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Purpose: To determine the incidence and predictors of prolonged opioid use (OU) following cervical spine fusion surgery. Methods: This is a retrospective cohort study of all patients who underwent cervical arthrodesis for degenerative cervical spine disease over 7 years, between 2010 and 2016, who had at least one year of postoperative follow up at the University of Missouri hospitals. Review of medical records was done to collect data on patient's characteristics, associated pain measures (pre/postoperative VAS), ASA score, and pre/postoperative OU. The predictors of prolonged OU at 3, 6 and 12 months following surgery were identified using the logistic regression analyses. Significance was considered at p

Background: Efforts to evaluate physicians’ awareness and attitude toward dentists’ comprehensive role in OSA management are relatively negligible. Therefore, this study aimed to assess physicians’ awareness and attitude toward the role of dentists in OSA management in Saudi Arabia. Methods: In a multi-center cross-sectional study, a total of 358 physicians in Saudi Arabia were subjected to an e-questionnaire composed of three sections: (1) physicians’ demographic data, (2) physicians’ general and specific knowledge of OSA and its management [using 29 factual statements to be responded by “True, False, or I don’t know” responses], and (3) physicians’ attitude towards dentists’ role in OSA management [using 12 attitude statements to be responded by a Likert scale of “Never, Rarely, Sometimes, Usually, Always” responses]. A scoring system was applied for both knowledge and attitude, total and percentage mean scores (PMS) were calculated, and knowledge and attitude levels were categorized accordingly. Predictors of correct knowledge and favorable attitude were identified using multiple regression analyses. Results: Physicians had an overall average knowledge level (PMS = 56% ± 19.4%), with 35.5% and 5.9% reporting good general and specific knowledge levels, respectively (χ2 = 143.0, p < 0.001). Physicians had an overall neutral attitude level (PMS = 64.4% ± 17.5%), with about one-half reporting a neutral attitude level (48.9%) and only one-fourth reporting a positive attitude level (27.7%). Higher levels of knowledge were a significant predictor of favorable attitudes (t = 5.71, p < 0.001). Higher training levels were a significant predictor of correct knowledge (t = 3.60, p < 0.001) and favorable attitude (t = 3.15, p = 0.002). Conclusions: Physicians showed insufficient knowledge about OSA and a less than favorable attitude towards dentists’ role in its management. Enhancing medical curricula and clinical protocols and guidelines on the dentists’ role in OSA management is recommended.

A one-day antismoking programme was conducted for 289 students in a male secondary school in Abha, Saudi Arabia. The one-group pretest/post-test design to evaluate the programme was based on an Arabic version of the WHO standard questionnaire for young people. The results showed that the prevalence rate of regular smoking was 14.5%. The students showed marked variability in correct responses to various factual items. The programme had a significant impact on nonsmokers [P < 0.01] and prespecialty students [P < 0.01]. With the exception of smokers, the students showed an overall positive attitude towards public action, but the impact of the one-day programme was less than satisfactory

Thistudy was designed to estimate the carrier rate of beta-haemolytic streptococci among 972 primary-school boys in a high-altitude area of Saudi Arabia, and its association with social class, crowding index and body mass index, and also to determine the seasonal variation of infection. A carrier rate of 13.1% for beta-haemolytic streptococci was detected. The carrier rate was significantly higher in spring than in winter. The association between streptococcal infection and social class, crowding index, or body mass index was statistically not significant. The low prevalence of streptococcal infection might be attributed to the high altitude but further studies are needed to determine whether this is the case

Aim: Children are normally treated in a dental chair, despite that some may have their treatment done under dental general anesthesia (DGA). Factors affecting the decision on DGA include the quality and quantity of treatment needed and child's age and cooperation. This study aimed to estimate the prevalence of DGA among children with dental caries and to identify the associated factors in a tertiary care setting in Saudi Arabia. Methods: A cross-sectional study of 400 children with dental caries was conducted. Data were collected from the patients' records including demographic, behavioral, and clinical information, diagnosis using caries indexes (Decayed, Missing, Filled Teeth/decayed filled teeth [dft]), and number of DGA and its indications. Logistic regression analysis was applied to identify the predictors of DGA, and significance was considered at P ≤ 0.05. Results: The study included 400 children; 55% of them were below the age of 6 years, with a mean age of 6.4 ± 2.3 years. About one-half of children were males (51.7%) and unhealthy (48.2%). The majority were of negative behavior (70.7%) and noncomplaint to dental appointments (70.3%). More than three-fourth of children (78.5%) experienced one or more DGA. GA use was significantly associated with gender (χ2 = 4.30, P < 0.04), age (t = 12.37, P < 0.0001), health status (χ2 = 16.02, P < 0.0001), dft index (z = 11.44, P < 0.0001), child behavior (χ2 = 48.54, P < 0.0001), age at the first dental visit (t = 11.73, P < 0.0001), number of dental treatment visits (z = 11.14, P < 0.0001) and dental preventive visits (z = 7.21, P < 0.0001) before the index dental visit, and compliance with dental appointments (χ2 = 39.50, P < 0.001). However, after adjusting for confounders, using the logistic regression analysis, DGA use was predicted by unhealthy children (odds ratio [OR] = 27.35, P = 0.002), those with a negative behavior (OR = 18.28, P = 0.003), and those with higher dft index (OR = 1.68, P < 0.001). Conclusions: Noncooperation, general health status, and dental caries level (dft) were the main factors for the decision of DGA. High caries-risk children must be the target for behavioral management to minimize their need for treatment under DGA. Post-DGA appointment to guide the child back to normal dental care is recommended.

Background Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The present study aimed to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in the prediction of pulmonary embolism. Patients and Methods This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA), irrespective of the D-dimer test results, at King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 years, from Jan. 2016 to Jan. 2019. The predictive accuracy of D-dimer, adjusted D-dimer, and RGS was calculated. The receiver operating characteristic "ROC" curve was applied to allocate the optimum RGS cutoff for PE prediction. Results The overall prevalence of PE was 16%. It was 0%, 25.8%, and 88.9% in low, intermediate, and high clinical probability categories of RGS, respectively. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.81, p

Background: Diabetes mellitus is a chronic and complex medical disease that leads to significant morbidity and mortality. Patient-centered diabetes education that emphasizes active patient involvement, self, and shared care constitutes a substantial and essential component of the comprehensive diabetes management approach. Objectives: To assess the impact of patient-centered diabetes education sessions on the prescribed treatment plan in controlling diabetes and other related cardiovascular risk factors. Methods: In a pre-experimental pretest-posttest one group study design, all referred patients with type 2 diabetes (T2DM) to the diabetes educator clinic (n = 130 patients) during the period of 6 months from January to July 2021 were subjected to multiple and consecutive patient-centered diabetes education sessions, based on the framework published by the Association of Diabetes Care and Education Specialties (ADCES), in addition to their usual treatment plan. Demographic, social, and biological data were obtained at the baseline, three months, and six months after the intervention. Nonparametric Friedman and Cochran’s Q tests for related samples were applied to examine the impact of this educational intervention on glycosylated hemoglobin (HbA1c) and other associated cardiovascular risks. The results of 130 patients with T2DM showed a significant reduction of mean systolic blood pressure “SBP” (p = 0.015), glycosylated hemoglobin (HbA1c) (p < 0.001), fasting blood sugar “FBS” (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride (p < 0.001), and significant rise of mean high-density lipoprotein (p = 0.011). At three and six months after the intervention, 43% and 58% of patients showed improved HbA1c levels. The mean HbA1c was reduced from 10.2% at the beginning of the study to 8.7% (p < 0.001) after six months. Moreover, a significant reduction in the prevalence of obesity (p = 0.018), high FBS (p = 0.011), and high SBP (p = 0.022) was detected. Conclusions: This study showed a considerable positive impact of diabetes education and patient-centered care on optimizing glycemic and other cardiovascular risk control. The needs of certain patients with T2DM should be addressed individually to achieve the best possible outcomes. Further research is needed to explore the long-term benefits of this intervention.

Majed Al Jeraisy,1,2 Shaden Al Osaimi,1 Abdullah Al Hawas,1 Alanoud Muamar,1 Lamia Aleidi,3 Njoud Khonain,4 Mostafa A Abolfotouh2 1College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 3Unaizah College of Pharmacy, Qassim University, Riyadh, Saudi Arabia; 4College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Mostafa A AbolfotouhKing Abdullah International Medical Research Center (KAIMRC)/King Saud bin-Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard- Health Affairs, P.O. Box 3660, Riyadh, 11426, Saudi ArabiaTel +966 11 429-4460; +966 503659204Fax +966 11 429-4440Email mabolfotouh@gmail.comBackground: Patients allergic to antibiotics are at higher risk of receiving treatment with a broader spectrum, more harmful, and expensive agents. The aims of this study were (1) to assess the quality of documentation of antibiotics allergies in the electronic medical records (EMR) in a Pediatric tertiary care setting, and (2) to determine the validity of physicians’ decision to hold antibiotics prescriptions.Methods: This is a retrospective cohort study at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia. A review of the EMR and all Adverse Drug Reaction (ADR) reports of pediatric patients 1– 14 years old, with a documented allergy to antibiotics from June 2016 until June 2019. The quality of documentation of antibiotics allergy was assessed based on the presence of four parameters: 1) allergy alert notification, 2) allergy severity classification, 3) setting notes, and 4) symptoms’ description. In addition, all physicians’ reports of allergy to antibiotics were cross-classified according to their corresponding ADR reports, and the validity of physicians’ documentation of allergy was assessed.Results: Of a total of 105 Pediatric patients’ EMR, documentation of antibiotics allergy was available in 98 (93.3%), with the presence of symptoms description (83%), allergy notes (87%), severity (67%), and signs of alert (50.8%). Overall documentation quality was good for only 23.5% of patients, while it was poor for 35.7%. Physicians’ documentation of antibiotics allergy was 0.82 sensitive [with 0.18 risk of allergy] and 0.60 specific [with 0.40 unnecessary restrictions of prescriptions]. Of all children with possible/actual allergies, only 38.9% were referred to the immunology clinic.Conclusion: The quality of documentation of antibiotic allergy in children and the validity of physicians’ decisions are less than satisfactory. Therefore, improving communications between all healthcare providers regarding patients’ allergy status and follow-up for further assessment of the reaction is recommended to improve patient care.Keywords: flagging, drug allergy, allergy documentation, quality, Naranjo scale

Study Design Cross-sectional survey. Objectives This study aimed to investigate work-related neck pain among AO spine surgeons in different regions by estimating its prevalence, predictors, consequences, and management methods. Methods A cross-sectional survey of 411 spine surgeon members of AO spine was conducted during March–May 2021, using the Modified Nordic Questionnaire and the Neck Disability Index. Data on neck pain experience during the last 12 months and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of neck pain. Significance was set at P < .05. Results The 1-year neck pain was experienced by 66.7% of surgeons. According to the Neck Disability Index, more than one-half (52.8%) experienced disability due to neck pain of mild (45.5%), moderate (6.5%), and severe (.8%) grades. Neck pain was responsible for stopping work in 17.5% of surgeons, with a median of 3.5 (IQR, 2-7.8) days off work. One-half of the participants (56.3%) were treated by medical care, 31.5% by physiotherapy, and 16.5% requested rest days and sick leave. Physical stress (P < .001) and non-exercising (P = .04) were the significant predictors of neck pain. Conclusion The 12-month prevalence of neck pain was high among spine surgeons, with an impact on activities of daily living, mainly of a mild degree, reported by one-half of surgeons. Physical stress was the only significant predictor, while sports practice was a protective factor against neck pain. Medication was the primary management adopted—an increased focus on pain prevention through improved workplace ergonomics and sports activity programs is recommended.

BackgroundThis study aimed to assess the prevalence of intimate partner violence (IPV) and its correlates, amongst currently married Saudi women.MethodsA total of 400 currently married females aged 19–65 years old who attended the outpatient clinics of PHC centres in Riyadh, from 1 November 2015 to 1 February 2016, were screened for the current and previous experiences with IPV, and its correlates, using the previously validated Arabic version of the WHO multi-country instrument on violence against women. Logistic regression analyses were applied to identify the correlates of IPV.ResultsThe lifetime overall prevalence of IPV was 44.8%, in the form of; physical (18.5%), emotional (25.5%), sexual (19.2%) and economic (25.3%) violence. Wife’s experience of child abuse was significantly associated with physical [OR = 3.63, P ConclusionIPV with its all forms was prevalent amongst Saudi women. Child abuse experience and polygamy were significantly associated with IPV. Designing tailored IPV national prevention programmes is a necessity.

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

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

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

Background Many studies are available in the literature about e-health in Saudi Arabia, however, data is limited to a few organizations and does not necessarily reflect the current and potential use of e-health for health care organizations in the country. This study aimed to determine the level of awareness of Saudi medical students of the internet-based health-related information seeking and developing to support health services and significant predictors of their practice. Methods A cross-sectional survey of 440 medical students in Riyadh, Saudi Arabia, was conducted, during October/November 2019, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude, and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p Results Of 440 medical students, the majority were females (55.7%) and from families whose monthly income was more than 10,000SR (82.8%). Overall knowledge about e-health was unsatisfactory (percentage mean score, PMS = 71.6%), with only 43.6% of students reporting a satisfactory level. However, this level was satisfactory for fields of application (Percentage mean score-PMS = 76.6%) and unsatisfactory for the definition of e-health (PMS = 70.7%) and methods of its use (PMS = 65.7%) domains. The overall attitude towards e-health use was positive (PMS = 82.3%), with nearly three-quarters of students (73.4%) reporting a positive attitude. Generally, a good level of practice of e-health was reported by students (PMS = 84.3%), with more than three-quarters of students (78.4%) reporting good practice. Adjusting for age, gender, stream, educational grade, and family monthly income, good practice was significantly predicted with higher knowledge (t = 2.22, p = 0.03) and attitude (t = 2.11, p = 0.04) scores. Conclusion This study provides basic information regarding medical students’ level of awareness of internet-based health-related information seeking and developing to support health services. More resources should be directed to elevate medical students’ knowledge and to motivate them to practice e-health using the available tools.

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

Occupational and physical therapists are at risk of musculoskeletal pain and injuries possibly due to their work-related activities, posture and affected body mechanics.To investigate the epidemiology of lower back pain among rehabilitation professionals.A cross-sectional survey of 259 physical and occupational therapists in rehabilitation centres in Saudi Arabia was conducted during July-August 2019, using the Modified Nordic Questionnaire. Data on different measures of lower back pain, and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of lower back pain.Rehabilitation professionals experienced 73.7% 1-year lower back pain prevalence, 52.5% intense pain that lasted ≥ 1 day, 22.4% chronic lower back pain, 23.9% sick-leave-seeking lower back pain and 18.5% medical-care-seeking lower back pain. Difficult/impossible activities of daily living in standing up (45.5%), employment (44.0%), climbing stairs (33.9%), walking (33.0%), sitting (29.3%), sleeping and travel (29.8% each), awakening (23.0%), social life (26.2%), and personal care (15.7%) were reported. Lower back pain was responsible for stopping work in 32.5% of participants, with a mean 1.38 (±2.96) days off work during the last year. One half of participants (50.3%) were treated by physiotherapy, 25.1% by medical care, and 39.3% requested rest days and/or sick leave. Physical stress and10 years' experience were significant predictors of lower back pain.Prevalence of lower back pain was high among rehabilitation professionals, with a high impact on activities of daily living. Physiotherapy was the main management adopted. Educational programmes are necessary to teach proper use of body mechanics, and sports activity programmes to reduce the risk of lower back pain and arrange for proper rest periods.وبائيات ألم أسفل الظهر المتعلقة بالعمل بين العاملين في إعادة التأهيل في المملكة العربية السعودية.مصطفى أبو الفتوح، فاي العُمير، دلال العنقري، إبراهيم بوشناق، بدر الدباسي، عفاف المنصوف.اختصاصيو العلاج المهني والطبيعي مُعرَّضون للآلام والإصابات العضلية الهيكلية، وقد يرجع ذلك إلى الأنشطة المتعلقة بعملهم ووضعية الجسم وتضرُّر ميكانيكا الجسم.هدفت هذه الدراسة إلى تقصي السمات الوبائية لآلام أسفل الظهر بين العاملين في إعادة التأهيل.أُجرِيَ مسح مقطعي لما مجموعه 259 من العاملين في العلاج الطبيعي والمهني في مراكز إعادة التأهيل في المملكة العربية السعودية خلال شهرَيْ يوليو / تموز و أغسطس / آب 2019، باستخدام استبيان «نورديك» المعدَّل. وجُعت بيانات عن المقاييس المختلفة لألم أسفل الظهر وعواقبه وعوامل الخطر المرتبطة به. وحُلِّل الانحدار اللوجستي لتحديد المنبِّئات المهمة بألم أسفل الظهر.عانى 73.7٪ من العاملين في إعادة التأهيل من ألم أسفل الظهر لمدة سنة، وعانى 52.5٪ من ألم شديد دام يومًا واحدًا أو أكثر، وعانى 22.4٪ من ألم مزمن أسفل الظهر، وطلب 23.9٪ إجازات مرضية بسببه، وطلب 18.5٪ الرعاية الطبية. وذُكِر أن أنشطة الحياة اليومية الصعبة/ المستحيلة التي تعرضوا لها كانت في أثناء الوقوف (45.5٪) ، وفي العمل (44.0٪) ، وصعود الدرَج (33.9٪) ، والمشي (33.0٪) ، والجلوس (29.3٪) ، والنوم والسفر (29.8٪ لكل منهما)، والاستيقاظ (23.0٪) ، والحياة الاجتماعية (26.2٪) ، والرعاية الشخصية (15.7٪). وتسبب ألم أسفل الظهر في توقف 32.5٪ من المشاركين عن العمل، بمعدل 2.96 (1.38) يوم خلال السنة الماضية. وحصل نصف المشاركين (50.3٪) على العلاج الطبيعي، وحصل 25.1٪ على الرعاية الطبية، وطلب 39.3٪ أيام راحة و/ أو إجازة مرضية. وكان الإجهاد البدني مع أقل من 10 سنوات في العمل منبِّئًا مهمًّ بألم أسفل الظهر.كان معدل انتشار ألم أسفل الظهر مرتفعًا بين أوساط العاملين في إعادة التأهيل، وله تأثير كبير على أنشطة الحياة اليومية. وكان العلاج الطبيعي هو العلاج الرئيسي المعتمد. وتُعد البرامج التعليمية ضرورية لتعليم الاستعمال السليم لميكانيكا الجسم، وبرامج الأنشطة الرياضية كذلك ضرورية للحد من خطر الإصابة بألم أسفل الظهر، وللترتيب للحصول على فترات راحة مناسبة.Épidémiologie des douleurs lombaires liées au travail parmi les professionnels de la réadaptation en Arabie saoudite.Les ergothérapeutes et les physiothérapeutes sont à risque de douleurs et de traumatismes musculosquelettiques pouvant être liés à leurs activités professionnelles, à leur posture et à leur mécanique corporelle affectée.Étudier l'épidémiologie de la lombalgie chez les professionnels de la réadaptation.Une enquête transversale a été menée auprès de 259 physiothérapeutes et ergothérapeutes dans des centres de réadaptation en Arabie saoudite entre juillet et août 2019, à l’aide du questionnaire nordique modifié. Des données ont été recueillies sur différentes mesures de la lombalgie, ses conséquences et ses facteurs de risque. Une analyse de régression logistique a été réalisée pour identifier les facteurs prédictifs significatifs de la lombalgie.Les professionnels de la réadaptation ont souffert de lombalgie au moins une fois durant l’année précédant l’étude pour 73,7 % ; 52,5 % d’entre eux ont connu une douleur intense ayant duré un jour ou davantage, 22,4 % ont souffert de lombalgie chronique, 23,9 % de lombalgie ayant occasionné un congé de maladie et 18,5 % de lombalgie ayant nécessité le recours à des soins médicaux. Les activités difficiles/impossibles de la vie quotidienne en posture debout (45,5 %), durant l'emploi (44,0 %), la montée des escaliers (33,9 %), la marche (33,0 %), la position assise (29,3 %), le sommeil et les voyages (29,8 % chacun), le réveil (23,0 %), la vie sociale (26,2 %) et les soins personnels (15,7 %) ont été signalées. La lombalgie a occasionné un arrêt de travail chez 32,5 % des participants, pour 1,38 jour (±2,96) au cours de la dernière année. La moitié des participants (50,3 %) ont été traités par kinésithérapie, 25,1 % par soins médicaux et 39,3 % ont demandé des jours de repos et/ou des congés de maladie. Le stress physique et le fait d’avoir moins de 10 ans d'expérience étaient des facteurs prédictifs significatifs de la lombalgie.La prévalence de la lombalgie était élevée chez les professionnels de la réadaptation, avec un impact important sur les activités de la vie quotidienne. La physiothérapie était la principale prise en charge adoptée. Des programmes éducatifs sont nécessaires pour enseigner la bonne utilisation de la mécanique corporelle et des programmes d’activités sportives pour réduire le risque de lombalgie et prévoir des périodes de pause appropriées.

Mostafa A Abolfotouh,1 Mohamed A Hussein,2 Sameh M Abolfotouh,3 Alanoud Al-Marzoug,4 Suliman Al-Teriqi,5 Abeer Al-Suwailem,6 Ra’ed A Hijazi7 1Research Training and Development Section, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Biostatistics and Bioinformatics Department King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3OrthoCure Medical Center, Dubai, UAE; 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 6College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Emergency Care Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia Background: The aim of this study was to describe the pattern of traumatic injuries and determine the predictors of inhospital mortality in patients admitted to the emergency department. Patients and methods: This is a retrospective cohort study of 3,786 patients with traumat injuries admitted to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2012 and December 2014. Data on patient characteristics, trauma characteristics and outcomes were extracted from medical records. A negative binomial regression model was utilized to identify significant predictors of inhospital mortality. Results: Of all injured patients, 77.5% were male, 29.8% were aged 15–25years and 25.7% were aged 26–45years. Blunt trauma was the main mechanism of injury, including motor vehicle crashes (MVCs) in 52.0% and falls in 25.8% of patients. Most patients had injuries to the extremities (61.3%), followed by the head (32.2%), chest (16.9%) and abdomen (8.9%). Injuries were mild in 49.7% of patients, moderate in 30.2% and severe in 20.1%. The sex of the patients was significantly associated with the mechanism of injury (p

Background In Saudi Arabia, healthcare industry is undergoing major expansions to meet the demand of rapidly growing healthcare needs. The aims of this study were; (1) to assess the pattern of smartphone use in healthcare facilities, and (2) to determine perception towards its use among healthcare workers. Method A cross-sectional survey of 351 healthcare workers (HCWs) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia was conducted, from October to November 2016, using a previously validated perception domain to measure perception towards usefulness (5 statements) and practicality (5 statements) of smartphones in clinical settings. Pattern of use of smartphones and health-related applications in healthcare facilities was also investigated. Logestic regression models were applied to identify the predictors of smartphone use and installation of health-related applications for use in healthcare facilities. Significance was considered at p-value of Results Utilization rate of smartphone was 42.3%, and only 6.1% of all healthcare providers reported always using applications in their practice. Reasons for use were: as a source of drug information (69.8%), for disease diagnosis (56.4%), to access medical websites (42.5%), to review guidelines and protocols related to healthcare (34.1%), for procedure documentation (23.5%), and as a source of patients education materials (22.3%). Perceptions of HCWs towards smartphone use was less than satisfactory (Overall percentage mean score = 60.4 ± 18.7), with only 11.6% reporting positive perception. After adjusting for possible confounders, the total perception mean score was a significant predictor of both smartphone use (β = 0.033, p p = 0.024). Conclusion Smartphone utilization in healthcare facilities by HCWs in Saudi Arabia is low. This could be attributed to their less than satisfactory level of perception towards its use. Smartphone use and installation of medical applications for use in health facilities were predicted by perceived usefulness and practicality of its use. Intervention from higher health authorities is necessary to enforce the importance of smartphone use in clinical practice. Conduction of further studies on the impact of smart phone use on the healthcare quality in Saudi Arabia is recommended.

Background Previous studies described the levels of awareness of patients and health care providers on e-health in general and on e-health for a certain condition/disease. However, none of these studies was conducted in Saudi Arabia. The aims of this study were 1)To determine the levels of knowledge, attitude and practice of medical students on e-health, and 2) To identify the predictors of e-health practice among medical students. Methods A cross-sectional survey of 440 medical students at the college of medicine, King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, was conducted, during October/November 2018, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p

Background and Aim: Violence is a life-threatening issue that mainly affects head and neck areas. Dentist might be the first person to notice this type of injury. This study aimed to investigate dentists’ willingness to report suspected violence exposure of their patients and factors associated with their willingness. Materials and Methods: In a cross-sectional study of 363 dentists in Riyadh, Saudi Arabia, a previously validated self-administered questionnaire was distributed, in both printed and electronic forms (Google Forms), to collect data on personal characteristics, professional background, and negative perception and professional attitude toward reporting suspected violence. Descriptive and analytic statistics were applied. Significance was considered at P ≤ 0.05. Results: The majority of dentists reported positive perception (88.4%) and positive attitude (68.0%) toward reporting suspected violence, with percentage mean scores of 35.2 ± 19.6 and 83.5 ± 15.0, respectively. Higher professional attitude score was significantly associated with the ability of dentists to recognize signs of violence (t = 3.19, P = 0.002). Negative perception mean scores were significantly higher with non-Saudi nationality (t = 2.03, P = 0.043), private sector (F = 3.33, P = 0.037), no training on abuse management (t = 3.02, P = 0.003), and perceived ability to identify victims of violence (t = 2.61, P = 0.01). After adjusting for potential confounders, negative perception was predicted by non-Saudi nationality (P = 0.028) and no history of previous training in abuse management (P = 0.004). Conclusion: Almost all dentists have high professional attitude scores and low negative perception scores toward reporting violence, which reflect a good sense of responsibility toward their patients and community. Educational training in abuse management must be a requirement for dental practice.

Background Survival of preterm neonates has steadily improved over the past five decades, due to changes in the neonatal intensive care. However, in Saudi Arabia, there are no written guidelines on the definition of the lower limit of viability, and there has been a call for such a limit. The aims of this study were: (1) to determine lower limits of viability and survival in extremely low birthweight (ELBW) infants, and (2) to determine incidence of neurodevelopmental and cognitive abnormalities within 3–6 years after birth. Methods Prospective study of all live inborn ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, within 3 years [between January 1st, 2005 and December 31st, 2007] was conducted (n = 117). Data were collected on demographic and birth data, neonatal complications & interventions and death on discharge. Prospective follow up of all survivors was done, within 6 years after birth, to assess the outcome in terms of neurodevelopmental and cognitive abnormalities. Predictors of survival were determined using logistic regression model. Significance was considered at p-value ≤0.05. Results Of all ELBW infants, 41% died before discharge. Survival rate was directly correlated with gestational age (GA) and birthweight (p 600 g. After adjusting for possible confounders, significant predictors of survival were birthweight (p = 0.001) and Apgar score (p

Background Cardiopulmonary resuscitation (CPR) increases the probability of survival of a person with cardiac arrest. Repeating training helps staff retain knowledge in CPR and in use of automated external defibrillators (AEDs). Retention of knowledge and skills during and after training in CPR is difficult and requires systematic training with appropriate methodology. The aim of this study was to determine the effect of basic life-support (BLS) training on the attitudes of health-care providers toward initiating CPR and on use of AEDs, and to investigate the factors that influence these attitudes. Methods A quasi-experimental study was conducted in two groups: health-care providers who had just attended a BLS–AED course (post-BLS group, n = 321), and those who had not (pre-BLS group, n = 421). All participants had previously received BLS training. Both groups were given a validated questionnaire to evaluate the status of life-support education and certification, attitudes toward use of CPR and AED and concerns regarding use of CPR and AED. Multiple linear regression analyses were applied to identify significant predictors of the attitude and concern scores. Results Overall positive attitudes were seen in 53.4% of pre-BLS respondents and 64.8% of post-BLS respondents (χ2 = 9.66, p = 0.002). Positive attitude was significantly predicted by the recent completion of BLS training (β = 5.15, p

Mostafa A Abolfotouh,1,2 Mahmoud Salam,1 Ala’a Bani-Mustafa,1 David White,3 Hanan H Balkhy2,4 1King Abdullah International Medical Research Center (KAIMRC), 2King Saud bin-Abdulaziz University for Health Sciences (KSAU-HS), 3Nursing Department, 4Infection Prevention andControl Department, King Abdulaziz Medical City, Riyadh, SaudiArabia Background: Although intravenous therapy is one of the most commonly performed procedures in hospitalized patients, it remains susceptible to infectious and noninfectious complications. Previous studies investigated peripheral intravenous catheter (PIVC) complications mainly in pediatrics, but apparently none were investigated among Saudi adult populations. The aim of this study was to assess the pattern and complications of PIVCs at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Methods: An observational prospective cohort study investigated PIVCs pattern and complications among adults with PIVCs, admitted to various wards at KAMC. PIVCs-related clinical outcomes (pain, phlebitis, leaking, and others) were recorded in 12-hour intervals, using the Visual Inspection Phlebitis scale. Density incidence (DI) and cumulative incidence (CI) of complications and their relative risks (RRs) were calculated. Regression analyses were applied and significance limits were set at P

Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after Achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A retrospective cohort study of all patients who were operated at Hamad General Hospital (HGH) between June 2010 and June 2012 for AT rupture (n = 102), was conducted. Data was collected on 1) patient’ characteristics such as age, sex; 2) disease characteristics such as mechanism of rupture, type of rupture (partial or complete), whether an anterior or posterior slab was applied, number of suture materials, number of antibiotics, surgical time, time to surgery and length of hospital stay (LOS), number of follow up visits, and 3) complications. Descriptive and analytical statistical analyses were applied. Receiver operating characteristic curve was applied to identify the validity of different LOS values, with a significance level at p ≤ 0.05. Results: Of the 102 patients with Achilles rupture, almost males (96.1%), with a mean age 31.07 ± 9.71 years, 52% with complete rupture, the majority were open ruptures (81.4%) and bathroom-related (70.6%). Anterior slab was applied to 58.2% and 2 types of suture materials to 71.6% of cases. Fifteen cases (14.7%, 95% CI: 7.8% - 21.6%) presented with one or more complications (9.8% post-operative infections, 5.9% stiffness and 2% re-rupture). Post-operative infections were significantly associated with: old age (z = 2.11, p = 0.035), longer LOS (z = 2.01, p = 0.04), and presence of diabetes (Fisher exact test: p = 0.003). After adjustment for age, LOS (p = 0.04) and diabetes (p = 0.017) remained as significant predictors of post-operative infections. LOS of 2.5 days was the optimum cut-off point above which post-operative infection is more likely to occur, with sensitivity of 80% and specificity of 54%. Conclusion: Achilles repair post operative infection ranks first as a complication of AT surgical repair, and its incidence is relatively higher in HGH than the counterpart figures in the literature. The presences

BACKGROUND CONTEXT Over the past 10 years, opioid expenditures for spine-related pain increased dramatically in USA. Orthopedic surgery has been reported as the third highest opioid-prescribing specialty, in patients older than 40 years old. PURPOSE The aim of this study was to determine the incidence of opioid use (OU) following cervical spine fusion surgery, and to identify the predictors of prolonged opioid use at 3 months, 6 months and 12 months following surgery. STUDY DESIGN/SETTING A retrospective cohort study at University of Missouri hospitals. PATIENT SAMPLE All patients who underwent cervical arthrodesis for degenerative cervical spine disease over 7 years, between 2010 and 2016, who had at least one year of postoperative follow up at the University of Missouri hospitals. OUTCOME MEASURES Incidence of pre- and postoperative opioid prescriptions and predictors of long-term postoperative opioid use. METHODS Patients’ medical records were examined to collect data on the following: patient's characteristics (age, sex, race, monthly income, occupation, BMI, smoking behavior, comorbidities) associated pain measures (pre/postoperative VAS), ASA score, and pre/postoperative OU. Logistic regression analyses were applied to identify the predictors of prolonged OU at intervals following surgery. Significance was considered at p RESULTS Opioid use was shown in 46.9% of patients before operation, of whom 68.1%, 60.9%, and 50.7% remained on OU at 3, 6 and 12 months following surgery. Incidences of postoperative OU were 50%, 42.5% and 30.2% at 3, 6 and 12 months. Preoperative use was significantly associated with postoperative use at 3 months (X 2 =18.2, p CONCLUSIONS Perioperative opioid prescription for patients with cervical spine fusion is quite common. Minimizing preoperative opioid use should be investigated as a way to mitigate long–term OU. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Mostafa A Abolfotouh,1 Abdullah A Alabdrabalnabi,2 Rehab B Albacker,3 Umar A Al-Jughaiman,4 Samar N Hassan5 1King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2University of Dammam, College of Medicine, Dammam, Saudi Arabia; 3King Saud University, College of Medicine, Riyadh, Saudi Arabia; 4King Faisal University, College of Medicine, Dammam, Saudi Arabia; 5Division of Reproductive Medicine, Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia Introduction: Infertility places a huge psychological burden on infertile couples, especially for women. Greater knowledge of the factors affecting fertility may help to decrease the incidence of infertility by allowing couples to avoid certain risk factors. The aim of our study was (1) to assess the knowledge and attitudes of infertile and fertile Saudi participants on infertility, possible risk factors, and social consequences; and (2) to determine the practices of infertile Saudi couples to promote their fertility before having them attend an in vitro fertilization (IVF) clinic. Methods and materials: We conducted a cross-sectional study on 277 fertile participants from outpatient clinics and 104 infertile patients from the IVF clinic at King Abdulaziz Medical City between June 24, 2012 and July 4, 2012, using a previously validated interview questionnaire. Descriptive and analytical statistics were applied with a significance threshold of P ≤ 0.05. Results: A generally poor level of knowledge (59%) and a neutral attitude (76%) toward infertility were reported by participants. Mistaken beliefs commonly held by the study participants regarding the causes of infertility were Djinns and supernatural causes (58.8%), black magic (67.5%), intrauterine devices (71.3%), and contraceptive pills (42.9%). The healer/Sheikh was reported as the primary and secondary preference for infertility treatment by 6.7% and 44.2% of IVF patients, respectively. Compared with fertile patients, IVF patients were significantly less likely to favor divorce (38.5% versus 57.6%; P = 0.001) or marriage to a second wife (62.5% versus 86.2%; P < 0.001), if the woman could not have a baby. The patients with infertility had more favorable attitudes toward fertility drugs (87.5% versus 68.4%; P = 0.003) and having a test tube baby (92.4% versus 70.3%; P < 0.001). Child adoption was accepted as an option for treatment by the majority of IVF patients (60.6%) and fertile outpatients (71.5%). Alternative treatments previously practiced by the IVF patients to improve fertility include practicing Ruqia (61%), using alternative medicine (42%), engaging in physical exercise (39%), eating certain foods (22%), and quitting smoking (12%). Conclusion: These findings have implications for health care providers regarding the reluctance that couples experiencing fertility problems may have, at least initially, to accept some interventions required for the couple to conceive. Keywords: infertility, knowledge, attitude, practice, KAP, misconceptions

Aims: The aim of our study was to examine the associations of dietary fat intake, serum estrogen level and obesity with the risk of breast cancer in a case-control study among Saudi females including newly diagnosed breast cancer patients. Study Design: Case-control study. Place and Duration of Study: King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the period between 1st February and 30th May, 2008 Methodology: Dietary histories were collected 40 newly diagnosed female breast cancer cases and 82 randomly selected control subjects matched for age, parity, gravidity, number of children, breast feeding practice and age at marriage. A modified food frequency questionnaire (FFQ).was applied. Anthropometric measurements and blood tests that measured LDL, HDL, triglycerides (TGs) and estrogen levels were performed. Significance was considered at P≤0.05. Results: Breast cancer was significantly associated with overall obesity based on BMI (OR = 3.10, 95%, CI = 1.17–8.25, P=0.02) and central obesity based on WC (OR = 3.95, 95%, CI = 1.27–12.28, P=0.01). Cases exhibited significantly higher fat mass (39.6 vs. 36.9 kg, p=0.04) and significantly lower Fat intake (46.0±27.5 vs 59.0±38.9 g/day, P=0.034) than did the control group. The mean levels of TGs (2.9±1.1vs.1.8±1.1 mmol/L, P

Background: Trauma is a major cause of death worldwide that can result death or permanent disability. Globally, 6–10% of all deaths are attributed to traumatic injuries. In Saudi Arabia, trauma is a public burden as a result of its socioeconomic impact. Our aim is to describe the pattern of traumatic injuries and predictors of in-hospital mortality among patients admitted through the ED of King Abdulaziz Medical City. Methods: A retrospective cohort study was conducted on 3786 trauma-injured patients admitted from 2012 to 2014. Data on: patient characteristics, trauma characteristics and outcome characteristics, were extracted from a prospectively collected database. Logistic regression analysis and ROC curve were applied. Results: Of 3786, (77.5%) of victims were males, (29.8%) injuries occurred in the age group (15–25 years). Blunt injuries constituted (87.1%), followed by burns (7%), intentional injuries (5%) and drowning & foreign body (1%). Data showed seasonal variation with two main peaks in March and August (p Conclusions: Our recommendation is targeted to ED policy makers to recognize the patterns of injury and the seasonal variation to structure and distribute the facilities and staff in a cost-effective manner. Also, enforcing trauma preventative measures should be encouraged. Secondly, for ED physicians to enhance the use of in-hospital predictors of mortality. Finally, educational programs targeting the general population are essential to cover all aspects.

BackgroundPeripheral intravenous catheters (PIVs) are invasive catheters that may endure risks of clinical complications affecting health care outcomes and patient satisfaction. Patients requiring frequent PIV insertions due to an extended length of stay of one week or more would undergo multiple PIV pricks during their course of hospitalization. The combined factors of multiple PIV insertions and extended hospital stay make chronic patients especially at a higher risk for phlebitis and subsequently infection No studies in the literature review discussed the phlebitis rates and risks when toxic medications were infused using a peripheral catheter. The aim of this study was to determine the pattern and incidence of PIV complications among patients admitted to a tertiary care military health care facility in central region of Kingdom of Saudi Arabia. This was achieved through the following objectives: (1) Estimation of the cumulative incidence and incidence density for major PIV complications (catheter occlusion, dislodgment, infiltration, and phlebitis) during a period of 1 month, (2) Identification of significant risk factors for PIV complications such as patient related characteristics (gender, age, co-morbidities) or catheter related characteristics (catheter size, dressing, site of insertion, type of infusion, dwell times), and (3) Determination of the time line for the occurrence of various PIV complications.MethodsAn observational prospective cohort study investigated PIV pattern and complications among 359 adults with 842 PIV catheters, admitted to various wards at KAMC with a total of 2505 catheter days. Data on patient characteristics (age, gender, and health complaints) and PIV characteristics (Catheter size, duration, insertion site, nature of PIV infusate, and type of dressing) was collected. PIV catheters-related clinical outcomes (Pain, Phlebitis, leaking and others) were recorded on 12–hour intervals, using the Visual Inspection Phlebitis (VIP) scale. Phlebitis was defined as the presence of two or more signs of pain, tenderness, warmth, erythema, swelling, or a palpable cord, with or without purulent drainage from the catheter insertion site. Infusion Phlebitis scale can range from (0), indicating no symptoms of phlebitis, to (5), with signs of purulent drainage, redness, and a palpable cord greater than 3 inches. Infiltration was defined as permeation of intravenous fluid into the interstitial compartment, causing swelling of the tissue around the site of the catheter. All PIV catheters were changed for a score of 2 or more, determined by the presence of a cold/warmth skin region around the insertion site, pain, redness, and/or edema extending from 1 to 2 inches above the PIV site. Incidence density (DI) and cumulative incidence (CI) of complications were calculated. Regression analyses were applied to determine the significant predictors of complications. Significance limits were set at P ResultsOne half of all patients were 65 years and above, with no significant sex difference. The majority of patients (76.88%) had medical chief admission complaints, whereas (51.53%) were admitted in cardiac wards. Complicated catheters were found in 141(39.3%) patients, with 273 complications (32.4/100 catheters), 190 complicated catheters (CI = 22.56/100 catheters & DI = 75.84/1000 catheter days). Phlebitis ranked first among complications, with a CI of (17.58%), followed by pain (7.60%), leaking (3.92%) and dislodgement (2.38%), and extravasations and occlusion (0.48% each). When the analysis was based on failure per 1000 device days, and after adjusting for all possible confounders, female gender remained as a significant predictor of higher incidence of overall complications (p = 0.00001), phlebitis (p = 0.000003) as well as other complications (p = 0.0.0003). Insertion in fore/upper arm was a significant predictor of both phlebitis (0.024) and other complications (0.049), while medical infusion was a significant predictor of phlebitis (0.02) and overall complications (0.006).ConclusionIncidence of complications in this study is comparable with figures in previous studies, however, better insertion techniques may be sought to lower the incidences of PIV complications, thus extending their onset beyond day 3. Changing catheters is recommended when clinically indicated rather than routinely post 72 hours of insertion which in return minimizes the frequency of insertions per patient and subsequently complications.

Background Hearing loss among school-entrant children in the developing world has been widely reported as a significant health problem. Failure to detect hearing loss, either congenital or acquired, in children may result in lifelong deficits in speech and language acquisition. The aims of this study were: (1) to estimate the prevalence of hearing loss and (2) to identify its different types. Methods This is a cross-sectional study that included all children ( n = 2574) aged 4–8 years who attended the obligatory health examination for kindergarten (=370) and primary school ( n = 2204) entry at the school health center of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from March 2009 to December 2010. Pure-tone air conduction audiometry was conducted for each child in a sound-treated room followed by a diagnostic test. Tympanometry was performed as a complement to the overall objectives of a hearing screening program. Results A total of 45 children were diagnosed with hearing impairment (84.4% conductive and 15.6% sensori-neural), with an overall prevalence of 1.75% (95% C.I.: 1.25, 2.25). The majority of cases were females (71.1%), of school age (80.0%), with conductive deafness (84.4%). More than one-half of cases had bilateral deafness (55.6%) of mild degree (57.8%). As for conductive deafness, otitis media with effusion ranked first as a cause of deafness (34.9%), followed by wax and chronic otitis media (23.3% each), while traumatic perforated drum came last (2.3%). Sensorineural deafness constituted 16.2% of all cases. Conclusion Conductive hearing loss is the primary type of hearing loss among children and is easy to correct. The urgent development of audiological services in other school health centers in the country, particularly those with good referral systems to Ministry of Health hospitals, is needed. Evidence-based guidelines to identify, monitor, and manage otitis media with effusion (OME) in children in the primary healthcare setting and a strategy to prevent hearing loss are recommended.

Mostafa A Abolfotouh, Abdallah A AdlanKing Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaBackground: Informed consent is considered the most important step in clinical interventions. The aims of this study were (1) to assess the quality of informed consent for invasive procedures with regard to consent process and information given about risks and alternative treatments, and (2) to determine patients' attitude toward informed consent at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: A cross-sectional study was conducted of 162 adult patients in different wards after undergoing surgery or invasive procedures within 1–2 days of signing the informed consent, using a previously validated interview questionnaire. Data on patients' characteristics, type of invasive procedure, and some informed consent-related issues were collected. Multiple linear regression analysis was used to identify the predictors of the percentage mean score of quality of informed consent, and significance was considered at P ≤ 0.05.Results: The quality of informed consent was generally poor (% mean score = 50.98 ± 17.49). About two-thirds of patients were told during the informed consent process that they have to sign merely as routine, 48% thought that if they refused the treatment plan they would lose the interest of the treating physician to help them, 42% thought that by saying no they would lose the good relationship with their physician, and 42.6% were not interested in having a copy of the informed consent document. Significantly higher quality was predicted when the physicians were the ones who explained the informed consent (t = 4.15, P < 0.001) and when informed consent was explained to younger patients (t = 2.754, P = 0.007). The overall attitude of the patients toward the process of informed consent was satisfactory (% mean score = 76.31 ± 7.63).Conclusion: The results suggest either that patients are not aware of their rights or that physician paternalism is practiced in Saudi Arabia. Cultural barriers should not be an argument to diminish the role of informed consent. Further studies should focus on how the value of autonomy can be appreciated in the Saudi culture.Keywords: informed consent, quality, invasive procedure, Saudi Arabia

The aim of this study was to determine the attitude of Saudi Arabians to research involving storage and use of human tissues from which genetic information may be derived and to assess their willingness to donate tissue samples to biobanks. In a cross-sectional interview study of 1051 outpatients at a hospital in Riyadh city, 68.8% had a positive attitude towards biomedical research and 78.4% were willing to allow use of excess surgical tissues for research purposes. Participants were less willing to allow the use of tissue or organs from a deceased relative. Logistic regression analysis found that predictors for a positive attitude to biomedical research and to use of tissue in research were: female sex, higher level of education, previous experience of blood testing and previous participation in health-related research. The attitudes towards biomedical research among the participants were satisfactory and comparable to findings from other countries.

Biobanks depend on the willingness of people to contribute samples for both research and storage; however, the requirements to perform research on biobanked samples are different than the requirements for their use in organ transplants. The objectives of this study were (1) to characterize public attitudes toward tissue and organ donation for transplantation and biobanking and (2) to identify significant predictors of these attitudes. A cross-sectional study was conducted with a total of 1051 adult subjects, all of whom accompanied their ill relatives to the outpatient clinics at King Abdulaziz Medical City. All subjects were given an interview questionnaire about their previous healthcare experiences and an attitude scale to assess their willingness to participate in organ donation for transplantation or tissue donation for research. A total of 64.7% of all participants reported having a positive attitude toward organ donation, and 68.8% of participants reported having a positive attitude toward biobanking. There was a significant and direct correlation between the attitude score related to organ donation and the attitude score related to tissue donation for research (r = 0.513, P 0.001). After adjusting for other variables by multiple regression analyses, a positive attitude toward either organ donation or tissue donation for research was significantly more prevalent among females (P 0.001), those who had previously participated in health-related research (P 0.001 and P = 0.002, respectively), and those who were aware of organ retention controversies (P = 0.036 and P = 0.001, respectively). Other significant predictors of positive attitudes toward only biobanking were a history of previous blood tests (P = 0.038) and the completion of secondary education (P 0.001). The attitude of the Saudi public is favorable toward both organ donation and tissue biobanking. Attitudes about the 2 types of donations are related. Previous participation in health-related research and awareness of organ retention controversies are significant predictors of attitudes toward both types of donations.