Context Adolescence is characterized by substantial physical and psychological changes.[1] Adolescents engage in risky behaviors and experience high rate of injury and death.[2] The heightened use of electronic devices by them has complicated the picture further.[3] These devices increase their screen time, entice them to snack on unhealthy food, and promote sedentary behavior. Extended screen time impacts their eyesight, alters brain function, produces cardiovascular stress, and gives rise to musculoskeletal disorders.[4] Besides these, there are indirect effects such as sleep disruption, insomnia, aggression, delinquency, addictions, social anxiety, obesity, and a decline of physical and mental health.[5] There is a dose-response relationship between screen time and negative health outcomes, i.e., the higher the screen time the worse are the health outcomes. The Problem: Screen Time Arab adolescents may not be any different, in terms of screen time, than those from the developed countries. The Arab Gulf countries are heavy consumers of electric gadgets (e.g., cell phone, computer, television, PlayStation, etc.), thanks to a high per capita income and the adoption of a free market economy. Although the proportion of the Arab adolescents who own devices (i.e., laptop, tablet, or smartphone) is unknown, available data have shown that 87% of US adolescents have a laptop or desktop and 58% have a tablet (the majority of those who do not own a device have access to one).[3] Few studies have examined screen time and physical activity among Arab adolescents. Two Emirati studies and one Bahraini study reported high levels of screen time (range >2 h per day: 37–85%).[6-8] However, the largest and most comprehensive data came from the Arab Teens Lifestyle Study (ATLS), which included approximately 2800 adolescents from Saudi Arabia.[9] It showed that boys were more likely to be physically active than girls (55% vs. 22 %). Girls were more likely to be sedentary (defined as screen time >3 h per day) than boys (82% vs. 70 %); the proportion was even higher (girls = 91%, bods = 84%) when standard cutoff value (>2 h per day) was applied. Despite the strengths of the ATLS study, the data are now outdated (data collection took place in 2009/2010) and more current estimates are warranted. Social Ecological Model (SEM) as an Explanation of Screen Time Behavior Screen time is a complex public health problem because: (a) Its presence is ubiquitous, (b) its clustering with other unhealthy behaviors, and (c) its varied short- and long-term health consequences. It may be helpful to rely on theory to understand this problem so that this can be addressed effectively. SEM provides a framework that captures the influencing factors of a specified health behavior at various levels.[10] According to SEM, there are multiple levels of influence on behavior and these influences interact across different levels (2 of 4 core principle of SEM).[11,12] The levels include intrapersonal, interpersonal, organizational, community, and public policy. Theoretically, each level independently acts on the outcome, and the effect accentuates further when the influencing factors interact across levels. For example, physical activity may not be included in a school curriculum; hence, an adolescent attending that school may not engage in physical activity. Since most of his friends attend the same school, they also are likely to have low levels of activity. Although an adolescent in this scenario may have some interest toward physical activity, his or her motivation is reduced since the interpersonal (i.e., friends) and the organizational (i.e., school) support is not present; thereby, creating a negative interaction. The absence of quality recreational facilities in the community may create a barrier, thereby exacerbating the risk for sedentary behavior in this scenario. Recommendations The power of SEM goes beyond diagnosing the problem; the model is “to inform the development of comprehensive intervention approaches that can systematically target mechanisms of change at several levels of influence.” It is hypothesized that interventions that target multiple levels simultaneously should be able to have a greater impact on the behaviors; hence, multilevel interventions should be more effective to change and to sustain behavior than single-level interventions (3rd core principle of SEM).[10] A proposed multilevel intervention for Arab adolescents could target each of the following levels: Intrapersonal: To conduct health promotion campaigns to encourage physical activity and to promote the use of activity tracking devices and apps (i.e., FitBit, GoogleFit, etc.) Interpersonal: To promote group-based activities such as team sports and group exercise classes. Organizational: To introduce physical activity into the school curriculum as well other extracurricular activities after school hours. Community and public policy: To improve the quality and quantity of recreational facilities inside the schools and in the community.  Data on screen time and other sedentary behaviors need to be updated regularly. One proposal is to develop a national survey with an aim to collect data on a periodical basis (e.g., every 5 years). This will allow researchers to analyze these behaviors over time, to examine their variation across factors (e.g., gender, geographical location, socioeconomic status, etc.), and to make comparisons with data from other countries, regionally and globally. More importantly, interventions need to be developed and tested to tackle this public health problem. Introducing physical activity and health education into the school curriculum are an essential component to any multilevel intervention and will likely reach the largest number of students. It is highly recommended that interventions and/or school-based physical activity programs should be grounded in theory such as the SEM that aims to influence behavior at multiple levels.

Objectives: The role of caveolin-1 (CAV1)(G>A, rs3807987) polymorphism is still dubious in cancer causation in Taiwanese population. The present study is an effort to assess the above relation for precise conclusion. Methods: EMBASE and PubMed (MEDLINE) databases were explored for the pertinent case–control studies reporting the connection of CAV1 G14713A polymorphism to the vulnerability to cancer. A cumulative analysis using meta-analytic approach was accomplished and pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for all the polymorphs. Results: Overall, 2549 subjects and 3161 controls were analyzed from six selected studies. Our study showed no confirmation of noteworthy risk between CAV1 G14713A polymorphism and susceptibility to cancer in any of the polymorph, for instance, allele (A vs. G: P = 0.165; OR = 1.252, 95% CI = 0.911–1.721), homozygous (AA vs. GG: P = 0.252; OR = 1.328, 95% CI = 0.817–2.157), heterozygous (AG vs. GG: P = 0.091; OR = 1.356, 95% CI = 0.952–1.930), dominant (AA vs. GG + AG: P = 0.345; OR = 1.191, 95% CI = 0.829–1.709), and recessive (AA + AG vs. GG: P = 0.125; OR = 1.344, 95% CI = 0.921–1.961). Conclusions: We conclude that CAV1 G14713A polymorphism does not contribute as an independent predisposing risk factor for developing cancer in Taiwanese population.

Objective: To investigate the deterioration of the brain functions by diabetes mellitus (DM) and the beneficial effect of caffeine.   Materials and Methods: First, the component of N-methyl-D-aspartate receptors (NMDA) of the field excitatory postsynaptic potential (fEPSP) were recorded in streptozotocin (STZ)-induced DM and compared with control animals. Later, 40 mice were divided randomly into five groups (8 mice in each): (1) Normal control (Cont) (2) diabetic group (DM), (3) animals pretreated with i.p. caffeine before the induction of DM (Pre Caf), (4) acute caffeine-treated group (Ac Caf), and (5) chronic caffeine group (Ch Caf). Learning and memory were assessed in Morris-Water maze, and motor coordination was tested by rotarod. Results: A significant reduction in the NMDA-component of the fEPSPs responses was recorded in the hippocampus of the diabetic animals. All the DM-groups demonstrated defects in learning and memory tasks; only the Ac Caf group could reverse the deteriorating effect of DM. This group showed a significantly lower latency values to reach their target (submerged platform) in the water maze in comparison to the DM, Pre Caf, and Ch Caf groups. Their performance was not significantly different from the control animals. Rotarod testing showed significant role of acute, but not chronic, caffeine administration in enhancing the motor skills. Conclusion: STZ -induced DM resulted into defects in memory tasks which are associated with a reduction in the hippocampal NMDA-receptor component of the fEPSP. Acute, but not chronic administration of caffeine could reverse the deteriorating effect of DM on learning and memory.

Objective: Physicians’ knowledge of antibiotics, their attitudes, expectations, and practices regarding antibiotic prescription is fundamental for controlling the irrational antibiotic use. This study evaluates primary health care (PHC) physicians’ knowledge, expectation, and practices regarding antibiotics use in upper respiratory tract infections. Methods: A cross-sectional study conducted in the Qassim region where 32 PHC centers were selected randomly. A total of 294 PHC physicians were surveyed. A pre-tested questionnaire was used after an orientation of participating physicians. Results: Response rate was 80.3%. There is a significant belief among participants that the use of antibiotics leads to relief of symptoms in the case of viral disease and that taking antibiotics without rational indication increases the side effects. Participants identified that inadequate prescription, use without prescription, and non-compliance of patients are the most important factors contributing to the development of bacterial resistance. Participants often blamed the pharmacist for contributing mostly to the development of the problem of antibiotic resistance. Most physicians identified that they feel under pressure if patients expect an antibiotic prescription. In the absence of laboratory confirmation, most physicians selected high fever as the symptom that makes them prescribe antibiotics. Although having practice guidelines, participants demonstrated that these guidelines do not consider individual variations of patients’ need. They do not support a regulation to prohibit antibiotic prescription without laboratory confirmation. Conclusions: The distribution of PHC physicians’ knowledge, attitudes, and practices did not significantly vary between urban and rural centers. Therefore, whichever measures will be taken to improve the antibiotics practices can be applied to any PHC setting.

Objective: To study the effect of thyroidectomy with totally preserved recurrent laryngeal nerve (RLN) on the objective vocal functions. Methodology: It is a prospective pilot study of 10 patients undergoing thyroid surgery on whom to study the effect of thyroidectomy with totally preserved RLN on the objective vocal functions. Patient history and demographic data were collected at the time of admission and in each period of assessment average fundamental frequency; absolute jitter, shimmer, and others were measured. Furthermore, one-way analysis of variance (ANOVA) repeated measurements statistical technique was used to test the difference among the 3 time period of measurements and P < 0.05 was considered significant (α = 0.05). Results: The mean age was 39.5 ± 3.31 years. There were two males and eight females. Total thyroidectomy was performed on eight patients while one had left hemithyroidectomy and one completion thyroidectomy. Histopathology revealed papillary thyroid carcinoma in 50%. 34 acoustic voice analysis parameters were measured using the multidimensional voice program, which showed no significant differences at the end of 1st and 3rd month post-operative as compared to the pre-operative measurements. There was no significant difference in measurement for each factor over the time (P > 0.05). Conclusions: All the acoustic analysis parameters for 10 patients showed no significant differences in 1st and 3rd month postoperatively as compared to the pre-operative values. However, due to small sample size, our study may have failed to detect any significant difference.

Objective: Inflammation and its associated cell signaling events have been well documented in psoriasis and psoriatic arthritis. However, the potential for interleukin (IL)-32 and its associated signaling to provoke an inflammatory response or to contribute in pathogenesis of psoriasis or psoriatic arthritis are still in early phase. This study determined the role of IL-32 and nuclear transcription factor (NF)-κB in patients with plaque psoriasis and psoriatic arthritis.  Methodology: Levels of IL-32 were determined in the plasma samples of patients with plaque psoriasis, psoriatic arthritis and normal healthy subjects by human IL-32 specific Sandwich enzyme-linked immunosorbent assays. To investigate the role of transcription factor in these patients, activated NF-κBp65 levels were determined in the peripheral blood mononuclear cells (PBMCs) by highly sensitive NF-κB transcription factor kit.   Results: The levels of IL-32 in the plasma samples of plaque psoriasis or psoriatic arthritis patients were found to be significantly higher as compared with the levels of IL-32 present in the normal human plasma samples (p<0.01). Levels of activated NF-κB were also found higher in plaque psoriasis or psoriatic arthritic patients as compared with the PBMCs of healthy humans (p<0.05). Conclusions: This study shows the role of IL-32 and NF-κB in plaque psoriasis and psoriatic arthritic patients. Results indicate that IL-32 and NF-κB promote inflammation in patients with psoriasis and psoriatic arthritis. Disruption of IL-32 or NF-κB signaling event might provide a novel target for the management of plaque psoriasis and psoriatic arthritis.

Objective: Selective degeneration of dopaminergic neurons is the pathological hallmark of Parkinson disease (PD). Enhanced oxidative stress, lipid peroxidation and susceptibility of dopaminergic neurons to apoptotic cellular death are the leading pathogenetic mechanisms. Chrysin is an active flavonoid. Its neuroprotective effects have been reported. This study examined the neuroprotective effects of chrysin in ameliorating the dopaminergic neuronal degeneration and motor behavioral changes in rotenone model of PD. Methods: Thirty Sprague-Dawley rats were assigned into three groups: Control, rotenone-treated, and rotenone+chrysin treated groups. Rotenone was given at a dose of 3 mg/kg daily intraperitoneally, and chrysin was given at a dose of 50 mg/kg daily intraperitoneally for 4 weeks. Using five neurobehavioral assessment tests, evaluation was done weekly to record the motor behavioral changes. After 4 weeks, animals were sacrificed, brains were removed, and section from striatum and substantia nigra were stained using hematoxylin and eosin and cresyl violet stains. Immunohistochemical sections were also prepared using anti-tyrosine hydroxylase (TH) antibody. Results: Rotenone-induced Parkinson like changes were evident from deteriorating motor behavior. These animals showed extensive loss of dopaminergic neurons, decreased immunoreactivity against anti-TH antibodies and number of TH positive dopaminergic neurons in the nigrostriatal region. Chrysin treated animals showed a significant reduction in motor behavioral changes, degeneration and loss of nigrostriatal dopaminergic neurons and increased immunoreactivity to anti-TH antibody. Conclusion: This study concludes that chrysin confers neuroprotection in rat model of PD. It attenuates the degeneration of the nigrostriatal dopaminergic neurons and motor behavioral abnormalities. 

Objective: The underlying molecular basis of ischemic heart diseases (IHDs) has not yet been studied among Iraqi people. This study determined the frequency and types of some cardiovascular genetic risk factors among Iraqi patients with IHDs. Methods: This is a cross-sectional study recruiting 56 patients with acute IHD during a 2-month period excluding patients >50 years and patients with documented hyperlipidemia. Their ages ranged between 18 and 50 years; males were 54 and females were only 2. Peripheral blood samples were aspirated from all patients for troponin I and DNA testing. Molecular analysis to detect 12 common cardiovascular genetic risk factors using CVD StripAssay® (ViennaLab Diagnostics GmbH, Austria) was performed. Results: The genotype frequencies of 12 genetic mutations/polymorphisms were as follows: MTHFR A1298C and C677T were the highest reported mutations (62.5% and 50%, respectively), followed by β-fibrinogen gene mutation, homozygous angiotensin-converting enzyme D/D, heterozygous human platelet antigen-1(a/b) polymorphisms, plasminogen activator inhibitor-1 4G/4G, homozygous E4 allele of apolipoprotein E gene, Leu allele of Factor XIII V34L variant, heterozygous FV R2, Factor V Leiden mutation, prothrombin G20210A mutation, respectively. Genetic risk scores were calculated and a number ranging from 0 to 8 were given to each patient. None (0%) had a risk score >6 or <2; 22 (39.3%) patients had a risk score of 4 and >60% of cases had a risk score of 4 or more. Conclusion: The obtained results constitute a reference guide where future studies on normal people and older IHD patients can rely on to determine whether these can be used for pre-clinical risk assessment.

Background: Most patients who have been hospitalized at some point in time must have experienced a measure of pain despite improvements in health-care systems. Globally, there is a dearth in information with regard to pain management. Pain management is an essential process for nurses because they spend most time of the day with the patients. Therefore, nurses’ level of knowledge and positive attitudes toward pain management reflect this vital and significant role played by nurses in critical care units. Aims: The aims of this are to evaluate the level of knowledge and attitude of nurses regarding pain management in high acuity care units of Palestine. Methods: For this cross-sectional descriptive study, data were obtained from seven hospitals in Palestine. Nurses were recruited from high acuity care units, including nurses from the medical and surgical wards. Their knowledge on the degree of pain was measured using the survey for “Knowledge and Attitudes Survey Regarding Pain.” Results: About 123 nurses took part in the survey. The total mean score of correct answers for the 39 questions asked was 17.4 ± 4.2, which is considered to be less than the pass mark of 19.5. There were no statistically significant differences between the nurses’ total average score and demographic characteristics, except for their initial level of education. Conclusions: The results of this study showed that Palestinian nurses in critical care units possess inadequate knowledge about pain management. Furthermore, there are inconsistencies in their attitudes and practices which require further research. There is a need for the council of health professionals to lay emphasis on pain management through continuous training and enlightenment of nurses to equip them with more knowledge and positive attitudes toward pain management.

Objective: There is a growing demand for health-care nursing services in several health care institutions. Understanding barriers to physical assessment among nursing students create a more detailed assessment in the development of quality patient’s care in nursing practice. This study examined the barriers to physical assessment skills among nursing students in a government university in Arab Peninsula. Methods : A cross-sectional research survey design of 206 nursing students using a standardized questionnaire was used. The questionnaire is composed of 7 subscales in evaluating the barriers to physical assessment skills between the classroom and clinical setting. Independent Samples t-test was used in comparing the gender mean of the nursing students about the barriers to physical assessment. Paired t-test was also used in determining the differences between perceived barriers to physical assessment in the classroom and clinical setting. Results: Subscale “reliance on others and technology,” ward culture, “lack of influence on patient care” have significant differences between perceived barriers in physical assessment among classroom settings and clinical setting. Conclusion: Although nursing students were oriented and educated about physical assessment in the nursing curriculum, this is not often practiced in clinical settings. The point that is if nursing students are incorrectly performing the patient assessment, then no amount of critical thinking could lead to better clinical decisions. Continuous exposure and enhancing the quality of planning and promotion of the nursing students could develop necessary skills. In addition, increasing self-confidence is vital to assess the patient’s health status effectively and minimize the barriers to performing the physical assessment.

Objectives: Anecdotal reports from Bangladesh indicated that some young adults were becoming addicted to online pornography similar to how others become addicted to gambling, drugs, and alcohol. Such behaviors can have social, academic, and behavioral implications in this population. This study investigated the association between consumption of online pornography and sociobehavioral patterns among students from a private university in Bangladesh. Methods: In total, 299 undergraduate students (70.6% male) at the First Capital University of Bangladesh were interviewed using a structured questionnaire. The questions included sociodemographic characteristics, online-based pornography consumption habits and sociobehavioral characteristics. Chi-square test and binary logistic regression analysis were performed to examine correlations between online pornography addiction and sociobehavioral factors such as socializing habits, nature of interactions, university attendance and study focus, sleeping habits, and consumption of main meals. Results: The use of pornography was significantly higher among students who gathered late nights with their friends (58.4%, P < 0.001). Furthermore, those who frequently argue/fight with their friends (51.0%, P = 0.001) frequently fooled around with their friends (48.4%, P < 0.001) and those who did not go to bed on time (57.7%, P < 0.001) reported greater consumption of pornography. Students who fooled around with their friends and those did not go to bed on time were more than twice as likely to watch pornography than students who did not fool around, and those went to bed on time. Conclusion: The study provides the first overview of online pornography consumption. A significant proportion of male students consumed erotic materials online than females. Students who did not go to bed emerged to consume online pornography. Such behaviors can have negative impacts on studies education outcomes as well as wider social and moral impacts for students and the society as a whole. In this digital era, technology has invaded every aspect of our lives, with increasing access to the internet. Therefore, it is imperative to provide specifically designed pornography addiction education programs to educate students about the adverse effects of pornography. Furthermore, targeted treatment programs for sexual addiction, sexual abuse, and pornography abuse are needed to support the individuals who are addicted to pornography. 

Sweetened oral medications are widely used for children to facilitate compliance. A variety of natural and artificial sweeteners are used in these drug formulations to augment the sweetness and thereby palatability of the product. There is growing concern among dentists about the increased consumption of sugars in these medications by children, especially those who are chronically ill as it may contribute to diabetes mellitus, dental erosion, and dental caries. This literature review provides information about the sweetener content and cariogenic potential of commonly prescribed pediatric oral medications that are used for managing acute and chronic conditions in children and measures for oral health prevention.

Change management studies have emphasized the significance of an organization’s readiness for change and transformation and have recommended strategies to affect change. Organizational readiness for change is a multi-faceted, multi-level, and multi-dimensional activity; its most important aspect is organizational members’ willingness to accept and implement change because ignoring the human factors may result in resistance and failure. Through its National Transformation Program 2020, the Saudi Arabian government is attempting to effect radical changes in the structure and function of its health-care system to achieve quality care and effective service delivery. The aim of the present review is to discuss the Saudi health-care system’s readiness to change that Saudi Arabia intends to implement by 2020, based on extensive review of different reports, documents, and empirical studies in the field of organizational readiness for change. The study concludes that if organizational readiness for change is high, resources are available, and situational factors are aligned, members of organizations will take the initiative to change, exert optimal effort, demonstrate greater determination, and engage in more cooperative behavior that may lead to efficient and effective implementation of the Saudi health-care transformational plan with fewer complications and less resistance.

Superoxide dismutases (SODs) constitute a very important antioxidant defense against oxidative stress in the body. The enzyme acts as a good therapeutic agent against reactive oxygen species-mediated diseases. The present review describes the therapeutic effects of SOD in various physiological and pathological conditions such as cancer, inflammatory diseases, cystic fibrosis, ischemia, aging, rheumatoid arthritis, neurodegenerative diseases, and diabetes. However, the enzyme has certain limitations in clinical applications. Therefore, SOD conjugates and mimetics have been developed to increase its therapeutic efficiency. Here, an overview is provided of some in vivo therapeutic effects observed with SOD.

It is commonly accepted to consider retroperitoneal germ cell tumors as the metastasis of a viable or burned out testicular tumor. In such cases, orchiectomy should be performed since the burned-out site in the testis could continue to harbor malignancy despite systemic chemotherapy. A 45-year-old male presented as an outpatient with complaints of back pain. He was diagnosed with a retroperitoneal mass and a palpable testis mass. He underwent radical orchiectomy.  Pathological study revealed a burned-out tumor. Following chemotherapy, retroperitoneal lymph node dissection was performed. Despite the residual and enhanced retroperitoneal lymph nodes in his computed tomography scan, none of the resected lymph nodes showed a viable tumor. This is the first reported case of a palpable and hypoechoic burned-out testicular tumor.