Purpose: Maternal metabolic health is increasingly recognized as a critical factor influencing early childhood development. This study examined the relationship between maternal pre-pregnancy glycemic status and neurodevelopmental outcomes in early childhood using a large national cohort in Korea. Patients and Methods: We conducted a population-based retrospective cohort study using national health examination and Korean Developmental Screening Test data from 2014 to 2021. Maternal fasting plasma glucose levels measured within one year prior to conception through delivery were used to classify women into normal, prediabetes, and diabetes mellitus (DM) groups. Neurodevelopmental outcomes were assessed at 18-24 and 30-36 months across six domains: gross motor, fine motor, cognition, language, sociality, and self-care. Inverse probability of treatment weighting was applied to adjust for baseline differences and weighted relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Results: Among 258,367 mother-child dyads, both prediabetes and DM were associated with significantly increased risks of developmental delays in multiple domains. Offspring of mothers with DM exhibited significantly increased risks of developmental delay across all domains at both 18-24 and 30-36 months, with the highest risk observed for self-care at 30-36 months (RR 1.466, 95% CI 1.408-1.525). Children of mothers with prediabetes also demonstrated increased risks in cognition (RR 1.061, 95% CI 1.008-1.117) and self-care (RR 1.119, 95% CI 1.058-1.184) at 18-24 months. Additionally, statistically significant elevations were observed in gross motor (RR 1.101, 95% CI 1.037-1.169), language (RR 1.058, 95% CI 1.019-1.100), and sociality (RR 1.106, 95% CI 1.060-1.154) skills at 30-36 months. Conclusion: Maternal pre-pregnancy glycemic abnormalities, even at the prediabetic level, were associated with an increased risk of developmental delays in early childhood. Optimizing maternal glycemic control prior to conception may promote more favorable developmental outcomes in offspring.
The Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling and institutionalized individuals. Our guideline panel consisted of clinical and methodology experts that formulated the guidelines questions. We conducted a systematic review to gather global data on fracture (CRD42019129540), regional data on vitamin D trials (CRD42014010488), and on patients’ values and preferences (CRD42022320022). We also complemented the latter with results from a cross-sectional local study. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to assess the quality and certainty of evidence, and to develop recommendations. For community-dwelling and institutionalized Lebanese adult population, the panel suggests no screening for vitamin D deficiency, over screening for vitamin D deficiency (conditional recommendation, based on very low certainty evidence). For community-dwelling Lebanese adult population, the panel suggests no supplementation with calcium and vitamin D, over supplementation (conditional recommendation, based on moderate certainty evidence). For institutionalized Lebanese adult population, the panel suggests supplementation with calcium and vitamin D, over no supplementation (conditional recommendation, based on moderate certainty evidence). The guidelines also identify high-risk subgroups, more likely to benefit from screening and supplementation. In community dwelling and institutionalized Lebanese adult individuals, for whom there is a decision to supplement with calcium and vitamin D, the panel suggests supplementation with a daily vitamin D equivalent of 600–2000 IU, as compared to doses higher than 2000 IU (conditional recommendation, very low certainty evidence). The Lebanese GRADE-based vitamin D guidelines recommend against population screening and vitamin D supplementation. Subgroups at high risk are identified. The guidelines take into account contextual factors, and allow their adoption or adaptation in countries in the region.
Background Prediabetes is a growing public health concern globally as well as in Saudi Arabia, where early detection and intervention are crucial. Primary care physicians (PCPs) play a pivotal role in the prevention and management of prediabetes. However, gaps in knowledge, attitude, and practice (KAP) may hinder effective care delivery. This study aimed to assess the knowledge, attitudes, and practices of PCPs toward prediabetes in Qassim, Saudi Arabia, and to explore perceived barriers and potential strategies for improving its management. Methods A cross-sectional survey was conducted among 163 PCPs working in primary healthcare centers across Qassim province. Data were collected using a structured online questionnaire assessing the awareness of risk factors, diagnostic criteria, management approaches, screening attitudes, and practical behaviors related to prediabetes. Results We found that the mean knowledge, attitude, and practice scores were 3.41/5 (±0.84), 12.84/16 (±1.78), and 3.38/5 (±0.54). The mean knowledge score was significantly higher among family physicians (3.84/5) as compared to general practitioners (2.85/5), p-value <0.001. Urban physicians also scored higher (3.52/5) than their rural counterparts (2.65/5), p-value <0.001. Attitude scores demonstrated a weak but significant correlation with age (r = 0.227, p-value 0.004) and years of experience (r = 0.202, p-value 0.010), while practice scores showed a similar pattern. Gender and location of practice were not significantly associated with practice behaviors. Notably, family physicians exhibited more favorable attitudes than general practitioners (p-value 0.004). The most common barriers in prediabetes management included a lack of patient awareness (96.9%), non-compliance (96.3%), follow-up difficulties (92%), and referral issues (86.5%). Conclusion Although PCPs in Qassim express generally positive attitudes toward prediabetes management, knowledge and practice gaps remain, particularly among general practitioners and those practicing in rural areas. These findings underscore the need for targeted interventions, such as mandatory continuing medical education (CME), integration of prediabetes care into routine workflows, and the use of region-specific decision-support tools like red flags in the current EHR system of PHCs. Broader national studies are recommended to validate these findings and guide policy at a systemic level.
BACKGROUND:In-flight medical emergencies (IMEs) pose unique challenges for healthcare professionals due to the limited resources and confined environment of aircraft. Despite the potential severity of such incidents, there is limited research on the knowledge, attitudes, and practices of medical professionals regarding IMEs, particularly in specific regions such as Qassim, Saudi Arabia. Understanding these factors is crucial for improving preparedness and ensuring better outcomes for passengers experiencing medical emergencies during flights. METHODOLOGY:This descriptive cross-sectional study was conducted among family medicine residents and primary healthcare physicians in Qassim, Saudi Arabia. A total of 155 participants were recruited from the Family Medicine Academy and affiliated primary healthcare centers. Data were collected using an online, self-administered questionnaire covering demographic information, previous training attendance, beliefs about IMEs, knowledge of managing IMEs, and attitudes and practices toward IMEs. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York), employing descriptive statistics and chi-square tests for qualitative data. RESULTS:The study revealed that 51.0% of participants (n = 79) had inadequate knowledge, while 49.0% (n = 76) demonstrated adequate knowledge regarding IMEs. There were no significant differences in knowledge levels across demographic factors, including gender, nationality, current qualifications, country of medical education, marital status, and monthly income. However, income below 10,000 SAR (Saudi riyal) was associated with higher rates of inadequate knowledge. Despite a willingness to volunteer during IMEs, participants expressed concerns about legal issues and their confidence in managing such emergencies. Practical responses to hypothetical IME scenarios varied widely, with correct responses ranging from 19.4% to 80.6%. CONCLUSION:The findings underscore significant gaps in knowledge, attitudes, and practices among healthcare professionals in Qassim regarding IMEs. Despite a strong sense of duty to volunteer, participants expressed apprehensions about their competence and legal liabilities. Enhanced training programs and clearer guidelines are needed to improve preparedness and confidence among medical professionals, ultimately ensuring better outcomes for passengers experiencing in-flight medical emergencies.
Background: Palliative care in the community is increasingly recognized as essential for improving quality of life in patients with advanced illnesses. Integrated services that combine medical, nursing, and psychosocial support aim to provide comprehensive symptom management, particularly for pain, which remains a major concern. Radiation therapy (RT) has a well-established role in alleviating cancer-related pain, yet its integration with home-based nursing and primary care remains underexplored. Objective: This systematic review aimed to evaluate the effectiveness, feasibility, and outcomes of community-based palliative care models that integrate RT for pain relief, home nursing, and family physician support. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published up to 2025. Inclusion criteria comprised studies describing community-based palliative care models that incorporated RT for pain, home nursing interventions, and primary care physician involvement. Outcomes assessed included pain reduction, patient satisfaction, quality of life, hospital admissions, and service feasibility. Data extraction and quality appraisal were performed independently by two reviewers, with discrepancies resolved by consensus. Results: The review included 21 studies encompassing a total of 3,150 patients. Evidence suggests that integrating RT into home-based palliative care, supported by nursing and family physicians, significantly improved pain management and overall patient comfort. Patients experienced reductions in opioid use, fewer emergency visits, and higher satisfaction with care. Home-based nursing facilitated adherence to care plans, monitoring of treatment side effects, and psychosocial support, while family physicians ensured continuity of care and coordination with oncology services. Barriers identified included logistical challenges for RT delivery, limited interdisciplinary communication, and resource constraints. Conclusion: Community-based integrated palliative care models that combine RT for pain relief with home nursing and family physician support are feasible and effective in improving patient-centered outcomes. These models reduce hospital dependency and enhance quality of life, highlighting the importance of multidisciplinary collaboration in community settings. Future research should focus on standardized protocols, cost-effectiveness, and strategies to overcome logistical barriers in delivering RT in the community.
