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

Why So Cynical? The Effect of Job Burnout as a Mediator on the Relationship Between Perceived Organizational Support and Organizational Cynicism

The current study represents a noteworthy step towards a better understanding of how perceived organizational support influences burnout and cynicism of healthcare staff. It explores whether perceived organizational support reduces job burnout and organizational cynicism and whether job burnout plays a mediating role in the relationship between POS and organizational cynicism. Data were collected from 211 personnel working in the healthcare industry in Saudi Arabia. Findings indicate that a high level of perceived organizational support ameliorates the experienced burnout symptoms, and allay cynical attitudes, emotions, and behaviors at work. The study also unfolds that burnout is mediating the relationship between POS and organizational cynicism, which highlights the importance of properly managing burnout. The study suggested that healthcare organizations should imperatively provide the necessary organizational support wherever and whenever it is needed and utilize the appropriate interventions to minimize the effects of burnout and cynicism. This is the first study that analyzed the impact of POS on organizational cynicism through the mediating variable of job burnout, and the first paper that investigates POS, organizational cynicism, and job burnout of healthcare staff in a single study. It adds to the growing body of literature on antecedents of organizational cynicism, job burnout, and POS as a mean to reduce negative workplace phenomena. Keywords: perceived organizational support, job burnout, organizational cynicism, social exchange theory, job demand model, healthcare industry, healthcare staff. DOI: 10.7176/EJBM/13-7-04 Publication date: April 30th 202

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

A novel digital score for abundance of tumour infiltrating lymphocytes predicts disease free survival in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck (H&N) cancers with an increasing worldwide incidence and a worsening prognosis. The abundance of tumour infiltrating lymphocytes (TILs) has been shown to be a key prognostic indicator in a range of cancers with emerging evidence of its role in OSCC progression and treatment response. However, the current methods of TIL analysis are subjective and open to variability in interpretation. An automated method for quantification of TIL abundance has the potential to facilitate better stratification and prognostication of oral cancer patients. We propose a novel method for objective quantification of TIL abundance in OSCC histology images. The proposed TIL abundance (TILAb) score is calculated by first segmenting the whole slide images (WSIs) into underlying tissue types (tumour, lymphocytes, etc.) and then quantifying the co-localization of lymphocytes and tumour areas in a novel fashion. We investigate the prognostic significance of TILAb score on digitized WSIs of Hematoxylin and Eosin (H&E) stained slides of OSCC patients. Our deep learning based tissue segmentation achieves high accuracy of 96.31%, which paves the way for reliable downstream analysis. We show that the TILAb score is a strong prognostic indicator (p = 0.0006) of disease free survival (DFS) on our OSCC test cohort. The automated TILAb score has a significantly higher prognostic value than the manual TIL score (p = 0.0024). In summary, the proposed TILAb score is a digital biomarker which is based on more accurate classification of tumour and lymphocytic regions, is motivated by the biological definition of TILs as tumour infiltrating lymphocytes, with the added advantages of objective and reproducible quantification

Cross-Priming Dendritic Cells Exacerbate Immunopathology After Ischemic Tissue Damage in the Heart.

BACKGROUND: Ischemic heart disease is a leading cause of heart failure and despite advanced therapeutic options, morbidity and mortality rates remain high. Although acute inflammation in response to myocardial cell death has been extensively studied, subsequent adaptive immune activity and anti-heart autoimmunity may also contribute to the development of heart failure. After ischemic injury to the myocardium, dendritic cells (DC) respond to cardiomyocyte necrosis, present cardiac antigen to T cells, and potentially initiate a persistent autoimmune response against the heart. Cross-priming DC have the ability to activate both CD4 METHODS: We induced type 2 myocardial infarction-like ischemic injury in the heart by treatment with a single high dose of the β-adrenergic agonist isoproterenol. We characterized the DC population in the heart and mediastinal lymph nodes and analyzed long-term cardiac immunopathology and functional decline in wild type and RESULTS: A diverse DC population, including cross-priming DC, is present in the heart and activated after ischemic injury. CONCLUSION: Activation of cytotoxic CD

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

How Different Preparation Techniques Affect MRI-Induced Anxiety of MRI Patients: A Preliminary Study

Background: Magnetic resonance imaging (MRI) exams may cause patients to feel anxious before or during the scan, which affects the scanning outcome and leads to motion artifacts. Adequate preparation can effectively alleviate patients’ anxiety before the scan. We aimed to assess the effect of different preparation methods on MRI-induced anxiety: We conducted a prospective randomized study on MRI patients between March and May 2022. We divided 30 patients into two groups: the control group, which received routine preparation (RP), and the experimental group, which received video preparation (VP).We used the State-Trait Anxiety Inventory (STAI) to measure anxiety levels before and after the interventions. We assessed patients’ self-satisfaction after the scan: After preparation, VP (STAI mean = 10.7500) and RP (STAI mean = 12.7857), we observed a significant association between the pre- and post-STAI results in VP (p = 0.025). The effects of both methods in decreasing anxiety were more significant for first-timers (p = 0.009 in RP/0.014 in VP). We noted high satisfaction levels for both forms of preparation. The VP technique was superior in reducing patient anxiety, especially in first-time MRI patients. Hence, VP techniques can be used in different clinical settings to reduce anxiety and facilitate patients’ understanding of the instructions given

Adenovirus and RNA-based COVID-19 vaccines’ perceptions and acceptance among healthcare workers in Saudi Arabia: a national survey

Objectives The aim of this study was to compare the perception, confidence, hesitancy and acceptance rate of various COVID-19 vaccine types among healthcare workers (HCWs) in Saudi Arabia, a nation with Middle East respiratory syndrome coronavirus experience. Design National cross-sectional, pilot-validated questionnaire. Setting Online, self-administered questionnaire among HCWs. Participants A total of 2007 HCWs working in the Kingdom of Saudi Arabia participated; 1512 (75.3%) participants completed the survey and were included in the analysis. Intervention Data were collected through an online survey sent to HCWs during 1–15 November 2020. The main outcome measure was HCW acceptance of COVID-19 candidate vaccines. The associated factors of vaccination acceptance were identified through a logistic regression analysis and via measurement of the level of anxiety, using the Generalised Anxiety Disorder 7 scale. Results Among the 1512 HCWs who were included, 62.4% were women, 70.3% were between 21 and 40 years of age, and the majority (62.2%) were from tertiary hospitals. In addition, 59.5% reported knowing about at least one vaccine; 24.4% of the participants were sure about their willingness to receive the ChAdOx1 nCoV-19 vaccine, and 20.9% were willing to receive the RNA BNT162b2 vaccine. However, 18.3% reported that they would refuse to receive the Ad5-vectored vaccine, and 17.9% would refuse the Gam-COVID-Vac vaccine. Factors that influenced the differential readiness of HCWs included their perceptions of the vaccine’s efficiency in preventing the infection (33%), their personal preferences (29%) and the vaccine’s manufacturing country (28.6%). Conclusions Awareness by HCWs of the several COVID-19 candidate vaccines could improve their perceptions and acceptance of vaccination. Reliable sources on vaccine efficiency could improve vaccine uptake, so healthcare authorities should use reliable information to decrease vaccine hesitancy among frontline healthcare providers