Uncontrolled asthma remains a frequent cause of emergency department (ED) visits and hospital admissions. Improper asthma inhaler device use is most likely one of the major causes associated with uncontrolled asthma and frequent ED visits.

The Epworth Sleepiness Scale (ESS) is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population (ArESS), to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 (normal sleep) and 24 (very sleepy). An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire (Cronbach's alpha=0.86 in the initial test, and 0.89 in the retest). The test-retest intra-class correlation coefficient (ICC) shows that the test-retest reliability was substantially high: ICC=0.86 (95% confidence interval: 0.789-0.909, p-value<0.001). The difference in ArESS scores between the initial test and retest was not significantly different from zero (average difference=-0.19, t=-0.51, df=89, p-value=0.611). In this study, the averages of the ESS scores (6.3 ± 4.7, range 0-20 in the initial test and 6.5 ± 5.3, range 0-20 in the retest) are considered high in Western cultures. The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures.

Our understanding of climate factors and their links to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreaks is incomplete. This study aimed to estimate the monthly incidence of MERS-CoV cases and to investigate their correlation to climate factors. The study used aggregated monthly MERS-CoV cases that reported to the Saudi Center for Disease Prevention and Control from the Riyadh Region between November 1, 2012 and December 31, 2018. Data on the meteorological situation throughout the study period was calculated based on Google reports on the Riyadh Region (24.7136°N, 46.6753°E). The Poisson regression was used to estimate the incidence rate ratio (IRR) and its 95% confidence intervals (CI) for each climate factor. A total of 712 MERS-CoV cases were included in the analysis (mean age 54.2±9.9 years), and more than half (404) (56.1%) MERS-CoV cases were diagnosed during a five-month period from April to August. The highest peak timing positioned in August 2015, followed by April 2014, June 2017, March 2015, and June 2016. High temperatures (IRR=1.054, 95% CI: 1.043-1.065) and a high ultraviolet index (IRR=1.401, 95% CI: 1.331-1.475) were correlated with a higher incidence of MERS-CoV cases. However, low relative humidity (IRR=0.956, 95% CI: 0.948-0.964) and low wind speed (IRR=0.945, 95% CI: 0.912-0.979) were correlated with a lower incidence of MERS-CoV cases. The novel coronavirus, MERS-CoV, is influenced by climate conditions with increasing incidence between April and August. High temperature, high ultraviolet index, low wind speed, and low relative humidity are contributors to increased MERS-CoV cases. The climate factors must be evaluated in hospitals and community settings and integrated into guidelines to serve as source of control measures to prevent and eliminate the risk of infection.

In August 2015, the Corona outbreak caused by Middle East respiratory syndrome coronavirus (MERS-CoV) was the 9th episode since June 2012 in Saudi Arabia. Little is known about the public awareness toward the nature or prevention of the disease. The aim of this work was to assess the knowledge of the adult population in Riyadh toward the MERS-CoV. In this cross-sectional survey, a self-administrated questionnaire was distributed to randomly selected participants visiting malls in Riyadh. The questionnaire contained measurable epidemiological and clinical MERS-CoV knowledge level variables and relevant source of information. The study included 676 participants. Mean age was 32.5 (±SD 8.6) years and 353 (47.8%) were males. Almost all participants heard about the corona disease and causative agent. The study showed a fair overall knowledge (66.0%), less knowledge on epidemiological features of the disease (58.3%), and good knowledge (90.7%) on the clinical manifestation of the MERS-CoV. Internet was the major (89.0%) source of disease information, and other sources including health care providers, SMS, television, magazines and books were low rated (all <25%). In a multivariate logistic regression analysis age ≤30 years (Odds Ratio (OR)=1.647, 95%CI 1.048-2.584, P=0.030), male gender (OR=1.536, 95%CI 1.105-2.134, P=0.01), and no tertiary education (OR=1.957, 95%CI 1.264-3.030, P=0.003) were independent significant predictors of poor epidemiological knowledge. This study concludes that there was inadequate epidemiological knowledge received by the public and the reliance mostly on the clinical manifestations to recognizing the MERS-CoV disease. Comprehensive public health education programs is important to increase awareness of simple epidemiological determinants of the disease is warranted.

The current challenges facing healthcare systems, in relation to the shortage of health professionals, necessitates mangers and leaders to learn from different leadership styles and staff empowerment strategies, so as to create a work environment that encourages nursing staff commitment to patients and their organization. This study intends to measure the effects of nurses’ overall perception of the leadership style of their managers, and psychological empowerment on their organizational commitment in acute care units, in National Guard Health Affairs, Riyadh City, Saudi Arabia. This was a cross-sectional survey, where the data was obtained from nurses at King Abdulaziz Medical City. Hard copy questionnaires were distributed to 350 randomly selected nurses. Three hundred and thirty two (332) were completed, representing a response rate of 95 %. Three validated survey instruments were used to obtain the data: (1) The Multifactor Leadership Questionnaire (MLQ), formulated by Bass and Avolio (1997), (2) The Psychological Empowerment Scale developed by Spreitzer (1995) and (3) The Three-Component Model of Employee Commitment developed by Meyer and Allen (1997). A theoretical model that conceptually links leadership, empowerment, and organizational commitment was used. The SPSS program version 19 was employed to perform descriptive and inferential statistics including correlation and stepwise multiple regression analysis. Overall most nurses perceived their immediate nursing managers as not displaying the ideal level of transformational leadership (TFL) behaviors. Nurses’ commitment appeared to be negatively correlated with TFL style and perceived psychological empowerment. However, commitment was positively correlated with the Transactional Leadership (TAL) style. Analysis, also, showed that commitment is significantly associated with the nurse’s nationality by region: North American (P = 0.001) and Arab (p = 0.027). The other important predictors of commitment include TAL (P = 0.027), Laissez-faire Leadership (LFL (P = 0.012), and autonomy (P = 0.016). The linear combination of these predictors explained 20 % of the variability of the nurses’ commitment. The study findings suggest that leadership styles and employee empowerment could play an instrumental role in promoting organizational commitment of nurses working in acute health care settings, at least in the Saudi Arabian context.