Voluntary testing for COVID-19: perceptions and utilization among the inhabitants of Saudi Arabia

ObjectivesVoluntary testing (VT) plays a crucial role in the prevention and control of infectious diseases. The present study investigated the perceptions and utilization of VT services for coronavirus disease 2019 (COVID-19) among the inhabitants of Saudi Arabia.MethodsIn total, 3,510 adult participants from all provinces of Saudi Arabia were recruited via a national online survey.ResultsOf the 3,510 participants, 88.9% were aware of the testing services available to them and of those, more than half (59.5%) had used the VT services and 96.1% were satisfied with the services. Contact with a positive COVID-19 case was the top reason for accessing VT, while a lack of awareness about the availability of VT services was the top perceived limiting factor. A history of chronic health conditions, anxiety and/or depression, and previous symptoms suggestive of COVID-19 were found to be predictors of the utilization of VT services (OR 1.55, 95% CI 1.22−1.96; OR 1.48, 95% CI 1.16−1.88; OR 3.31, 95% CI 2.77−3.95; and OR 1.62, 95% CI 1.34−1.96; respectively), respectively.ConclusionThe awareness of voluntary COVID-19 testing services was satisfactory among the Saudi Arabian population, but can be improved. Sociodemographic and health history predictors of the utilization of VT services were identified.     

Parental experiences with vaccine information statements: Implications for timing,delivery, and parent-provider immunization communication

ObjectiveWe examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions.MethodsWe conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility.ResultsMost parents received a VIS (77.2%; [95% CI: 74.5–79.7%]), 59.7% [56.6–62.7%] before vaccination but 14.5% [12.5–16.8%] reported receiving it after their child’s immunization; 15.1% [13.0–17.6%] were unsure of receipt status or timing; another 10.7% [9.0–12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8–97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions.ConclusionsMost parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.     

Hypercholesterolemia and its associated risk factors—Kingdom of Saudi Arabia, 2013

PurposeTo assess the prevalence of hypercholesterolemia and its associated factors in the Kingdom of Saudi Arabia.MethodsA national multistage representative sample of Saudis aged 15 years or older was surveyed through face-to-face interviews. Data on sociodemographics, risk factors, and health information were collected, and blood sample analysis was performed. Data were analyzed using SAS 9.3 to account for the sample weights and complex survey design.ResultsBetween April and June 2013, a total of 10,735 participants completed the survey. Overall, 8.5% of Saudis had hypercholesterolemia. Another 19.6% had borderline hypercholesterolemia. Among hypercholesterolemic Saudis, 65.1% were undiagnosed, 2.3% were treated uncontrolled, 28.3% were treated controlled, and 4.3% were untreated. The risk of being hypercholesterolemic increased with age and among individuals who reported consuming margarine, obese individuals, and those who have been previously diagnosed with hypertension or diabetes.ConclusionsMore than a million Saudis have hypercholesterolemia, and 700,000 of them are unaware of their condition which can be controlled through early detection campaigns and lifestyle change and medication. An urgent awareness and screening campaign is needed in Kingdom of Saudi Arabia to prevent and avoid disease progression toward more serious stages.     

Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys

ObjectiveUnderstanding the current status of parents’ vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children.MethodsWe conducted a web-based national poll of parents of children <7 years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines.ResultsIn 2012, 89.2% (95% CI, 87.3–90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5–6.6%) reported intentionally delaying one or more, and 5.4% (4.1–6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3–92.1%), 5.6% (4.6–6.9%), and 3.6% (2.8–4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2–6 years) but not younger children (0–1 years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1–94.1%) and a significant decrease in intentional ongoing refusal (5.0–2.1%). Vaccine delay increased in the Northeast (3.2–8.8%).ConclusionsNationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically.     

Parental acceptance of and preferences for administration of routine varicella vaccination in the UK: A study to inform policy

ObjectivesTo explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule.DesignWe conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered.Participants596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4 years) whose youngest child was aged 0–5 years.Main outcome measuresWillingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR + V], on a separate additional visit).Results74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit.ConclusionsMost parents would accept a varicella vaccination. These findings highlight parents’ preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy.     

Pulmonary Function of Workers Exposed to Ammonia: A Study in the Eastern Province of Saudi Arabia

Abstract

To determine the effect of chronic exposure to ammonia on pulmonary function among ammonia workers, 77 workers were randomly selected from an ammonia factory in the Eastern Province of Saudi Arabia and 355 were selected as controls from the administrative staffs of four industrial groups in Eastern Province. Spirometry was carried out and FEV₁ FVC, and FEV₁/FVC% were calculated. The ammonia level in the working environment was determined spectrophotometrically. 30% of the air samples had ammonia concentrations that exceeded the threshold limit value. Significant reductions in FEV₁% predicted and FVC % predicted were observed in ammonia workers exposed to higher cumulative ammonia levels (above 50 mg/m³-years). FEV₁% predicted and FEV₁/FVC% were significantly lower in symptomatic than in asymptomatic workers in the exposed group. These findings may raise the possibility that exposure to a high cumulative ammonia level produces a combined restrictive/obstructive ventilatory defect.     

Pulmonary Effects of Occupational Exposure to Portland Cement: A Study from Eastern Saudi Arabia

Abstract

A cross-sectional study was conducted in a randomly selected factory producing Portland cement in eastern Saudi Arabia to determine the prevalence of respiratory symptoms and diseases and chest x-ray changes consistent with pneumoconiosis in the employees. A sample of 150 exposed and 355 unexposed employees was selected. A questionnaire about respiratory symptoms was completed during an interview. Chest x-rays were read according to the ILO criteria for pneumoconiosis. Dust level was determined by the gravimetric method. Concentrations of personal respirable dust ranged from 2.13 mg/m³ in the kilns to 59.52 mg/m³ in the quarry area. Cough and phlegm were found to be related to cigarette smoking, while wheezing, shortness of breath, and bronchial asthma were related to dust levels. It is recommended that engineering measures be adopted to reduce the dust level in this company, together with health monitoring of exposed employees.     

A cross sectional study of maternal iron status of Korean women during pregnancy

The purpose of this study was to determine the iron status of Korean women during pregnancy and to assess the relationship between maternal iron status and the outcome of their newborns. A total of eighty-one pregnant women living in Gwangju, Korea, participated in the study: 26 women were in the first trimester, 23 in the second trimester, and 32 in the third trimester. Maternal red blood cell (RBC) number, hemoglobin (Hb) concentration, and serum iron and ferritin levels were reduced significantly in the last trimester (p < 0.05) compared to the findings both in the first and second trimesters. On the other hand, total iron binding capacity (TIBC), transferrin level, and the ratio of sTfR to ferritin in the third trimester were higher (p < 0.05) than those both in the first and second trimesters. Dietary intake of iron in the three trimesters was 9.7 ± 2.3, 13.3 ± 4.3, and 10.6 ± 2.5 mg/day, respectively. All were far below the Korean Recommended Dietary Allowances (RDA) of iron for pregnant women. Approximately, ninety percent of the subjects consumed iron supplements after the 20th week of their pregnancies until delivery. The supplemental iron intake in the second and third trimesters was 40 ± 12 and 46 ± 11 mg/day, respectively. There was a significant correlation between the maternal Hb level in the third trimester and the birth weight of infants. In conclusion, maternal iron status deteriorated during pregnancy, although most subjects consumed more than the RDA of iron by taking iron supplements after the 20th week of pregnancy. The results confirm that maternal iron deficiency during pregnancy negatively affects the outcome of newborns.     

Addressing personal parental values in decisions about childhood vaccination: Measure development

ObjectiveEvidence-based strategies to address vaccine hesitancy are lacking. Personal values are a measurable psychological construct that could be used to deliver personalized messages to influence vaccine hesitancy and behavior. Our objectives were to develop a valid, reliable self-report survey instrument to measure vaccine values based on the Schwartz theory of basic human values, and to test the hypothesis that vaccine values are distinct from vaccine attitudes and are related to vaccine hesitancy and behavior.MethodsParental Vaccine Values (PVV) scale items were generated using formative qualitative research and expert input, yielding 24 items for testing. 295 parents of children aged 14–30 months completed a self-report survey with measures of Schwartz’s global values, the PVV, vaccine attitudes, and vaccine hesitancy. Factor analysis was used to determine vaccine values factor structure. Associations between vaccine values, vaccine attitudes, vaccine hesitancy, and vaccination behavior were assessed using linear and logistic regression models. Late vaccination was assessed from electronic medical records.ResultsA six-factor structure for vaccine values was determined with good fit (RMSEA = 0.07, Bentler’s CFI = 0.91) with subscales for Conformity, Universalism, Tradition, Self-Direction, Security- Disease Prevention, and Security- Vaccine Risk. Vaccine values were moderately associated with Schwartz global values and vaccine attitudes, indicating discriminant validity from these constructs. Multivariable linear regression showed vaccine hesitancy was associated with vaccine values Conformity (partial R² = 0.10) and Universalism (0.04) and vaccine attitudes Vaccine Safety (0.52) and Vaccine Benefit (0.16). Multivariable logistic regression showed that late vaccination was associated with vaccine value Self-direction (OR = 1.80, 95% CI: 1.26–2.65) and vaccine attitude of Vaccine Benefit (OR = 0.44, 95% CI: 0.32–0.60).ConclusionsThe PVV scale had good psychometric properties and appears related to but distinct from Schwartz global values and vaccine attitudes. Vaccine values are associated with vaccine hesitancy and late vaccination and may be useful in tailoring future interventions.     

Burnout among nurses working in the primary health care centers in Saudi Arabia,a multicenter study

Background: Burnout is a common psychosocial phenomenon among nursing. It has been attributed to prolonged exposure to stress in the work place. This study aimed to determine the prevalence and associated factors of burnout among nurses in the primary health care centers in Saudi Arabia. Methods: This cross-sectional study was conducted among 200 nurses by using a self-administered questionnaire. Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. Results: Most participants were females (73.0%) and aged ≤35 years (52.0%). About 39% had high emotional exhaustion, 38% had high depersonalization and 85.5% had low personal accomplishment. About 89% (178) scored high at least on one subscale of burnout. Burnout was associated with age, educational level and sources of stress in the workplace. Conclusion: Level of burnout among nurses was high and was associated mainly with stressors in the workplace. Improving work environment and management of stress in the workplace should be a priority to minimize burnout among nurses.     

食物不耐受流行现状及其相关因素的横断面调查

目的 探讨居民食物不耐受流行情况及相关影响因素.方法 选取2008年8月至2009年6月某综合医院健康医学中心第一次查体进行食物不耐受项目检测的全部健康体检者(12 766人),应用非条件logistic回归模型进行多因素分析.结果 排名前三位的食物不耐受种类分别为鸡蛋、蟹和牛奶,其阳性率分别为28.5%、24.5%和24.5%.食物不耐受发生率随年龄的增加有增高趋势(P＜0.05),女性发生率(67.3%)显著高于男性(56.2%),P＜0.05.食物不耐受不同分级、不同种类与年龄和性别间存在相关关系(P＜0.05),其中食物不耐受不同分级与年龄分组间x2=19.555(P=0.021),与性别间x2=208.406(P=0.000);食物不耐受种类与年龄分组间x2=81.796(P=0.000),与性别间x2=132.068(P=0.000).logistic回归分析结果显示,与≤40岁组比较,41～50岁组、51～60岁组和＞60岁组OR值(95%CI)分别为1.125(1.027～1.233)、1.307(1.176～1.452)和1.536(1.275～1.849);与男性比较,女性OR值(95%CI)为1.602(1.475～1.741).与正常体重者比较,体重过轻者OR值(95%CI)为1.772(1.207～2.602).结论 食物不耐受与年龄、性别和体重指数相关,健康教育应针对其年龄和性别分布特点进行,保持适宜体重水平可以减少食物不耐受发生的风险.

Abstract：

Objective To study the prevalence of food intolerance among attendants in a general hospital and to learn its related determinants in Beijing,China.Methods An cross sectional survey,from August 1st,2008 to June 30th,2009,was carried out,including 12 766 adults from Health Sciences Center,Chinese PLA General Hospital.Data for epidemiological analysis were entered (double entry) into computer and organized by EpiData 3.0.Non-conditional logistic regression model was used for odd ratio (OR) and 95%CI calculation,with statistic analysis through SPSS 13.0.Results The three leading intolerance food items were egg,crab and milk,and the prevalence rates were 28.5%,24.5% and 24.5% respectively.Prevalence of food intolerance increased along with aging.Levels and the kinds of food intolerance were associated with age,sex and appeared a linear correlation tendency (P＜0.05).Prevalence of food intolerance in females (67.3%) was higher than that in males (56.2%).Data from multiple regression analysis showed that,comparing with age group under 40 and 40 years,the OR(95%CI) of age group 41-50,51-60,and above 60 were 1.125(1.027-1.233),1.307(l.176-1.452)and 1.536(1.275-1.849)respectively.Compared to males,the OR (95% CI) of females was 1.602 (1.475-1.741).When compared with normal weights,the OR (95%CI) of people with low weight was 1.772 (1.207-2.602).Conclusion Food intolerance was associated with age,sex and body mass index.Health education should be carried out according to the related characteristics of age and sex.Suggesting that reducing the risk of food intolerance,keeping the suitable weight was necessary.     

Kohl (surma): a toxic traditional eye cosmetic study in Saudi Arabia

The use of kohl (surma) as eyeliner is a popular practice in Saudi Arabia and people firmly believe that it is safe to use. A total of 107 kohl samples (branded and unbranded) were collected from different regions of Saudi Arabia, and analysed for the presence of lead. In addition, aluminium and antimony levels were also determined. Lead levels up to 53% were detected in some kohl preparations, and some samples were found to contain camphor and menthol. The blood analyses of regular kohl users revealed a high lead concentration and relatively low haemoglobin levels. Due to the health risk, an official public awareness campaign is suggested to encourage the use of lead-free kohl.     

The use of silicon gel for treating children's burn scars in Saudi Arabia: a case study

This case study is presented to illustrate the effectiveness of silicon gel as an important option in burn scar treatment and to provide treatment guidelines that address cultural, clinical and patient compliance issues in Saudi Arabia. The case study involves an 18-month-old child whose burn scar was treated for a period of 15 months with silicon gel. The Vancouver Burn Scar Scale assessment (Baryza and Baryza, 1995), used to track progress across the duration of treatment, reflected an improvement in the scar as the composite score changed from 9 to 2. Strategies for problem solving and addressing needs unique to the environment of Saudi Arabia were also developed over the treatment period. The findings of this case study indicate that silicon gel may be a superior treatment option under certain circumstances. Further research with a wider sample is indicated, given the high incidence of childhood burn injuries in Saudi Arabia.     

Dietary Supplement Use among Primary Health Care Attendants in Abha City,Southwestern Saudi Arabia

Dietary supplements are commercially available manufactured products used as an addition to the normal diet and involve vitamins, minerals, herbs (botanicals), amino acids, and various other products. With the use of a cross-sectional survey, the present paper intended to analyze dietary supplement usage and its health and sociodemographic determinants among attendants of primary health care centers in Abha City, southwestern Saudi Arabia. The sample was selected randomly using the two-stage cluster sampling technique. The study included 438 participants (115 males and 323 females). Their ages ranged from 18 to 59 years, with an average of 36.2 ± 11.7 years. The study showed that 330 people used dietary supplementation, giving a prevalence of 75.3% (95% CI: 71.1–79.2%). The most commonly used supplements were multivitamins (215, 65.2%), specific vitamins (60, 18.2%), and mineral pills (38, 11.5%). Advice from health care workers was the most frequent reason for using dietary supplements (49.4%). The majority (71.2%) reported feeling a better quality of life after using dietary supplements. The most frequent disadvantages of using dietary supplements were constipation and headache (30%) and the most frequent advantage was increasing appetite (59.8%). The people who most frequently recommended the use of supplements were health care workers (190, 57.6%), followed by friends or family members (62, 18.8%), and people on social media (43, 13%). Females had a significantly higher probability of using dietary supplements than males did (Cor = 2.0, 95% CI = 1.21–3.27), and those with a chronic disease had a considerably higher likelihood of using dietary supplements (cOR = 3.48, 95% CI = 2.04–6.06). Age, educational level, and marital status were not significantly related with dietary supplement usage. In conclusion, health care workers should focus on females and persons with chronic diseases in their practice. They should provide them with evidence-based advice regarding the use of dietary supplements. Continued medical education training programs tailored to the needs of health care staff addressing this issue should be provided. New guidelines should be developed to help health professionals to provide their patients with comprehensive care at the primary health care level.     

Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers

BackgroundHajj is the world’s largest annual mass gathering that attracts two to three million Muslims from around the globe to a religious assemblage in Makkah, Saudi Arabia. The risk of acquisition and transmission of influenza among Hajj pilgrims is high. Therefore, influenza vaccination is recommended, and was monitored frequently among pilgrims from different countries. However, the vaccination uptake among Saudi pilgrims has not been assessed in recent years.ObjectiveThis analysis aims to evaluate influenza vaccine uptake among Saudi Hajj pilgrims, and identify the key barriers to vaccination.MethodData on influenza vaccination were obtained from Saudi pilgrims who took part in a large trial during the Hajj of 2013, 2014 and 2015. Pilgrims were met and recruited in Mina, Makkah during the peak period of Hajj and were asked to complete a baseline questionnaire that recorded their influenza vaccination history, including reason(s) for non-receipt of vaccine.ResultsA total of 6974 Saudi pilgrims aged between 18 and 95 (median 34) years were recruited; male to female ratio was 1:1.2. Of the total, 90.8% declared their influenza vaccination history, 51.3% of them reported receiving influenza vaccine before travel to Hajj. The vaccination rates for the years 2013, 2014 and 2015 were 21.4%, 48.2% and 58.1%, respectively (P < 0.001). Of 1,269 pilgrims who were at higher risk of severe disease, 54.5% received the vaccine. Lack of awareness (47.5%), reliance on natural immunity (15.8%) and being busy (15.5%) were the main reasons for non-receipt.ConclusionThese data from a convenience sample indicate that influenza vaccine uptake among Saudi Hajj pilgrims is increasing over years but still needs further improvement. Lack of awareness and misperceptions are the main barriers. Education of Saudi pilgrims and health professionals is required to raise awareness about influenza vaccination. Further studies are needed to understand pilgrims’ misperceptions.     

Middle East Respiratory Syndrome Coronavirus in Bats,Saudi Arabia

The source of human infection with Middle East respiratory syndrome coronavirus remains unknown. Molecular investigation indicated that bats in Saudi Arabia are infected with several alphacoronaviruses and betacoronaviruses. Virus from 1 bat showed 100% nucleotide identity to virus from the human index case-patient. Bats might play a role in human infection.     

Socioeconomic factors affecting the prevalence of obesity among female patients attending primary health centers in Jeddah,Saudi Arabia

A sample of 852 Saudi women who attended the primary health care centers in Jeddah seeking medical care were examined. Obesity was defined as a value for the body mass index (kg/m2) ≥ 25.0. The prevalence of obesity in the examined sample was high (64.3%). Obesity was significantly related to age, marital status, parity, level of education, level of work, women's income levels, who is the householder and the number of servants. There was no significant association between obesity and the following factors: being the only or youngest daughter, inhabitant's number, number of cars, time spent watching television, eating while watching television, number of times per week inviting or being invited to meals, householder's income, and his education or work. Multiple regression analysis indicated that five variables were significant predictors: age, marital status, number of servants, giving birth, and parity. Knowledge of the social factors associated with obesity will help to identify high risk groups. Those most vulnerable to the development of obesity, should then be the focus of a vigorous preventive program.     

Levels of Selected Heavy Metals in Black Tea Varieties Consumed in Saudi Arabia

The metal contents (Fe, Cu, Zn, Mn, Cr, Pb, Ni, Cd, Co) of 17 black tea samples were analyzed by using Inductively Coupled Plasma Atomic Emission Spectroscopy (ICP-AES). Among the investigated metals Mn was the highest (1,071.7 microg/g), whereas Pb showed minimum levels (0.30 microg/g). Iron was the second highest element found in black tea samples. Lowest Pb concentration (0.30 microg/g) was found in Abu Jabal tea; whereas maximum (2.2 microg/g) was found in Manasul tea. Lowest Cd concentration was found in Lipton whereas maximum level was observed for Al-Diafa tea. The concentrations of Co and Zn in the analyzed samples were in the range of 4.5-17.4 and 23.7-122.4 microg/g, respectively. Metal-to-metal correlation studies showed strong correlations between iron-chromium, iron-cadmium and lead-copper pairs. The data obtained in the present work compared well with the counterpart data reported internationally. Based upon the present safety standards, the tea versions selected in the present study were found to be safe for human consumption.