Assessing Mental Illness Referral Request Acceptance: A Nationwide E-Referral Data From Saudi Arabia

Abdullah A Alharbi,1 Nawfal A Aljerian,2– 4 Hani A Alghamdi,5 Meshary S Binhotan,4,6 Ali K Alsultan,2 Mohammed S Arafat,2 Abdulrahman Aldhabib,2 Ahmed I Aloqayli,2 Eid B Alwahbi,2 Ronnie D Horner7 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Kingdom of Saudi Arabia; 2Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; 3Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia; 4King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia; 5Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 6Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 7Health Services Research and Administration Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USACorrespondence: Meshary S Binhotan, Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 22490, Kingdom of Saudi Arabia, Email [email protected] and Objective: Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC’s effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates.Methods: This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals.Results: The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15– 25 years (aOR = 0.84; 95% CI = 0.70– 0.99) and 46– 65 years (aOR = 0.83; 95% CI = 0.70– 0.99) compared to ages 26– 35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51– 4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17– 1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42– 0.64).Conclusion: SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system’s selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.Keywords: mental health, psychiatry, referral systems, acceptance rates, health policy, Saudi Arabia, regional variation, Saudi Medical Referral Cente

The Burden of Obesity in Saudi Arabia: A Real-World Cost-of-Illness Study

Mouaddh Abdulmalik Nagi,1,2 Ziyad Saeed Almalki,3,* Montarat Thavorncharoensap,4,5,* Sermsiri Sangroongruangsri,4 Saowalak Turongkaravee,4 Usa Chaikledkaew,4,5 Abdulhadi M Alqahtani,6 Lamis S AlSharif,6 Ibrahim A Alsubaihi,7 Abdulaziz I Alzarea,8 Mohammed M Alsultan9 1Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 2Department of Pharmacy, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen; 3Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Riyadh - Al-Kharj, Saudi Arabia; 4Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 5Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand; 6Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; 7Department of Clinical Trials Support and Development, Saudi National Institute of Health, Riyadh, Saudi Arabia; 8Department of Clinical Pharmacy, Al-Jouf University College of Pharmacy, Sakaka, Saudi Arabia; 9Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia*These authors contributed equally to this workCorrespondence: Ziyad Saeed Almalki, Department of Clinical Pharmacy, Prince Sattam bin Abdulaziz University, P.O. Box: 173, Riyadh - Al-Kharj, 11942, Saudi Arabia, Email [email protected] Montarat Thavorncharoensap, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand, Email [email protected]: The rising prevalence of obesity in the Kingdom of Saudi Arabia (KSA) poses a significant public health challenge. Estimates of the economic cost of obesity are crucial for prioritizing healthcare interventions, guiding policy choices, and justifying budget allocations aimed at reducing obesity prevalence. This study aimed to estimate the cost of obesity in the KSA in 2022.Methods: A prevalence-based cost-of-illness approach was used to determine the cost of obesity. This analysis encompasses 29 diseases, namely obesity and twenty-eight diseases attributable to obesity. Both direct and indirect costs were considered. The annual cost of treatment for each obesity-attributable disease was obtained from the hospital records of one tertiary hospital in the KSA. Data on direct non-medical costs were obtained from the patient survey. The human capital approach was used to estimate the indirect costs of morbidity and mortality.Results: The total economic burden of obesity (2022 values) was estimated at US$116.85 billion from a societal perspective and US$109.67 billion from a healthcare system perspective. From a societal perspective, the total direct medical cost accounted for the largest portion of the total cost (94%). In terms of direct medical costs, the cost of treating diseases attributable to obesity was substantially greater than the cost of treating obesity itself. According to the sensitivity analysis, the total cost ranged from 3.4% of the country’s Gross domestic product (GDP) when the unit cost of treatment was reduced by 74% to 9.5% of the country’s GDP when the prevalence of obesity and its comorbidities was reduced by 5%.Conclusion: Obesity imposes a substantial economic burden on the healthcare system and society in the KSA. Interventions aimed at promoting healthier lifestyles to reduce the prevalence and incidence of obesity and its comorbidities are highly warranted to alleviate the impact of obesity in the country.Keywords: body mass index, cost-of-illness, economic burden, obesity, Saudi Arabi

Active and Passive Immunization Protects against Lethal, Extreme Drug Resistant-Acinetobacter baumannii Infection

Extreme-drug-resistant (XDR) Acinetobacter baumannii is a rapidly emerging pathogen causing infections with unacceptably high mortality rates due to inadequate available treatment. New methods to prevent and treat such infections are a critical unmet medical need. To conduct a rational vaccine discovery program, OmpA was identified as the primary target of humoral immune response after intravenous infection by A. baumannii in mice. OmpA was >99% conserved at the amino acid level across clinical isolates harvested between 1951 and 2009 from cerebrospinal fluid, blood, lung, and wound infections, including carbapenem-resistant isolates, and was ≥89% conserved among other sequenced strains, but had minimal homology to the human proteome. Vaccination of diabetic mice with recombinant OmpA (rOmpA) with aluminum hydroxide adjuvant markedly improved survival and reduced tissue bacterial burden in mice infected intravenously. Vaccination induced high titers of anti-OmpA antibodies, the levels of which correlated with survival in mice. Passive transfer with immune sera recapitulated protection. Immune sera did not enhance complement-mediated killing but did enhance opsonophagocytic killing of A. baumannii. These results define active and passive immunization strategies to prevent and treat highly lethal, XDR A. baumannii infections

Valorization of walnut shell ash as a catalyst for biodiesel production

The catalytic activity of the walnut shell ash was investigated in the biodiesel production by the sunflower oil methanolysis. The catalyst was characterized by the TG-DTA, XRD, Hg porosimetry, Ny physisorption, SEM, and Hammett method. In addition, the effects of the catalyst loading and the methanolto-oil molar ratio on the methyl esters synthesis were tested at the reaction temperature of 60 degrees C. The walnut shell ash provided a very fast reaction and a high FAME content (over 98%). As the reaction occurred in the absence of triacylglycerols mass transfer limitation, the pseudo-first-order model was employed for describing the kinetics of the reaction. The catalyst was successfully reused four times after the regeneration of the catalytic activity by recalcination at 800 degrees C

Post-Arab Spring: The Arab World Between the Dilemma of the Nation-State and the Rise of Identity Conflicts

The Arab world is one of the most volatile regions in the world suffering from identity conflicts. These conflicts, which revolve around religious, sectarian, ethnic, and tribal issues, represent the other side of the crisis of nation-state building in the Arab world in the postindependence era. Although identity conflicts are not new to the region, they have intensified after the US invasion of Iraq in 2003 and the revolutions of the so-called Arab Spring. These two events revealed the deep crisis of the nation-state, thereby highlighting the failure of the postindependence ruling elites to establish nation states that can maintain a position of legitimacy and effectiveness. Being both legitimate and effective enables a state to include religious, sectarian, ethnic, and tribal pluralism within the framework of its national identity, based on the foundations and principles of citizenship, rule of law, respect for human rights, minority rights, and social justice.Additionally, identity conflicts are linked to two other factors that escalated after the US invasion of Iraq and the events of the “Arab spring.” First, was the increased politicization of religious, sectarian, and tribal affiliations, which was used to serve political ends, either by ruling regimes, political parties, or non-state actors. Second, is the current expansion of the political polarization between the forces of political Islam which rose rapidly after the “Arab spring” on one hand and the liberal, leftist, and national civil forces on the other hand. This polarization reflects the deep gap between the advocates of the “religious state” and the advocates of the “civil state.” The purpose of this chapter is to analyze and interpret the dimensions of the relationship between the deep crisis of the nation–state and identity conflicts in the post-Arab spring era

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population