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. Running head: Influenza vaccination in primary healthcare workers in Saudi Arabia

Despite the significant role of seasonal influenza vaccination in preventing and minimizing the serious complications of influenza infection in type 2 diabetes mellitus (T2DM) patients, unsatisfactory compliance still exists for vaccination. Study objectives were to explore the vaccination status and determinants in T2DM patients in southwestern Saudi Arabia. A cross-sectional study on a representative sample of T2DM patients in Abha city, southwestern Saudi Arabia, was conducted. Data for sociodemographic characteristics, clinical criteria, vaccination status, vaccination motivators and barriers and seasonal influenza knowledge were collected. Out of 353 T2DM patients included in the study, seasonal influenza vaccination coverage was 61% in year 2017. A significant factors associated with non-vaccination were; poor influenza and its vaccine knowledge (OR = 4.31, 95% CI: 2.73–6.80), illiteracy (OR = 1.93, 95% CI: 1.11–3.37), and more than 10 years disease duration (OR = 2.07, 95% CI: 1.11–3.87). Presence of family history of DM and ischemic heart comorbidity minimized the possibility of non-vaccination (OR = 0.54 and 0.28 respectively). Healthcare givers’ advice was the most reported vaccination motivator (84.7%) while; fear of vaccine side effects was the most stated barrier (73%). In conclusion, influenza vaccination rate among T2DM in the present study is less than the recommended level. Continuous primary health care center-based educational programs should be implemented to aware and encourage influenza vaccination among T2DM patients.

Aim of Study. To assess serum thyroid hormones levels among Saudi adults and to correlate participants’ serum levels with their grades of body mass index (BMI).Methodology. A total of 278 adult subjects were recruited. Participants were categorized according to their BMI grades into normal weight (BMI < 25 kg/m²), overweight (BMI 25–29.9 kg/m²), or obese (BMI≥30 kg/m²). Serum thyroid hormones levels were assessed at the central laboratory of Aseer Central Hospital, Abha City, by chemiluminescence immunoassay.Results. More than three-fourths of participants were either overweight (31.3%) or obese (44.6%). Mean TSH serum levels showed a significantly increasing trend with increasing BMI (p<0.001). A negative trend was observed regarding participants’ mean serum levels of fT4 with their BMI, but there were no significant differences in mean serum fT4 levels according to BMI. Moreover, no significant differences were observed in serum fT3 levels according to BMI.Conclusions. Mean TSH serum levels increase with BMI increase. Further largescale multicentric and longitudinal studies are necessary to prove the association between serum levels of thyroid hormones and BMI of euthyroid adults.

Background: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school. Objectives: To assess the schoolteachers’ knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program. Methods: A randomized controlled trial study design was followed on 100 primary school teachers from Abha City, Saudi Arabia. Teachers were randomly selected and allocated into trial and control groups. A self-administered questionnaire was used to evaluate teachers’ knowledge about ADHD. After the baseline assessment, participants in the trial group received a two-day ADHD knowledge improvement program. Teachers’ knowledge about ADHD was reassessed using the same questionnaire immediately after finishing the intervention program and after three months in both groups. Results: Only 16% and 22% of trial and control groups, respectively, showed adequate baseline knowledge about ADHD. Teachers’ main sources of information about ADHD were the internet (67%), friends (47%), TV (34%), and reading books (23%). Knowledge of teachers in the trial group significantly improved immediately after the intervention. After three months, these knowledge benefits slightly declined but remained more adequate than those of teachers in the control group. The logistic regression model revealed that being a participant in the trial group and of higher qualification were associated with significant improvement in teachers’ retained knowledge on ADHD (p < 0.001 and p = 0.050, respectively). Conclusions: The majority of male primary school teachers in Abha City, Saudi Arabia, have inadequate knowledge about ADHD. Applying a knowledge improvement program can substantially improve their knowledge of ADHD. Consideration should be given to the integration of ADHD knowledge improvement program into teachers’ educational programs.

This study aimed to evaluate knowledge about monkeypox and confidence in dealing with monkeypox diagnosis and management among resident physicians in the Asir region of Saudi Arabia. The data of this cross-sectional study were collected online through a structured questionnaire (N = 315). Knowledge about monkeypox was assessed by 24 questions and a three-item scale assessed confidence in managing monkeypox cases. Multiple logistic regression analysis was performed to assess the associations. Overall, two-thirds of the respondents (67.3%) showed good knowledge about monkeypox and the rest of them (32.7%) had poor knowledge. Respondents who received a copy of the Saudi MOH protocol for monkeypox and attended any conference or lecture about monkeypox were more likely to have good knowledge about monkeypox. Moreover, almost two-thirds of the participants were not confident that they could diagnose or manage the monkeypox. Respondents who received information about monkeypox during residency or medical school had higher confidence in managing monkeypox cases. It can be concluded that the Saudi healthcare system has scope to take necessary steps to contain the monkeypox endemic. The Saudi MOH should arrange conferences and educational programs on monkeypox so that healthcare professionals can improve their knowledge and be confident in the management and diagnosis of monkeypox cases.

Objective: To report a Saudi young patient with early onset type 2 diabetes, who was misdiagnosed for 6 years as type 1 diabetic. Case Report: A Saudi male aged 18-year old presented with uncontrolled diabetes. He was diagnosed 6 years earlier to have type 1 diabetes mellitus. He was kept insulin, but he was not compliant to treatment and his blood glucose kept on fluctuating and not controlled. He came to our diabetes center for management of his uncontrolled diabetes. There was no past history of hospitalization. His father was type 2 diabetic. His body mass index was 46.7 kg/m². His glycosylated hemoglobin (HbA1c) level was 9.9%. Immune dysfunction was evaluated using serum antibody levels of glutamic acid decarboxylase, which proved to be negative (0.7 U/mL), while serum C-peptide level was not low (2.2 ng/mL). Therefore, the patient was diagnosed as early onset type 2 diabetic, not type 1 diabetic. The patient was advised to start physical exercise through daily walking for at least 1 h. The dietitian planned a strict diet plan for him to follow. Insulin injections and Metformin tablets were started. The patient received detailed health education on nature and management of his condition. After 4 months, his body mass index became 39.4 kg/m² and his HbA1c became 6%. Insulin was stopped, and he was advised to continue on metformin, the diet, and daily walking. Two months later, his body mass index was 37.7 kg/m² and his HbA1c became 5.41%. Conclusions: Early onset type 2 diabetes should be suspected among obese children with symptoms of diabetes. Proper health education and patient's compliance to medication, diet, and physical activity are essential for successful management of early onset type 2 diabetes. Moreover, primary care physicians need to be aware that type 2 diabetes is not necessarily adult-onset.