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Introduction: Hypercholesterolemia (HC) is a well-known risk factor for cardiovascular diseases, which are the leading cause of death worldwide. Many factors can contribute to HC, including advanced age, chronic diseases (such as diabetes and nephrotic syndrome), and the use of certain medications. Aim: Our goal was to compare the sociodemographic, behavioral, and other comorbid conditions of adult participants living with HC in Saudi Arabia to the general population. Methods: This is a secondary data analysis from the Sharik Health Indicators Surveillance System (SHISS). SHISS consists of cross-sectional phone interviews conducted in all administrative regions of Saudi Arabia on a quarterly basis. Participant recruitment was limited to Arabic-speaking Saudi residents who were ≥18 years old. Results: Out of 20,492 potential participants contacted in 2021, 14,007 completed the interview. Of the total participants, 50.1% were male. The mean age of participants was 36.7 years, with 1673 (11.94%) having HC. A regression model showed that participants with HC had a higher likelihood of being older, living in Tabouk, Riyadh, or Asir regions, being overweight or obese, having diabetes, hypertension, genetic or heart diseases, or having a higher risk of depression. Gender, all types of smoking, physical activity, and education level were eliminated from the model. Discussion: In this study, participants with HC were identified with some co-existing conditions that may affect the progression of the disease and the participants' quality of life. This information could assist care providers in identifying patients who are at higher risk, improve screening efficiency, and improve disease progression and quality of life.

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Background: Prevalence estimates for overweight and obesity in the Gulf Cooperation Council countries, including Saudi Arabia, have increased over the last 4 decades. Although the World Health Organization encourages countries to implement initiatives aimed at controlling obesity, limited research has been published on the impact of such initiatives in Saudi Arabia. Aims: To assess the epidemiology of overweight and obesity in Saudi Arabia, describe and evaluate the effectiveness of past and current interventions, and recommend actions for prevention and control. Methods: A narrative review of data from the Global Health Observatory was used to determine yearly estimates of prevalence of overweight and obesity in Saudi Arabia from 1975 to 2016. Large-scale interventions aimed at controlling obesity and its risk factors in Saudi Arabia were identified and summarized. Results: Prevalence estimates of overweight and obesity among men and women in Saudi Arabia continued to increase from 1990 to 2019. Prevalence among adults was more than 60% and among children and adolescents it was 20-60%, suggesting a continuing trend. Interventions were identified but their impact on the prevention and control of obesity and its risk factors was unclear. Conclusion: Prevalence estimates of overweight and obesity have been steadily increasing in Saudi Arabia since 1975. Integrated, "whole-of-community" approach, with continuous evaluation, is needed to achieve sustainable prevention and control of obesity in the country.

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Although the micronutrient status of a population is of high national priority, as it critically impacts public health, limited data is available for quantifying the micronutrient status in Saudi Arabia. We aimed to provide comprehensive, epidemiological, descriptive data regarding micronutrient levels in Saudi adults. This cross-sectional study included 3432 adults aged ≥18 years (mean age, 37.7 ± 11.7 years; women, 51.2%) across all 13 Saudi administrative regions (March 2019-November 2021). Laboratory data for 14 micronutrients (8 vitamins, 4 minerals, and 2 nonessential heavy metals) were characterized using descriptive analysis. Vitamin D deficiency (64.3%) was the most prevalent, followed by vitamin B2 (44.9%) and A (9.6%) deficiencies. Among minerals, iron deficiency was the most prevalent (23.2%), followed by zinc (15.3%) and copper (8.7%) deficiencies. Most Saudi adults exhibited normal arsenic (99.7%) and mercury (99.9%) levels. Men exhibited significantly higher vitamin B2, B9, and D deficiencies than women, while women exhibited higher vitamin A, B12, iron, and zinc deficiencies than men. Younger adults demonstrated a significantly higher prevalence of vitamin D and iron deficiencies, whereas older adults exhibited a higher prevalence of vitamin B1 and magnesium deficiencies. As micronutrient deficiencies are a public health concern, health policies and programs need to be developed and implemented to address them.

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BACKGROUND: Commitment to organ donation may vary among willing younger and older adults. We aimed to understand attitudes toward organ donation among Arab adults. METHODS: We conducted a cross-sectional survey of a representative sample of adults from 13 regions in Saudi Arabia between February 12, 2021, and March 14, 2021. We stratified the analyses by individuals' age (younger, 18 to 39 years old; older, ≥40 years old). RESULTS: Of 4217 individuals contacted, 3120 respondents (1846 younger and 1274 older) completed the survey, with a response rate of 74%. We found that 54% of younger and 47% of older respondents expressed support for organ transplantation, and 49% of younger and 35% of older respondents wanted to donate their organs. However, only 4% of younger and 3% of older respondents had registered in the national donor database. Knowledge sources that most likely to influence attitudes toward organ donation for younger and older respondents, respectively, were physician/health care worker (58% and 55%), family member (29% and 26%), scientist/researcher (29% and 22%), and religious scholar (16% and 23%). CONCLUSION: Though many younger and older adults express a willingness to donate, few are registered to be a donor. Our findings highlight the influential sources of knowledge that can be implemented in future interventions to increase commitment to organ donation.

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Purpose: This study aims to explore sociodemographic, behavioral and clinical factors in adult participants with Diabetes in Saudi Arabia. Methods: A population-based cross-sectional study of 20492 potential participants conducted in quarters 1 and 2 in 2021 from all 13 administrative regions of Saudi Arabia. A backward maximum likelihood logistic regression model, including all variables, was used to identify variables associated with participants living with Diabetes. Results: A total of 14007 participants, aged ≥18 years, completed the interview, with a response rate of 68.3% and successful quota sampling. Fifty percent were male, the mean age was 36.7 (SD 13.7; range: 18-90). Of the total sample, 1633, 11.7% had Diabetes. Seven percent only of diabetic patients (124 participants) had an acceptable level of fruit and vegetable intake. In addition, only (274, 16.8%) had an acceptable level of physical activity, compared to (2389, 19.3%) in the non-diabetic group. Daily smokers were slightly higher in the diabetic group compared to the non-diabetic group (13.2% vs 11.7%). Hypertension was reported mostly by the diabetic group (45.1% vs 8%). Overweight and Obesity were more prevalent in patients with Diabetes (72.50% vs 51.62%). The results of the logistic regression have shown that several sociodemographic, behavioral and intermediate risk factors were significantly associated with Diabetes. Conclusion: The study found that the prevalence of Diabetes in Saudi Arabia is around 12%, which is lower than the previously reported prevalence of Diabetes in Saudi Arabia. Moreover, Diabetes was found to be associated with lower educational level, smoking, obesity and overweight, hypercholesterolemia and hypertension. These factors are essential to be identified and screened in the community at regular interval; furthermore, controlling these factors may improve their disease management and quality of life. Additionally, knowing these factors will assist policymakers to shape an effective practical approach to combat diabetes widespread.

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Purpose: Several studies have investigated gender differences in various obesity-related outcomes. Females were found to have more accurate weight perception and reported more frequency of attempted weight loss. The objective of this study was to assess gender differences in the attitudes and management of people with obesity (PwO) in Saudi Arabia using data from the ACTION-IO study. Patients and Methods: A survey was conducted in Saudi Arabia in June and July 2018 on adults with obesity (based on self-reported body mass index of ≥30 kg/m2). Results: A total of 1000 people with obesity completed the survey; 565 (56.5%) were male (mean age of 36.9 years and mean BMI of 33.5 kg/m2) and 435 (43.5%) were female (mean age of 36.3 years and mean BMI of 34.5 kg/m2). The two most reported motivations for wanting to lose weight for both groups were to improve appearance (38%) and to have more energy (35%). Females were more likely to trust their health-care provider (HCP) advice about weight management when compared to males (87% females, 82% males, p = 0.059) and were more likely to have concerns regarding long-term safety associated with prescription weight loss medications (65% female versus 59% males, p = 0.043). On the other hand, males were more likely to seek their physician to prescribe weight loss medication if they hear of a new medication (55% males versus 46% females, p = 0.014), and more to believe that there are good options available for weight loss medications (74% males versus 67% females, p = 0.040). Also, more males prefer to take weight loss medications than to have a weight loss surgery (65% males, 59% females, p = 0.054). Conclusion: Overall, this study increases our understanding on the attitudes of both females and males towards the management of weight loss and opens the discussion for gender-specific weight loss interventions.

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BACKGROUND: Use of nutrition facts labels can be associated with healthier eating behaviors; however, consumers currently face difficulty understanding these labels or do not use them often. Thus, improving healthy grocery shopping behaviors among consumers might increase the overall health of the community. AIM: The study aims to explore consumers' behavior during grocery shopping and measure their basic knowledge regarding food product labels. METHOD: A national observational study (cross-sectional) was carried out on a convenience sample of Saudi Arabian residents aged 18 years and above. The data were obtained from all 13 administrative regions in Saudi Arabia at three different major supermarkets in each region. The data were analyzed using descriptive analysis, and binary logistic regression was used to investigate behavior variables. RESULTS: A total of 12,675 participants were observed; of those, 52.2% did not interact with the product before putting it in their shopping cart. The study found that the production date (66.6%) and expiry date (51%) were the most frequently checked aspects of food labels; they were checked more frequently than nutrition facts (29%). Furthermore, there was a low level of dietary knowledge among consumers and a moderate level of believing food packages and media claims. CONCLUSIONS: Our results suggest that the Saudi community's understanding of food product information is limited and greater awareness and community education campaigns are required to improve the use of nutritional labels and increase nutritional knowledge.

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OBJECTIVES: To analyze symptomatic and asymptomatic COVID-19 patients in Saudi Arabia in terms of initial presentation, risk factors, laboratory findings, clinical outcomes and healthcare utilization. METHODS: All laboratory-confirmed reverse transcription-polymerase chain reaction positive COVID-19 patients who had been tested at three governmental hospitals in Saudi Arabia (two in Riyadh and one in Makkah) between March 8 and May 18, 2020 were included. Demographics, COVID-19 variables, clinical characteristics and healthcare utilization variables were extracted and combined, and a descriptive analysis was conducted. Symptomatic and asymptomatic (on presentation) patients' data were compared. RESULTS: Eighty percent of the patients were males (81.4% of symptomatic and 73.2% of asymptomatic patients, P = 0.02). Moreover, 47.6% and 38.4% of symptomatic and asymptomatic patients were aged 40-64 years, respectively. Fever, cough and breathing difficulties were frequent presenting symptoms. Overall, diabetes (16.4%), hypertension (11.7%), chronic respiratory disease (7.1%) were the most frequent comorbidities, with no differences between the two groups. Symptomatic patients had higher C-reactive protein levels (3.55 vs. 0.30 mg/L; P < 0.0001) and lower total lymphocytes (1.41 vs. 1.70; P = 0.02). ICU admission and mortality were 12.1% and 4.1% in symptomatic, compared to 6.0% and 2.9% in asymptomatic patients, respectively. CONCLUSION: In the studied COVID-19 cohort, symptomatic patients tended to be older, had higher C-reactive protein and more lymphopenia with worse outcome than asymptomatic patients. This granular analysis of COVID-19 cohorts enables identification of at-risk cohorts in future waves, optimizing development of patient pathways and public health interventions.

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BACKGROUND: Saudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization's recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization. OBJECTIVE: The main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath. METHODS: This study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation. RESULTS: This study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=-0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=-0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette. CONCLUSIONS: After controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand.

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The global prevalence of obesity is increasing. Obesity is associated with many chronic diseases and health conditions. This study aims to estimate the current prevalence of obesity in Saudi Arabia and described the current national-level status of the association between obesity and various health conditions. This study is a nationwide cross-sectional survey conducted over phone-interviews in June 2020. In this study, a proportional quota-sampling technique was used to obtain equal distributions of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. Weight and height were self-reported, and the obesity was determined as BMI ≥ 30. Logistic regression adjusted for age and gender was used for exploring current associations between obesity and health conditions. Of the 6239 participants contacted, 4709 participants responded and completed the interview with a response rate of 75.48%. Of them, 50.1% were female, the mean age was 36.4 ± 13.5 (Range: 18-90), and the median age was 36. The national weighted prevalence of obesity (BMI ≥ 30) was 24.7%, and the prevalence in the sample (unweighted) was 21.7%. Obesity was significantly associated with type 2 diabetes [Odd ratio, (OR) = 1.52], hypercholesterolemia (OR = 1.69), hypertension (OR = 1.61), lung diseases (OR = 1.69), rheumatoid arthritis (OR = 1.57), sleep apnea (OR = 1.82), colon diseases (OR = 1.31), and thyroid disorders (OR = 1.8). This study provides an update on the recent prevalence of obesity in Saudi Arabia. It also shows the variation in prevalence rates between different regions, which might be explored further. Although obesity shows a decreasing trend, almost one-quarter of this study sample were obese. Obesity is currently associated with many health conditions that can affect the individuals' quality of life, impose stress on the healthcare system and impose an economic burden on the country. This evidence highlights the need for action to focus more on obesity in Saudi Arabia.

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BACKGROUND: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. OBJECTIVE: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. METHODS: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. RESULTS: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. CONCLUSIONS: Monitoring the population's mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23748.

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BACKGROUND: During pandemics, healthcare workers (HCWs) may be prone to higher levels of anxiety than those of the general population. This study aimed to explore the anxiety levels among HCWs in Saudi Arabia during the COVID-19 pandemic and the predictors of increased anxiety levels. METHOD: HCW participants in this cross-section study were solicited by email from the database of registered practitioners of the Saudi Commission for Health Specialties between 15 May and 18 May 2020. Sociodemographic characteristics, work-related factors, and organization-related factors were collected. RESULTS: Four thousand nine hundred and twenty HCWs (3.4%) responded. Reported levels of anxiety were low anxiety (31.5%; n = 1552), medium (36.1%; n = 1778), and high (32.3%; n = 1590). Participants reporting high anxiety levels were more likely to be unmarried (OR = 1.32, 95% CI: 1.14-1.52); nurses (OR = 1.54, 95% 1.24-1.91); workers in radiology (OR = 1.52, 95% CI: 1.01-2.28); or respiratory therapists (OR = 2.28, 95% CI: 1.14-4.54). Social factors associated with high anxiety levels were: living with a person who is elderly (p = 0.01), has a chronic disease (p < 0.0001), has immune deficiency (p < 0.0001), or has a respiratory disease (p-value <0.0001). Organization-related factors associated with a high level of anxiety were: working in an organization that hosts COVID-19 patients and working with such patients (p-value <0.0001). CONCLUSION: Self-reported medium and high levels of anxiety were present in 68.5% of HCWs in the COVID-19 pandemic. This highlights the urgent need to identify high-risk individuals to offer psychological support and provide up to date information on the pandemic. These data should help policymakers drive initiatives forward to protect and prepare HCWs psychological wellbeing.

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BACKGROUND: The rapid spread of COVID-19 worldwide has confined millions of people to their homes and has caused a substantial degree of psychological distress. This study aims to investigate the psychological distress impact of the COVID-19 pandemic among the Saudi population. METHODS: This is a cross-sectional study, using data collected from 3036 participants via an online self-reported questionnaire. The psychological distress was constructed using the COVID-19 Peritraumatic Distress Index to classify individuals in the sample as having normal, mild or severe distress levels. The study used descriptive analysis and multinomial logistic regressions to examine the sociodemographic factors associated with psychological distress levels during the COVID-19 pandemic. RESULTS: The evidence showed that 40% of the Saudi population are distressed due to COVID-19, of whom approximately 33% are mildly distressed, while 7% are severely distressed. The distress levels are particularly high amongst the young, females, private sector employees and health workers, especially those working on the frontline. CONCLUSION: The COVID-19 pandemic is associated with increased distress amongst people living in Saudi Arabia. In support of evidence found in other countries, the study has established that the distress levels vary across different sociodemographic characteristics. Therefore, limiting people's psychological damage demands both medium- and long-term policy strategies, which include mapping the rates of stress and anxiety for effective psychological treatment allocation and establishing innovative online methods of heightening people's mental wellbeing.

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BACKGROUND: An adverse drug reaction (ADR) is a response to a medicine that is not intended and is harmful, and which occurs at normal dose levels for humans. Currently, there are no estimates of the population-based prevalence of ADRs in the Kingdom of Saudi Arabia (KSA). OBJECTIVE: The aims of this study were to (1) estimate the population-based prevalence of ADRs in KSA, (2) describe the ADRs experienced by survey respondents, and (3) investigate the level of awareness of the ADR reporting system. PATIENTS AND METHODS: This was a cross-sectional survey using stratified, population-based sampling conducted at a chain of community pharmacies. RESULTS: Analysis was conducted on 5228 surveys; 50.17% of respondents were males, and the mean age was 39 ± 15 years (min = 18, max = 98). The sample prevalence of ADRs was 23.45% (95% CI 22.30-24.60%, P < 0.001). The estimated population prevalence (after weighting) was 28.00% (26.10-30.00%). Gastrointestinal disorders were the most commonly reported ADRs (58.73%), followed by general disorders and administration site conditions (19.74%). The largest drug class that was reported to lead to ADRs was nonsteroidal anti-inflammatory drugs (NSAIDs) (11%). Over 19% of the respondents who experienced an ADR required medical intervention to control the suffering induced by the ADR. Of the respondents who experienced an ADR, 371 (30.26%) were aware of the ADR reporting system but only 53 (14.29%) said that they had filed a report in the system. CONCLUSIONS: Our study estimated that 28% of the population experienced an ADR over a 1-year period in KSA. Risk factors for ADR included certain chronic disease groups and the use of certain classes of medications. Regulatory authorities in KSA intend to conduct more research and deploy educational interventions to reduce ADR rates in KSA. This will hopefully occur in an international context that promotes the standardized measurement of ADRs in the community. A subset of findings from this report was presented in an oral presentation at the Saudi Food and Drug Authority (SFDA) Annual Conference, September 27, 2018. In addition, a subset of findings from this report were presented on a poster at the International Conference of Pharmacoepidemiology and Therapeutic Risk Management (ICPE), August 27, 2019.

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This study aims to describe the distribution of low health literacy (HL) in the population in the Kingdom of Saudi Arabia (KSA), and to analyze factors associated with low HL in KSA. A cross-sectional national survey using quota sampling, population-based of residents of KSA conducted via phone interviews supplemented by in-person interviews. The survey included an overall evidence-based measurement of HL. Both descriptive statistics of the sample and a multivariable logistic regression model predicting low HL were developed. A total of 3557 surveys were available for analysis, and 46% of the respondents were classified as having low HL. In regression modelling, low HL was associated with older age groups (age 47-56 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.30-1.97; age 57-66 OR 1.38, 95% CI 0.98-1.94), the regions of Ha'il (OR 0.65, 95% CI 0.5-0.85) and Najran (OR 1.27, 95% CI 0.99-1.64), having been formerly married, lower levels of education (less than elementary OR 3.20, 95% CI 2.10-4.88; and elementary, OR 1.62, 95% CI 1.14-2.30), lower levels of income, and having sought healthcare exactly three times in the last year. Approximately half of KSA has low HL, and risk factors for low HL were older ages, lower income and education, having been formerly married, and a moderate pattern of health use. Future studies are needed to better characterize the distribution and determinants of low HL across KSA.

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OBJECTIVES: To evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals. DESIGN: Quasi-experimental study consisting of a single group before-and-after study design. SETTING: A public emergency hospital in Mecca, Saudi Arabia. PARTICIPANTS: 660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed. INTERVENTION: The intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011. MAIN OUTCOME: Reduction in the incidence of HRAs use from the preintervention to postintervention study period. FINDINGS: The five most common abbreviations recorded prior to the interventions were 'IJ for injection' (28.6%), 'SC for subcutaneous' (17.4%), drug name and dose running together (9.7%), 'OD for once daily' (5.8%) and 'D/C for discharge' (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%). CONCLUSIONS: Pharmacist-led educational interventions can significantly reduce the use of HRAs by healthcare providers. Future research should investigate the long-term effectiveness of such educational interventions through a randomised controlled trial.

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