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Geetha Kandasamy,1 Dalia Almaghaslah,1 Mona Almanasef,1 Tahani Musleh Almeleebia,1 Khalid Orayj,1 Ayesha Siddiqua,1 Eman Shorog,1 Asma M Alshahrani,1 Kousalya Prabahar,2 Vinoth Prabhu Veeramani,2 Palanisamy Amirthalingam,2 Saleh Alqifari,2 Naif Alshahrani,3 Aram Hamad AlSaedi,4 Alhanouf A Alsaab,5 Fatimah Aljohani,6 M Yasmin Begum,7 Akhtar Atiya8 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 2Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Kingdom of Saudi Arabia; 3Department of Pharmacy, Ad Diriyah Hospital, Ministry of Health (MOH), Riyadh, 13717, Kingdom of Saudi Arabia; 4College of Medicine, Taibah University, Al Madinah, Al Munawwarah, Saudi Arabia; 5Pharmacist at Abha International Private Hospital, Abha, Saudi Arabia; 6Pharmacist at Prince Sultan Armed Forces Hospital, Almadenah, Almonwarah, Saudi Arabia; 7Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia; 8Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi ArabiaCorrespondence: Geetha Kandasamy, Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia, Email glakshmi@kku.edu.saBackground: Migraine is a disabling disease that poses a significant societal burden. Migraine is a major cause of disability. Migraine is the eighth leading disease-causing disability in the population.Objective: To study the clinical profile and measure the pain and migraine-related disability of patients with all types of migraine using the McGill pain assessment scale and Migraine Disability Assessment (MIDAS) before and after 3 months of effect on the medication.Methods: A Prospective-Cross sectional study was carried out in a multispecialty hospital with male and female patients between 18 and 65 years. The data were collected from the patients directly through the questionnaire of McGill pain assessment scale-short form (SF) and MIDAS, which was provided before and after the medication.&#x00A0Results: There were 165 subjects of which 52 were men and 113 were women. The mean age of all the subjects was 43 years. About 26.06% of the subjects had a family history of headaches. The scores of McGill pain and MIDAS assessment before and after medication were as follows: 0– 15 were 30.90% and 73.33%, Score 16– 30 were 54.54% and 18.18%, the score of 31– 45 were 14.54% and 7.87% of the subjects. MIDAS grade I was 17.57% and 50.90%, Grade II 33.93% and 21.81%, Grade III 30.30% and 15.75% Grade IV 18.18% and 11.51% of the subjects.Discussion: The calculated “t” value between the before and after medication values of McGill and MIDAS by paired ‘t-test was 13.85 and 17.49 respectively. As the calculated “t” value is more than the table value, the alternate hypothesis is accepted.Conclusion: This study confirms that there is a significant difference in disability levels before and after acute and preventative treatments when measured over 3 months. In addition, the preponderance of females was high, and the functional disability that affects work and social activity associated with migraine is moderate to severe.Keywords: migraine, pain, disability, loss of productivity, MIDAS

Sultan M Alshahrani,1 Khalid Orayj,1 Ali M Alqahtani,2 Adel Alfatease,3 Atheer Alshahrani,4 Ahmed RN Ibrahim1,5 1Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 4Alnahdi Pharmacies, Khamis Mushait, Saudi Arabia; 5Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, EgyptCorrespondence: Ahmed RN Ibrahim, Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia, Tel +966 554088979, Email aribrahim@kku.edu.saIntroduction: Community pharmacists play a key role as vaccinators for COVID-19. They can reduce the burden of the disease worldwide.Objective: This study used a cross-sectional questionnaire to determine whether the Saudi Arabian public was willing to obtain the COVID-19 vaccine via community pharmacists.Results: The questionnaire focused on the satisfaction, concerns, and opinions towards providing vaccination by community pharmacists. The study featured 415 individuals aged 18 and older (eligible for the COVID-19 vaccine). Of the participants in this study, 58.1% were aged 18– 25, with 55.4% female. Most participants (72.8%) have not been exposed to COVID-19 and are not aware of the approval of COVID-19 vaccination by community pharmacists. Of the 415 complete questionnaires, 45% believed that community pharmacists are not experienced in administering vaccines. However, 63% of participants are satisfied with getting the COVID-19 vaccination by a community pharmacist if no other option is available. More than 68% of the respondents agree that community pharmacies should expand their health care services to include vaccinations, prescriptions, checkups, and other forms of preventative medicine.Discussion: The availability of community pharmacist-administered vaccination in Saudi Arabia could be a significant factor in the success of the country’s vaccination program. This study may serve as a model to expand the role of pharmacists in other countries’ vaccination programs.Keywords: SARS-CoV-2, community pharmacy, immunization, perspective, adherence, patient satisfaction

Khalid Orayj,1 Khalid Alahmari,2 Moath Alasiri2 1Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Khalid Orayj, Email korayg@kku.edu.saIntroduction: Pharmacists’ involvement in patient care is expanding. The inclusion of this function within a complex healthcare system populated by demanding patients may create ethical challenges. In Saudi Arabia, few studies have been conducted on pharmacy ethics, and the available data are quantitative in nature. Thus, there remains a need for a qualitative assessment of the ethical dilemmas facing pharmacists.Methods: This exploratory study utilized a qualitative methodology that included open-ended, in-depth, semi-structured interviews, followed by content analysis. The study recruited credentialed pharmacists from community and hospital pharmacies. Themes and codes were created and classified.Results: Eighteen pharmacists were interviewed, and their responses were categorized into eight areas of ethical dilemma: beneficence and non-maleficence, autonomy, justice, confidentiality, veracity, communication skills, sincerity and religion, and law. Taken together, it appears that most of the ethical challenges to the practice of pharmacy center on the theme of beneficence and non-maleficence. Additionally, it was found that some social and religious practices and beliefs contribute to the formation of participants’ ethical backgrounds.Conclusion: These findings may aid in the development of national pharmacy ethics guidelines in Saudi Arabia. Additional quantitative research is necessary to confirm the study’s findings.Keywords: pharmacy ethics, community pharmacy, hospital pharmacy, bioethics

Adel Alfatease,1 Ali M Alqahtani,2 Khalid Orayj,3 Sultan M Alshahrani3 1Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Sultan M AlshahraniClinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, 61441, Saudi ArabiaTel +966 508747473Email shahrani@kku.edu.saIntroduction: Social media platforms are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination.Purpose: The objective of this study is to understand the influence of social media on the attitudes and willingness of the general public of the Aseer region of Saudi Arabia to receive COVID-19 vaccination.Materials and Methods: A cross-sectional self-administrated online survey was conducted in Saudi Arabia Aseer region, where 613 persons willingly took part in the survey in April and May 2021. Residents of Aseer in Saudi Arabia, who are over the age of 18 (eligible for COVID-19 vaccination) and willing to participate in the survey, were included in the study.Results: Overall, 74.6% agreed that the COVID-19 vaccine was misrepresented via social media. However, 37% of those respondents strongly agreed that social media had increased their willingness to get the COVID-19 vaccine. In addition, employees reported (21.8%) or strongly agreed (28%) that the quantity and quality of information on social media has a detrimental impact on their psychological well-being. Additionally, participants also agreed (21.8%) or strongly agreed (28%) that social media had a negative effect on their psychological condition.Conclusion: The study provides that there was a high degree of awareness indicated among Aseer population regarding misleading information about COVID-19 vaccination via social media. Thus, social media that can share up-to-date scientific information about vaccination must be utilized optimally by the government to assist people in making decisions about accepting vaccinations.Keywords: social media, COVID-19, vaccination, survey, Saudi Arabia

OBJECTIVE: The aim of this study was to investigate the relationship between organizational characteristics and diabetes care from the perspective of healthcare professionals (HCPs) in Abha, Kingdom of Saudi Arabia. SUBJECTS AND METHODS: A cross-sectional, self-reported survey of healthcare professionals was done. The study comprised a total of 106 HCPs from various departments involved with diabetes patient clinics or service providers. The electronic data collecting form was used to gather the data. RESULTS: The study revealed a stronger association between the availability of bed facilities and better glycemic control. Moreover, the majority of HCPs believes that urbanization and sedentary lifestyles are the main contributors to the rise of diabetes mellitus in Saudi Arabia. Depending on organizational features, the regulations that are available for monitoring defaulter patients and running continuous medical education (CME) programs are vastly different. The main cause of the reported lack of medications for managing diabetic care was described as being a problem with the central medical supply store's drug supply, which was influenced by the type of health sector. CONCLUSIONS: Facilitating change at all levels, including patient education, HCPs education, and organizational development, can improve the quality of treatment. The current study can provide insight into the focus of interventional strategies to deliver diabetes patients with high-quality patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Adverse drug reactions (ADRs) are widespread worldwide, and their intervention is critical to patient safety and healthcare quality. Pharmacists are essential in monitoring and reporting ADRs, directly influencing patient care. This study aimed to examine the prevalence of ADRs among pharmacists and their knowledge regarding ADRs, including the factors affecting ADR reporting. SUBJECTS AND METHODS: From September 2021 to November 2021, a cross-sectional survey among pharmacists in the Asir area of Saudi Arabia was planned. This study involved contacting 97 pharmacists using a cluster sampling method. The study's goals were met using a 25-item self-administered questionnaire. Data analysis was done using SPSS version 25 (IBM Corp., Armonk, NY, USA). RESULTS: Ninety-seven pharmacists (male 53.6% and female 46.4%) completed the survey. More than three-fourths of the participants (78.4%) know the ADR reporting system. The survey was completed by 97 pharmacists (male 53.6% and female 46.4%). More than three-quarters of the participants (78.4%) were aware of the ADR reporting system, and the majority (70.8%) were aware that it is done using an online system. Still, only 56.7% knew that the Saudi FDA is the regulatory agency collecting ADR data in Saudi Arabia. Furthermore, 73.2% cited stress in the workplace as a critical deterrent to reporting. Most respondents (76.3%) had an unfavorable attitude about reporting ADRs. CONCLUSIONS: Pharmacists understand ADR reporting, but most lack the mentality to report the incidents. As a result, comprehensive and ongoing training for pharmacists is required to raise awareness on the need for ADR reporting. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Breast cancer is the most common malignancy in Kingdom of Saudi Arabia (KSA) and an increasing burden in terms of incidence, morbidity and mortality. It accounts for about 28.7% of all new cancers in women. In 2015, the Saudi cancer registry shows that breast cancer was graded first among women and it accounts for 16.7% of all cancers reported among Saudi nationals. This study was designed to assess breast cancer screening knowledge and practices among women in the Asir region, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study recruiting 1,021 female participants was performed. The variables included breast cancer knowledge, socio-demograph-ic features, breast self-examination knowledge and practice. Descriptive statistics was used to compare and analyze the collected data while chi-square test was used to check the statistical significance among the selected variables. Saudi married women from Asir region were the participants of this cross-sectional study. ReSULTS: Our findings suggested that participants had a satisfactory level of knowledge about breast self-examination and mammo-grams at a rate of > 90% and 44.76% respectively. Over 90% of participants had good breast self-exam knowledge, however, only 6.37% was always performed breast self-examination. Similarly, nearly 40% of participants performed mammograms, while 40.5% were unaware. Leaflets and doctors were the primary sources of information for participants regarding the information of breast cancer screening. CONCLUSIONS: Breast self-examination is a crucial approach to the timely detection of breast cancer and is subsequently critical for effective treatment. From the findings of this study we concluded that most women in the Asir region have a good awareness of breast cancer screening methods. However, either screening of self-examination or mammogram for breast cancer was not carried out thoroughly and regularly. This means that we must continue to emphasize the importance of primary health care in the earliest stages of breast cancer. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a prevalent global health issue affecting millions of patients worldwide, impacting quality of life, impeding physical and psychological well-being, causing financial stress, and increasing mortality rates. This study aimed to highlight the prevalence of CKD and its associated risk factors across Saudi Arabia., Method: This is a cross-sectional study conducted from 2015 to 2022, using data from 42 branches of a major network of diagnostic laboratories in Saudi Arabia, covering the country's 13 administrative areas., Results: The mean age was 40.35 ± 14.5 years. The highest proportion of participants resided in the Makkah region at 35.77%, followed by the Riyadh region at 25.75%. The overall prevalence of CKD was 4.76%, with most having CKD in stage 3 (3.5%). The prevalence of CKD was higher among males compared to females (5.83% vs. 3.88%) and increased significantly with age, being 0.45% among participants aged 18-29 years and reaching 50.94% among participants aged 90 years or older. Predictors of CKD included increasing age, male sex, administrative area (Makkah 1.40 [95% CI:1.26-1.55], Jazan 1.34 [95% CI:1.18-1.52], Najran 0.47 [95% CI, 0.39-0.57], Alqasim 0.73 [95% CI, 0.64-0.82]), and a high hemoglobin A1C. CKD in Saudi Arabia is influenced by various demographic and geographic determinants contributing to its prevalence and associated burden on the population., Conclusion: These findings emphasize the need for targeted screening and prevention strategies, especially for at-risk populations. Continued surveillance, early detection, and effective management are crucial to reducing CKD's burden and improving kidney health outcomes in Saudi Arabia. Further research is essential to better understand the disease's regional and demographic drivers., Competing Interests: Declarations. Ethics approval and consent to participate: The King Khalid University committee of research ethics granted ethical approval for this study on 19–02-2023 with the approval number ECM#2023–708. The study further received ethical approval from the Unit of Biomedical Ethics in Alborg Laboratory, under IRB Approval Number No08/23. Consent to participate was waived from our study due to the nature of the study and approved from The King Khalid University committee of research ethics with the approval number ECM#2023-708. The use of human tissue samples must confirm that all experiments were performed in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Sleep is an active process that affects human health and quality of life. Sleep is essential for learning and memory consolidation. Good sleep is required for good academic performance. Sleep disorders are common among medical students, due to the high academic load, stressful life, and hectic schedule. Therefore, this study aims to assess sleep quality among medical students., Methods: A cross-sectional study was conducted among medical students at King Khalid University by using the Pittsburgh sleep quality index (PSQI) to assess sleep duration, sleep efficiency, sleep latency, and global PSQI score. Participants were enrolled from second to sixth year. Bivariate and multivariate logistic regression were used to predict factors related to poor sleep quality., Results: Out of 514 medical students, 453 (88.1%) of students exhibited poor sleep quality. Fourth year students were less likely to have poor sleep quality (AOR, 0.381; CI, 0.158-0.934) p = 0.035 and students with regular sleep schedule were more likely to be good sleepers (AOR,0.349; CI, 0.129-0.940) p = 0.037. Additionally, students who had more than five courses per semester more frequently had daytime sleepiness p = 0.03. However, Insufficient sleep was not significantly affected by factors like gender, different age groups, number of courses per semester, daytime sleeping, and students with varying Grade Point Averages (GPA)., Conclusion: Poor sleep quality is common among medical students, which may affect academic performance and general health. It is essential to educate them about good sleep hygiene and time management skills., Competing Interests: Declarations. Ethics approval and consent to participate: Prior to data collection, all participants provided written informed consent, ensuring they were fully aware of the study’s purpose, procedures, and potential risks. The methods employed in this investigation comply with the principles of the Helsinki Declaration on human subjects research. This study received approval from the Research Ethics Committee at King Khalid University (HAPO-06-B-001), approval no. ECM#2020 − 1203, ensuring rigorous ethical standards were met throughout the research process. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interests: The authors declare that there are no potential conflicts of interest regarding the research, authorship and/or publication of this article. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: The erythrocyte sedimentation rate (ESR) is a widely used haematological test that indirectly measures inflammation in the body. It is influenced by various factors, including age, sex, and physiological condition. Altitude is another critical factor due to its impact on red blood cell physiology and plasma protein composition. This study aims to evaluate how altitude influences ESR values in the Saudi Arabian population, considering demographic and clinical variables., Methods: This cross-sectional study analyzed data from 158,539 participants collected from 42 commercial laboratory branches across 13 administrative regions in Saudi Arabia from 1 January 2015 to 31 December 2022. Participants were categorized based on city altitude and demographic characteristics including body mass index (BMI), alanine transaminase (ALT), chronic kidney disease (CKD), glycated haemoglobin (HbA1c), and thyroid-stimulating hormone (TSH) level. Univariate and multivariate logistic regression models were used to assess the factors influencing elevated ESR., Results: The study analyzed 158,539 participants, with an equal sex distribution (49.9%) and a mean age of 40 years. The adjusted model results showed a CKD prevalence of 3%, with a higher prevalence at lower altitudes (3.8% at 0-500 meters). ESR levels were significantly influenced by sex, age, altitude, and clinical measurements. Males were less likely to have elevated ESR than females (odds ratio (OR) = 0.470, 95% confidence interval (CI): 0.440-0.510, p < 0.001). Older age was a strong predictor of elevated ESR, with those aged 90+ at a fourfold higher risk (OR = 4.540, 95% CI: 1.410-14.548, p = 0.011). Higher altitude was associated with reduced ESR, with an odds ratio of 0.660 (95% CI: 0.560-0.769, p < 0.001) above 2000 meters., Conclusion: Altitude significantly impacts ESR values, highlighting the need for altitude-specific reference ranges to improve diagnostic accuracy in high-altitude regions. The results also emphasize the importance of considering demographic and clinical factors when interpreting ESR. These findings can guide clinicians in refining diagnostic algorithms and optimizing patient management strategies in diverse geographical settings.

The increasing cost of prescription drugs has high concern and associated with medication nonadherence and adverse health outcomes. The use of generic prescription drugs by the patients depends on if recommended by competent healthcare providers. Generic medicines, which are cheaper and bioequivalent to brand-name drugs, offer an opportunity to reduce healthcare expenditures of Saudi Arabia's healthcare system as per the Vision 2030 plan. Therefore, the current study was conducted to assess the population awareness, attitude and perception towards the generic medications particularly those locally manufactured in Saudi Arabia. We managed a cross-sectional, questionnaire-based study and included indices like demographic sections, knowledge of generic medications, perception of generic medication use, and previous experience. Data was collected over 12 weeks from February 2022 to April 2022 using an online survey tool. A study of 462 participants found that the majority were male (54.97%), young (55.4%), with a graduate or post-graduate degree (73.5%) and employed (43.29%). The majority reported good health, with 75.5% reporting good health. The study found significant differences in knowledge about generic drugs, their country of origin, and their benefits and utility. Most participants had positive attitudes towards generic medications, with 45% believing they are as effective as those from other countries. The study also revealed a significant difference in participants' experience and usage of medications particularly satisfaction to health outcome. Enhancing healthcare professionals' perceptions of generics can positively influence patient/consumer opinions and trust in generic medicines. Patients' high trust in prescribing physicians also influences these opinions, as their opinions can influence patient/consumer opinions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Akhtar, Orayj. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This research aimed to study the knowledge, attitudes, and practices (KAP) toward physical activity (PA) of healthcare students at King Khalid University in Abha, Saudi Arabia., Methods: A prospective web-based cross-sectional study was carried out among healthcare students of King Khalid University from March to May 2024. The questionnaire contained questions on sociodemographic details, five questions about knowledge, eight questions about attitudes, and seven practice-related questions. A multivariable logistic regression analysis was used., Results: Out of the 383 participants, 175 (45.7%) were men and 208 (54.3%) were women. Most of the students, 292 (76.2%), had a body mass index (BMI) of 18.5-24.9. Among the 383, 264 (68.9%) showed good knowledge, 288 (75.2%) had positive attitudes, and 242 (63.2%) had satisfactory PA practice. Most of them, 310 (80.9%), were aware that "regular exercise helps promote strong bones and muscles." Three hundred and fifty-two (91.9%) students believed that individuals who frequently engaged in PA had longer lifespans. More than half of the students ( n  = 239, 62.4%) engaged in the recommended level of PA. Of the students, 179 (46.8%) agreed that they planned to begin increasing their physical activity during the next 6 months. One hundred and fifty-six (40.7%) stated that they did sports with a high level of intensity for 20 min, three to five times a week, and 175 (45.7%) stated that they did moderate-intensity sports for 30 min, more than five times a week. None of the independent variables had a significant effect on good knowledge levels ( p  > 0.05). The regression results show being male OR = 0.473 (CI 0.285-0.783 p  = 0.004), and being a first-or third-year student OR = 0.329 (CI 0.130-0.832 p  = 0.013), OR = 0.276 (CI 0.100-0.762 p  = 0.019) has a significant effect on positive attitude levels, while being male OR = 1.945 (CI 1.207-3.135 p  = 0.006) and having a BMI between 18.5 and 24.9 OR = 10.101 (CI 2.104-48.49 p  = 0.004) has a significant effect on satisfactory practice levels., Conclusion: The majority of participants in our study showed good knowledge and positive attitudes toward PA. A lower number of participants, though still the majority, had satisfactory levels of PA. Health education and health promotion initiatives should maintain and enhance knowledge of the positive effects of PA on health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kandasamy, Almanasef, Almeleebia, Orayj, Viswanath Reddy, Shorog, Alshahrani, Prabahar, Veeramani, Amirthalingam, Alqifari, Vasudevan, AlSaedi, Begum and Ahmed.)

Introduction: Musculoskeletal disorders (MSDs) are rapidly rising in Saudi Arabia, reaching levels similar to those in the Western world. Hence, we aimed to assess the prevalence of neck, shoulder, and lower back pains (musculoskeletal pain, MSP) among students at King Khalid University in Abha, Saudi Arabia., Methods: This cross-sectional study was conducted at King Khalid University in Abha, Saudi Arabia, from March 2023 to August 2023. Inclusion criteria were: university students aged 18 years and older of both sexes who agreed to participate in the study. The modified Nordic questionnaire was used, which comprised three parts., Results: Out of 536 respondents, 337 were women and 199 were men. The average body mass index (BMI) of the study population was 25.3 ± 4.01. In total, 223 (41.60%) had a history of MSDs. Only 232 (43.28%) of the population did regular exercise. According to multiple logistic regression analysis, factors associated with MSDs are mobile device use (with both hands) with a large neck tilt below the horizon line position (OR = 2.276, CI 1.178-4.397, p  = 0.014), family history of trauma (OR = 5.450, 95% CI 3.371-8.811, p  = 0.000), family history of MSDs (OR = 4.241, 95% CI 2.296-7.835, p  = 0.000), coffee consumption (OR = 1.967, CI 1.281-3.020, p  = 0.002), and time spent on electronic devices: 1-3 h (OR = 0.252, 95% CI 0.124-0.511, p  = 0.0001), 4-6 h (OR = 0.455, 95% CI 0.237-0.873, p  = 0.018), and 6-9 h (OR = 0.348, 95% CI 0.184-0.660, p  = 0.001)., Conclusion: The present study concludes that MSP among university students is high. A history of trauma, a family history of MSDs, the hand and neck position when using electronic devices, the amount of time spent using them, and regular exercise are risk factors that are strongly associated with MSP. There is strong evidence to suggest that increasing physical activity plays a significant role in enhancing the functionality of the musculoskeletal (MSK) system and alleviating pain. It is recommended that universities implement educational programs to raise awareness and health screenings about the impact of device usage on MSK health and the benefits of regular exercise., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kandasamy, Almanasef, Almeleebia, Orayj, Shorog, Alshahrani, Prabahar, Veeramani, Amirthalingam, Alqifari, Alrashidi, Aldurum, Almutiri, Alzaidi and Almutairi.)

Measuring patient safety culture in the community pharmacy can help with identifying areas for development. The current study is a descriptive, cross-sectional, electronic survey conducted among pharmacists working in community pharmacies located in the southern region of Saudi Arabia. The community pharmacy version of the "Pharmacy Survey on Patient Safety Culture" (PSOPSC) was used to collect data. The positive response rate (PRR) was calculated as per the guidance provided by the Agency for Healthcare Research and Quality (AHRQ). Based on the PRR, two least-achieved items (<25%) were taken for further analysis to identify the possible predictors. A sum of 195 pharmacists were included in this study and most of them were working in chain pharmacies. The highest PRRs were observed with teamwork (94.99), and patient counseling (94.13), followed by physical space and environment (93.07). The lowest PRRs were observed with staffing, work pressure, and pace (47.70), followed by communication openness (72.60). Specific characteristics, such as experience and the number of working hours, are significantly related to a poor PRR. The current study results indicate that the scope for improving patient safety exists in various areas of community pharmacies. However, it is necessary to prioritize the need based on a positive response rate.

This study aimed to evaluate Saudi Arabian public perceptions toward influenza and COVID-19 immunization during the flu season. A cross-sectional self-administered, structured, and closed-questionnaire online survey was conducted on the general public. A total of 422 people willingly participated in the survey using several social media platforms from 15 May to 15 July 2021. Residents of Saudi Arabia aged 18 or older (eligible for COVID-19 vaccination) were included in the study and willing to answer questionnaires. The 422 participants who agreed to participate in the study completed the questionnaire. Thirty-seven percent of the participants were youth (18-25 years). More than 80% of the participants in the study agreed or strongly agreed that flu and COVID-19 vaccines must be mandatory for all populations. At the same time, 42.4% considered that the COVID-19 vaccine might positively impact the public and the economy in the future. Participants confirmed to have had COVID-19 or the flu since the beginning of the outbreak totaled 21.3%. Of the participants, 54% had sufficient knowledge about vaccine types and safety. Most of our participants (54.9%) agreed that preventive measures were still required, even with the existence of vaccines. Our study provides an overview of COVID-19's influence on Saudi Arabia during the flu season. The Saudi Arabian government should consider preventive efforts to strengthen confidence in the health advantages offered by prospective immunization to prevent a twindemic of influenza and COVID-19.

Being in a rapidly changing and dynamic environment during the COVID-19 pandemic, individuals' perceptions change on a daily basis, and this starts to inform the status of knowledge, attitude, and practices (KAP) during the second wave of the pandemic., Aim: To assess the KAP on COVID-19 among students, teaching staff, and administrative staff in the Asir region for the first time., Methods: A questionnaire-based survey cross-sectional study was conducted from 10 February to 10 March 2021 using an online questionnaire., Results: In the survey of students and staff in educational institutes in the Asir region, the target population were well informed about COVID-19; in 10 out of 13 questions, more than 80% of the respondents answered correctly. The attitude of the target populations was quite positive. They were worried about the increase in the number of COVID-19 cases. The target populations were concerned (94.8%) for their kith and kin not to get infected. The target populations agree with the precautionary measures that were taken by Saudi authorities. A positive association was found between knowledge and practices as well as knowledge and attitudes of the target population. A significantly positive association was observed between attitudes and practices of the educational institutes' respondents in Asir, Saudi Arabia., Conclusion: The students and staff in educational institutes in the Asir region have a high level of knowledge about COVID-19, have a positive attitude toward it, take proper precautions against it, and are enthusiastic about the COVID-19 vaccine.

Pregabalin is a first-line therapy for neuropathic pain and for chronic pain. It has abuse potential. This study was conducted to assess community pharmacists' perceptions towards pregabalin abuse and misuse in the Aseer region, Saudi Arabia, and identify predictors and associated factors. A cross-sectional survey using a structured questionnaire following a self-administrative study was conducted across community pharmacies in the Aseer region (Abha, Khamis Mushait, Mahayel, Sarat Abeeda, Ahad-Rufaida, and Bishah). A total of 206 respondents from community pharmacists participated in the study. Over the last six months, 136 respondents (66.0%) suspected pregabalin abuse in community pharmacies; male dominance in pregabalin abusers was also recorded ( n = 165, 80.1%). Additionally, 40 (19.4%) respondents stated that a prescription was not issued for pregabalin demands. Over half (61.7%) of community pharmacists recorded an increased change in pregabalin abuse compared to the previous year. This is the first study to explore pharmacists' perceptions in the community of the Aseer region towards customers' misuse and abuse of pregabalin. Further monitoring and regulations on the prescribing and procurement of pregabalin are needed to avoid abuse.

Objectives: Although depression symptoms are common among patients with Parkinson's disease (PD), the medical literature still reports underrecognition of depression in patients with PD. Our main objective is to examine the trend of depression recognition during the first year of PD diagnosis using large population data., Methods: We conducted a population-based study of residents in Wales, using the Secure Anonymized Information Linkage (SAIL) Databank. We included newly diagnosed patients with PD aged 40 years or older with a first PD diagnosis between 2000 and 2015. Depression and antidepressants related data were extracted from SAIL. A series of multilevel logistic regressions were run to determine the factors affecting depression recognition. The results were presented using odds ratios (ORs) with 95% confidence intervals (CI)., Results: The study included 6596 patients with PD. About 38% of patients had a recorded code of antidepressants, depression diagnosis, or both within the first year of PD diagnosis. There was a significant association of depression diagnosis, antidepressant use, or both with the year of PD diagnosis (OR 0.972, 95% CI 0.962-0.983). We also found that patients who used monoamine oxidase inhibitors (MAO-B inhibitors) were associated with a lower depression diagnosis, use antidepressants, or both, compared to those who did not use MAO-B inhibitors (OR 0.769, 95% CI 0.627-0.943)., Conclusion: There is a slight decrease in depression recognition in PD patients between 2000 and 2015, which could be due to an increase in depression recognition during the prodromal phase of PD., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Purpose: This study investigated the 1-year risk of ischemic heart disease (IHD), all cardiovascular events, and all-cause mortality among newly diagnosed Parkinson's disease (PD) patients who used antidepressants compared to those who did not., Patients and Methods: Patients with PD aged 40 years or older were identified using data from 2000 through 2016 held within the Welsh Secure Anonymized Information Linkage (SAIL) databank. Antidepressant users were propensity-score matched 1:1 with non-users, adjusting for patients' demographics, socioeconomic status, and multiple comorbidities. Cox proportional hazard regression analyses were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the antidepressants and the study outcomes. The follow-up period was 1 year after the initial prescription of antidepressants., Results: The study group comprised a total of 3364 participants, with numbers split equally between the antidepressant-user and non-user groups, based on the propensity score-matching process. Overall, the propensity score-adjusted model showed that antidepressant usage in PD patients was not significantly associated with the risk of IHD (HR = 1.05; 95% CI 0.63-1.75) or all cardiovascular events (HR = 1.01; 95% CI 0.71-1.45) compared to non-users. The propensity score-adjusted model also showed that the use of any antidepressant, regardless of its category, was not statistically significantly associated with all-cause mortality (HR = 0.81; 95% CI 0.65-1.02). However, this association reached statistical significance in the multivariate adjusted model (HR = 0.67; 95% CI 0.54-0.84)., Conclusion: There was no evidence that antidepressant use was associated with an increased risk of IHD or all cardiovascular events in newly diagnosed PD patients who suffered from depression. Furthermore, antidepressant use might reduce the mortality rate in PD patients during the first year after initiation., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)

Purpose: Observational studies have examined the association between antipsychotics and ischemic heart disease (IHD) in general populations, but results did not take into account other comorbid diseases, such as Parkinson's disease (PD). This study investigates the one-year risk of IHD, all cardiovascular events, and all-cause mortality among newly diagnosed PD patients who used antipsychotics compared to non-users., Materials and Methods: This study included individuals aged 40 years or older with a first definitive PD diagnosis Read Code in the Secure Anonymised Information Linkage (SAIL) databank who had been initiated on any PD medication between 2000 and 2016. Antipsychotic users were matched 1:1 with non-users by a propensity score model to control the confounding effects of patients' demographics, social deprivation status, comorbidities, and medication history. Cox regression was performed to calculate the hazard ratios (HR) and 95% CIs for the association between antipsychotics and study outcomes., Results: A total of 1837 participants were included in the analysis. Users of first-generation antipsychotics (FGA) were significantly more likely to develop IHD compared to non-users, with an HR of 2.60 (95% CI 1.103-6.167). Among the FGAs, haloperidol had the highest likelihood of IHD developing, with an HR of 3.01 (95% CI 1.038-8.729). Any use of antipsychotics, regardless of whether they were FGA or second-generation antipsychotics (SGA), was linked to all-cause mortality, with an HR of 4.201 (95% CI 3.272-5.394). When subdividing antipsychotics into FGAs and SGAs, mortality was more likely in FGA users, with an HR of 7.557 (95% CI 5.633-10.139). Mortality also occurred in SGA users, but with a lower HR of 3.278 (95% CI 2.509-4.282)., Conclusion: FGAs were associated with an increased risk of IHD and all-cause mortality in newly diagnosed PD patients with psychosis. This finding emphasizes the need to use antipsychotics with caution in PD patients with psychosis., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)

Purpose: During examinations, many students use various over-the-counter (OTC) drugs to improve their concentration or treat exam-related medical symptoms. The purpose of this study was to scrutinize the use of OTC drugs during examinations in Saudi Arabia., Materials and Methods: A cross-sectional study was designed, consisting of online, self-administered questionnaires comprising 27 items, including the awareness, knowledge, and attitude of students toward OTC drug use during examinations. A logistic regression model was fitted to determine factors that predict OTC drug use. The data were analyzed using Statistical Package for Social Science (SPSS)., Results: A total of 463 (92.6%) completed questionnaires were received from 500 recruited participants. Among participants, 58.5% were women, 47.9% were 22 years or older and completing their final year of study, and 44.1% of students preferred not to disclose their monthly income. The most common cause (35.6%) for OTC drug use during the examination period was headache, followed by pain (21%), fever (16.6%), and cough (8.2%). The most commonly used medication were painkillers, antipyretics, cough and cold medications, and vitamins (57.2%, 16.4%, 11%, and 7.3%, respectively). Male students showed a significant lack of awareness and knowledge regarding the safety and reasons for OTC drug use compared with their female counterparts and were less likely to read the medication leaflet before use (p < 0.001, odds ratio [OR]: 0.36, confidence interval [CI]: 0.23-0.57) and did not know which drugs require prescriptions (p < 0.001, OR: 0.41, CI: 0.27-0.63). Other significant factors that predicted OTC drug use included age, university level, and drug income., Conclusion: The most common reported cause for OTC drug use during examinations among students was headache. Sex, age, university level, and monthly income were significant factors affecting OTC drug use during examinations., Competing Interests: The authors reported no conflicts of interest for this work., (© 2021 Orayj et al.)

Purpose: Psychosis is very common in later stages of Parkinson's disease (PD) patients, but its prevalence in newly diagnosed patients is not rare. The use of antipsychotics in PD patients is complex given their association with worsening Parkinsonian motor symptoms and increased mortality rate. This study aims to examine factors that affect the use of antipsychotics in newly diagnosed PD patients and to identify changes in prescribing over time., Patients and Methods: The Secure Anonymized Information Linkage (SAIL) databank was used to identify a cohort of newly diagnosed PD patients aged 40 years and older in Wales. The cohort was longitudinally examined over 17 years to determine the incidence of new antipsychotic use. Logistic regression models were used to analyze the data and were adjusted for several potential confounding variables., Results: A total of 9142 PD patients were identified after applying inclusion and exclusion criteria, of whom 58.6% were male. During the first year of PD diagnosis, 12% of the patients developed psychosis and were prescribed antipsychotics. Quetiapine was the most commonly prescribed (49%), followed by risperidone (10.7%). The use of antipsychotics in newly diagnosed PD patients was significantly lower in the years 2009-2016 compared to 2000-2008 (OR 0.37, 95% CI 0.32-0.43). Other significant prescribing factors included patient's age and history of dementia., Conclusion: A dramatic decline in antipsychotic use was identified across years, showing adherence to warnings against use of antipsychotics for PD patients. Given that psychosis is prevalent in PD patients, the continuous assessment of the safety risks of antipsychotics is a matter of priority., Competing Interests: The author reports no conflicts of interest in this work., (© 2021 Orayj.)

First line treatment for Parkinson's disease (PD) is typically either L-dopa or a non-ergot dopamine agonist (DA). However, the options for the treatment of motor symptoms in PD patients have increased in the last thirty years, which have seen several new classes of PD medications introduced onto the market. The purpose of this study is to examine the changes in first line therapy of newly diagnosed Parkinson's patients between 2000 and 2016 in Wales. A population-based study evaluated data from the Secure Anonymised Information Linkage (SAIL) Databank of residents in Wales, aged 40 years or older, newly treated with PD medications between 2000 and 2016. The data was compared across three intervals: 2000-2005, 2006-2011 and 2012-2016. Patients were classified by age at diagnosis into young: 40-60 years; mid, 61-80 years; and older >80 years. Logistic regression was undertaken to determine the predictors of PD medication prescribing. For the whole study period, the profiles of 9142 newly diagnosed PD patients were analysed. L-dopa was the most common first line therapy (80.6%), followed by non-ergot DAs (12.9%) and monoamine oxidase B (MAO-B) inhibitors (7.9%). Odds of L-dopa prescribing were greater in patients >80 years (OR = 20.46 95%CI: 16.25-25.76) and in the period 2012-2016 (OR = 1.98 95% CI: 1.70-2.29). Prescribing of non-ergot DAs significantly declined in 2012-2016 (OR = 0.42 95% CI: 0.35-0.49). Additional factors influencing first line therapy were deprivation, presence of diabetes and prior use of antidepressants. For example, PD patients residing in the least deprived area were less likely to be prescribed L-dopa compared to patients residing in the most deprived area (OR = 0.77 95% CI: 0.65-0.93). First line therapy in PD in Wales has undergone a significant switch towards L-dopa over the last 16 years. The data indicates reasonable compliance with guidelines on efficacy and safety issues related to Parkinson's medications., (© 2021 The Authors.)

Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2 nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2019 Khalid Orayj and Emma Lane.)