Hammad Ali Fadlalmola

Background: Adequate nurse staffing is essential for ensuring workforce well-being and patient safety. Imbalanced nurse-to-patient ratios contribute to burnout, job dissatisfaction, and turnover, which compromise care quality. Objective: This systematic review and meta-analysis evaluated the impact of nurse-to-patient ratios on nurse burnout, job dissatisfaction, intention-to-leave, and patient outcomes. Methods: A systematic search of PubMed, Scopus, and Web of Science identified cross-sectional studies examining nurse-to-patient ratios and related outcomes. Results: Eighteen studies involving 183 876 nurses from 4085 hospitals were included. Higher nurse-to-patient ratios increased the odds of burnout (OR: 1.08), job dissatisfaction (OR: 1.10), and intention-to-leave (OR: 1.09). Each additional patient per nurse increased mortality and readmission risks by 7% to 8%, with decreased perceived care quality. Conclusion: Higher nurse-to-patient ratios adversely affect nurses and patients. Ensuring adequate staffing is critical to prevent burnout and maintain safe, high-quality care.

Background: Patients with latent tuberculosis infection are mainly asymptomatic, but they still carry a notable risk of developing active TB, particularly when the host becomes immunosuppressed. Hence, appropriate diagnosis and management for LTBI are essential. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are among the most commonly utilized methods for detecting LTBI. Until now, no agreement has been established regarding the most effective diagnostic test, either TST or IGRA, so our study aims to evaluate the diagnostic utility of TST versus IGRA in detecting LTBI. Methods: An extensive literature search was executed in several databases from inception till June 2024. We included all the available studies that compared TST versus IGRA concurrently applied to the same study participants, utilizing one of the following proxy reference standards: previous contact with a tuberculosis patient, tuberculosis history, chest x-ray suggestive of tuberculosis, or a combination of them. The sensitivity (SN) and specificity (SP) were imputed with their 95% confidence interval (CI). A bivariate random-effects model within the OpenMeta-Analyst software was utilized for data analysis. Results: We included 39 studies, and our primary analysis regarding LTBI revealed that TST has an SN of 0.320 (95% CI [0.254–0.393]) and an SP of 0.808 (95% CI [0.752–0.854]). Nevertheless, the IGRA exhibited a higher SN estimated at 0.362 (95% CI [0.295–0.434]) and a lower SP estimated at 0.758 (95% CI [0.700–0.808]). Regarding the adult population, TST consistently showed a lower SN and a higher SP relative to IGRA. However, within the pediatric population, TST showed higher SN and lower SP when compared to IGRA. Furthermore, TST also showed a lower SN and a higher SP within hemodialysis and organ transplant patients than IGRA. Conclusions: Our diagnostic test meta-analysis revealed that TST was associated with a lower SN and a higher SP than IGRA. Clinicians should interpret these findings with caution, considering the substantial heterogeneity observed across the included studies, the reliance on proxy reference standards, the potential influence of BCG vaccination status, and the considerable overlap in confidence intervals between TST and IGRA estimates across most analyses.

Background/Objectives: Domestic violence against women is a widespread global health issue profoundly affecting victims, their families, and society. This study aimed to assess the prevalence, patterns, risk factors, and health sequelae of domestic violence among females during reproductive age in Sharkia governorate, Egypt. Methods: A cross-sectional descriptive study was conducted from April to December 2024. A total of 379 females of reproductive age (15–49 years) were recruited using simple random sampling from secondary schools and Maternal and Child Health centers affiliated with the Ministry of Health. Data were collected using a structured interview questionnaire covering sociodemographic characteristics, violence exposure (physical, psychological, economic, and sexual), risk factors, causes, severity, perpetrators, and consequences. Results: The overall prevalence of domestic violence was 88%. Psychological violence was the most common form (78%), followed by physical violence (63%), and economic violence (43%). Insults were the predominant form of verbal abuse, while slapping and beating were the most common manifestations of physical violence. Husbands were identified as the primary perpetrators across all violence types. Major risk factors included cigarette use by the abuser (47%), alcohol and drug use (14%), and psychological problems (11%). The most frequently reported consequences were anxiety, fear, and depression (82%), followed by insomnia (55%) and seeking separation (49%). Conclusions: Domestic violence against women of reproductive age is highly prevalent in the study setting, with significant physical and psychological consequences. Comprehensive interventions, including awareness campaigns, legal enforcement, women empowerment programs, and healthcare provider training, are urgently needed to address this critical public health issue.

Background: Nursing students often experience high levels of stress during clinical training, particularly in maternal and child health (MCH) rotations, which may affect learning and well-being. Understanding stress levels, stressors, and coping strategies can inform the development of supportive and culturally appropriate educational approaches. Objective: To assess perceived stress levels, identify clinical stressors, and examine coping strategies among nursing students during MCH clinical rotations in Saudi Arabia. Methods: A cross-sectional study was conducted in 2024 among 187 female nursing students enrolled in MCH clinical rotations. Data were collected using validated Arabic versions of the Perceived Stress Scale (PSS-10), the Nursing Student Clinical Stressor Scale (NSCSS), and the Brief COPE Inventory. Descriptive statistics and Spearman’s rho correlation analyses were performed using SPSS. Results: Most students reported moderate perceived stress (75.4%), with a mean PSS-10 score of 20.5 ± 5.9. The highest stressor domains were MCH-specific challenges (9.13 ± 5.00), academic pressures (8.72 ± 3.95), and the clinical environment (7.65 ± 3.64). Religion (5.20 ± 2.06) and acceptance (4.79 ± 1.80) had the highest mean scores among coping strategies, while substance use was least reported (3.04 ± 1.40). Self-blame showed the strongest association with total clinical stressors (rho = 0.501, p <0.001). Conclusion: Female nursing students experienced moderate stress during MCH clinical rotations, largely related to clinical and academic demands. Coping strategies were predominantly emotion-focused, with self-blame showing a strong association with higher stress levels. These findings highlight the importance of culturally sensitive support strategies in nursing education.

Introduction: Nursing care plans are fundamental learning tools for assessing students’ clinical judgment, yet documentation quality is influenced by resource accessibility and information-seeking competence. Despite growing emphasis on evidence-based practice and digital literacy, limited research examines how nursing students identify, evaluate, and apply information sources—particularly artificial intelligence—when developing care plans during clinical placements. Objectives: To examine undergraduate nursing students’ online information-seeking behaviours when developing nursing care plans during clinical placements, including their use of artificial intelligence tools. Methods: Convergent mixed-methods study at a single Saudi university. Eligible undergraduate nursing students were engaged in clinical courses requiring care plan development. Sixteen final-year students were purposively sampled for four focus groups, and all 192 eligible students were invited to a cross-sectional survey; 157 responded (81.7%). The survey used a validated 17-item information-seeking assessment tool. Qualitative and quantitative strands were collected concurrently, analysed separately—thematically and via descriptive statistics—and integrated at interpretation; no inferential tests were performed. Results: Qualitative findings revealed persistent challenges including time constraints and variable clinical staff collaboration; students used cross-checking and peer consultation to ensure credibility, though concerns about artificial intelligence reliability persisted. Quantitatively, students reported high confidence in online information-seeking (aggregate mean 4.14/5.0), drawing on multiple sources including professional databases and artificial intelligence tools. Conclusions: While nursing students demonstrate confidence as information seekers, gaps exist between perceived competence and actual critical appraisal skills. Although derived from a single Saudi university using a descriptive design, findings may be transferable to programmes facing similar challenges in integrating digital health literacy and emerging technologies into clinical training.

Background: Toxoplasmosis, caused by the parasite Toxoplasma gondii, is a zoonotic disease that poses significant health risks to immunocompromised individuals, pregnant women, and infants. Transmission occurs primarily through infected cat feces or contaminated food. Awareness of transmission routes, prevention strategies, and health consequences remains limited in high-prevalence humid regions such as Jazan, Saudi Arabia. Methods: This cross-sectional study was conducted in Jazan, Saudi Arabia, between April and May 2025, surveying 485 adults using a five-section questionnaire covering demographics, knowledge, practices, medical history, and recommendations. The survey was distributed in both English and Arabic. Self-reported previous diagnoses were used to estimate prevalence, with risk factors presented as frequencies and percentages. Binary logistic regression analyzed categorical variables, and independent t-tests assessed continuous variables to identify predictors of awareness and knowledge regarding toxoplasmosis. Results: Participants comprised 58.6% females, 97.3% Saudis, and 69.1% individuals aged ≤30 years; 49.7% had heard of toxoplasmosis. Females (adjusted odds ratio [AOR]: 1.67, 95% CI: 1.13–2.5, p < 0.01) and those >30 years old (AOR: 1.8, 95% CI: 0.80–4.29, p > 0.05) demonstrated greater awareness and knowledge, though this was not statistically significant. No significant differences were observed based on marital status (p > 0.05). Risk behaviors included consuming unwashed fruits and vegetables (27.6%) and unpasteurized dairy products (28.2%), with 62.7% always washing hands after handling raw meat or soil. Cat ownership (20.6%) was not associated with knowledge (p = 0.97). Self-reported diagnosis prevalence was 1.9%. Conclusions: Low awareness and prevalent risky behaviors underscore the urgent need for targeted public health education interventions focusing on hygiene practices and zoonotic disease prevention in Jazan. Serological studies are recommended to obtain more accurate prevalence estimates and guide evidence-based interventions.

Introduction: Menstruation often causes dysmenorrhea, affecting 50–90% of women and impairing daily activities. Among schoolgirls, pain, poor menstrual hygiene management (MHM), and cultural stigma contribute to absenteeism. This review examined the prevalence, duration, and contributing factors of menstruation-related absenteeism among schoolgirls. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were searched to February 2025. Eligible cross-sectional studies on primary and secondary schoolgirls were screened and extracted by two independent reviewers. Outcomes included prevalence, duration of absenteeism, and association with maternal illiteracy. Random-effects meta-analyses were conducted using R 4.3.3. Results: Fifty-four studies with 41,112 participants were analyzed. The pooled prevalence of menstruation-related absenteeism was 26.5% (95% CI: 21.98–31.89; I ² = 99.1%). Absenteeism was highest in girls with severe pain (42.32%) compared to moderate (13.14%) and mild pain (11.37%) ( p < 0.0001). Mean absence duration was 1.93 days (95% CI: 1.63–2.28). Maternal illiteracy was associated with higher odds of absenteeism (OR = 1.71, 95% CI: 0.91–3.22) but was not statistically significant ( p = 0.0936). Discussion: Severe dysmenorrhea, inadequate MHM, and cultural restrictions are key drivers of school absenteeism. Infrastructure improvements and maternal education appear protective, but heterogeneity and inconsistent reporting limit generalizability. Conclusion: Menstruation-related absenteeism remains a significant barrier to education for schoolgirls. Addressing pain management, hygiene infrastructure, and socio-cultural barriers is essential to improve attendance and equity.

Labor pain is often managed with pharmacological interventions, which can lead to several adverse effects for mothers and neonates. Consequently, non-pharmacological interventions are gaining attention as safer alternatives for pain relief during labor. This systematic review aimed to assess the effectiveness of non-pharmacological methods in reducing labor pain. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases up to September 2024. Only randomized controlled trials (RCTs) evaluating non-pharmacological interventions for labor pain relief were included, with pain intensity during cervical dilatation as the primary outcome. Data synthesis was performed using RevMan (V5.3). Seventy-seven RCTs involving 8,805 pregnant women were analyzed. The results indicated that non-pharmacological methods significantly reduced pain at 3-4 cm cervical dilatation compared to control groups (M.D. = -1.63, 95% C.I. [-2.05 to -1.21], P < 0.0001). Notably, subgroup analysis showed that body acupressure (M.D. = -2.08, 95% C.I. [-2.76 to -1.40], P < 0.0001) and foot reflexology (M.D. = -2.48, 95% C.I. [-2.84 to -2.13], P < 0.0001) were particularly effective. High heterogeneity (I² > 90%) was noted, partly reflecting differences in intervention types, protocols, and participant characteristics. Overall, non-pharmacological interventions provided substantial relief in labor pain compared to standard care, suggesting their potential utility in obstetric practice. Further large-scale studies are warranted to confirm these findings.

Background: Ethnopharmacological approaches to treating urinary and renal disorders remain integral to healthcare practices throughout Sudan, yet comprehensive documentation of these traditional interventions is lacking. The growing incidence of kidney disorders in Sudan, attributable to environmental conditions and limited healthcare access, underscores the importance of these traditional approaches. Methods: This review employed a systematic approach following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify and synthesize information about traditional Sudanese remedies for urinary system and kidney diseases. A literature search was conducted using databases including PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online. Initially, 487 articles were identified, with 52 included in the qualitative synthesis. Results: Analysis reveals diverse botanical agents used across Sudanese regions, with significant usage of Acacia senegal (gum Arabic), Ambrosia maritima, Boscia senegalensis, Solenostemma argel, and Cymbopogon proximus. Preliminary investigations have substantiated the potential of select remedies, notably gum Arabic, for renal insufficiency, demonstrating improved metabolic parameters and reduced serum creatinine in controlled trials. Conclusion: While traditional Sudanese remedies show promising potential, most lack rigorous validation. This review highlights the need for phytochemical analysis, toxicological assessment, and clinical trials to establish safety and efficacy for integration into contemporary nephrology practice.

Background/Objectives: Timely initiation of antenatal care (ANC) services is crucial for ensuring maternal and fetal well-being. Despite the importance of ANC, research regarding its initiation remains limited in the Jazan region of Saudi Arabia, an area with notable adverse birth outcomes. Therefore, this study aimed to assess pregnant women’s initiation of ANC and identify associated factors and significant barriers for timely initiation. Methods: A cross-sectional study was conducted among 369 Saudi pregnant women in their third trimester attending ANC clinics in the Jazan region in 2024. A structured questionnaire was used to collect data. Andersen’s behavioral model of healthcare utilization provided the framework for the study. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyze the data. Results: The majority of women (78.9%) initiated ANC in the first trimester. Higher maternal education was positively associated with early ANC initiation (aOR = 2.369, 95% CI: 1.154–4.901), whereas higher paternal education was negatively associated with early ANC initiation (aOR = 0.350, 95% CI: 0.175–0.699). When modeled independently, the positive association of higher maternal education was attenuated but was not significant, while the negative association of higher husband’s education remained the same. Those living more than three km from health facilities (aOR = 0.510, 95% CI: 0.276–0.941) and seeking care for reasons other than routine follow-up were less likely to initiate ANC early. Most women received essential services, but only 37.1% had ultrasound tests. Conclusions: While ANC initiation in Jazan showed promising trends, factors like geographical accessibility remain a significant barrier. Targeted interventions should address these identified barriers, which fall within predisposing, enabling, need, and external environmental factors. Further investigations of pregnant women’s familial decision-making and low ultrasound test utilization in relation to ANC are recommended.