Feasibility of National Health Insurance for Saudi Healthcare Services: Qualitative Study

In this paper, we determine the advantages and disadvantages of implementing the NHI system. The Kingdom of Saudi Arabias (KSA) health-care system is funded by oil earnings and is free at the point of delivery. Because of rising expenditures and rising oil market volatility, this system is being increasingly stressed. Based on face-to-face interviews, the goal of this work is to examine qualitatively the advantages, challenges, and variables related to the implementation of the National Health Insurance (NHI) system in Saudi Arabia. Interviews were performed to gather qualitative data on the advantages, challenges, and issues connected with the implementation of the NHI system in the Kingdom of Saudi Arabia. For the qualitative data analysis, an Atlas.ti.8 version was chosen. The implementation of the National Health Insurance- NHI, TAKAFUL type following the formation of high levels of citizen awareness, the installation of an administrative control center, and the building of a robust healthcare infrastructure is the researchs ultimate proposal. Based on the nature of Saudi residents and their level of satisfaction with present public healthcare facilities, this is a viable alternative scheme

Feasibility of National Health Insurance for Saudi Healthcare Services: Qualitative Study

In this paper, we determine the advantages and disadvantages of implementing the NHI system. The Kingdom of Saudi Arabias (KSA) health-care system is funded by oil earnings and is free at the point of delivery. Because of rising expenditures and rising oil market volatility, this system is being increasingly stressed. Based on face-to-face interviews, the goal of this work is to examine qualitatively the advantages, challenges, and variables related to the implementation of the National Health Insurance (NHI) system in Saudi Arabia. Interviews were performed to gather qualitative data on the advantages, challenges, and issues connected with the implementation of the NHI system in the Kingdom of Saudi Arabia. For the qualitative data analysis, an Atlas.ti.8 version was chosen. The implementation of the National Health Insurance- NHI, TAKAFUL type following the formation of high levels of citizen awareness, the installation of an administrative control center, and the building of a robust healthcare infrastructure is the researchs ultimate proposal. Based on the nature of Saudi residents and their level of satisfaction with present public healthcare facilities, this is a viable alternative scheme

Portulaca oleracea Linn seed extract ameliorates hydrogen peroxide-induced cell death in human liver cells by inhibiting reactive oxygen species generation and oxidative stress

Purpose: To investigate the protective effects of Portulaca oleracea seed extract (POA) against cytotoxicity, oxidative stress and reactive oxygen species (ROS) generation induced by hydrogen peroxide (H2O2) in human liver cells (HepG2).Methods: The extract (POA) was obtained by ethanol extraction of P. oleracea seeds. Cytotoxicity in HepG2 cells was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, neutral red uptake (NRU) assay and morphological changes. The cells were pre-exposed to noncytotoxic concentrations (5 - 25 μg/mL) of POA for 24 h, and then cytotoxic (0.25 mM) concentration of H2O2. After 24 h of exposure, MTT and NRU assays were used to evaluate cell viability, while morphological changes were assessed using phase contrast inverted microscopy. The effect of POA on reduced glutathione (GSH) level, lipid peroxidation (LPO), and ROS generation induced by H2O2 was also studied.Results: The results showed that pre-exposure to POA (25 μg/mL) significantly (p <0.01) attenuated the loss of cell viability by up to 38 % against H2O2-induced oxidative stress and ROS generation. In addition, POA (25 μg/mL) significantly (p <0.01) increased GSH level (31 %), but decreased the levels of LPO (37 %) and ROS generation (49 %).Conclusion: This study demonstrates that POA has the capacity to protect HepG2 cells against H2O2- induced cell death by inhibiting oxidative stress and ROS generation.Keywords: Portulaca oleracea, HepG2 cells, Cytotoxicity, Oxidative stress, Reactive oxygen specie

Literature review on the efficacy of near-infrared device in improving peripheral venous access time and number of attempts in pediatric patients

IntroductionThe process of peripheral venous access (PVA) in children can be challenging for the patient and the clinician, as failed attempts often exceed the recommended two insertions, which can be painful. To speed up the process and increase success, near-infrared device (NIR) device technology has been introduced. This literature review aimed to investigate and critically evaluate the impact of NIR devices on the number of attempts and the time of the catheterization procedure in pediatric patients from 2015 to 2022.MethodsAn electronic search was performed to identify studies in PubMed, Web of Science, Cochrane Library, and CINAHL Plus, from 2015 to 2022. After applying eligibility criteria, seven studies were considered for further review and evaluation.ResultsThe number of successful venipuncture attempts ranged from 1 to 2.41 in control groups and from 1 to 2 in NIR groups. The procedural time required for success ranged from 37.5 s to 252 s in the control group and from 28.47 s to 200 s in the NIR groups. The NIR assistive device could be successfully used in preterm infants and children with special health care needs.ConclusionsWhile more research is needed to examine the training and application of NIR in preterm infants, some studies have shown improvement in placement success. The number of attempts and time required for a successful PVA may depend on several alternative factors, including general health, age, ethnicity, and knowledge and skills of healthcare providers. Future studies are expected to investigate how the level of experience of a healthcare provider performing venipuncture influences the outcome. More research is needed to explore additional factors that predict the success rate

Sickle Cell Illness Awareness among the General Public

Background: Lifelong ickle cell disease (SCD), a group of inherited blood disorders, afflicts millions of individuals. Sickle cell disease (SCD), with a global prevalence of 112 cases per 100,000 individuals, frequently gives rise to this condition. Sickle Cell Disease (SCD) exhibits a high prevalence in various regions, including Sub-Saharan Africa, Saudi Arabia, India, South and Central America, as well as the Mediterranean. We conducted a study in Tabuk, Saudi Arabia to assess the level of public knowledge and awareness of Sickle Cell Disease (SCD). Methods: The present study employed a cross-sectional observational design, encompassing a sample of 386 individuals residing in Tabuk, who were over the age of 18 and represented both genders and various nationalities. Demographic data and sickle cell disease awareness were obtained through the utilization of a structured questionnaire that was developed from previous research. Results: The present study included a total of 386 adults residing in Tabuk, Saudi Arabia, who satisfied the predetermined inclusion criteria. Among the participants, 47.4% fell between the age range of 18 to 25 years. The majority of participants had a satisfactory level of knowledge, with 24.1% of individuals aged 18-25, 10.1% of those aged 26-35, 7.3% and 6.55% of individuals aged 36-45, and a significant proportion of participants aged over 45. Conclusion: The survey participants demonstrated a satisfactory degree of understanding on the prevalence of sickle cell disease (SCD) in the Kingdom of Saudi Arabia (KSA).&nbsp

Impact of Smoking Exposure on Pregnancy and Perinatal Outcome Among Saudi Women: A Cross-Sectional Study

Objective: To assess the impact of smoking exposure on pregnancy and perinatal outcomes among Saudi women. Methods: This research will employ a cross-sectional study design to assess the impact of smoking exposure on pregnancy and perinatal outcomes among Saudi women. Cross-sectional studies are particularly suitable for examining associations and prevalence within a defined population at a specific point in time. In this case, the study aims to collect data on smoking behavior, pregnancy history, and perinatal outcomes among a representative sample of Saudi women in healthcare facilities across different regions of the country. The cross-sectional design allows for the efficient collection of data from a diverse population, providing insights into the relationship between smoking and perinatal outcomes without the need for long-term follow-up. Results: The study included 450 participants. The most frequent age among them was 35 and more years (n= 309, 68.7%) followed by 30-34 (n= 94, 20.9%). The most frequent educational level among study participants was the university (n= 408, 90.7%) followed by the school (n= 39, 8.7%). The most frequent job among study participants was a Governmental job (n= 159, 35.3%) followed by a housewife (n= 135, 30%). Number of previous births among study participants with most of them having a previous birth (n= 396, 88%) followed by this is the first birth (n= 54, 12%). Number of previous pregnancies among study participants with most of them having a previous pregnancy (n= 408, 90.7%) followed by this is the first pregnancy (n= 42, 9.3%). Number of abortions among study participants with most of them nothing (n= 234, 52%) followed by there is (n= 216, 48%). Participants were asked about smoking. The most frequent were don’t smoke (n= 315, 70%) followed by smoking (n= 135, 30%). The most frequent exposure to smoking among them was yes (n= 333, 74%) followed by no (n= 117, 26%). Conclusion: Study results showed that most of the study participants are the university according to their educational level. Most frequencies of participants had a previous birth. Most of them don’t smoke in another hand most of them were exposed to smoking. In addition, most of the study participants had good social connection

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe