The high risk of cardiovascular disease is well recognized in rheumatoid arthritis. Type 2 diabetes also attributes to this increase in risk. Rheumatoid arthritis is a chronic inflammatory condition, which aggravates insulin resistance, placing the patients at a higher risk of type 2 diabetes and subsequent cardiovascular outcomes. Methotrexate treatment, as a gold standard anti-inflammatory drug in the treatment of rheumatoid arthritis has shown beneficial effects on cardiovascular health. However, its impact on type 2 diabetes is still unknown. To assess the strength of the association between exposure to methotrexate and the rate of development of type 2 diabetes in rheumatoid arthritis patients. All rheumatoid arthritis studies reporting the use of methotrexate as an exposure and type 2 diabetes as an outcome were searched until March 2020 using MEDLINE, Cochrane and Scopus databases. Studies were included if the diagnosis of rheumatoid arthritis was made according to current guidelines or by a rheumatologist, and if there was information about methotrexate exposure and the type 2 diabetes outcome. The author and an independent assessor evaluated the articles for eligibility. Meta-analyses combined relative risk estimates from each study where raw counts were available. Sixteen studies reporting sufficient data for inclusion in the meta-analyses were identified. Methotrexate showed a promising effect on the risk of type 2 diabetes as this risk decreased in rheumatoid arthritis patients using methotrexate (Relative risk 0.48, 95% CI 0.16, 1.43). Rheumatoid arthritis patients on methotrexate treatment had a lower risk of developing type 2 diabetes compared to rheumatoid arthritis patients not exposed to methotrexate. This finding highlights the need for future, randomized control trials to confirm the beneficial effect of methotrexate on type 2 diabetes in the rheumatoid arthritis population.

Background: Routine childhood immunization is the most cost-effective method to prevent infection and decrease childhood morbidity and mortality. The COVID-19 pandemic has affected access to health care in Saudi Arabia, including mandatory vaccinations for young children. We aimed to assess the prevalence of intentionally delayed vaccinations in children aged ≤ 2 years during the COVID-19 pandemic curfew in Saudi Arabia, its relation to the caregivers' fear of infection, and identifying factors affecting the caregivers' decision.Methods: We conducted a cross-sectional study using a self-administered survey that targeted primary caregivers of children aged ≤ 2 years residing in Saudi Arabia during the COVID-19 pandemic curfew (March 4–July 6, 2020).Results: We received responses from 577 caregivers, of whom 90.8% were mothers. The prevalence of intentional vaccination delay was 37%. Upon adjusting the potential confounders, the odds of delaying scheduled childhood vaccination because of COVID-19 pandemic fears were greater among caregivers with higher levels of fear (OR 1.10, 95% CI 1.02–1.11). Common reasons for delaying vaccinations were COVID-19 infection and prevention of exposure to COVID-19 cases.Conclusion: Intentional vaccination delay leaves young children vulnerable to preventable infectious diseases. Identifying these children and offering catch-up vaccinations reduces this risk. Campaigns to increase awareness about the dangers of delaying vaccine-preventable diseases must be promoted to caregivers in addition to the promotion of home vaccination services. In preparation for future pandemics, we recommend countries consider interventions to control the level of fear and anxiety provoked by the pandemics and media, and interventions for improved access to vaccinations.

Background: Artificial intelligence (AI) is widely used in various medical fields, including diagnostic radiology as a tool for greater efficiency, precision, and accuracy. The integration of AI as a radiological diagnostic tool has the potential to mitigate delays in diagnosis, which could, in turn, impact patients’ prognosis and treatment outcomes. The literature shows conflicting results regarding patients’ attitudes to AI as a diagnostic tool. To the best of our knowledge, no similar study has been conducted in Saudi Arabia. Objective: The objectives of this study are to examine patients’ attitudes toward the use of AI as a tool in diagnostic radiology at King Khalid University Hospital, Saudi Arabia. Additionally, we sought to explore potential associations between patients’ attitudes and various sociodemographic factors. Methods: This descriptive-analytical cross-sectional study was conducted in a tertiary care hospital. Data were collected from patients scheduled for radiological imaging through a validated self-administered questionnaire. The main outcome was to measure patients’ attitudes to the use of AI in radiology by calculating mean scores of 5 factors, distrust and accountability (factor 1), procedural knowledge (factor 2), personal interaction and communication (factor 3), efficiency (factor 4), and methods of providing information to patients (factor 5). Data were analyzed using the student t test, one-way analysis of variance followed by post hoc and multivariable analysis. Results: A total of 382 participants (n=273, 71.5% women and n=109, 28.5% men) completed the surveys and were included in the analysis. The mean age of the respondents was 39.51 (SD 13.26) years. Participants favored physicians over AI for procedural knowledge, personal interaction, and being informed. However, the participants demonstrated a neutral attitude for distrust and accountability and for efficiency. Marital status was found to be associated with distrust and accountability, procedural knowledge, and personal interaction. Associations were also found between self-reported health status and being informed and between the field of specialization and distrust and accountability. Conclusions: Patients were keen to understand the work of AI in radiology but favored personal interaction with a radiologist. Patients were impartial toward AI replacing radiologists and the efficiency of AI, which should be a consideration in future policy development and integration. Future research involving multicenter studies in different regions of Saudi Arabia is required.

In 2019, a novel severe acute respiratory syndrome (SARS-CoV-2 (COVID-19)) caused a global pandemic. There was an urgent need to develop a vaccine against COVID-19 to reduce its spread and economic burden. The main objective of this study was to understand the attitudes and concerns of healthcare workers (HCWs) towards the upcoming COVID-19 vaccine, whether their decision was influenced by their history of taking the seasonal influenza vaccine, and factors that influence the acceptance of the upcoming COVID-19 vaccine. This was a cross-sectional study conducted in Riyadh, Saudi Arabia. We selected and surveyed 356 HCWs via an electronic self-administered questionnaire. A total of 61.16% of HCWs were willing to receive the COVID-19 vaccine, and 55.9% of them had received the seasonal influenza vaccine in the preceding year (2019–2020). The strongest predictors for taking the COVID-19 vaccine were the HCWs’ belief that the COVID-19 vaccine would be safe, needed even for healthy people, that all HCWs should be vaccinated against COVID-19, and that HCWs will have time to take the vaccine. Being female, being middle aged, having <5 years of work experience, having no fear of injections, and being a non-smoker were predictive factors for taking the upcoming COVID-19 vaccine. No associations were found between the intention to take the COVID-19 vaccine and a history of taking the seasonal influenza vaccine.

Patients with chronic diseases can experience psychological conditions, including anxiety and depression. However, the association between chronic diseases and these psychological conditions remains unclear. This study aimed to identify the relationship between anxiety, depression, and common chronic diseases (hypertension, type 2 diabetes, dyslipidemia, and rheumatoid arthritis), and their association with social determinants at an outpatient primary care setting. The validated hospital anxiety and depression scale was administered electronically to eligible participants. For each condition (anxiety and depression), participants were categorized as normal, borderline abnormal, and abnormal, according to their score out of 21 (≤7 = normal, 8-10 = borderline abnormal, ≥11 = abnormal). The scores and numbers of participants in each category were analyzed and compared with their demographic characteristics and chronic diseases for associations and relationships. We recruited 271 participants (mean age of 51.65 + 11.71 years) attending primary care clinics. Of these patients, 17.7% and 8.9% had borderline abnormal and abnormal depression, respectively, and 10.3% and 8.9% of patients had borderline abnormal anxiety and abnormal anxiety. Common social determinants and lifestyle factors were examined. Age, gender, and sugary drinks’ consumption significantly increased the odds of hypertension and type 2 diabetes; vigorous physical activity 3 times a week, decreased the odds of developing these chronic diseases. Adjusted regression models showed a statistically significant association between the hospital anxiety and depression scale score for borderline and abnormal anxiety and the presence of type 2 diabetes (OR 3.04 [95% CI 1.13, 8.19], P-value = .03 and OR 4.65 [95% CI 1.63,13.22], P-value <.03, respectively) and dyslipidemia (OR 5.93 [95% CI 1.54, 22.86], P-value = .01, and OR 4.70 [95% CI 0.78, 28.35], P-value = .09, respectively). The odds of developing depression were 4 times higher (P-value .04) in patients with rheumatoid arthritis. Among patients attending primary care outpatient clinics, anxiety, and depression were significantly associated with type 2 diabetes and rheumatoid arthritis, respectively. Social determinants and lifestyle factors play a major role in the development of common chronic diseases in Saudi Arabia. Primary care physicians should consider the patients’ psychological status, sociodemographic status, and lifestyle risks during the management of chronic diseases.

Background: There is high prevalence of prediabetes and type 2 diabetes mellitus (T2DM) in Saudi Arabia that is still increasing. Early diagnosis of prediabetes, and immediate, effective intervention is yet unestablished. Conventional health promotion approaches are used to educate prediabetic patients. Behavior modification is very effective in prediabetics to delay T2DM. Thus, the main objective of this study is to examine the effect of the new behavioral model, the Transtheoretical Model short messages (text 4 change) to modify lifestyle to prevent or delay the onset of T2DM, through promotion of a healthy diet and increased physical activity, in impaired glucose tolerance patients. Another objective is to estimate the impact of this model on markers of cardiovascular and metabolic risks as T2DM is one of the modifiable risk factors to prevent cardiovascular diseases.Methods: This is a randomized controlled trial. One thousand and sixteen, eligible Saudi adults will be recruited from the Heart Health Promotion study (HHP), which was conducted at the King Saud University from July 2013 to April 2014. These adults were at a higher risk of developing T2DM within 2–3 years. The research team’s database has a contact list and they will recruit individuals over 6–8 weeks. All participants will be randomized at a 1:1 ratio into two groups, receive group education about lifestyle modifications and written information about diet and physical activity. Text 4 change SMS texts will be sent only to the intervention group. All participants will be assessed at baseline, 6, 12, 18, 24, 30, and 36 months for behavioral change using a World Health Organization (WHO) STEPS questionnaire and for glycated hemoglobin, biochemical and anthropometric measurements using standard methods.Discussion: This new approach for promoting the importance of behavior modification in prediabetics is expected to delay and/or prevent the development of T2DM in Saudi Arabia, subsequently reducing the risk of cardiovascular morbidity and mortality too. Results from this study will promote an innovative and high-tech way to decrease the burden of cardiovascular diseases in Saudi Arabia.Trial registration: International Standard Randomized Control Trial, registration numberISRCTN10857643. Registered 4 June, 2018.