National and regional prevalence rates of hypertension in Saudi Arabia: A descriptive analysis using the national survey data

BackgroundLimited studies have examined the prevalence of hypertension (HTN) at the national and regional levels in Saudi Arabia. Therefore, this study aimed to examine the national and regional prevalence of HTN in the Saudi population.MethodsThis study used the data from household health survey carried out by the General Authority for Statistics in 2017. It included 24,012 households representing the Saudi population across all 13 administrative regions. The diagnosis of HTN was confirmed by a self-reported history of a physician diagnosed HTN.ResultsThe prevalence of HTN was 9.2% among Saudi population aged 15 years and older. It was relatively higher in women (10.0%) than in men (8.5%). The prevalence of HTN increased with advancing age (aged 65 years and older), accounting for 55.3% in women and 48.0% in men; its prevalence was relatively low among the younger age group, accounting for 0.1% in those aged 15–19 years. A large difference was found in the prevalence of HTN between regions, ranging from 6.0% in Najran region to 10.0% in Makkah region.ConclusionThis study reported the national and regional prevalence of HTN among Saudi adults using a representative sample with large variations in the prevalence rates according to age, sex, and regions. Older age, men, and Makkah region had higher prevalence of HTN. Our findings will help determine the etiological factors, identify the priorities for healthcare, and generate initiatives for policymakers, and develop preventive and therapeutic strategies for HTN

Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective: The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods: This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results: This study recruitment began in February 2019 and was completed in September 2019. Conclusions: The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control

The Impact of Diabetes on Osteoarthritis Prevalence and Pain

A growing body of evidence shows that there is an association between osteoarthritis (OA) and Type 2 diabetes mellitus (DM). However, the impact of DM on OA prevalence, specific OA locations, and pain remain poorly understood. Therefore, the primary purpose of this work was to examine the association of DM with OA in terms of prevalence and pain using large data sets. Particularly, three specific aims were studied in this dissertation. First, we examined the prevalence and risk factors for generalized OA (involving 3 or more joints) compared localized OA (involving only one or two joints). Second, we examined the association between type 2 DM and pain severity in people with localized OA. Finally, we examined the association between DM and knee pain locations, including localized, regional and diffused knee pain in people with knee OA. Chapter 2 describes a preliminary work for this dissertation examining the association of DM with knee pain severity and knee pain distribution (unilateral or bilateral versus no pain) in people with knee OA. This work included a cross-sectional analysis of the baseline visit of individuals who were enrolled in the Osteoarthritis Initiative. Data for participants with knee OA were used for this analysis (n=1319). Pain severity was measured using a numeric rating scale from 0 to 10 over the past 7 and 30 days for each knee. We found that DM was significantly associated with increased knee pain severity. Moreover, we observed a significant association between DM and unilateral and bilateral knee pain. These results indicated the potential effect of DM on short-term and long-term knee pain severity as well as joint distribution. Building upon the preliminary findings from the preliminary study in chapter 2, we examined the association between DM and OA with a focus on comparing people with generalized and localized OA. As described in chapter 3, we examined the prevalence of type 2 DM among people with generalized OA compared to localized OA along with the associated risk factors including demographic risk factors and chronic diseases (i.e. Type 2 DM, hypertension, dyslipidemia, neuropathy, and body mass index). A retrospective review of data was performed using the Healthcare Enterprise Repository for Ontological Narration (HERON), and patients with diagnostic codes for OA were selected. Data from 3855 individuals included patients with generalized OA (n=1265) and localized OA (n=2590). The prevalence of type 2 DM was significantly greater among patients with generalized OA compared to localized OA. Significant associations were found between generalized OA and type 2 DM, hypertension, and dyslipidemia. The findings from this chapter highlighted that chronic diseases including type 2 DM, hypertension and dyslipidemia might affect any joints or multiple parts due to their systemic inflammatory impact on joints and vascular systems innervating joints resulting in generalized OA. Investigating the association between type 2 DM and OA in further details, we analyzed the association of type 2 DM with pain severity in people with localized OA to understand the association whether limited to knee joint as described in chapter 2 or at any other localized joint. Chapter 4 examined the association between Type 2 Diabetes and pain severity in people with localized OA, and explored the association between glycemic control measured by A1c level and pain severity in people with localized OA and type 2 DM. A retrospective design using HERON database was used, and data from 819 patients were obtained and grouped into localized OA only (n=671) and localized OA+type2 DM (n=148) based on diagnoses codes. An index date was set as the first diagnosis date of localized OA and linked to pain severity, measured by numeric rating scale from 0 to 10. Hemoglobin A1c values were obtained for patients with T2D within six months of the index date. Type 2 DM was significantly associated with increased pain severity. Furthermore, for patients with type 2 DM and localized OA with available data for A1c (n=87), the results showed that increased A1c value was significantly associated with higher pain severity. These results suggested a negative impact of type 2 DM on pain severity in people with localized OA and extends beyond the knee joint, as shown in chapter 2 using a different dataset and population. To study in-depth the association of DM with pain in people with OA, Chapter 5 described the results of the association of DM with knee pain locations in people with knee OA. Another exploratory analysis emerged to identify the association of DM with knee pain during walk and walking speed. This study used data from 1790 individuals from the osteoarthritis initiative with knee pain and grouped into knee OA and diabetes (n=236) or knee OA only (n=1554). Knee pain locations were categorized to no pain, localized, regional, or diffused pain. Knee pain during a 20-meter walk test was categorized as: no pain, mild, moderate, and severe knee pain. Walking speed was measured using a 20 m walk test. The results showed that DM was associated with regional knee pain, moderate, and severe pain during walk. Additionally, DM was associated with decreased walking speed. These results suggested that DM can cause damage to the musculoskeletal system and might affect pain locations and walking performance in people with knee OA. In summary, this body of work has shown that DM was associated with higher pain severity, bilateral and unilateral knee pain in people with knee OA. This work has identified the prevalence of DM in people with generalized OA and age, sex, DM, hypertension, and dyslipidemia were associated with generalized OA compared to localized OA. Our results found that DM was associated with higher pain severity in people with localized OA. Furthermore, glycemic control measured by A1c was associated with higher pain severity in people with DM and localized OA. Our findings demonstrated that DM was associated with specific knee pain pattern (regional knee pain), but not diffused or localized knee pain in people with knee OA. Finally, we found that DM was associated with increased knee pain during walk and walking speed in people with knee OA. This body of work is important for clinicians in many aspects. First, clinicians should consider DM as a risk factor during pain management for people with knee OA, whether bilateral or unilateral. Second, because people with DM, hypertension, and dyslipidemia appear to be at higher risk of generalized OA, they may benefit from screening and an interventional approach to manage arthritis in multiple parts of the body. Third, health care providers should emphasize that better A1c control might help with pain management in people with DM and OA. Finally, we suggest that clinicians should include walking speed assessments for patients with DM and knee OA to rule out any future risk. The findings from this dissertation highlighted the need for future research to identify whether DM causes OA or vice versa. In addition, the potential mechanisms for the association between DM and OA is an essential step for future studies. Although parts of this dissertation focused on pain, there is a critical need to examine the longitudinal impact of DM on pain and symptoms in this population

Cognitive Frailty among Older Adults in Rural Areas: Prevalence and Risk Factors

Background: Cognitive frailty (CF), which is a combination of physical frailty and cognitive impairment, has been associated with functional deterioration in the elderly. However, information about the prevalence of CF and associated factors among Saudi older adults is lacking. Objectives: To assess the prevalence of CF and its associated factors in Saudi community-dwelling older adults. Design: Cross-sectional. Setting: Community-based. Subjects and methods: Thise study included community-dwelling elderly adults aged 60 years and over living in the Riyadh region. This study took place from August 2019 to June 2020. CF was defined as the co-existence of physical frailty and mild cognitive impairment (MCI) without dementia. The association between sociodemographic and clinical factors and CF was estimated using the relative risk ratio and confidence intervals (RRR; CIs 95%) using a multivariable binary logistic regression. Main outcome measures: Fried’s frailty phenotype index; and the Mini-Mental State Examination. Sample size: A total of 421 community-dwelling older adults (63% male; mean [SD] age 70 [7.1] years). Results: The overall prevalence of CF was 6.1%. The following factors were associated with CF: age (RRR 16.3; 95% CI 4.91–54.4), being single (RRR = 3.76 95% CI 1.70–8.31), and number of chronic conditions (RRR 3.1; 95% CI 1.74–5.49). Conclusions: This study indicated the high prevalence of CF among Saudi community-dwelling older individuals compared to other populations. Screening for early diagnosis should be incorporated during examination for older adults. Limitations: The cross-sectional design limits the causality inference with associated risk factors

Effects of backward walking exercise using lower body positive pressure treadmill on knee symptoms and physical function in individuals with knee osteoarthritis: a protocol for RCT

Abstract Objectives The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status. Methods The study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures. Results Not applicable. Conclusion Using lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making. Trial registration: This study was registered in ClinicalTrails.gov (ID: NCT05585099)

Obesity and Multisite Pain in the Lower Limbs: Data from the Osteoarthritis Initiative

Background. Although several studies investigated the relationship between obesity, osteoarthritis, and pain, no study examined the association between obesity and multijoint pain in the lower limbs. The purpose of this study was to address this gap. Method. This cross-sectional study was performed in Riyadh, Saudi Arabia, between March and April 2019. In this study, a total of 4,661 adults aged 45–79 years with or at high risk for knee osteoarthritis were included from the Osteoarthritis Initiative. The persons who had an elevated risk of developing symptoms of knee osteoarthritis during the study were defined as high risk for knee osteoarthritis. According to the body mass index, participants were categorized into three groups: normal weight (n = 1,068), overweight (n = 1,832), and obese (n = 1,761). Logistic regression was used to examine the association between obesity and multisite pain. Results. The odds of multisite pain was associated significantly (p<0.001) by 1.36 times higher with obesity than normal weight, no, or sigle-site pain, even after adjusting for sociodemographic and health variables Conclusion. Obesity is associated with an increased likelihood of multisite pain in the lower limbs. The results enable clinicians to adopt better standards of practice for the prevention and screening of multisite pain in this community

Prevalence and Risk Factors Associated with Low Back Pain in the Saudi Adult Community: A Cross-Sectional Study

Worldwide, low back pain is common and linked with many risk factors. There is a lack of studies in the Saudi Arabian community on low back pain prevalence and risk factors. Therefore, the present research will investigate the prevalence of low back pain in the middle-aged and elderly community population and examine the risk factors contributing to low back pain in Saudi Arabia. The present paper is a cross-sectional study of the community living in Riyadh and the surrounding areas in Saudi Arabia. Data were collected between October 2019 and April 2020 via trained research assistants. A total of 276 participants were included in the analysis. The prevalence of low back pain was 27.9% (n = 77) among the participants included in this study. All participants reported low back pain severity with a mean of 4.35 &plusmn; 2.19 on the pain rating scale. Older age, arthritis, hypertension, anemia, osteoporosis, and a history of fractures were all associated with having LBP. Low back pain is highly prevalent in the Saudi community adult population living in Riyadh and its surrounding areas. More than a fourth of the sample reported experiencing back pain. The study outlines several modifiable risk factors (BMI, education, employment status, marital status, and smoking status) and unmodifiable risk factors (arthritis, hypertension, anemia, osteoporosis, and a history of fractures) associated with low back pain in the study sample

National and regional prevalence rates of diabetes in Saudi Arabia: analysis of national survey data

Background The prevalence of diabetes mellitus (DM) has grown globally including Saudi Arabia. However, there are no recent national and regional reports about DM in Saudi Arabia. Therefore, this study aimed to explore the national and regional prevalence rates of DM among the Saudi population. Methods Data from an ongoing household health survey that was carried out by the General Authority for Statistics in 2017 was utilized in this study. The study sample was selected by including 24,012 households which was representative of the population and distributed according to the 13 administrative regions. A self-reported diagnosis of DM was collected by asking subjects if they have been diagnosed by a doctor. Results The proportion of DM was 8.5% among the Saudi Arabia population (≥ 15 years) and was higher in male (10.3%) than female (9.9%). The prevalence of DM among the age group ≥ 60 years was the highest (49.2%), followed by the age group 45–64 years (38.9%) while the lowest prevalence was found among the younger group Conclusion This study showed the recent national and regional prevalence rates of DM among Saudi populations. The high prevalence of DM in Saudi Arabia requires an urgent public health call to improve early detection program and lifestyle interventions. This study urges to minimize the health and economic burden of DM by establishing and implementing a national diabetes prevention program.</p

Effects of trunk exercises using virtual reality technology on trunk performance and impairment post stroke: a systematic review and meta-analysis

To systematically explore the effects of trunk exercises using virtual reality technology compared to conventional exercises for trunk impairment in patients with subacute and chronic strokes. A comprehensive search of literature published from inception until December 2022 was conducted using PubMed, Cochrane Library, Web of Science, Scopus, IEEE, and the Physiotherapy Evidence Database (PEDro). The inclusion criteria encompassed all randomized controlled trials (RCT) published in the English language involving adults who had had strokes and the evaluation of the effectiveness of virtual reality -based trunk exercises in reducing trunk impairment post stroke as measured by the trunk control test (TCT) and/or the trunk impairment scale (TIS) compared to conventional trunk exercises. A total of 397 studies were retrieved, and six studies were included in the current analysis. A random-effects meta-analysis of six studies indicated that video games had a very large, significant effect (SMD = 1.11; 95%, P  The study findings indicate that trunk exercises using virtual reality have a highly significant effect on reducing trunk impairment in patients with subacute and chronic stroke. Large RCTs are needed to study the effects of virtual reality trunk exercises on the acute, subacute, and chronic stages of stroke.</p