Factors affecting the self-management practices of people with type 2 diabetes in Almadinah, Saudi Arabia

In the Middle Eastern Gulf Cooperation Countries, the prevalence of type 2 diabetes mellitus (T2DM) is increasing steadily. It has recently been estimated that up to 23% of the Saudi Arabian population meet the diagnostic criteria. Due to the potential for serious micro and macro-vascular complications such as peripheral vascular disease and nephropathy, T2DM places a significant burden on the individuals concerned and their families. In addition, T2DM is having catastrophic consequences for the health-care systems of many countries that are unable to cope with the increased demand for services. Furthermore, the prevalence is expected to increase and the burden of the disease is expected to worsen. As a consequence the Saudi government is implementing a number of strategies to address the issue, such as the National Plan to Combat Diabetes. The major problem is that T2DM is largely a lifestyle disease caused by an affluent diet and inactivity, and the goal of effective glycaemic control is impossible without competent patient self-management.This study identified factors affecting self-management practices among people who have T2DM in Almadinah, Saudi Arabia. The study had three phases. The first phase involved the development of a valid questionnaire instrument to measure diabetes self-management practices in Arabic speaking populations. The Summary of Diabetes Self-care Activities (SDSCA) instrument was translated into Arabic and validated according to the World Health Organisation’s Steps of Translation and Adaptation of Instruments. Two samples of T2DM participants were purposively recruited in this phase. The first sample consists of 33 while the second was 210 participants. Translation indicators showed satisfactory outcomes for each stage of the process.The Arabic Summary of Diabetes Self-care Activities (ASDSCA) instrument proved to have very acceptable psychometric properties: splithalf reliability (.90); test-retest (.912, p = <.001); and Cronbach’s alpha (.76). The internal consistency of the instrument’s sub-scales was good for diet (.89), exercise (.83), blood glucose testing (.92), and foot care (.77). Factor analysis revealed the presence of four components explaining 34.4%, 16%, 15.4%, and 11.2% of the variance of daily self-management practices for these items respectively (accumulated total of 77.1%). Based on these outcomes, the A-SDSCA was utilised in the second phase of the study.The second phase of the study measured diabetes self-management practices and identified socio-demographic factors affecting these practices. The sample of 210 T2DM participants purposively recruited from three primary health-care centres completed the A-SDCA (N=1,477). HbA1c scores indicated that only 30 (14.7%) participants had controlled blood glucose level (_ 7%). Bivariate analyses showed that blood glucose testing (85% _ four days/week) and exercise (47% _ two days/week) were the least practiced self-management activities. In contrast, selfmanagement levels were greatest for medication (75% 7days/week), diet (71% _ three days/week), and foot-care (56% _ three days/week). A regression model showed that high blood glucose level (-.122, p = .050) and smoking (-.192, p = .004) were negatively associated with self-management practices. On the other hand, being female (.321, p = .000) and having a good income (.129, p = .050) were positive factors. Overall, these factors accounted for 25% of the variability in everyday selfcare practices (R² = .251).The third phase further explored factors affecting self-management practices, not identified by the questionnaire alone. Using semi-structured interviews, qualitative data were collected from 24 T2DM participants and 12 health-care providers. Raw data were analysed by means of quantitative thematic analyses using the Chronic Care Model (CCM) as the conceptual framework. The result identified 30 sub-themes under the six CCM domains (themes). In total, 365 related statements were extracted. Major inputs were derived from health-care providers’ interviews (132 statements) followed by female (118 statements) and then male (115 statements) T2DM participants. Community domain was the most frequently identified theme (100 statements; 27%) while health system was the least frequently identified (38 statements; 10%). Factors relating to delivery system; decision making; clinical information system; and self-management represented 20%, 11%, 14% and 17% of the total identified statements, respectively.In conclusion, the fact that only 15% of participants had controlled glycaemic level despite a high level of dependence on medications is very good evidence that medication alone, is not the complete answer to the effective management of T2DM in the study context. The fact that the study participants demonstrated low levels of compliance with most other self-management practices indicates that they were facing difficulties and obstacles to practice optimal self-management activities. Furthermore, these findings reflect serious limitations in the way T2DM self-management is promoted and enhanced in the various study locations. The ASDSCA could be utilized by health-care researchers to measure self-management practices among T2DM people. Furthermore, the instrument might be used to measure improvements in self-management practices before and after self-management programs application

The Role of Movement Pattern in Relation to Running Related Injuries Risk Factors

About 52.3 million American run on a regular basis. Up to 79% of runners get injured every year and the rate of injury has not declined over the past decades. Females have twice the risk of developing a running related injury (RRI). Rate of loading (ROL), tibial impact shock (TIS), and low movement variability may contribute to the development of RRI. Not much is known, however, about the relationships between impact kinetics (i.e. ROL, TIS) and movement variability. In addition, there is a lack of understanding about the effects of sex and speed on the aforementioned RRI risk factors. Therefore, the purpose of this dissertation was to study the association between impact kinetics and movement variability, and to investigate the effects of sex and speed on biomechanical variables including ROL, TIS, movement variability and coordination patterns during running.Thirty-six healthy runners participated in study one and two. In study three, data from thirty-two of those runners were analyzed. Vertical ground reaction force, 3D motion-analysis of lower extremities joint angles, tibial vertical acceleration, and electromyography (EMG) of lower extremity muscles were collected at running speeds that represented subject’s long slow distance speed (LSD), LSD+15%, and LSD+30%. Movement variability and patterns of hip and knee joints were quantified by using the vector coding method. ROL and TIS, peak EMG of five lower extremity muscles were calculated. In study one, Pearson’s correlation coefficients were used to investigate the association between movement variability and patterns with ROL and TIS at LSD speeds. In study two, repeated measure ANOVAs were used to investigate the effect of sex and speed on EMG and impact forces. In study three, a self-organizing map (SOM) was used to investigate biomechanical coordination patterns during running at LSD and LSD+30%.The most notable results from this dissertation suggest that 1) movement variability and patterns of hip and knee joints are associated with impact kinetics, 2) females exhibit a greater increase in ROL as running speed increases, and 3) greater running speeds are associated with a general shift to a coordination strategy characterized by greater magnitudes of RRI risk factors

Enhancing the Knowledge of Cervical Cancer Screening among Female Nursing Students: An Interventional Educational Program

Background: Cervical cancer is a growing health risk facing women worldwide with the human papillomavirus (HPV) as the primary underlying cause. Pap smear is a simple screening test that can detect early changes in cervical cells, which might develop into cancer cells. Raising awareness of cervical cancer prevention has a significant impact on decreasing the burden of the disease. The aim of the study is to assess female nursing students' knowledge on early detection and screening of cervical cancer, and to determine the effectiveness of an educational program. Methods: A quasi-experimental research design (one group for pre- and post-tests) was utilized with a convenience sample of 130 female nursing students in one of the nursing colleges in Saudi Arabia. The study’s educational intervention included information about anatomy of genital tract and the importance of regular check-ups. The pre- and post-tests were applied to identify changes after intervention measures. Results: The mean age of the participants were 21.32 years (SD: 1.34). The findings revealed a significant improvement of post-test students’ knowledge in all items related to risk factors, signs and symptoms, occurrence, identification of HPV as causative agent, vaccination against HPV, and finally Pap smear for early detection and screening of cervical cancer. Conclusion: The study results support implementing educational intervention to improve nursing students' knowledge and awareness about cervical cancer prevention. Furthermore, it is imperative that cervical cancer awareness education modules should be developed and integrated within the nursing curriculum. Further studies with large sample size are recommended to increase generalization of the results.&nbsp; Key words: cervical cancer, education program, primary prevention, nursing students, Saudi Arabi

Psychological and social impacts of families of handicapped people during COVID-19 in the Arab world (A comparative study between Saudi Arabia and Egypt)

The study ​ aimed at revealing the psychological and social effects of the families of handicapped people during COVID-19 in Saudi Arabia and Egypt. The triangulation approach was used that gives a deeper understanding of the results derived from quantitative and qualitative data, and a questionnaire prepared by researchers was applied to (142) families with intellectual disabilities, autism disorder, visual impairment, physical and health disabilities, and a semi-structured interview was used with ( 15) of these respondents to find out the most important psychological and social impacts of the families of handicapped people. The psychometric properties of the study tools were verified. The data were analysed quantitatively and qualitatively. ​Quantitative results show that participants have an average level of psychosocial impacts for the families of handicapped people. Furthermore, there were no differences in the psychological and social effects in general between the Egyptian and Saudi societies, while it was found that there were differences in psychological pressure as one of the psychological effects between the two societies for Egyptian society​.&nbsp; Quantitative statistics were supported by qualitative data​​. Also, the qualitative analysis revealed that there were four dimensions related to the psychological and social effects of the families of handicapped people. They are: the presence of psychological effects ranging from high to medium, the presence of moderate social effects, the presence of moderate economic effects, ​​the finding also indicated that the ranking of psychological effects ​​and social issues for different groups of disabilities depends on​ their families according​ to&nbsp; (intellectual disability, autism disorder, physical and health disabilities, visual disabilities).​​The study provided several recommendations. The families of handicapped people especially mothers must be supported and provided with specific training programs that suit different disability groups

Understanding factors contributing to nurses’ intention to care for COVID-19 patients using the theory of planned behavior

Background: Globally, the nursing community has lost several colleagues during the Coronavirus Disease 2019 (COVID-19) battle. One of the negative consequences of the disease is the pressure on healthcare services and demands that exceed the system’s capacity to provide sufficient resources. Similarly, the experiences of care providers might trigger emotional and physical stress, which could affect the healthcare system’s readiness to manage infectious outbreaks. This study was aimed at investigating nurses’ intention to care for COVID-19 patients and determining factors contributing to their intentions to care at the Ministry of Health facilities in Saudi Arabia.Methods: This descriptive cross-sectional survey design was used to recruit 336 nurses working in Al Madinah Ministry of Health hospitals where COVID-19 patients received medical and nursing care. The instrument was created following the framework of the Theory of Planned Behavior.Results: Nurses’ intention to care for COVID-19 patients was significantly correlated with their education level, nationality, knowledge about COVID-19, and nurses’ exposure during their earlier education for emerging infectious diseases. Factors related to social pressure from friends, colleagues, and workplace administration support needed improvement. Examining the model fits through multiple regression revealed that the combination of six subscales – “attitude, subjective norms, perceived behavioral control, behavioral beliefs, normative beliefs, and control beliefs” – accounted for a significant (89%) variability of intention to care, R2 = 0.892, adjusted R2 = 0.793, F (6-329) = 201, p ≤ 0.000.Conclusion: Providing nursing education is the main predictor of higher nurses’ intention to care for COVID-19 patients, it is imperative that nursing education courses should continue investing in enhancing nurses’ capabilities in caring for COVID-19 patients

Understanding Factors Contributing to Nurses’ Intention to Care for COVID-19 Patients Using the Theory of Planned Behavior

Background: Globally, the nursing community has lost several colleagues during the Coronavirus Disease 2019 (COVID-19) battle. One of the negative consequences of the disease is the pressure on healthcare services and demands that exceed the system's capacity to provide sufficient resources. Similarly, the experiences of care providers might trigger emotional and physical stress, which could affect the healthcare system's readiness to manage infectious outbreaks. This study was aimed at investigating nurses’ intention to care for COVID-19 patients and determining factors contributing to their intentions to care at the Ministry of Health facilities in Saudi Arabia. Methods: This descriptive cross-sectional survey design was used to recruit 336 nurses working in Al Madinah Ministry of Health hospitals where COVID-19 patients received medical and nursing care. The instrument was created following the framework of the Theory of Planned Behavior. Results: Nurses’ intention to care for COVID-19 patients was significantly correlated with their education level, nationality, knowledge about COVID-19, and nurses’ exposure during their earlier education for emerging infectious diseases. Factors related to social pressure from friends, colleagues, and workplace administration support needed improvement.&nbsp; Examining the model fits through multiple regression revealed that the combination of six subscales – “attitude, subjective norms, perceived behavioral control, behavioral beliefs, normative beliefs, and control beliefs” – accounted for a significant (89%) variability of intention to care, R2 = 0.892, adjusted R2 = 0.793, F (6-329) = 201, p ≤ 0.000. Conclusion: Providing nursing education is the main predictor of higher nurses' intention to care for COVID-19 patients, it is imperative that nursing education courses should continue investing in enhancing nurses' capabilities in caring for COVID-19 patients

Analysis of 99Mo Production Capacity in Uranyl Nitrate Aqueous Homogeneous Reactor using ORIGEN and MCNP

99mTc is a very useful radioisotope in medical diagnostic procedure. 99mTc is produced from 99Mo decay. Currently, most of 99Mo is produced by irradiating 235U in the nuclear reactor. 99Mo mostly results from the fission reaction of  235U targets with a fission yield about 6.1%. A small additional amount is created from 98Mo neutron activation. Actually 99Mo is also created in the reactor fuel, but usually we do not extract it. The fuel will become spent fuel which is a highly radioactive waste. 99Mo production system in the aqueous homogeneous reactor offers a better method, because all of the 99Mo can be extracted from the fuel solution. Fresh reactor fuel solution consists of uranyl nitrate dissolved in water. There is no separation of target and fuel in an aqueous homogeneous reactor where target and fuel become one liquid solution, and there is no spent fuel generated from this reactor. Simulation of the extraction process is performed while reactor in operation (without reactor shutdown). With an extraction flow rate of 3.6 L/h, after 43 hours of reactor operation the production of 99Mo is relatively constant at about 98.6 curie/hour./hour.Received: 11 January 2014; Revised: 18 February 2014; Accepted: 28 February 201

Pharmaceutical Bioequivalence Studies: Ensuring Safety, Effectiveness and High Quality

Poor quality medicines are a global problem affecting both developed and developing countries. Governments and the health authorities are focusing on the spread of counterfeit medicines, as it is a threat to patients and funds criminal activities. Recently questions have been raised about using generic substitutes, especially for Narrow Therapeutic Index Drugs (NTIDs), such as ciclosporin. In-vitro dissolution testing was undertaken to identify differences in dissolution performance between branded and generic ciclosporin capsules. Dissolution testing of the capsules was carried out according to the USP guidelines. According to the USP not less than 80% of the labelled amount of ciclosporin should dissolve in 90 min. The samples were analysed using a HPLC method. Two ciclosporin generic products showed less than the minimum percentage of labelled amount < 80%. Statistical analysis showed significant differences (p<0.0001) of the mean percentage content between brand and generic. Investigations were carried out to detect impurities in ciclosporin capsules using LC-MS. Concentrations of inactive ingredients such as sorbitol were variable between capsules. One from South America, manufactured in central Asia, showed contamination with a plant product (Zizyphine A). the synthetic intermediate (Delcorine) was found to be more than 1000 fold higher in the generic product compared to reference capsules (p<0.001). In 2013, the FDA warned of the possible fatal effect of azithromycin. LC-MS quantification for azithromycin tablets were carried out in order to quantify azithromycin content in different products. A bioequivalence study in man, confirmed that generic (Mazit) capsules were bioequivalent with brand (Zithromax™) capsules. Based on the results presented in this thesis, HPLC and LC-MS proved suitable approaches for analysis of drugs and their unknown impurities in brand, generic and counterfeit medicines. Some ciclosporin preparations did not contain the mass labelled. Therefore, switching between branded and generic ciclosporin may lead to undesirable effect