An epidemiological investigation of health-related behaviours among male high school adolescents in Riyadh, Saudi Arabia

PhD ThesisObjective: Little is known about health-related behaviours and their co-occurrence among male adolescents in Saudi Arabia. The main purpose of this study was to determine the prevalence of health related behaviours, and to investigate the associations between socio-demographic variables and health related behaviours and the clustering of health risk behaviours. Research Methods: A cross-sectional study using a self-completion anonymous questionnaire was undertaken between February and April, 2008. A stratified random sample of 1501 male adolescents was recruited from one private and public high school in each of the five districts in the city of Riyadh, Saudi Arabia. Main Outcome Measures: Prevalence and associations between health, social and demographic factors and health-related behaviours, including dietary behaviours, oral health, physical activity, smoking, violence, injuries and safety, and mental health factors. Results: The results of this study showed that only 24.2% and 39.9% of the students consumed fruit and vegetables on a daily basis (at least once every day), and only 7% and 13.7% ate fruit and vegetables 3 times or more every day. Also, only 52.4% consumed dairy products at least once every day and only 18.3% of the students consumed dairy products 3 times or more every day. 48.1% reported to not consume any fish products on any day of the week. About 48.7%, 60.2% and 25.2% of the students consumed sweets, soft drinks, and energy drinks at least once every day. The results of this study also showed that only 36.7% of students eat breakfast regularly (≥ 5 days per week). Eating breakfast regularly was positively associated with lower age, liking school, good academic performance, not eating high fat food every day, drinking soft drinks ≤ 1 time/day, drinking milk every day, low BMI, brushing teeth every day, physical activity ≥ 3 days/week, and not engaging in physical fights. Around half (51.3%) participants reported good teeth health status, 22.6% brushed their teeth two times daily, 29.7% brushed their teeth once daily, whereas 47.7% of the subjects do not brush their teeth daily and 54.3% never visited the dentist during the past year. About 29.5% of participants suffered teeth pain sometimes or most of the time and 16.4% missed some school days for this reason. Brushing teeth every day was positively associated with higher standards of parental education, attending private school, living district, good academic performance, liking school, visiting dentist during the last year, good teeth status, and not suffering from teeth pain. Only 18.4% of the students were physically active and only 65.2% participated in physical activity classes in schools. Regular physical activity was positively associated with younger age, liking school, good health status, lower BMI, father’s, mother’s, siblings’ and peers’ physical activity, not smoking, not fighting, not wanting to use drugs or alcohol, and not feeling lonely. Over a third (36.3%) of the participants were overweight or obese. A fifth (20.8%) of the adolescents were current smokers. 20.8% of the students were current smokers. Smoking among students was positively associated with higher age, studying in private school, poor health status, poor school performance, not liking school, father smoking, mother smoking, sibling smoking, peers smoking, low physical activity, wanting to use drugs and alcohol, carrying weapons, fighting, performing car drifting, and being abused by teachers. ii Over half the sample (55.5%) reported an injury, 21.8% had been threatened or injured by weapons. Just under half (49%) of the adolescents reported they were involved in a physical fight. Moreover, fighting among students was positively associated with the interaction of low parental education, not liking school, poor academic performance, skipping breakfast, low physical activity, current smoking, being threatened or injured by weapons, carrying weapons, joining people performing car drifting, bullying others, being abused by teachers. Carrying weapons during the last 30 days was reported by 36.6% of the sample. Carrying weapons was positively associated with higher age, not liking school, poor academic performance, current smoking, fighting, being threatened or injured by weapons, performing car drifting, joining people performing car drifting, taking part in bullying others, and being abused by family. Some (26.1%) of participants reported having been bullied and 24.6% of the students reported bullying others. Many of the adolescents reported being abused by a family member (34.4%) or one of their school teachers (39.5%) during the past 12 months preceding the survey. During this time period, many of the students reported feeling lonely (22.8%), feeling very worried about something that they could not sleep at night sometimes or more (27.0%), and feeling very sad or hopeless almost every day for two weeks or more (40%). About 14% of the participants in this study reported that they had wanted to use alcohol or drugs. A small but notable proportion (13.9%) of the participants reported that they had thought of attempting suicide and 6.9% had actually attempted suicide. Over a third (36.1%) of adolescents had performed car drifting 12 months preceding the survey. However, car drifting was positively associated with higher age, attending a private school, not liking school, poor academic performance, not brushing teeth every day, current smoking, wanting to use drugs and alcohol, carrying weapons, joining people who performing car drifting, bullying others, and attempting suicide. The majority (78.7%) of participants drove vehicles and 96% and 97.7% reported that they did not use a seat belt when doing so and did not use a seat belt when riding in a car as a passenger, respectively. Only 2.1% and 1.4% of participants wore a helmet when used motorized vehicle or nonmotorized. Conclusions and implications: The results of this study reveal that the adolescents engage in multiple health-risk behaviours, and these risk behaviours are relatively common among adolescents and cluster together. Health related behaviours are associated with several socio-demographic variables (age, father’s and mother’s education, school factors, health status and living districts), although not necessarily in the same order. However, the data emphasized the need for further quantitative and indepth qualitative research throughout Saudi Arabia, including other cities, rural communities, female adolescents, and other Middle Eastern countries. Cross-sectional research to gather evidence on youth health to collect population-based data on a range of health-related behaviours along with physical and social environments amongst school-age students and out-of-school youth facilities are important and highly needed to investigate health-related behaviours and associated risk factors and to measure change over time

School safety and emergency preparedness in Saudi Arabia: a call for effective action

Accidents and injuries are a growing global public health problem. Both accidents and injuries can happen anytime and anywhere. Children and school personnel might experience medical emergency situations because of injuries, complications of chronic health conditions, or unexpected major accidents that occur in schools. A safe learning environment is essential for students, and without it they are unable to focus on learning the skills needed for a successful education and future development. There are about 6 million children younger than 18 years living in the kingdom of Saudi Arabia. Regrettably, many accidental tragedies occurred during the few last years in schools in Saudi Arabia which caused many forms of injuries and death among children and school teachers. Unfortunately, most schools lack a health care professional to respond to school medical emergencies. It is essential to believe that there is a fundamental link between emergency preparedness and disaster response. Therefore, schools that are prepared for an emergency are more likely to be prepared for complex events such as major fire, injury related accidents and natural disaster. The quality of schools about safety management and emergency preparedness is far worrying in Saudi Arabia. Thus, there is a need in creating a ‘‘culture of safety’’ and realize that injuries prevention and safety promotion are everybody’s business. The time has come to develop effective injury prevention strategies and promote safety that can help reduce the impact of injuries on the health of the Saudi population, economy and health care system. The issue of school safety must be a major concern at all levels of government. Efforts should be made to increase the education of school personnel in the assessment and management of safety and life-threatening emergencies, particularly head injury, cardiac arrest, suffocation and fire events

Two opposing hippocampus to prefrontal cortex pathways for the control of approach and avoidance behaviour

The decision to either approach or avoid a potentially threatening environment is thought to rely upon the coordinated activity of heterogeneous neural populations in the hippocampus and prefrontal cortex (PFC). However, how this circuitry is organized to flexibly promote both approach or avoidance at different times has remained elusive. Here, we show that the hippocampal projection to PFC is composed of two parallel circuits located in the superficial or deep pyramidal layers of the CA1/subiculum border. These circuits have unique upstream and downstream connectivity, and are differentially active during approach and avoidance behaviour. The superficial population is preferentially connected to widespread PFC inhibitory interneurons, and its activation promotes exploration; while the deep circuit is connected to PFC pyramidal neurons and fast spiking interneurons, and its activation promotes avoidance. Together this provides a mechanism for regulation of behaviour during approach avoidance conflict: through two specialized, parallel circuits that allow bidirectional hippocampal control of PFC

Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review

ReviewThis is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Background Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified. Purpose The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions. Method Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009). Results We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms. Conclusion There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions

Control of parallel hippocampal output pathways by amygdalar long-range inhibition

Projections from the basal amygdala (BA) to the ventral hippocampus (vH) are proposed to provide information about the rewarding or threatening nature of learned associations to support appropriate goal-directed and anxiety-like behaviour. Such behaviour occurs via the differential activity of multiple, parallel populations of pyramidal neurons in vH that project to distinct downstream targets, but the nature of BA input and how it connects with these populations is unclear. Using channelrhodopsin-2-assisted circuit mapping in mice, we show that BA input to vH consists of both excitatory and inhibitory projections. Excitatory input specifically targets BA- and nucleus accumbens-projecting vH neurons and avoids prefrontal cortex-projecting vH neurons, while inhibitory input preferentially targets BA-projecting neurons. Through this specific connectivity, BA inhibitory projections gate place-value associations by controlling the activity of nucleus accumbens-projecting vH neurons. Our results define a parallel excitatory and inhibitory projection from BA to vH that can support goal-directed behaviour

Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy Compared with Mindfulness-Based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: A three-arm Randomised Controlled Trial

This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.Depression co-occurs in 20 % of people with cardiovascular disorders, can persist for years, and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with co-morbid depression and cardiovascular disorders. A 3-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of selfreport measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after, and three months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. 3,400 potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1 %) were interested in taking part, 59 (1.7 %) were screened as being suitable, and 33 (<1 %) were eventually randomised to the three groups. Of 11 participants randomised to adapted MBCT, seven completed the full course, levels of home mindfulness practice were high, and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three-time points. The means PHQ-9 scores for the MBCT-HeLM group were lower at post-intervention and at the three-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (one to 25 years). The adapted MBCT intervention was feasible and acceptable to participants, however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.This research was, in part, supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Also, the research was carried out as part of a PhD funded by King Saud University, Saudi Arabian Ministry of Higher Education

Extraneous terms to local dialects in contemporary Arab societies

The extraneous terms that have invaded some local dialects in Arab societies has caused the extinction of a large arsenal of Standard Arabic words and expressions, which were until recently common and circulating, and as a result, some people need language dictionaries to understand their meaning. The problem with this article lies in the common use of extraneous terms in local dialects in Arab societies, and the way they are used is not from one community to another, but even from one city to another, which must be studied. This study aims to highlight the fields that use extraneous words and reveal the subtleties of their meanings while highlighting a sample of these used words, as well as revealing the different purposes of the extraneous vocabulary on the local dialect of these societies; The article will follow the inductive and analytical approaches, in the method of collecting and investigating words and indicating their meanings and destinations, in addition to comparing their letters in their original language and highlighting what has been localized; This article concluded the following results, namely, highlighting the change in the structure of terms introduced by Arabic speakers, and analyzing how they deal with the techniques of integrating those words in the context of their daily communication, with the possibility of using linguistic controls in dealing with foreign terms in the local dialects subject of the article

Mindfulness-based interventions for young offenders: a scoping review

Youth offending is a problem worldwide. Young people in the criminal justice system have frequently experienced adverse childhood circumstances, mental health problems, difficulties regulating emotions and poor quality of life. Mindfulness-based interventions can help people manage problems resulting from these experiences, but their usefulness for youth offending populations is not clear. This review evaluated existing evidence for mindfulness-based interventions among such populations. To be included, each study used an intervention with at least one of the three core components of mindfulness-based stress reduction (breath awareness, body awareness, mindful movement) that was delivered to young people in prison or community rehabilitation programs. No restrictions were placed on methods used. Thirteen studies were included: three randomized controlled trials, one controlled trial, three pre-post study designs, three mixed-methods approaches and three qualitative studies. Pooled numbers (n = 842) comprised 99% males aged between 14 and 23. Interventions varied so it was not possible to identify an optimal approach in terms of content, dose or intensity. Studies found some improvement in various measures of mental health, self-regulation, problematic behaviour, substance use, quality of life and criminal propensity. In those studies measuring mindfulness, changes did not reach statistical significance. Qualitative studies reported participants feeling less stressed, better able to concentrate, manage emotions and behaviour, improved social skills and that the interventions were acceptable. Generally low study quality limits the generalizability of these findings. Greater clarity on intervention components and robust mixed-methods evaluation would improve clarity of reporting and better guide future youth offending prevention programs

Elevated concentrations of metal(loids) in seaweed and the concomitant exposure to humans

While the consumption of seaweed and seaweed-based products is very common amongst East Asian nations, forming a notable component of the daily diet, relatively very few studies have concerned the concentrations of heavy metals in these together with potential effects on human health. The present study analyses the concentrations of 17 elements in locally resourced seaweed, also assessing potential noncarcinogenic and carcinogenic risks. The samples were ground, homogenized, and quantified using the ICP-OES technique. It has been found that the essential elements K, Ca, Mg, Zn, and Na typically show concentrations somewhat greater than a number of potentially toxic metals, in particular, Cd, Pb, Ag, and As, with exceptions being Ni, Cr-VI, and Si. Statistical analysis indicates all of the latter to have similar origin, with increased concentration of these metals within the marine ecosystem. While the daily estimated intake of most metals is seen to be within the daily dietary allowance level recommended by various international organizations, the noncarcinogenic risk shows a value greater than unity, estimated via the hazard quotient. This indicates a potential for adverse effects to health arising from consumption of the sampled seaweed. The carcinogenic risk resulting from nonessential elements shows values greater than the United States Environmental Protection Agency (US-EPA) reference limit of 10−4 . Considering the nonbiodegradability of heavy metals and metalloids and their potential accumulation in seaweed, there is need for critical examination of metal levels in the seaweeds obtained from the present study locations, together with the introduction of practices of removal of heavy metals via bio-adsorbent techniques