicians' interpretations with physicians' handwriting and completeness of patient information on the request forms, quality of x-ray films and adequacy of x-ray film views. Also, there were significant negative correlations of interpretations with chest and head and neck x-ray films. The study reveals a significant need for training of hospital and primary health care center physicians in diagnostic radiology.