The prevalence extent of Complementary and Alternative Medicine (CAM) use among Saudis

Perceived Usefulness Drives the Use of Traditional, Complementary, and Integrative Medicine: A Systematic Umbrella Review

Introduction: The use of traditional, complementary, and integrative medicine (TCIM) has grown rapidly worldwide. The aim of this umbrella review is to provide a comprehensive synthesis of the available evidence on factors associated with TCIM use to identify the most influential factor driving the use of TCIM. This review was guided by the following research question: What is the most influential factor driving TCIM use? Methods: This review was conducted in accordance with PRISMA guidelines. International literature was systematically searched using PubMed, Embase, and manual searching of reference lists. The search was limited to peer-reviewed systematic literature reviews published between January 2005 to March 2024, in Arabic and English languages, and reported empirical research findings on factors associated with TCIM use. Results: A total of 62 review articles were included. The following five prominent factors were identified and critically analyzed: Socioeconomic status; dissatisfaction with conventional medicine; internal locus of control; being holistic, natural, and safe; and perceived usefulness. Of these, perceived usefulness, defined as the perceived benefits of a TCIM modality in meeting specific health needs or goals, was the most influential factor driving TCIM use. Discussion: The findings of this umbrella review revealed that individuals would not use a specific type of TCIM unless they perceived some benefit from its use, even if the benefit lacked supporting scientific evidence. This insight provides a foundation for researchers, health practitioners, and policymakers to advance TCIM research, clinical practice, and policy by targeting its perceived benefits. Focusing on perceived benefits can help researchers prioritize areas that are most valued by patients, leading to more impactful studies and evidence-based recommendations for practice. Understanding perceived benefits can also lead to more informed discussions between patients and health practitioners, creating a more collaborative and culturally sensitive health care environment. Furthermore, addressing perceived benefits can guide regulations to ensure the safe, effective, and ethical use of TCIM practices, leading to more effective integration of TCIM into conventional medicine as the evidence of its usefulness accumulates.

A Comprehensive Look at Complementary and Alternative Medicine (CAM) in Saudi Arabia: A Meta-Analysis Study

Background and Aims

Complementary and Alternative Medicine (CAM) refers to a diverse array of healthcare practices that lie outside conventional Western medicine, including herbal remedies, spiritual healing, and traditional therapies. CAM use has become increasingly prevalent worldwide, driven by cultural, religious, and socioeconomic factors, including in Saudi Arabia. This systematic review and meta-analysis aimed to estimate the prevalence of CAM use in Saudi Arabia and examine the patterns of its utilization across various populations.

Methods

A systematic literature review was conducted using the PRISMA framework to identify studies investigating the prevalence and patterns of CAM use among diverse populations in Saudi Arabia. Databases searched included Cochrane, Clinicaltrials.gov, CINAHL, Web of Science, and PubMed.

Results

Seven cross-sectional studies, with a total of 4112 participants were included. The studies encompassed a wide range of populations, from adolescents to adults with chronic illnesses. The pooled prevalence of CAM use was calculated to be 0.515 (95% CI [0.373-0.657]) using a random-effects model, showing that 51.5% of the Saudi population engages in CAM practices. Significant heterogeneity was observed across the included studies, likely due to differences in population demographics, CAM definitions, and study methodologies.

Conclusion

The findings emphasize the cultural and religious impact on CAM use and its significance in healthcare delivery. Future research should focus on standardizing CAM definitions, exploring the efficacy of popular therapies, and integrating CAM into conventional healthcare to provide holistic and culturally sensitive care.

Review Registration ID

PROSPERO CRD42024608257.

The effect of inhaled aromatherapy on cognitive function in patients with cognitive impairment: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Cognitive function is the basis of human thinking and behavior. Cognitive impairment has a serious impact on each individual and imposes a financial burden to families and healthcare systems. Inhalation aromatherapy has advantages, due to its safety, convenience, lack of toxicity, and wide use in the treatment of cognitive impairment. This systematic review was conducted to provide evidence for the use of inhaled aromatherapy in patients with cognitive impairment.

METHODS

We searched nine databases for pertinent Chinese and English studies published through November 2024 studies using inhaled aromatherapy in patients with cognitive impairment. Literature screening and data extraction were performed independently by two researchers and evaluated using the Cochrane Collaboration's quality criteria and were then cross-checked. A meta-analysis was carried out using Cochrane's Review Manager (RevMan, version 5.4), and we followed the PRISMA guidelines.

RESULTS

We included fourteen studies involving 888 patients with cognitive impairment in our study. Meta-analyses indicated that inhaled aromatherapy increased Mini-mental State Examination (MMSE, mean difference MD = 3.89 95 % CI [3.19, 4.58], P < 0.00001) and Montreal Cognitive Assessment Scale (MoCA, MD = 4.11, 95 % CI [3.54, 4.68], P < 0.00001) scores and decreased Homocysteine levels (Hcy, MD = -2.27 95 % CI [-2.80, -1.74], P < 0.00001) in patients with cognitive impairment compared with controls.

CONCLUSION

Inhaled aromatherapy could improve global cognition and lower Hcy in patients with cognitive impairment.

Prevalence and Predictors of Self-Medication Among Ophthalmic Patients in Jordan: A Cross-Sectional Analysis

Background: When people decide to treat themselves with medication without going to a physician for a prescription, it is called self-medication (SM). This study aims to detect the prevalence rate of SM among ophthalmic patients in Jordan. Methods: This study applied a cross-sectional study design using a questionnaire tool completed by 1009 ophthalmic patients. Binary logistic regression was used to identify predictors of practicing SM. Results: The prevalence rate of participants practicing SM for ophthalmic conditions was 21.0%. The most common reason for SM was medical recommendations from a pharmacist or optician (55.7%), followed by failure to recognize the severity of the symptoms so that the patients thought they did not need a doctor to treat their eyes (34.4%). Eye symptoms included redness (69.3%), itching (61.3%), and a burning sensation (38.7%). The 24-30 age group was more likely to practice SM (p < 0.05). Other patients who had previously undergone ophthalmic surgery and were currently wearing contact lenses were less susceptible to SM practice (p < 0.05). Conclusions: Younger patients with ophthalmic conditions showed a higher probability of practicing SM. SM for eye diseases carries significant risks and requires careful consideration to avoid harmful consequences.

The Use of Non-pharmacological Herbs in Treating Cough and Respiratory Symptoms in Saudi Arabia: a Multi-center Study

Background

Herbal medicinal products, a subgroup of complementary and alternative therapy (CAM), are widely used for pediatric respiratory symptoms in Saudi Arabia. However, regional variations and safety concerns remain understudied.

Objective

This study examines the prevalence and patterns of herbal remedy use for cough and respiratory illness among Saudi children.

Methods

A multi-center cross-sectional questionnaire-based study was conducted across five Saudi regions (N=475). Data were collected via a validated questionnaire (Cronbach's α = 0.85) and analyzed using SPSS v25.

Results

The mean age was 3.97 ± 3.60 years. Herbal remedy use was highest in the Western province (37.8%, p <0.001). Sesame oil (19.8%) and olive oil (18.2%) were most common. Family/friends provided 82.8% of advice. Self-rated improvement was "excellent/good" in 59.9%, with 96.6% reporting no adverse effects. Fathers with postgraduate degrees used fewer herbal remedies (p=0.003).

Conclusion

Herbal remedy use is prevalent, emphasizing the need for healthcare providers to document usage and educate families. Further research is required to evaluate efficacy and safety.

The use of complementary and alternative medicine among surgical patients: a cross-sectional study

BACKGROUND

The use of complementary and alternative medicine (CAM) has increased substantially around the world; various global studies have documented the use of CAM by surgical patients in the preoperative period, with rates of herbal medications and other nonherbal treatments ranging from 12 to 69%. This study aimed to identify the prevalence of CAM and its patterns of use among surgical patients.

METHODS

From December 2020 to April 2021, a descriptive cross-sectional study was undertaken in Palestine. A face‒to-face interview questionnaire was used. The participants were asked questions regarding sociodemographics, clinical information, CAM usage, reasons for its use, and opinions on its efficacy.

RESULTS

Among the 300 surgical patients who were interviewed in this study, 252 (84.0%) reported that they had ever used CAM, while a total of 122 (48.4%) had used CAM before their surgery, 81.7% of the respondents used herbal methods, and 64.7% of them used nonherbal methods. CAM use among our study population was not linked to specific demographics or other characteristics, except health insurance (p = 0.004). The most commonly used herbs among surgical patients are Salvia officinalis L. (Sage) (84.1%) and Pimpinella anisum L. (Anise) (75.5%). The highest percentage was found among patients with university qualifications (73.2%), who used more than three methods (p < 0.001). In addition, 59.4% of the females used more than three therapies, whereas 45.9% of the males did (p = 0.032).

CONCLUSIONS

The herbal methods used are common among surgical patients in Palestine and are consistent with the enormous increase in the use of CAM. Therefore, awareness should be raised among the public regarding the risks and benefits of CAM use.

The relationship between phytoestrogen-rich supplements and breast cancer: A multicenter case-control study in Saudi Arabia

Objectives

The prospective effect of phytoestrogen-rich supplements has been explored by many researchers in an attempt to reduce breast cancer (BC) risk worldwide. In Saudi Arabia, some widely used supplements have high phytoestrogen content. Therefore, we aimed to (1) assess the relationship between phytoestrogen supplements (PSs) that are widely used among women of Saudi Arabia and BC and (2) assess the relationship based on the menstrual status.

Methods

The study took place during 2020-2022 to assess several PSs using a case-control design that included five centers from different provinces around the country. A questionnaire was answered by the participants that included 381 (46%) cases (diagnosed with BC) and 449 (54%) controls (free of BC). The PS items were assessed individually and on the multivariant analysis model.

Results

Of the 12 phytoestrogen-rich supplements, soy milk showed a significant decrease in BC risk. However, Echinacea showed an increased risk of BC among its users. A subgroup analysis based on the menstrual status demonstrated an increased risk of BC among licorice root and green tea users on premenopausal and postmenopausal women, respectively.

Conclusion

Soy isoflavones continue to show a significant risk reduction that could be used for a modified approach to reduce the risk of BC. However, Echinacea, licorice root, and green tea have shown to increase the risk of BC.

Can alternative medical methods evoke somatosensory responses and functional improvement?

Background

Evidence-based scientific studies focusing on complementary alternative medicine (CAM) and potential functional improvement after an insult of the central nervous system are lacking.

Aims

We aim to demonstrate that functional recovery after stimulation applied as a CAM treatment through cauterization might trigger neural repair and regenerative paths similarly as acupuncture, cupping, electrical or magnetic stimulations. Those paths are important in recovery of function.

Procedures

Medical records and information of ten patients, with initial presentations of cerebral trauma or spinal cord insult inducing paralysis, were studied. Patients ages ranged from 17 to 95-year-old. Patients consulted for alternative medical treatment one year or more after initial diagnosis.CAM treatment consisted in 10-point stimulation on the skull and 4-point stimulation located at the right and left calves and forearms. Stimulations consisted of a heated steel rod application (cautery) in a one-time session. The duration of each stimulation was about 0.5 s.

Results

Most studies using CAM stimulations (acupuncture, cautery, cupping, moxibustion, electrical and magnetic stimulations) describe improvement. In all 10 medical records and information from our practitioner, patients had improvement in their motor skills, including gain of weight support, unassisted small walks, independent and voluntary movements of limbs. Improvement was steady over a period of one to several years.

Conclusion

We compared our findings to acupuncture, electrical, magnetic field effects to highlight common paths and to provide scientific evidence for recovery of the function. We believe that CAM treatments triggered existing or new neuronal networks as well as synaptic efficiency or reactivation, through highly increased, sensory nociceptive coupled to proprioceptive, afferences. Those results also highlight the need to further investigate neural function of cortical and subcortical areas through indirect pathways stimulations.

Assessment of Knowledge and Communication Regarding Complementary and Alternative Medicine Among Physicians in Madinah City

INTRODUCTION

Despite the recognition of the importance of physician knowledge and physician-patient communication about the use of complementary and alternative medicine (CAM), few studies have explored this issue. Therefore, this study aims to assess physicians' knowledge and physician-patient communication regarding CAM.

METHODS

A cross-sectional study was conducted among physicians working at governmental hospitals and primary healthcare centers in Madinah, Saudi Arabia. The data collection tool was a validated English language questionnaire distributed using social media platforms. The questionnaire included sections to assess physician knowledge and communication about CAM.

RESULTS

Of the 373 completed questionnaires, around 151 (40.5%) of the respondents stated that they have a poor level of knowledge about CAM, and 272 (72.9%) need to gain additional knowledge to properly counsel patients on CAM. Medical journals were the main source of knowledge about CAM. There were 121 (32.4%) physicians who believed that <20% of their patients use some form of CAM, and 180 (48.3%) believed that <20% of their patients spontaneously reported their CAM use without prompting or direct questioning. Around 180 (48.3%) of physicians believed that they asked <20% of their patients about using CAM. Regarding barriers that limit communication with the patient about CAM, the highest percentage was insufficient knowledge about CAM (137, 36.7%).

CONCLUSION

The study showed that a significant number of physicians lack the appropriate knowledge about CAM and most of them agreed to gain additional knowledge to properly counsel their patients. Further research is needed to evaluate physicians' knowledge about CAM using a more objective method.

Perspective of adults in Saudi Arabia toward complementary and alternative medicine use for autism spectrum disorder: a cross-sectional study

BACKGROUND

Autism Spectrum Disorder (ASD) is a high-prevalence neurodevelopmental disorder characterized by communicational, social, and behavioral challenges. Complementary and alternative medicine (CAM) is a group of practices and products that fall outside the realm of conventional medicine practiced worldwide. Traditional CAM is a health practice that comes from a particular culture, such as the use of Zamzam water and black seeds in Saudi Arabia. CAM comprises widely utilized practices in Saudi Arabia for children of various ages and adults. In many cases, CAM is used to treat ASD. The aim of this study is to investigate the perspectives of adults in Saudi Arabia toward CAM for treating ASD.

METHODS

A cross-sectional study was conducted by distributing an online questionnaire to adults in different regions of Saudi Arabia.

RESULTS

A total of 4,311 adults participated in this study; 66.8% were females and 33.2% were male. Half of the participants reported that they knew about ASD (54.7%). More than half of the participants indicated that CAM-including art therapy (69.0%), physical exercise (67.0%), and limiting the use of electronic (55.4%)-could help in ASD management. Around half of the respondents indicated a belief that traditional treatment cannot help in treating ASD (53.9%). Only 20.0% of the respondents thought that ASD could be entirely treated using CAM therapies. The most common source of knowledge about CAM was social media and the internet (58.6%).

CONCLUSIONS

The majority of participants in this study did not believe that ASD could be treated entirely using CAM. In addition, fewer than half of the participants believed that CAM therapies could improve different aspects of ASD, such as behavioral issues. The study highlighted the need for awareness among residents of Saudi Arabia regarding specific treatments for ASD.

Ethical and Legal Aspects of Telerehabilitation in Saudi Arabia

Organizations have their own policies and procedures to govern operational aspects of health care facilities. With the advent of telemedicine, there has been a growing trend in providing telehealth practices without formally exploring the ethical and legislative aspects. The potential use of electronic and digital services in telerehabilitation can influence various ethical and legal factors, such as confidentiality, consent. and negligence. Thus, establishing clear strategies in this regard is necessary. Ethical and legal aspects of healthcare are influenced by cultural, religious, and legislative rulings of a state. At the same time, the multidimensional scope of rehabilitation in a health system has its own challenges. This narrative review intends to highlight the importance of incorporating the ethical and legislative framework in the telerehabilitation process in Saudi Arabia. A summary of various aspects in-line with unique local attributes is included, which can also help to facilitate regional telerehabilitation services in the Arab World.

The Prevalent Use of Complementary and Alternative Medicine Among Patients With Chronic Disease in the Al-Madinah Population of Saudi Arabia

BACKGROUND

Global interest in complementary and alternative medicine (CAM) has recently risen, particularly in Saudi Arabia, and the use of CAM is gaining popularity as a healthcare option.

OBJECTIVES

This study aims to assess the prevalence of CAM use among patients with chronic diseases and identify the reasons for resorting to CAM in Al-Madinah, Saudi Arabia.

METHODS

A cross-sectional study was conducted in Al-Madinah City. Data for analysis were derived from 416 participants with chronic diseases. The data were collected using a valid, structured online questionnaire that was designed to extract socio-demographic data as well as data on the predominant use of herps, hijama (cupping), acupuncture, and other specific CAM applications. The collected data were analyzed using appropriate statistical methods.

RESULTS

Of the 416 participants, 164 (39.4%) were men, and 96.9% were Saudi citizens. Approximately one-third of the studied participants had diabetes (34.1%), while 29.3%, 25.2%, 15.1%, and 12.3% had hypertension, obesity, asthma, and gastrointestinal tract disease, respectively. The prevalence of herb and natural supplement use was 89.2%. The most commonly used herbs and natural supplements were ginger (55.5%), honey and its derivatives (53.4%), cinnamon (45.4%), and frankincense (33.4%). Of the studied participants, 36.1% and 6.5% reported undergoing cupping and acupuncture, respectively. No statistically significant differences were found between the use of herbs and acupuncture or any of the studied factors. Further, the use of acupuncture exhibited no significant differences. However, the use of cupping displayed statistically significant differences in age, sex, and income among the participants.

CONCLUSION

The prevalence of CAM use among patients with chronic diseases in Al-Madinah is high. It appears to play an essential role in health care, particularly in treating patients with chronic diseases in this population. Therefore, promoting research in the field of CAM is warranted.

Integrated traditional herbal medicine in the treatment of gastrointestinal disorder: the pattern of use and the knowledge of safety among the Eastern Region Saudi population

BACKGROUND

Herbal medicine is commonly integrated with conventional medicine in Saudi Arabia, especially for the management of digestive disorders. However, the majority of Saudis use herbal remedies without prior consultation with a physician, which raises concerns about their appropriate and safe use. The aim of this study was to assess the level of awareness among the Saudi population regarding the proper utilization and potential adverse effects of frequently used herbs for the treatment of gastrointestinal (GI) diseases.

METHODS

A cross-sectional survey was conducted in Saudi Arabia from January to March 2021. An electronic self-administered questionnaire was distributed.

RESULTS

A total of 543 participants from different age groups, educational levels, and cities across Saudi Arabia completed the study questionnaire. The most commonly used herbs at home by the participants were: myrrh, parsley, black seed, chamomile, mint, anise, clove, and green tea. 57.7% of the participants perceived herbs as safer than conventional medicines; 27.3% reported that using herbal remedies over conventional medicine was a family tradition, and 21.4% used herbs because they were cheaper than conventional medicines.

CONCLUSION

Herbal remedies, including myrrh, parsley, blackseed, chamomile, mint, and anise, are commonly employed for the treatment of gastrointestinal disorders in Saudi Arabia. However, the knowledge level of participants regarding potential side effects and drug-herb interactions was found to be deficient. As such, there is a pressing need for educational campaigns and community awareness programs to elucidate the proper usage of herbal remedies and to caution against their potential adverse effects.

Public Use of Complementary Medicine for Children in Saudi Arabia: A Questionnaire-Based Cross-Sectional Study

BACKGROUND AND OBJECTIVES

The use of complementary and alternative medicine (CAM) is growing among adults and children. Extensive data is available regarding the pattern and frequency of CAM used in adults in Saudi Arabia, but limited data is available for children. This study aims to examine the level of knowledge, attitude, and practice about the use of CAM in the pediatric population in Saudi Arabia.

SUBJECTS AND METHODS

A cross-sectional descriptive study on the use of CAM in children was carried out in the general population of Saudi Arabia. Data was collected by non-probability consecutive sampling technique through an online-based questionnaire from 132 participants. In addition, data analysis was done using IBM's Statistical Package for the Social Sciences (SPSS). The data collected consisted of socio-demographic details, knowledge, attitude, and practice of CAM in children.

RESULTS

CAM was reported in all 132 participants (100%), with 45% (N=59) using it without informing their physicians. The mean age of the children was 17 months old, 55.3% (N=73) children were males, and 44.7% (N=59) were females. The most common form of CAM used was herbal medicine, 91% (N=120), while alternative medicine was used in 16.7% (N=12) of the children. Honey was the most used herb (68.2%, N=90), followed by anise (65.2%, N=86), Zamzam water (holy water) (59.1%, N=78), and olive oil (56.8%, N=75).

CONCLUSIONS

The use of CAM is very common for children in the general population of Saudi Arabia, with herbal medication being the most common. This constitutes a dire need to regulate this field and provide enough information for the public and health care practitioners to provide the best health care. In addition, future awareness campaigns are needed to bridge the communication gap between parents and physicians and provide better information about the benefits and safety of CAM use.

Complementary and Alternative Medicine Use Among Patients With Diabetes Mellitus in Saudi Arabia: A Community-Based Cross-Sectional Study

BACKGROUND

Global studies have observed a disparity in the use of complementary and alternative medicine (CAM) among diabetic patients.

OBJECTIVES

To estimate the prevalence, types, and correlates of CAM use among patients with diabetes mellitus (DM) in Saudi Arabia.

METHODOLOGY

A cross-sectional study was conducted among 1290 Saudis with type 2 DM aged ≥18 years. An electronic questionnaire was distributed through social media to collect data about patient demographics and DM-related characteristics, including age at DM diagnosis, DM duration, family history of DM, DM complications, DM medicine, and chronic diseases. The use of CAM and its type, cost, and duration; sources of CAM-related information; reason for using CAM; usefulness and side effects; CAM use in the future; and doctor consultation before CAM use were also evaluated. Among CAM non-users, the reason for not using CAM and future considerations of CAM were assessed.

RESULTS

A total of 1290 patients were included (27.4%) aged 18-29 years; 726 (56.3%) were women; 554 (42.9%) had a bachelor's degree in education; and 457 (35.4%) were unemployed. The prevalence of CAM use was 528 (40.9%). The most commonly used types were bitter apple 503 (95.3%), cinnamon 341 (64.6%), and ginger 290 (55.1%). The most frequent sources of CAM-related information were friends, families, and neighbors 259 (49.2%), while the most frequent justifications for use were the need for another DM treatment and faith in its advantages. Only 106 (20.1%) of the patients who used CAM disclosed adverse effects; 373 (51.8%) said they would use it again, and 66.1% said they would recommend it to other patients. Only 145 (27.5%) consulted a doctor before using CAM. CAM was more commonly used by patients who were older, women, married, and taking hypoglycemic drugs; whose most recent HbA1c level was 7-10%; and who had dyslipidemia, chronic disease, and a family history of DM.

CONCLUSION

The prevalence of CAM use is high among the Saudi population. Analyzing CAM use is essential in clinical interactions with Saudis with DM. The managing healthcare professionals must educate patients with DM on how to use CAM more effectively and safely.

Prevalence, types and disclosure of complementary and alternative medicine (CAM) use among chronic kidney disease (CKD) patients in Saudi Arabia

INTRODUCTION

Despite the paucity of scientific evidence, CAM is widely used for the prevention and treatment of illness among patients with chronic kidney disease, including end-stage renal disease and kidney transplant recipients. It is evident that the irrational use of CAM among CKD patients and its non-disclosure to healthcare providers could lead to adverse drug events. Hence, the current study was conducted to evaluate the prevalence, types, and non-disclosure of CAM use among CKD patients and kidney transplant recipients in Saudi Arabia.

METHODS

A cross-sectional study was conducted on 170 CKD patients (121 with stages 3 and 4, two with stage 5 and on hemodialysis, and 47 kidney transplant recipients). Face-to-face questionnaire-based interviews were conducted employing a convenience sampling technique. The study outcomes were the prevalence of CAM, types of CAM use, monthly expenditure on CAM, the source of information about CAM, and CAM disclosure to healthcare providers. A p-value of < 0.05 was considered significant.

RESULTS

The study found that out of 170, 60 (35.3%) CKD patients use CAM. The most used CAM was Acacia gum (49, 81.6%) followed by spiritual therapies (34, 56.6%). Female CKD patients had higher use of CAM compared to the male gender (p = 0.015). The monthly expenditures that most users (47, 78.3%) spent on CAM were less than 50 Saudi Riyals (SR). The study results also showed that 55% of CKD patients did not report their CAM use to their physicians. Furthermore, 46.6% of CAM users discontinue their use of CAM after observing no benefit.

CONCLUSION

This study reported relatively high use of CAM among CKD patients in Saudi Arabia. The study found that most CKD patients use Acacia gum and spiritual therapies and do not disclose the use of CAM to healthcare professionals, which could lead to adverse drug events. Therefore, the study recommends that healthcare providers should inquire and provide evidence-based counselling about the use of CAM to CKD patients to prevent any adverse drug event or unwanted effect on the renal function of the patients.

Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019

BACKGROUND

Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019.

METHODS

The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs).

RESULTS

In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6-70.4) and 16.0 (11.3-22.0), which were 11.4% (7.3-15.4) and 5.9% (2.6-9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3-17.0) per 100,000 in 2019, which was 11.8% (5.2-19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1-36.2)], incidence [24.6% (18.6-30.4)] and DALY [30.5% (22.6-38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15-19 age group for males and the 20-24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10-34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period.

CONCLUSIONS

The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15-19 age group for males and the 20-24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

Knowledge and behaviors of using vitamin D to boost immunity against COVID-19 pandemic: A cross-sectional study in Saudi Arabia

The coronavirus 2019 (COVID-19) pandemic has globally impacted all aspects of life since its emergence and spread. There is a strong biological assumption and progressing epidemiological data supporting the role of vitamin D (VD) in COVID-19 infection. This study aims to determine the knowledge about VD supplements to boost immunity against COVID-19 and if participation in specific behaviors has increased the consumption of VD supplements during social distance restriction in Saudi Arabia (SA) in May 2021. This cross-sectional study used a structured online questionnaire for 2369 SA people, including demographic characteristics and knowledge about VD supplements to boost immunity against COVID-19 showed that there was a significant association between sex and vitamin D deficiency (VDD) (P = .000), and having VDD was strongly associated with having another vitamin deficiency (P = .008). Additionally, there was a statistically significant difference between VDD and cardiovascular (P = .027) and respiratory diseases (P = .019). Almost half of the participants used VD supplements to reduce or heal their COVID-19 symptoms. The adverse association between having VDD and understanding of COVID-19 symptoms was statistically significant (P = .01). Ginger is commonly used as an alternative medicine for the treatment of VD. The administration of VD is now known to be of physiological significance for general health, and evidence suggesting the beneficial role of VD in the prevention and/or treatment of diseases, particularly infectious diseases, such as COVID-19, is increasing.

Apitherapy combination improvement of blood pressure, cardiovascular protection, and antioxidant and anti-inflammatory responses in dexamethasone model hypertensive rats

Hypertension-induced ventricular and vascular remodeling causes myocardial infarction, heart failure, and sudden death. Most available pharmaceutical products used to treat hypertension lead to adverse effects on human health. Limited data is available on apitherapy (bee products) combinations for treatment of hypertension. This study aims to evaluate the antihypertensive effects of combinations of natural apitherapy compounds used in the medical sector to treat a variety of diseases. Rats were assigned into six groups consisting of one control group and five hypertensive groups where hypertension (blood pressure > 140/90) was induced with dexamethasone. One of these groups was used as a hypertension model, while the remaining four hypertensive groups were treated with a propolis, royal jelly, and bee venom combination (PRV) at daily oral doses of 0.5, 1.0, and 2.0 mg/kg, and with losartan 10 mg/kg. The PRV combination at all doses decreased arterial blood pressure below the suboptimal value (p < 0.001), and PRV combination treatment improved dexamethasone-induced-ECG changes. The same treatment decreased angiotensin-II, endothelin-1, and tumor growth factor β serum levels in hypertensive rats. Additionally, PRV combination improved histopathological structure, and decreased serum levels of NF-kB and oxidative stress biomarkers. We concluded that PRV combination therapy may be used as a potential treatment for a variety of cardiovascular diseases.

Use of Complementary and Alternative Medicine in the General Public of Western Saudi Arabia: A Cross-Sectional Survey

BACKGROUND

Complementary and alternative medicine (CAM) has been continuously used worldwide. Various cultures have used this path of healing, and to our date, people are still using it and some even prefer it to modern medicine. Thus, this study aims to analyze awareness, self-use, perceptions, beliefs, and attitudes toward CAM in the general public of Jeddah, Saudi Arabia.

METHODS

A descriptive observational cross-sectional study was conducted in the public places of Jeddah. Data were collected from 784 participants using a self-administered paper-based questionnaire, and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS).

RESULTS

The majority of the population was aware of massage (91.8%), herbs (90.7%), nutritional supplements (89.8%), and prayers (88.1%). With regards to usage and effectiveness, prayers and spirituality is used by 75.5% of the population and considered to be the most effective by 76.0%. Respondents obtained information about CAM mostly from friends and relatives (76.6%), followed by media (67.2%), while lack of knowledge about CAM and lack of trained professionals are the most perceived barriers to CAM implementation. Data showed a significant association (p < 0.05) between gender, awareness, and self-use of CAM modalities. Yoga (44.2%) and herbs (72.6%) were mostly used by females, whereas males were mostly aware of cupping (90.4%) and cauterization (76.2%). Another significant association was found between the level of education, awareness, and self-use of CAM modalities indicating that those who were not educated were aware of and used cauterization the most, while those who went to college were more aware of yoga (75.4%). Lastly, having a relative in the healthcare field showed a significant association with awareness of yoga, prayers, and spirituality compared to other CAM modalities.

CONCLUSION

In conclusion, the present study revealed that the majority of the Western Saudi Arabian population was aware of several CAM modalities and practiced some form of CAM. However, awareness of specific types of CAM may relate to gender, educational level, and relationship to the medical field.

The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.

Quality of life in terminally ill cancer patients: what is the role of using complementary and alternative medicines?

BACKGROUND AND PURPOSE

Cancer is the world's second greatest cause of mortality and a leading cause of death in both developed and developing countries. Patients employ a number of complementary and alternative medicine (CAM) methods to deal with the problems and difficulties of cancer, which can have an impact on their quality of life (QOL). The aim of the present study was to assess the correlation between QOL and the use of different CAM methods in terminally ill cancer patients.

METHODS

This was a cross-sectional study. In southern Iran, 238 individuals with advanced cancer were studied in oncology centers and doctors' offices. During the months of January to August 2021, patients were selected using convenience sampling. A demographic information questionnaire, the EORTC core quality of life questionnaire, and the CAM questionnaire were used to collect data.

RESULTS

The results showed that terminally ill cancer patients had a good quality of life. Last year, 85.7% of participants used at least one kind of CAM. Furthermore, 45.4% of participants used only one form of CAM, 30.3% used two types of CAM, 6.7% used three types of CAM, and 3.4% used four to five types of CAM. When all CAM users were compared to non-CAM users, CAM users had significantly higher social QOL and overall quality of life. Two subscales of QOL symptoms and function were correlated with cancer history, income, and use of CAMs, and the scores of QOL symptoms and function were greater in CAM users compared to non-CAM users. Among all the study variables, only the usage of CAM was correlated to overall QOL among terminally ill cancer patients.

CONCLUSION

The current study found that using CAM could affect different aspects of QOL in terminally ill cancer patients. As a result, it is feasible that using CAM could help these people enhance their health and QOL.

The Prevalence and Pattern of Using Complementary and Alternative Medicine in Saudi Patients With Diabetes: A Cross-Sectional Study

Background Diabetes mellitus is a common disease in Saudi Arabia. Patients with chronic diseases, such as diabetes, tend to use complementary and alternative medicine (CAM) either as an addition or alternative to their medical therapy. Many studies have evaluated the CAM herbal products used by patients with diabetes; however, there have been few and inconsistent studies on other types of CAM, and most studies on CAM have focused on their use in type 2 diabetes. Objective This study aimed to determine the prevalence and patterns of CAM use among patients with type 1 or type 2 diabetes in Riyadh, Kingdom of Saudi Arabia. Methods This cross-sectional study was conducted in an adult Saudi population at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Data were collected from December 2019 to February 2020 using a data collection form and patient interviews. Results We included 332 patients, 43% of whom had type 1 diabetes; 26% of the patients had previously used one or more types of CAM. Approximately 53% of CAM users had glycated hemoglobin (HbA1c) level of ≥9%. Among CAM users, 51% mentioned that their blood sugar readings were improved with CAM treatments. Mind-body therapy was the most commonly used CAM (54%), followed by biologically based CAM, including herbs (46%). The most commonly used herbal supplements were black cumin (42%), followed by fenugreek (28%), myrrh (24%), frankincense (22%), cinnamon (15%), garlic (15%), and onion (15%). Older age and employment status were predictors of CAM use in Saudi patients with diabetes. The main sources of knowledge about CAM were from family and friends. Conclusions CAM use is common among Saudi Arabian patients with diabetes. Patients with diabetes who are aged >65 years and employment status were the main predictor of CAM use. Assessing CAM use is an important aspect of clinical encounters with Saudi patients, especially patients with type 1 diabetes.

Perception of integrating complementary and alternative medicine practice in patient's treatment among the healthcare practitioners: a systematic review

There is a growing trend in complementary and alternative medicine (CAM) usage among the population with medical conditions. However, there is hesitancy for medical practitioners to integrate its application with the current treatment modality, despite governance by the authority. Hence, our objective is to systematically evaluate the healthcare perception towards integrating CAM in their practices. We systematically searched three large and renowned databases i.e., Scopus, Web of Science and PubMed, regarding "Perception on Integrating CAM Usage in Patient's Treatment among Healthcare Practitioners" from 2016 until 2020. At least two independent reviewers comprehensively screened and extracted the data from the accepted articles. A total of 15 studies were included in the final qualitative synthesis following a strict and rigorous assessment checked using MMAT 2018 checklist. The studies included providing the richness of information due to the qualitative nature of the study design. There were three main domains extracted i.e. knowledge, attitude, and perspective of the healthcare practitioner towards CAM integration. Limited knowledge of CAM among healthcare providers may be the possible main reason for non-supportive attitude and negative perspective on CAM. However, those who showed an inclination towards CAM were found to be more open and ready to learn about CAM if it provides benefits to the patients. There is a heterogeneity of perception towards CAM integration from healthcare providers' point of view. A proactive and systematic CAM literacy awareness program may help to improve their understanding and possibly gain more trust in its application.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Knowledge, use and practices of licensed dietitians related to dietary supplements in Lebanon

OBJECTIVE

To evaluate Lebanese licensed dietitians' knowledge, prevalence of use and recommendation of dietary supplements (DS), and their associated factors.

DESIGN

Cross-sectional survey.

SETTING

Dietitians across Lebanon were contacted through the telephone and were asked to participate in the study. An online self-administered questionnaire was designed and sent to dietitians either by email or by WhatsApp, between 4 March and 4 May 2020.

PARTICIPANTS

This study included 319 dietitians randomly selected from the dietitians' list that was provided by the Lebanese Ministry of Public Health.

RESULTS

Around 75 % of dietitians had a knowledge score above 50 %. Overall, 73·7 % of them have used DS and 46·1 % have recommended them. Higher knowledge score was associated with less years of experience, using scientific articles as source of information on DS, and participating in research. Resorting to pharmacists was significantly associated with both nutrient supplements (NS) and herbal supplements (HS) use, whereas referring to health food stores was associated with HS use only. NS recommendation to patients was associated with personal NS use (OR = 3·38, P < 0·001), considering pharmacists as a source of information on DS (OR = 2·29, P = 0·01) and discussing DS with patients (OR = 3·82, P = 0·01). Having personally used HS (OR = 12·23, P < 0·001) and having discussed DS with patients (OR = 8·51, P = 0·01) increased the likelihood of recommending HS.

CONCLUSIONS

A proper DS education, the elaboration of national scientific guidelines and the implementation of concise laws regarding the regulations of DS would play a crucial role in supporting dietitians' practices and improving the quality of patient care with respect to DS.

Assessment of Knowledge about Traditional Medicine Reveals Overuse as a Potential Risk for Aggravating COVID-19 and Underlying Diseases in Geriatrics and Women’s Health in the Saudi Population

The devastating COVID-19 pandemic has created several gaps in the management of viral infections, leaving biocontainment and supportive measures as the only resorts for control. As such, there has been a dramatic increase in the use of dietary supplementations and herbal medicine for COVID-19. However, serious concerns regarding the efficacy, safety, and recommended doses of these medicines have been raised. In this study, we aimed to assess the population knowledge about alternative medicine administration for COVID-19 and the associated factors. Using a self-administered cross-sectional survey, we analyzed a total of 2042 valid responses. Most of the included participants were females (69.7%), with an overall mean age of 20.8 ± 11.8 years. Most respondents (62.8%) obtained their knowledge from social media while only 16.6% received knowledge from the health care workers. Half of the participants (50.6%) correctly identified all COVID-19 symptoms, where fever (18.5%) and loss of smell and taste (17.1%) were the most frequent answers. On the use of traditional medicines and supplements for COVID-19, 57.8% did not answer, 23.7% admitted regular use, and 18.5% used sometimes. Family members or friends suggested the use of traditional medicines and dietary supplements to 28.0% of the participants while only 14.7% were advised by a nutritionist, physician, pharmacist, nurse, or a health worker. Moreover, seniors and illiterate portions of society had lower knowledge scores and increased utilization of alternative medicine. Marital status, income, and previous COVID-19 were all significant predictors of the awareness and knowledge score. Thus, this study has identified overuse of unregulated medicinal products in the region, which potentially aggravates COVID-19 or other underlying risks of the disease, making clinical management challenging, particularly in geriatrics and women’s health. Regulation of medicinal products and establishment of educational campaigns about the disease have become imperative.

Perception of Individuals with Diabetes about Efficacy and Safety of Complementary and Alternative Medicines (CAM) in the Jazan Region, Saudi Arabia

Background

CAM is widely accepted for the management of diabetes, and CAM users from many countries showed positive perception towards its use. However, little is known about the perception of individuals with diabetes in Saudi Arabia.

Objectives

This study was aimed to assess the perception of the individuals with diabetes of Jazan region in Saudi Arabia towards CAM.

Methods

An online, anonymous cross-sectional survey was designed and conducted between September 5 and December 31, 2021. Data were collected using 19-item self-report survey from the individuals with diabetes of the Jazan region.

Results

A total of 359 validated responses were received. Approximately, 34% of the participants reported using CAM with modern medicine to control diabetes. Most of the participants reported that CAM is affordable, accessible, acceptable, and effective. Of the study sample, 28% reported using herbal medicine to control diabetes. Significantly, higher percentages of CAM users reported media (42% vs 27%) and friends/family (31% vs 27%) as the primary sources of information about CAM as compared to non-CAM users. Individuals who used CAM for diabetes showed significantly more positive perception (β = 2.386; p=0.001) than those who did not use CAM in the adjusted analysis. Similarly, students had a significantly higher positive perception towards CAM (β = 4.121; p=0.013) compared to employed individuals.

Conclusion

A quarter of the sample of individuals with diabetes used herbal medicine to control diabetes. Individuals who ever used CAM for diabetes showed positive perception towards CAM. However, there is a need of healthcare workers to be involved in educating the individuals with diabetes and the general public in order to use CAM more effectively and safely.

Knowledge, Attitudes, and Practices Toward Self-Medicating Eye Symptoms in Saudi Arabia

Purpose

Self-medication is the selection and use of drugs by individuals to treat self-diagnosed diseases or symptoms. While some patients regard self-medicating as harmless, it is far from being a safe practice. The aim of this study was to evaluate the knowledge, attitudes, and practices toward self-medicating eye symptoms in Saudi Arabia.

Patients and Methods

A cross-sectional study was conducted through an online questionnaire on a study population that consisted of Saudi nationals aged 18 and older who were using or had previously used ophthalmic medications.

Results

Among the 524 responses obtained, 79.4% were female, and more than half were less than 40 years old. Participants admitting to practicing ophthalmic self-medication measured 62.4%. The most commonly self-prescribed ophthalmic medications were artificial tears (n=276), followed by antiallergic (n=57) and antibiotic medications (n=33). Many participants reported that the reason for self-treatment was for repeated and simple symptoms that did not require professional care. While approximately 51% showed high levels of knowledge about ophthalmic medications, no significant relationship was seen with their choice to self-medicate (P=0.153).

Conclusion

Despite detecting a high level of knowledge and acceptable practices and attitudes among participants, a high incidence of self-medication was observed. This effect was mostly attributed to long hospital waiting times and patient self-diagnosis. Increasing the number of healthcare units and properly educating patients on ophthalmic medications may help decrease the incidence of self-medication.

Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial

BACKGROUND

Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores.

PARTICIPANTS AND METHODS

This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time.

RESULTS

A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction.

CONCLUSION

The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor.

TRIAL REGISTRATION

ISRCTN87414969, registered 3 May 2019.

Use of complementary and alternative medicine in general population during COVID-19 outbreak: A survey in Iran

OBJECTIVE

Some epidemic diseases such as coronavirus disease 2019 (COVID-19) have caused many physical, psychological, and social challenges, despite the existence of treatment strategies. Many people are looking for complementary and alternative medicine (CAM) to prevent such diseases. The present study was performed to determine how some types of CAM were being used during the COVID-19 epidemic in Iran.

METHODS

The present study had a cross-sectional descriptive correlational design. All Iranian residents above 17 years old were eligible to participate in the study. A total of 782 participants completed a demographic information questionnaire, a questionnaire about their use of CAMs and a questionnaire about their satisfaction with the CAMs they used. Web-based sampling was conducted from 20 April 2020 to 20 August 2020.

RESULTS

Of the participants, 84% used at least one type of CAM during the COVID-19 outbreak. The most used CAMs were dietary supplements (61.3%), prayer (57.9%), and herbal medicines (48.8%). The majority of the participants (50%-66%) have used CAMs to prevent the transmission of COVID-19 or to reduce anxiety caused by the COVID-19 pandemic. CAM use was associated with sex, having children, place of residence, COVID-19 status, and source of gathering information about CAM (P < 0.05). All 32 participants who had been infected with COVID-19 used at least one type of CAM for treatment or alleviation of the disease symptoms.

CONCLUSION

During the COVID-19 outbreak, some types of CAM, particularly nutritional supplements, medicinal herbs, and prayer, were commonly used to prevent COVID-19 and reduce pandemic-related anxiety.

COVID-19: A Review on the Role of Trace Elements Present in Saudi Arabian Traditional Dietary Supplements

The novel coronavirus infection is also called COVID-19 (coronavirus disease 2019). The infection has affected millions of people worldwide and caused morbidity as well mortality in patients with pre-existing chronic conditions such as metabolic, respiratory and cardiovascular disorders. The severity of the disease is mostly seen in people with low immunity and chronic sufferers of respiratory, cardiovascular and metabolic disorders. To date, there is no specific treatment available for COVID-19. Precaution and prevention are the most recommended options followed for controlling the spread of infection. Trace elements such as zinc, calcium, iron and magnesium play an important role in boosting the immunity of the host system. These components assist in the development and functioning of lymphocytes, cytokines, free radicals, inflammatory mediators and endothelial functioning. This review summarizes the common dietary supplements that are regularly consumed in Saudi Arabia and are known to contain these vital trace elements. Data available in Google Scholar, NCBI, PUBMED, EMBASE and Web of Science about COVID-19, micronutrients, trace elements and nutritional supplements of Saudi Arabia was collected. By highlighting the traditionally used dietary components containing the essential elements, this review could provide useful knowledge crucial for building immunity in the population.

Attitudes Towards Complementary and Alternative Medicine Among Pediatricians in Saudi Arabia

Background Complementary and Alternative Medicine (CAM) refers to a variety of healthcare practices outside the domain of conventional medicine, which may be integrated with conventional medicine by many physicians. Objectives This study aims to assess the attitudes and beliefs of pediatricians toward the use of CAM on children and to evaluate their knowledge and experience regarding CAM therapies and their desire for additional CAM training courses. Methods This is a cross-sectional study that was conducted in Saudi Arabia. A self-administered electronic questionnaire consisting of 27 questions was distributed among pediatricians to assess the demographics, beliefs, experiences, and attitudes of pediatricians related to the use of CAM for children. Non-probability convenience sampling was used in selecting the sample of pediatricians. Data analysis was performed using SPSS version 21 (IBM Corp., Armonk, NY). Results In this study, 140 participants completed the questionnaires. Most of the participants were of the male gender (83, 59.3%) and Saudi nationals (127, 90.7%). With regards to questions related to the experiences and opinions of participants regarding the use of CAM, 101 (72.1%) subjects reported the use of CAM among family members. Pediatricians cited affirmative encounters of use of CAM in 94 (67.1%) by parents. Pediatricians were not in favor of the use of CAM for end-stage (114, 81.4%) and chronic disease (108, 77.1%). The overall median self-reported CAM knowledge score was statistically higher for males in comparison with females [3 (IQR 1-5)] versus 2 (IQR 2-4), P = 0.030]. Also for nationality, median scores were significantly greater for the Riyadh region in contrast to other regions [[3 (IQR 2-5)] versus 2 (IQR 1-4), P = 0.041]. There was a significant difference in median scores for qualification of participants (P = 0.002). A multiple pairwise comparison revealed a statistically significant (P = 0.012) difference between participants with the qualification of residents and specialization. No differences in median CAM scores were found for responses related to the experiences, opinions, and attitudes of pediatricians towards the use of CAM therapies. Conclusion Most of the pediatricians in Saudi Arabia don't recommend the use of CAM treatment in their practice, but they acknowledge that learning more about CAM and imparting appropriate knowledge regarding it may incorporate its use in their routine clinical practices in a safe way.

Traditional and Complementary Medicine use and beliefs during COVID-19 outbreak: A cross-sectional survey among the general population in Turkey

Objective

Coronavirus disease 2019 (COVID-19) caused a universal psychosocial impact, with many individuals exposed to threats preferring to try self-care interventions and non-conventional approaches such as traditional and complementary medicine (T&CM) for preventive purposes. This study was conducted to determine the use of and beliefs about T&CM among a subset of the general Turkish population during the COVID-19 outbreak.

Method

A cross-sectional online survey was carried out among the general population (aged ≥ 18 years) of Adana, Turkey during the strict lockdown period (April 11 to April 30, 2020). The survey instrument included details about sociodemographic characteristics, general information, T&CM use and beliefs. It was distributed among eligible participants via social media channels (Instagram, WhatsApp and Facebook accounts).

Results

Out of a total 389 participants, 39.3% (n = 153) used T&CM and 60.7% were non-T&CM users during COVID-19. Of those using T&CM, 61 (39.8%) reported the usage of more than one form of T&CM, mostly herbal medicine (30.8%), followed by nutritional supplements/vitamins (23.8%). 33.9% (n = 52) of participants using T&CM did not report T&CM use to theirmedical physicians. A statistically significant difference was observed between T&CM users and non-T&CM users in gender, age, marital status, level of education, income, and prior use of T&CM (p < 0.05). Social media (n = 204; 52.4%) was the primary source of information for T&CM use. Overall, 33.7%, 54.8% and 39% of participants in this stduy believed that T&CM therapies are effective, have fever side-effects/safe and should be use for COVID-19, respectively.

Conclusion

During the outbreak of COVID-19, a significant proportion of the population reported the use of T&CM, with different beliefs about T&CM being observed. Better-structured T&CM-specific educational programs, enhanced physician-patient communication and access to reliable information are needed to ensure appropriate T&CM use during pandemics in Turkey.

The trends of complementary alternative medicine use among cancer patients

BACKGROUND

The use of complementary and alternative medicine (CAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. Our study aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018.

METHODS

We included 2 Cohorts of patients with cancer who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of CAM used, the reasons to use them and the perceived benefits. We compared the changes in the patterns of CAM use and other variables between the two cohorts.

RESULTS

A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less CAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use CAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used CAM for symptom management such as pain control and improving appetite among others. Disclosure of CAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against CAM use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively).

CONCLUSION

There is a significant change in CAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.

In vitro effects of aqueous extract of fermented rooibos (Aspalathus linearis) on human sperm function

Aspalathus linearis (rooibos) is a herbal medicinal plant originally from South Africa's fynbos and well known for its medicinal effects in treating different medical conditions. Rooibos contains significant levels of antioxidants capable of inhibiting the production of reactive oxygen species, which may improve seminal parameters. This study focussed on investigating the direct effect of fermented rooibos on human sperm functions in vitro. Semen samples collected by masturbation from unproven fertile donors (n = 25) and infertile patients (n = 25) after 3-5 days' abstinence were liquefied and centrifuged (300 × g; 10 min) in human tubular fluid medium containing 1% bovine serum albumin. Afterwards, semen samples (7.5 × 10⁶ /ml) were incubated at 37°C for one hour with aqueous extract of fermented extract in sperm preparation medium (0, 0.10, 1.0, 10 and 100 μg/ml) and assessed. Our data showed that fermented rooibos did not affect functional sperm parameters (motility, vitality, intracellular reactive oxygen species and acrosome reaction, p > .05), in vitro except in the reduced percentage of intact mitochondrial membrane potential and DNA fragmentation (p < .05). The decrease in DNA fragmentation generates the possibility of using the extract in patients prior to assisted reproductive techniques.

The Commonly Utilized Natural Products during the COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Online Survey

OBJECTIVES

The utilization rate of herbal and dietary supplements among the Saudi population is reported to be high. However, the utilization rate and types of herbal and dietary supplements during the COVID-19 pandemic are largely unknown.

METHODS

This was an online questionnaire-based cross-sectional study that used convenience sampling and social media platforms (Telegram®, Twitter®, and WhatsApp®) to disseminate a 12-item questionnaire across the Saudi general public aged 18 years and above. The questionnaire inquired about the sociodemographic characteristics (e.g., age, gender, education, geographical location), presence of chronic health conditions and the use of prescription medications, awareness of the viral nature of COVID-19 infection and its common symptoms, and the commonly utilized herbal and/or dietary supplements.

RESULTS

Sixty-four percent of the 1473 participants reported using herbal and/or dietary supplements for the purpose of boosting their immune system to prevent COVID-19 infection. In addition, 88.2% of the respondents were misinformed about the manifestation of COVID-19 symptoms. Most of the participants were Saudi (91.9%), aged 49 years and younger (83%), female (52%), and healthy (81%). Honey (46%), lemon (45%), ginger (36%), vitamin C (32%), black seed (26%), garlic (26%), and turmeric (19%) were the most commonly used herbal and/or dietary supplements by the participants. Saudi nationals (OR = 1.67, 95% CI: 1.08 to 2.6, p = 0.02), older adults (OR = 1.30, 95% CI:1.10 to 1.55, p = 0.002), and those taking prescription medications had higher odds of using dietary and/or herbal supplements (OR = 3.31, 95% CI: 2.61 to 4.18, p < 0.0001).

CONCLUSION

The utilization rate of herbal and dietary supplements among the Saudi public during the COVID-19 pandemic is high. Future studies should examine the impact of different public awareness campaigns aimed at improving the public knowledge of the risk and benefits associated with the use of different commonly utilized herbal and dietary products identified in this study.

Complementary and Alternative Medicine Use by Patients From the Gulf Region Seen in the International Practice of a Tertiary Care Medical Center

BACKGROUND

Patients from various countries may have unique patterns of using complementary and alternative medicine (CAM) and unique reasons for using it.

OBJECTIVE

Our objective was to assess the use of CAM among patients from the Gulf region attending the Executive and International Health Program of the Department of General Internal Medicine at Mayo Clinic in Rochester, Minnesota.

METHODS

This cross-sectional survey was administered to all patients who were from the Gulf region and were undergoing outpatient evaluation in the Executive and International Health Program. After their initial medical evaluation by a physician, the patients were invited to anonymously complete the modified International Complementary and Alternative Medicine Questionnaire.

RESULTS

The survey was completed by 69 patients (41 women, 27 men; mean age, 45.4 years). The most frequently seen providers for CAM treatments were physicians (71.0% of patients), spiritual healers (29.0%), and chiropractors (20.3%). CAM treatments most frequently received from a physician were massage therapy (51.0%), hijama (38.8%), spiritual healing (24.5%), and acupuncture or herbs (16.3%). The most frequently used dietary supplements were ginger (42.0%), bee products (30.4%), and garlic (27.5%). The most common self-help therapies were prayers for health (68.1%), meditation (15.9%), and relaxation techniques (11.6%). CAM therapy, including visits to CAM providers, was used by 92.8% of patients. CAM was mainly used to improve well-being and long-term health conditions rather than for acute illnesses.

CONCLUSION

The use of CAM was high among our patients from the Gulf region, and the CAM therapies used by this population differed from the ones used by US patients. Physicians providing care to patients from the Gulf region should be aware of how the use of CAM may affect the care needs of these patients.

Stakeholder attitudes to the regulation of traditional and complementary medicine professions: a systematic review

BACKGROUND

There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions.

METHODS

A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions.

RESULTS

Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations (n = 6), education providers (n = 2), and policy-makers (n = 2).

CONCLUSIONS

There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .

The Proportion of Complementary and Alternative Medicine Utilization Among Saudi Population for Eye Care: Cross-Sectional Study

Purpose

To estimate the prevalence, determinants and perceived benefit of complementary and alternative medicine (CAM) use for ophthalmic purposes among the Saudi population.

Methods

A cross-sectional study was carried out in 2019 targeting visitors of King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. The survey had 18 questions in Arabic regarding the use of CAM for eye ailments. The magnitude was associated to the demographic and eye-related factors.

Results

We interviewed 999 participants. The prevalence of CAM usage was 21.9% (95% confidence interval 19.3; 24.5). Castor oil (49.3%), antimony (khohl alethmed) (40.6%), chamomile (19.6%), and green tea leaves (11.4%) were the most common medications used. Other traditional eye treatments included eye vitamins, faith healing (prayer, reciting Quran, Zamzam water), cautery, cupping, and acupuncture.

Conclusions

One in five Saudi eye patients used CAM. The factors governing this health behavior should be studied to change this practice pattern.

Telerehabilitation Guidelines in Saudi Arabia

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.

Patterns and Outcomes of Complementary and Alternative Medicine Use Among Adult Patients With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination of the central nervous system. No treatment has been shown to be curative; thus, we assume that the tendency for patients with MS to use unconventional therapies, such as complementary and alternative medicine (CAM), might increase. The aim of this study was to explore the pattern of CAM use among patients with MS at a tertiary health care center in Saudi Arabia (SA). This was a questionnaire-based observational cross-sectional study that targeted adult patients diagnosed with MS at King Abdulaziz Medical City in Riyadh, SA, from 2018 to 2019. The sample size included 176 patients, and a consecutive non-probability sampling technique was used to engage them during their appointments. An Arabic questionnaire was used to evaluate patients' use of CAM. The mean age of participants was 34.6 ± 10.9 years, females represented the majority 125 (71%) of participants, and 89% of the participants reported using CAM at least once, with one or more modalities being used. Prayer, Salat, was the most frequent modality (60%) followed by supplication, Dua'a (59%), Ruqia, reciting Holy Quran (52%), and vitamins (44%). Symptomatic improvement was reported by 49 (27.8%) of dietary supplement users and 81 (46%) of non-dietary supplement medicine users. The study found a high prevalence of CAM utilization among Saudi adult patients with MS, which exceeded internationally reported rates. Although some patients described some improvement in their symptoms, further research is needed to evaluate the effectiveness of CAM.

Complementary and alternative medicine use among ischemic stroke survivors in Jeddah, Saudi Arabia

OBJECTIVE

To determine the prevalence and pattern of complementary and alternative medicine (CAM) use and the CAM types used by stroke patients in Jeddah, Kingdom of Saudi Arabia.

METHODS

This cross-sectional study included 152 ischemic stroke survivors who visited King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia, between January 2018 and December 2019. Phone-based and face-to-face surveys were conducted. Data on the patients` demographic characteristics, their use of CAM, and their pattern of CAM use were gathered.

RESULTS

Ninety (59.2%) stroke patients used CAM, mainly cauterization (29.61%) and Quran recitation by a religious sheik (28.95%). Most of the patients (72.22%) used CAM post-hospitalization and within less than one month from stroke onset (62.22%). A minority (6.67%) of the patients stopped their medication while on CAM. Some patients (25.56% to 31.11%) discussed with their physician their use of CAM. The CAM users reported a subjective improvement in their physical weakness (45.6%) and psychological wellbeing (62.2%). The patients learned about CAM mainly from their relatives and friends (96.7%), and the most common reason for their CAM use was their belief in this intervention (42.22%).

CONCLUSION

The CAM use was prevalent among our cohort of Saudi ischemic stroke patients, and cauterization and Quran recitation were the most commonly used CAM interventions. An effective communication was lacking between the medical professionals and the stroke patients as regards CAM use despite the interest of the patients in this intervention.

Patterns of Complementary and Alternative Medicine Use in Saudi Arabian Patients With Inflammatory Bowel Disease: A Cross-Sectional Study

Background Inflammatory bowel disease (IBD) concerns a group of chronic autoimmune diseases that results in uncontrolled inflammation of the gastrointestinal (GI) tract, which can lead to long-term complications. Conventional treatments for IBD usually target inflammation and include biologics and immunosuppressants, which have been associated with significant adverse effects. Also, non-response to biologics has been reported in up to 50% of patients. Hence, patients sometimes turn to unconventional methods of treatment, such as complementary and alternative medicine (CAM). In this study, we examine patterns of CAM use in Saudi patients diagnosed with IBD. Materials and methods We conducted a cross-sectional study of patients with IBD who were seen at the outpatient gastroenterology clinic between January 2018 and December 2019. Adult patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) were identified and surveyed. Clinical, laboratory, endoscopic, radiologic, and histologic data were collected. The patients completed a detailed questionnaire focusing on CAM use. Descriptive statics, quantitative variables, means, standard deviations (SDs), and minimum and maximum values or medians with interquartile ranges were used where appropriate; for qualitative variables, we reported frequencies. The prevalence of CAM use was calculated using standard prevalence formulae. Logistic regression analysis was performed to identify predictors for CAM use. A p-value of <0.05 was set as statistically significant. Results A total of 71 IBD patients were surveyed, of which 75% had CD. Severe symptoms were reported by 54% of patients, and 41% were receiving biological treatment; 90% of this cohort reported using some form of CAM, of which 78% used them within the past year, and 52% reported CAM treatment having a positive effect. Of note, 63% of patients reported using CAM therapy without the knowledge of their treating physician. The most common source of advice regarding the use of CAM medicine was relatives (66%), and the most common forms of CAM used were honey (62%), Zamzam water (54%), and physical activity (32%). Binary logistic regression analysis identified watery diarrhea (OR=5.7, 95% CI=1.0-31, P=0.04) and azathioprine (OR=18.1, 95% CI=1.3-255, P=0.03) as predictors of CAM use. Conclusions CAM use is very common in Saudi patients with IBD. The majority of patients seem to turn to CAM if their symptoms are severe. They generally appear to be influenced by culture, the Internet, local society, and family tradition in their decision to use CAM, rather than expert advice from their treating physician.