Saudi Journal of Health Systems Research
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Published By S. Karger AG

2673-6136

Author(s):  
Salwa M. Almomen ◽  
Mona A. Almaghrabi ◽  
Saja M. Alhabardi ◽  
Adel A. Alrwisan

<b><i>Background:</i></b> Hepatotoxicity is a major reason for medication withdrawal from the markets. Unfortunately, serious adverse hepatic effects can occur after marketing with limited indicators during clinical development. Therefore, finding possible predictors for hepatotoxicity might guide the monitoring program of various stakeholders such as drug regulatory authorities. <b><i>Objective:</i></b> To explore the potential of drugs, pre-approval regulatory factors as predictors for the occurrence of hepatotoxicity-related post-marketing regulatory actions. Pre-approval factors were specified as: (a) Hy’s Law hepatotoxicity grade ≥3, (b) accelerated approval status, and (c) labeled hepatic adverse effects and regulatory actions at approval. <b><i>Methods:</i></b> Using publicly accessible FDA data, we examined clinical review documents for drugs approved in the USA during the period from 2011 to 2016 to evaluate their hepatic safety profile, identifying the 3 specified indicators for analysis. <b><i>Predictors (Covariates):</i></b> We assessed whether these medications meet: (a) Hy’s Law hepatotoxicity grade ≥3, (b) accelerated approval status, and (c) labeled hepatic adverse effects and regulatory actions at approval. <b><i>Outcome (Dependent Variable):</i></b> Post-marketing regulatory action related to hepatotoxicity including products withdrawal and updates to either warning, precaution or adverse effects sections. <b><i>Statistical Analysis:</i></b> Drugs that were approved between 2011 and 2016 were included in the analysis with follow-up time from the date of approval until end of December 2019 or the date of first post-marketing regulatory action related to hepatotoxicity, whichever occurred first. The hazard ratio (HR) was estimated using Cox-regression analysis. <b><i>Results:</i></b> A total of 192 medications were included in the study. We classified 48 drugs with grade ≥3 hepatotoxicity, 43 with accelerated approval status, and 74 with labeled information about hepatotoxicity prior to marketing. The adjusted HRs for post-marketing regulatory action for products with grade ≥3 hepatotoxicity was 0.61 (95% confidence interval [CI], 0.17–2.23), 0.92 (95% CI, 0.29–2.93) for drug approved via accelerated approval program, and 0.91 (95% CI, 0.33–2.56) for drugs with labeled hepatotoxicity information at approval time. <b><i>Conclusion:</i></b> Hy’s Law with hepatotoxicity grade ≥3, accelerated approval, and label information on hepatotoxicity were not identified as predictors for post-marketing additional regulatory actions concerning liver adverse effects. However, the evidence is inconclusive due to small sample size and potential channeling bias.


Author(s):  
Mahmoud Mahmoud ◽  
Maha M. Alanazi ◽  
Maha S. Albarrak ◽  
Najd K. Aljarba ◽  
Nehal G. Almutairi

<b><i>Background:</i></b> Vaccines are largely regarded as one of medicine’s greatest breakthroughs, yet vaccination rates have been declining in many parts of the world in recent years. Although there are numerous contributing variables to decreased vaccination rates, it is critical to evaluate the impact of the relevant factors. Also, because we are in the midst of a sad epidemic and vaccination for COVID-19 is critical to maintaining public health and limiting the virus’s spread, there is a risk of vaccine rejection on the horizon. <b><i>Methods:</i></b> Five hundred and fourteen married Riyadh inhabitants aged 18 years and over were issued an online Web-based survey. The research took place from June to October 2020. The study calculates the percentage of vaccination apprehension and analyzes immunization attitudes and knowledge. It also contrasts the participants’ attitudes regarding vaccines before and during the COVID-19 global pandemic, as well as the associated causes for vaccine reluctance and rejection. <b><i>Result:</i></b> The majority of the respondents (48.1%) were between 37–47 and 26–36 years of age (37.5%). Females (80%) made up the majority of the group. Around 66.3% of participants have a bachelor’s degree, and 80.8% have an average monthly income. During the pandemic, 38.5% of participants said they do not want to be vaccinated. When comparing vaccine-hesitant participants’ sociodemographic characteristics, it was discovered that the percentage of vaccine-hesitant participants was significantly higher in the younger age-group (&#x3c;36 years), those who had been married for more than 10 years, those with 1–3 children (<i>p</i> &#x3c; 0.001), and those who did not work (<i>p</i> = 0.002). <b><i>Conclusion:</i></b> The percentage of people who are hesitant to get vaccinated has grown by 5.2% from the previous level, and the level of reluctance has increased by 2.3%.


Author(s):  
Hala Elnazeer Elgoni ◽  
Mutaz Mohammed

<b><i>Background:</i></b> The aim of this review was to investigate the published papers about prevalence, patterns, and determinants of tobacco use in Sudan. <b><i>Methods:</i></b> Four scientific databases were searched for relevant articles published between 1900 and 2020. Applying the inclusion criteria, which were original articles published in peer-reviewed journals, conducted on Sudanese in Sudan and about tobacco prevalence, patterns of use, or determinants, in either English or Arabic languages, 20 articles were included in this review. <b><i>Results:</i></b> Two articles (10%) were among the general population, 8 (40%) among schoolchildren and adolescents, 4 (20%) among medical and health professions university students, 3 (15%) studies among non-health professions university students, and 3 studies among special groups (prisoners, diabetic patients and school workers). The reported prevalence ranged from 1% to 47.5%, with significant differences between males and females. All patterns of tobacco use are practiced in Sudan. Peer pressures, having more money, and family tobacco user or friends were associated with tobacco use initiation. <b><i>Conclusion:</i></b> All patterns of tobacco utilization (cigarette smoking, Toombak dipping, and shisha) are practiced in Sudan as well as combined patterns. Tobacco prevalence ranges from 1–25% and 10–47.5% among adolescents and adults, respectively, indicating the need for intervention programs to enhance decreasing this high prevalence.


2021 ◽  
pp. 1-11
Author(s):  
Abdallah Mohammad Alferdaus ◽  
Abdulaziz Shaher

<b><i>Introduction:</i></b> Trauma is one of the leading causes of morbidity and mortality in Saudi Arabia (SA) and worldwide and remains the leading cause of mortality in younger people. We conducted a literature review to assess the current trauma system in SA and formulated an action plan that might help guide leaders and colleagues in implementing a mature trauma system across the country. <b><i>Methods:</i></b> We searched PubMed, ScienceDirect, publications from the World Health Organization (WHO), and American College of Surgeons (ACS) and formal reports from the ministries and authorities in SA. <b><i>Results:</i></b> After aligning the trauma care system in SA to the WHO trauma system maturity index (TSMI) and ACS criteria for a mature system, the SA system was found to have many deficiencies in essential components such as national trauma registry or active trauma research activities. Injury prevention and prehospital care are progressing and may be graded as TSMI level III, indicating room for improvement. Regarding the definitive care at hospitals and centers, only 2 centers at Riyadh met the criteria for level I trauma centers. Other regions in SA do not have major trauma centers yet. Overall, the components of the SA trauma care system were graded from levels I to III on the basis of the WHO TSMI and ACS criteria for a mature trauma system. <b><i>Conclusion:</i></b> In SA, injury remains the primary cause of death in children and other younger people. Efforts to reduce the prevalence and burden of trauma in SA are progressing. Completion of a nationwide trauma system would be a major step toward achieving that goal. We have proposed an action plan to achieve that goal.


Author(s):  
Alhanouf A. Bin Dakhil ◽  
Saad Altalhab

<b><i>Background:</i></b> In recent years, telemedicine has led to a dramatic shift in healthcare service delivery, mainly due to the ease with which telemedicine can be integrated into a multitude of specialties and its flexibility as a means of providing care. Over the last 2 decades, technological advancements have made telemedicine integral to healthcare in many countries. In particular, dermatology was benefited from telemedicine as a new tool, thanks to the visual character that pervades this practice. Teledermatology is the interactive practice of remote dermatological assessment, involving live contact with patients (“live interactive”) and data access and retrieval (“store-and-forward”). This review discusses the role of this new discipline in medical education, inpatient care, and primary care through the analysis of several studies addressing this topic. Also examined are the status and limitations of teledermatology in Saudi Arabia and some proposed solutions. <b><i>Summary:</i></b> Visual assessment of dermatological conditions is common practice among dermatologists. However, due to the scarcity of specialists in some areas, wait times have been a hindrance for patients requiring an assessment. Teledermatology improves access by reducing wait times, speeding up the referral process, and streamlining assessments. Furthermore, teledermatology effectively serves as a form of triage, particularly for cases of suspected cutaneous malignancy that typically require the shortest referral time. Earlier diagnoses, more effective management of chronic skin disease, and inpatient care are all additional benefits offered by the teledermatology practice. The use of teledermatology is now widespread, with roles extending beyond patient care to medical teaching and training in residency programs. This perhaps reflects physicians’ highly positive perceptions regarding teledermatology; however, patient perception in Saudi Arabia is still lagging behind the global standard, possibly due to privacy concerns. <b><i>Key Message:</i></b> Teledermatology can be reliably utilized to advance healthcare services and medical education. Improving patient awareness and perception of this emerging discipline is crucial; to that end, the practice must address privacy concerns. Patient uploads of photographs and videos should be stored on an end-to-end encrypted platform to provide optimal service and encourage patients’ participation. Ultimately, physicians should be well acquainted with the medical, ethical, and technical aspects of teledermatology.


Author(s):  
Amal Aqeeli ◽  
Alla T. Alsharif ◽  
Estie Kruger ◽  
Marc Tennant

<b><i>Objectives:</i></b> This study aimed to investigate sociodemographic, clinical, and behavioral characteristics of 9- to 12-year-old schoolchildren who attend regular dental visits. <b><i>Methods:</i></b> A stratified sample from 10 schools in Al Madinah, SA, was selected, and a total of 1,000 students aged 9–12 years were included in the study. The WHO criteria (2013) for assessing dental caries were used to collect clinical data, and information on dental visits and sociodemographic and behavioral variables was collected through the WHO questionnaire. The logistic regression model was used to examine the relationship between regular dental visits and sociodemographic, clinical, and behavioral factors. <b><i>Results:</i></b> Only 9.2% of the sample reported regular dental visits. The multiple logistic regression model showed that gender (female: OR = 1.715; <i>p</i> = 0.041), high family income (middle income: OR = 0.464; <i>p</i> = 0.024; and low income: OR = 0.517; <i>p</i> = 0.015), and the consumption of sugary food and drinks (almost daily: OR = 0.438; <i>p</i> = 0.017; and several times a week: OR = 0.511; <i>p</i> = 0.050) were associated with regular dental visits after accounting for other sociodemographic and clinical variables and other oral health behavior. <b><i>Conclusion:</i></b> In the population studied, &#x3c;10% of 9- to 12-year-olds made regular annual visits to dental clinics in Al Madinah, SA.


2021 ◽  
pp. 1-10
Author(s):  
Yuchi Young ◽  
Amani Alharthy ◽  
Akiko S. Hosler

<b><i>Objective:</i></b> The objective of this study was to describe the historic transformation of the Kingdom of Saudi Arabia (KSA) health system and analyze the impact of transformation on selected health outcomes in KSA. <b><i>Methods:</i></b> Secondary data from the following standard repositories were compiled for analysis: WHO, UN, UNICEF, and the Saudi Arabia Ministry of Health. The 6-part WHO health system framework was used to structure the analysis. The USA was chosen as a comparator country because KSA and the USA are both high-income OECD countries with predominantly Western-trained physicians and similar health outcomes, yet the 2 nations diverge in 2 important ways: the KSA is a single payer, and its percent GDP healthcare spending is one-half that of the USA. <b><i>Results:</i></b> Life expectancy at birth increased nearly 30 years (from 45.6 years in 1960 to 74.9 years in 2019) among KSA citizens, narrowing the gap with the USA, which gained 8.7 years, from 69.8 to 78.5, during the same period. KSA had identical infant mortality to the USA (2/1,000 live births in both countries) and lower maternal mortality rates (17 vs. 23/100,000 live births) than the USA. <b><i>Conclusion:</i></b> The rapid improvement of selected health outcomes in KSA may be attributable to improved access to care provided by the universal healthcare system. Healthcare spending in the USA is 18% GDP, nearly twice that of KSA (9.2% GDP), yet important health outcomes are largely indistinguishable. Future research should evaluate which elements of the KSA system might inform improvements to decentralized systems in the USA.


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