LEADERSHIP STYLE AMONG MIDDLE MANAGERS IN SAUDI MINISTRY OF HEALTH

Background: Middle managers within ministry of health act under continuous pressure from board level to be successful leaders of today's and tomorrow's healthcare service. Leadership styles are important factors among middle managers to retain employees in organizations and to ensure a high quality of practice.Aims: Two main aims: to examine the leadership style(s) of middle managers as perceived by them as leader from different departments of the Saudi Ministry of Health, and to examine the leadership style(s) of the middle managers as perceived by their subordinates as raters from different departments of the Saudi Ministry of Health.Materials and methods: A cross-sectional descriptive design was used to answer the research questions. A convenience sample of 121 participants, 30 middle managers and 91 subordinates, who were recruited through different departments at Saudi Ministry of Health during the period of June 2010 through September 2010.Participants were subjected to Univariate and Multivariate analysis. The Multifactor Leadership Questionnaire (MLQ) was used to collect data.Results: the mean ratings of all four components of transformational leadership for the subordinates and middle managers were between 2.90 to 3.29 .The mean ratings for contingent reward and management by exception active were 3.30 and 2.50 respectively and this was well within the optimum range as suggested by Bass. Management by exception passive and laissez-faire showed mean ratings of 1.67 and 1.25 respectively. The correlation coefficients among transformational leadership style and each variable of, satisfaction, effectiveness and extra effort for raters and leaders sample was high positively reached (r = .72, p< 0.05) , (r = .81, p< 0.05) , (r = .80, p< 0.05) respectively, The correlation coefficients among transactional leadership style and each variable of, satisfaction, effectiveness and extra effort for raters and leaders sample was high positively reached (r = .20, p<0.05) , (r = .44, p< 0.05) , (r = .35, p< 0.05) respectively, and The correlation coefficients among laissez -Faire leadership style and each variable of, satisfaction, effectiveness and extra effort for raters and leaders sample was high negatively reached (r = -.48, p< 0.05) , (r = -.46, p< 0.05) , (r = -.43, p< 0.05) respectively. There are agreement between leaders and raters on transformational, transactional and laissez-faire as distributive in Saudi Ministry of Health in kingdom of Saudi Arabia. The result showed there was no significant difference on the MLQ factors for raters and Leader due to gender, marital status, and age. Also , the analysis showed significant differences among raters’ opinions due to work experiences as contingent reward and extra effort in favor of raters who experience of them more than ˃ 6 Month, and finally, the analysis showed there significant differences among raters’ opinions due to period working with leaders as transformational, idealized Influence attributed, inspirational motivation, intellectual stimulation, contingent reward, and effectiveness in favor of raters who working with leaders for a period between 6 months - ˂ 1 year, but significant differences among raters’ opinions due to period working with leaders as Laissez –Faire in favor of raters who working with leaders for a period between 1 year - 2 years.Conclusions: transformational leadership can contribute a lot to the effectiveness of organizations and that there is a need for further investigation of leadership at different levels

Study Protocol for "MOVEdiabetes":A Trial to Promote Physical Activity for Adults with Type 2 Diabetes in Primary Health Care in Oman

Abstract Background Benefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman. Methods/design The study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention) versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week), pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week) over 12 months, (at a power of 80%, and significance level of 5%), 128 participants would be required to complete the study (64 in each arm). Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm). Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All intervention delivery and support costs will be monitored. Discussion This study will contribute to the evidence on the feasibility, cultural acceptability and efficacy of interventional approaches for increasing physical activity in primary care for persons with type 2 diabetes in Oman. Trial registration International Standard Randomised Controlled Trials No: ISRCTN14425284 . Registered 12 April 2016

Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman:a cross-sectional survey

Objectives: Physical activity is fundamental in diabetes management for good metabolic control. This study aimed to identify barriers to performing leisure time physical activity and explore differences based on gender, age, marital status, employment, education, income and perceived stages of change in physical activity in adults with type 2 diabetes in Oman.Design: Cross-sectional study using an Arabic version of the “Barriers to Being Active” 27 item questionnaire.Setting: Seventeen primary health centres randomly selected in Muscat.Participants: Individuals >18 years with type 2 diabetes, attending diabetes clinic for > 2 years and with no contraindications to performing physical activity.Primary and secondary outcome measures: Participants were asked to rate how far different factors influenced their physical activity, under the following categories: fear of injury, lack of time, social support, energy, willpower, skills, resources, religion and environment. On a scale of 0-9, barriers were considered important if scored ≥5.Results: A total of 305 questionnaires were collected. Most (96%) reported at least one barrier to performing leisure time physical activity. Lack of willpower (44.4%), lack of resources (30.5%) and lack of social support (29.2%) were the most frequently reported barriers. Using chi-square test, lack of willpower was significantly different in individuals with low vs high income (54.2% vs 40%, P=0.002) and in those reporting inactive vs active stages of change for physical activity (50.7% vs 34.7%, P=0.029), lack of resources was significantly different in those with low vs high income (40% vs 24.3%, P=0.004) and married vs unmarried (33.8% vs 18.5%, P=0.018). Lack of social support was significant in females vs males (35.4% vs 20.8%, P=0.005).Conclusions: The findings can inform the design on physical activity intervention studies by testing the impact of strategies which incorporate ways to address reported barriers including approaches that enhance self-efficacy and social support

Health professionals’ perceptions about physical activity promotion in diabetes care within primary health care settings in Oman

Background: As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals’ perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches. Methods: Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis. Results: Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, the potential for dieticians to include individualised PA consultations as part of their role was highlighted. Participants felt that consultations should be augmented by approaches within the community (volunteer support and/or appropriate facilities). However, despite lack of experience with technology supported approaches and motivational tools, the telephone application “WhatsApp” and use of pedometers were considered potentially suitable. The need for training in behaviour change techniques and clearly communicated intervention guidelines was emphasised. Conclusions: A multi-component approach including PA consultations, possibly led by trained dieticians, technological routes for providing support along with community mapping for resources appear to offer promising approaches for further PA intervention studies within diabetes primary health care

The Benign Prostatic Hyperplasia and Its Aetiologies

This study aimed at investigating the Benign Prostatic Hyperplasia and Its Aetiologies, therefore th prostatic hyperplasia predominantly involves the stromal compartment of the gland and affects more than 70% of men of 70 years or older with or without obstructive symptoms of benign prostatic hyperplasia. A consensus view is emerging concerning the factors and control systems that modulate cell proliferation and connective tissue biology in the prostate. The purpose of this review is to discuss some of the recent work contributing to the latter in the context of the aetiology of benign prostatic hyperplasia. The current study also reviews the most important findings regarding the key mechanisms involved in the pathophysiology of BPH. The study concluded that although the pathogenesis of BPH is not yet fully understood, several mechanisms seem to be involved in the development and progression of the disease. These mainly include systemic and local hormonal and vascular alterations as well as prostatic inflammation that would stimulate cellular proliferation

Correlates of physical activity and sitting time in adults with type 2 diabetes attending primary health care in Oman

Abstract Background Despite evidence of the benefits of physical activity in the management of type 2 diabetes, it is poorly addressed in diabetes care. This study aimed to identify the prevalence and correlates of meeting ≥600MET-min/wk. (150 min/wk) of physical activity and sitting time in adults with type 2 diabetes in Oman. Approaches to encourage physical activity in diabetes care were explored. Methods A cross-sectional study using the Global Physical Activity Questionnaire was conducted in 17 randomly selected primary health centres in Muscat. Clinical data including co-morbidities were extracted from the health information system. Questions on physical activity preferences and approaches were included. Patients were approached if they were ≥18 years, and had been registered in the diabetes clinic for >2 years. Results The questionnaire was completed by 305 people (females 57% and males 43%). Mean age (SD) was 57 (10.8) years and mean BMI (SD) was 31.0 (6.0) kg/m2. Duration of diabetes ranged from 2 to 25 (mean 7.6) years. Hypertension (71%) and dyslipidaemia (62%) were common comorbidities. Most (58.4%) had an HbA1c ≥7% indicating poor glycaemic control (55% in males vs 61% in females). Physical activity recommendations were met by 21.6% of the participants, mainly through leisure activities. Odds of meeting the recommendations were significantly higher in males (OR 4.8, 95% CI 2.5–9.1), individuals ≤57 years (OR 3.0, 95% CI 1.6–5.9), those at active self-reported stages of change for physical activity (OR 2.2, 95% CI 1.2–4.1) and those reporting no barriers to performing physical activity (OR 2.7, 95% CI 1.4–4.9). Median (25th, 75th percentiles) sitting time was 705 (600, 780) min/d. Older age (>57 years) was associated with longer sitting time (>705 min/d) (OR 2.8, 95% CI 1.7–4.6). Preferred methods to support physical activity in routine diabetes care were consultations (38%), structured physical activity sessions (13.4%) and referrals to physical activity facilities (5.6%) delivered by a variety of health care providers. Conclusions The results suggest that intervention strategies should take account of gender, age, opportunities within daily life to promote active behaviour and readiness to change. Offering physical activity consultations is of interest to this study population, thus development and evaluation of interventions are warranted

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Frictional Behavior and Mechanical Performance of Al Reinforced with SiC via Novel Flake Powder Metallurgy

This paper targets developing new low-cost sustainable materials. To achieve this objective, aluminum was utilized as base material for metal matrix nanocomposites (MMNC). Three routes of advanced manufacturing techniques were designed and implemented. Flake powder metallurgy as a reliable method to synthesis nanocomposites powder was employed. By reinforcing aluminium with SiC and using a similar amount of both constitutes, three metal matrix nanocomposites (MMNCs) with different properties were produced. The ball milled powder were characterized using filed emission scanning electron microscope (FE-SEM) to analyze the morphology of the powder. Different investigations and analysis were conducted on the produced samples. These include X-ray diffraction (XRD) analysis, density and porosity, mechanical properties, and frictional performance. The obtained results include relative density, Young’s modulus, compressive yield strength, elongation, toughness, hardness, coefficient of friction, and specific wear rate. Achieving superior mechanical and tribological performance is evident from these results. This is accredited to the homogeneity of the reinforcement dispersion within the aluminum matrix