The COVID-19 pandemic has disrupted the daily life and academic trajectory of many students. The objectives of this study were to evaluate the effect of the pandemic on perceived stress levels among ...medical students.
Comparative pre-pandemic and pandemic surveys were conducted among samples of undergraduate medical students. Students responded to a questionnaire including personal and academic data, and Cohen's Perceived Stress Scale (PSS).
Overall, the prevalence of high perceived stress during the pandemic (20.6%) was significantly higher (
= 0.001) than pre-pandemic (11.6%). A multivariable analysis revealed that the independent factors associated with high perceived stress were: participation in the study during the pandemic (aOR = 1.79, 95% CI: 1.22-2.63), female sex (aOR = 1.74, 95% CI: 1.23-2.47), younger age (aOR = 1.62, 95% CI: 1.04-2.55) and lower family income (aOR = 1.50, 95% CI: 1.12-2.03). PSS score was negatively correlated with increasing age, family income, and academic level. PSS score was positively correlated with: worries about the possible disruption of education or exams, excessive news exposure, worries about the possibility of COVID-19 infection, and the effects of mandatory isolation and social distancing.
The COVID-19 pandemic increased the level of stress among medical students. Female students, younger students, and those in lower academic grades are the most at risk of having high stress. Worries about possible academic disruptions due to the pandemic are significant stressors. The implementation of online stress management programs is recommended.
Background: Vaccination of primary healthcare workers (PHCWs) help to prevent the spread of influenza among at-risk patients.
Objectives: To assesses seasonal influenza vaccination (SIV) coverage and ...the factors affecting SIV's utilization among PHCWs in Abha city, southwestern Saudi Arabia.
Methods: A cross-sectional survey was carried out between June 2018 and August 2018 in all primary healthcare centers in Abha city. It targeted physicians, nurses, technicians, and pharmacists. A self-administered questionnaire was used to collect data regarding SIV status during the 2017-2018 season, obtain knowledge regarding SIV and influenza disease, and identify potential motivators for and barriers to SIV.
Results: Of 312 PHCWs, the SIV coverage rate was 45.5% in the 2017-2018 vaccination season. A multivariable logistic regression model showed that the risk groups for non-vaccination were PHCWs less than 40 years old (adjusted Odds Ratio (aOR) = 4.07, 95% CI: 1.50-11.03), technicians (aOR = 3.73, 95% CI: 1.20-11.54), single PHCWs (aOR = 2.36, 95% CI:1.20-4.62), and PHCWs lacking adequate influenza vaccine knowledge (aOR = 4.22, 95% CI: 2.13-8.35). Approximately 23% and 32% of PHCWs were found to have inadequate knowledge about SIV and influenza disease, respectively. PHCWs' awareness about their risk of infection and their need for protection was found to be the most common motivator (77.5%), and a fear of side effects was found to be the most frequent barrier (40%).
Conclusion: SIV coverage rate is suboptimal. Knowledge gaps and misconceptions about the influenza vaccine are the main barriers to an adequate coverage.
The left ventricular thrombus is one of the serious complications of ischemic cardiomyopathy. In this study, we aimed to search for the independent factors to predict the resolution of left ...ventricular thrombus.
This retrospective study included all patients with coronary artery disease, aged above 18 years old, and with the thrombus at the apical location of the left ventricle. Demographic, clinical, and echocardiographic characteristics of the patients were recorded. Major adverse cardiovascular events developed within the follow-up period were recorded. The time in the therapeutic range of each patient was calculated. The presence of left ventricular thrombus beyond 180 days despite warfarin usage was classified as persistent left ventricular thrombus.
The study included 174 subjects (169 males and 5 females). The mean age of the study population was 54.5 ± 11.0 years. The number of patients in whom the left ventricular thrombus resolved with treatment in less than 180 days was 56 (32.2%). Median anticoagulation time in the study population was 252 150-480 days and the meantime in the therapeutic range of the patients was 54 ± 19%. The time in therapeutic range value of the groups was similar (P=.593). It was found that concomitant clopidogrel use (P=.003) and left ventricular thrombus area (P < .001) were the independent predictors of left ventricular thrombus resolution within less than 180 days in the logistic regression analysis.
Concomitant use of clopidogrel was found to be associated with left ventricular thrombus resolution but left ventricular thrombus size was related to left ventricular thrombus persistency. Although standard 3-6 months of anticoagulation is advised for left ventricular thrombus, considering the presence of these predictors in such patients may guide the physicians to individualize the treatment.
: Breast cancer (BC) is ranked as the most frequently diagnosed cancer site among women in Saudi Arabia. Several studies in Saudi Arabia have reported low awareness of BC and significant obstacles to ...early presentation among Saudi women. A key sociocultural obstacle against breast screening and early detection of BC in several conservative cultures is that men manage women's choices and activities. The aim of this research is to find out the key background knowledge, attitudes, and related practice among male partners in the city of Abha in relation to women's BC prevention and means for early detection.
: A cross-sectional study targeting husbands aged 20 years or older chosen from the outpatient clinics in the Urban Primary Health Care Centers in Abha City. Through questionnaires, interview data were collected regarding knowledge about BC and wife practices and attitudes towards BC.
: The study included 832 husbands. The study showed that only 20.2% (95% confidence interval (CI): 19.9-24.1) of husbands had heard about mammography and only 22.1% had heard about breast self-examination among women as a screening test for BC. The most commonly mentioned variations that might occur in relation to BC were size changes (45.6%). The leading source of BC knowledge was from television (48.9%), and the least-mentioned source of information was healthcare workers (22.4%). Husbands mentioned that only 9.3% of wives had been examined before by mammography. In a multivariate logistic regression of male factors associated with wives' practices and attitudes towards BC, only good knowledge among husbands was a significant factor.
: The study documented the low level of BC knowledge among male partners. There is an urgent need to pay more consideration to disseminating awareness among men, as they are associates, and they must be armed with proper awareness. There is an urgent demand for establishing a national program and educational campaigns towards BC. Stressing the advantages and access to free mammography is necessary.
The incorrect carriage of schoolbags and heavy bags may result in back pain (BP) in adolescents. Our objective was to assess the problem of BP and associated factors among adolescents. This was a ...cross-sectional study targeting intermediate and secondary school adolescents in Abha City, Saudi Arabia. An anonymous questionnaire for BP was used. Student body weight and the weight of their full schoolbag were measured. The study included 876 adolescents. An overall prevalence of BP of 39.4% (95% CI: 35.3-43.7) was found. Upper BP (UBP), middle BP (MBP), and lower BP (LBP) amounted to 14.5%, 13.4%, and 11.5%, respectively. Associated significant factors with MBP were carrying the bag on one side compared to on the back (adjusted odds ratio (aOR) = 2.13, 95% CI: 1.20-3.73) and being at intermediate level compared to secondary (aOR = 1.56, 95% CI: 1.04-2.40). On the other hand, gender and schoolbag weight/body weight percent were not found to be significantly associated with MBP. None of the studied factors were significantly associated with overall BP, UBP, or LBP. BP is a prevalent among adolescents in southwest Saudi Arabia. One-sided schoolbag carriage is a significant associated factor for middle back pain. Parents and teachers should encourage students to consider the correct way to carry schoolbag.
Abstract
In the limbic brain, mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) both function as receptors for the naturally occurring glucocorticoids (corticosterone/cortisol) but ...mediate distinct effects on cellular physiology via transcriptional mechanisms. The transcriptional basis for specificity of these MR- vs GR-mediated effects is unknown. To address this conundrum, we have identified the extent of MR/GR DNA-binding selectivity in the rat hippocampus using chromatin immunoprecipitation followed by sequencing. We found 918 and 1450 nonoverlapping binding sites for MR and GR, respectively. Furthermore, 475 loci were co-occupied by MR and GR. De novo motif analysis resulted in a similar binding motif for both receptors at 100% of the target loci, which matched the known glucocorticoid response element (GRE). In addition, the Atoh/NeuroD consensus sequence was found in co-occurrence with all MR-specific binding sites but was absent for GR-specific or MR-GR overlapping sites. Basic helix-loop-helix family members Neurod1, Neurod2, and Neurod6 showed hippocampal expression and were hypothesized to bind the Atoh motif. Neurod2 was detected at rat hippocampal MR binding sites but not at GR-exclusive sites. All three NeuroD transcription factors acted as DNA-binding–dependent coactivators for both MR and GR in reporter assays in heterologous HEK293 cells, likely via indirect interactions with the receptors. In conclusion, a NeuroD family member binding to an additional motif near the GRE seems to drive specificity for MR over GR binding at hippocampal binding sites.
Genome-wide identification of corticosteroid receptor binding loci on the DNA suggests that at MR-exclusive binding sites, NeuroD factors cooperate with MR binding and/or functionality.
The depletion of fossil fuels have seriously encouraged extensive search for alternative renewable resources. Among these resources are the use of biodiesel (highly expensive, low yield) and the ...blending of waste cooking oil (WCO) with light diesel oil (LDO). The present paper undertakes an experimental investigation to study the effects of varying the blending ratio of WCO/LDO on the flame characteristics, combustor efficiency, and exhaust emissions. This blending ratio is varied from 0% to 100%. For any particular blend, the equivalence ratio is varied from 0.6 to 1.05. The experiments are conducted inside a water cooled, cylindrical, combustor fitted with a coaxially mounted waste oil burner. The measurements include the inflame and exhaust mean gas temperatures and the dry volumetric species concentrations (CO, NOx, CxHy and O2) at the combustor exit. The present results indicate that the blending ratio should not exceed 20% to ensure acceptable combustor efficiency and lower emissions.
Bullying is a type of behavior that involves frequent, hostile activities expected to harm another person physically, mentally, or emotionally. Bullying behavior uses force, pressure, or threats to ...maltreat, forcefully dominate, or terrify another individual. The aim of this study was to assess the bullying prevalence and related features among secondary school pupils in Khamis Mushait city, southwestern Saudi Arabia. A cross-sectional investigation was performed among governmental and private secondary schools in Khamis Mushait city. Data were gathered from the study pupils using a pre-structured questionnaire. Bullying was assessed using the school climate bullying survey. The study included 300 secondary school students (163 females and 137 males). The overall rate of bullying was 64.7% (95% CI 59.1–69.9). The most prevalent type of bullying was verbal (41.7%, 95% CI 36.0–47.5) followed by physical (17.0%, 95% CI 12.9–21.7), and social (6.0%, 95% CI 3.6–9.3). Males had more than two times greater probability of having been bullied than females (aOR = 2.522, 95% CI 1.408–4.518). Similarly, students in first-level grade classes had more than three times greater probability of being bullied victims than those in the higher classes, i.e., second- and third-level grade classes (aOR = 3.417, 95% CI 1.159–10.07). More than half of the students tell teachers when other students are being bullied (53.7%) and tell a teacher or staff member at the school if they are being harassed (53.6%); teachers are doing anything they can to help if they are told that a student is being bothered (58.7%), and teachers are making clear to students that bullying is not tolerated (52.3%). In conclusion, in the present study, we reported a high prevalence rate of bullying among secondary school pupils in Khamis Mushait city, southwestern Saudi Arabia. Concerted efforts among teachers and health care providers in the region should be mandatory to deal with the problem.
The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the ...factors associated with in-hospital stroke mortality.
: Hospital based follow-up study.
First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted.
A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality.
: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.
Steroid receptors are pleiotropic transcription factors that coordinate adaptation to different physiological states. An important target organ is the brain, but even though their effects are well ...studied in specific regions, brain-wide steroid receptor targets and mediators remain largely unknown due to the complexity of the brain. Here, we tested the idea that novel aspects of steroid action can be identified through spatial correlation of steroid receptors with genome-wide mRNA expression across different regions in the mouse brain. First, we observed significant coexpression of six nuclear receptors (NRs) androgen receptor (Ar), estrogen receptor alpha (Esr1), estrogen receptor beta (Esr2), glucocorticoid receptor (Gr), mineralocorticoid receptor (Mr), and progesterone receptor (Pgr) with sets of steroid target genes that were identified in single brain regions. These coexpression relationships were also present in distinct other brain regions, suggestive of as yet unidentified coordinate regulation of brain regions by, for example, glucocorticoids and estrogens. Second, coexpression of a set of 62 known NR coregulators and the six steroid receptors in 12 nonoverlapping mouse brain regions revealed selective downstream pathways, such as Pak6 as a mediator for the effects of Ar and Gr on dopaminergic transmission. Third, Magel2 and Irs4 were identified and validated as strongly responsive targets to the estrogen diethylstilbestrol in the mouse hypothalamus. The brain- and genome-wide correlations of mRNA expression levels of six steroid receptors that we provide constitute a rich resource for further predictions and understanding of brain modulation by steroid hormones.
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