Periodontal pathogens, including Porphyromonas gingivalis, can form biofilms in dental pockets and cause inflammation, which is one of the underlying mechanisms involved in the development of periodontal disease, ultimately leading to tooth loss. Although P. gingivalis is protected in the biofilm, it can still cause damage and modulate inflammatory responses from the host, through secretion of microvesicles containing proteinases. The aim of this study was to evaluate the role of cysteine proteinases in P. gingivalis colony growth and development, and subsequent immunomodulatory effects on human gingival fibroblast. By comparing the wild type W50 with its gingipain deficient strains we show that cysteine proteinases are required by P. gingivalis to form morphologically normal colonies. The lysine-specific proteinase (Kgp), but not arginine-specific proteinases (Rgps), was associated with immunomodulation. P. gingivalis with Kgp affected the viability of gingival fibroblasts and modulated host inflammatory responses, including induction of TGF-β1 and suppression of CXCL8 and IL-6 accumulation. These results suggest that secreted products from P. gingivalis, including proteinases, are able to cause damage and significantly modulate the levels of inflammatory mediators, independent of a physical host-bacterial interaction. This study provides new insight of the pathogenesis of P. gingivalis and suggests gingipains as targets for diagnosis and treatment of periodontitis.

Background: The prevalence of obesity and physical inactivity in the Kingdom of Saudi Arabia (KSA) has been escalating to levels that are threatening the public health of the entire KSA population, especially the female population. However, both physical activity (PA) education and research have only focused to a limited extent on women’s health status.

Objectives: The overall aim of this thesis was to increase our knowledge on the current health situation of both a hospital-based and a healthy female population in the KSA with regard to nutritional status, habits, practices, and PA.

Methods: This thesis contains four Papers (I–IV) whose data were collected in the southwestern region of the KSA. A total of 166 hospital patients (60 women and 106 men) were screened regarding their nutritional status, 15 registered nurses were interviewed, and 663 female university students self-reported their PA levels and nutritional habits and had their anthropometrics measured. The data were analyzed using SPSS (Papers I, III, and IV) and latent content analysis (Paper II).

Findings: Significantly more women (29%) than men (10%) were found to be obese in Paper I. There was no significant difference in the prevalence of patients at risk for undernutrition between women and men (40% vs. 38%), but significantly more women than men received care targeting undernutrition in the hospital-based study population. Individual interviews with nurses in Paper II showed that nurses were “bridging malnutrition and physical inactivity” by identifying “potentials to provide good nutrition and PA” to the patients and their relatives and by stating their “ability to provide patients with good nutrition and PA”. The majority (57.0%) of the female participants in Papers III and IV were of normal weight, 19.2% were underweight, and 23.8% were overweight/obese. The mean body mass index (BMI) of the students in relation to high, moderate, and low levels of PA was 23.0, 22.9, and 22.1, respectively. Significant associations were found between PA and marital status, the mother’s education level, the participant’s BMI, and residential proximity to parks and recreational facilities. Several variables were found to correlate with dietary habits, underweight, and overweight/ obesity. Of special interest were the negative and positive associations between the number of siblings and the participants’ BMI and dietary habits.

Interpretations: The results of these studies emphasize the coexistence of underweight and overweight/obesity among both healthy persons and hospital patients. The total prevalence of overweight/obesity among both hospital patients and female university students is higher in the KSA compared to other international settings. Furthermore, the fact that patients at risk of undernutrition or with manifest undernutrition do not get adequate nutritional care is understandable given our results showing that the interviewed nurses were not given the authority to provide the nutritional care that they thought necessary.

Conclusions: This thesis suggests that the promotion of PA and nutritional education for women should be a major target for policy makers as well as public health practitioners and researchers. The goal for such activities would be to prevent the inevitable health complications related to poor dietary habits and lack of PA.

In recent years there has been an increase in research conducted in the Middle East, with a corresponding increase in the challenges faced by members of the Research Ethics Committees (RECs). This study compares the structures of Omani and Jordanian RECs and investigates the perceptions of the challenges affecting the work of the REC members in Oman and Jordan. A convenience sample of 34 Omani and 66 Jordanian participants from 21 universities was recruited in this cross-sectional study. Almost 70% disagreed that the members of RECs are unqualified, providing comments without justification; half believed that members have limited experience in research, and almost three-quarters that they have different opinions regarding some ethical issues. No significant differences were found between Omani and Jordanian REC members regarding their perception of the challenges, except for the perception that reviewing proposals is a time-consuming task (p = 0.048) and that multi-REC centres are less available (p = 0.026). The regression model showed that there were significantly more male members of Jordanian RECs, and that Jordanian members were less likely to receive formal training. In conclusion, the current structure of RECs and the challenges faced by members need to be re-evaluated by decision makers to improve the overall quality of research activities, and to ensure that current REC members’ practices adhere to international standards.

Background:

Undernutrition is a problem in institutional care, where 20–46% of all inpatients are classified as being “at nutritional risk”. This study explores the prevalence of undernutrition risk and overweight/obesity and the targeting of nutritional care in relation to undernutrition risk among inpatients in southwestern Saudi Arabia.

Methods:

A cross-sectional, point prevalence study was carried out in a Central hospital in southwestern Saudi Arabia. The subjects were inpatients, over the age of 18 who had their nutritional status assessed. Moderate/high undernutrition risk was defined as the occurrence of at least two of: weight loss, low BMI, and/or eating difficulties. Overweight/obesity was graded by using Caucasian and Asian cut-offs for BMI.

Results:

Out of 219 patients 166 (76%) agreed to participate (106 men and 60 women) with a significantly higher drop-out among women (n=35, 37% vs. men n=18, 14%). There was no significant difference in the prevalence of moderate/high undernutrition risk between men and women (40% vs. 38%) but more women (29% or 40%, depending on cut-off) than men (10% or 23%) were obese. Among patients at moderate/high undernutrition risk, more women (61%) than men (31%) were served small portions.

Conclusions:

There is a need to increase awareness about nutrition among nurses, to implement nutritional guidelines and to do more research regarding overweight/obesity among the female population. Motivational strategie  need to be developed to focus on increasing the Saudi female participation in research.

Rationale: The aim of this study was to examine the prevalence and determinants of PA, sedentary behaviors, and BMI among female university students in south western KSA.

Methods: This cross-sectional study included 663 female students who were randomly selected from a female university centre. Logistic regressions were used to identify determinants for moderate and vigorous PA, sedentary behaviors, and overweight/obesity and underweight.

Results: The females reported moderate PA in 49% and vigorous PA in 21% of cases, as defined by the American College of Sports Medicine recommendations. Total energy expenditure in METs-min/week increased with increased BMI (1216 among underweight, 1474 among normal weight, and 1810 among overweight). Sedentary behaviors were found among 15% of participants. The prevalence of overweight and obesity was 24%, and underweight 19%. Significant predictors for moderate PA were found to be present of one obese parent (negative relation), proximity to parks, and BMI (positive relation) while vigorous PA was predicted by age, fathers' level of education, waist-height ratio (negative relation), mothers' level of education, proximity to molls and parks, and BMI (positive relation). Sedentary behaviours were only predicted by proximity to parks. Overweight and obesity were found to correlate to the number of sisters (negative relation), presence of one obese parent, obese siblings, and proximity to molls (positive relation). On the other hand, both age and presence of obese parents were found to be negatively and significantly correlated to underweight.

Conclusion: A minority of the subjects met with current recommendations for PA. Intervention studies and implementation of national nutritional and PA guidelines are needed and should be integrated in the education of the adolescents and young adults.

Rationale: The prevalence of obesity in Saudi Arabia (KSA) is a growing challenge to public health, it may affect and be related to the levels of physical activity. The aim of this study was to examine the prevalence of overweight and obesity, physical activity, and unhealthy food intake among female university students in Saudi Arabia. In addition, determinants for levels of physical activity and unhealthy food intake were examined.

Methods: This cross-sectional study included 663 female students in a university centre in KSA. Measures included anthropometric, socioeconomic, environmental, cultural, and life style factors such as physical activities, sedentary activities and eating habits. Logistic regressions were used to identify predictors of physical activity and unhealthy food intake respectively.

Results: The prevalence of overweight was 19% and obesity 6%. Physically active females were 41%, as defined by the American College of Sports Medicine (ACSM) recommendations for moderate physical activity (Haskell et al. 2007). Concerning vigorous physical activity, only 17%, of the subjects met the current recommendations. According to WHO’s recommendations for physical activity levels 55% were minimally active and 12% active. Significant predictors for moderate/vigorous physical activity were found to be proximity to parks, mothers’ education (positive relation), lack of knowledge, and number of brothers (negative relation). It also emerged that 88% of the participants had unhealthy food intake with the fathers’ level of education as the only significant predictor.

Conclusion: A minority of the subjects met with current recommendations for physical activity. Intervention studies and implementation of national nutritional guidelines are needed and should be integrated in the education of the adolescents and young adults.

Background: The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to examine the prevalence of physical activity (PA) and associated factors among female university students. Methods: This cross-sectional study involved 663 randomly selected female university students who completed the Arab Teens Life Style questionnaire. Data included measurements of anthropometric, socioeconomic and environmental factors, as well as self-reported PA. Ordinal regression was used to identify associated factors with low, moderate and high PA levels. Results: The mean age of participants was 20.4 years (SD 1.5). Mean BMI of the students in relation to PA were 23.0, 22.9, 22.1 for high, moderate and low levels of activity, respectively. The analysis revealed significantly higher PA levels among married students, those with high educated mothers, and those who lived far from parks, and lower activity levels among underweight students. Conclusions: This study raises four important determinants for female university students’ PA levels. These factors could be of great importance in the endeavor to prevent the health-threatening increase in physical inactivity patterns and thus non-communicable diseases and obesity where the focus should be on the specific situation and needs of women in Saudi Arabia.

OBJECTIVE: Research about the prevalence of underweight and overweight/obesity in the Saudi Arabian female population is limited. The aim of the present study was to examine the dietary habits and the prevalence of underweight and overweight/obesity and associated factors among female university students.

DESIGN: A cross-sectional study.

SETTING: A university centre for female students in south-western Saudi Arabia.

SUBJECTS: The study involved 663 randomly selected female university students who self-reported their physical activities, nutritional habits and socio-economic factors. Multiple linear and logistic regression analyses were used to identify factors associated with the students' BMI, dietary variables, underweight and overweight/obesity.

RESULTS: The majority of the university females were normal weight (56·9 %), but a high prevalence of underweight (19·2 %) and overweight/obesity (23·8 %) occurred. Social factors significantly associated with BMI were the presence of obese parents and siblings as well as physical activity levels, marital status, number of sisters, father's level of education and more frequent intake of French fries/potato chips (>3 times/week). Several variables were found to correlate with dietary habits, underweight and overweight/obesity. Of special interest is the association between the number of siblings and the participants' BMI and dietary intake in both negative and positive ways.

CONCLUSIONS: The findings of this research have implications for health promotion and prevention of malnutrition among college-aged females. Health-care providers and policy makers need to involve the whole family when promoting females' physical activity. The study serves as an evidence-based background for planning and implementation of interventions targeting improvement of highly educated populations' nutritional habits.

Objectives. The aim of this study was to investigate perceived and ideal body image (BI) and associated factors among female university students in Saudi Arabia. Methods. This cross-sectional study included 663 university female students. Anthropometric measurements including weight, height, BMI, and BI perception (the 9-figure silhouette) were obtained. Descriptive and logistic regression analysis were conducted. Results. An agreement between actual, perceived, and ideal BI was found in 23% of the participants. Behavioral (activity levels), social (presence of obese parents and fathers’ level of education), and economic factors (households’ monthly income, number of cars in the household, and kind of residence) were positively and significantly associated with the desire to be thinner. Similarly, socioeconomic associations (number of sisters and number of cars in the household) correlated positively and significantly with the desire to be heavier. Conclusions. The whole family should rather be considered in interventions related to appearance concerns and BI discrepancies. Furthermore, campaigns targeting improvement of adolescents’ physical self-image should be a major priority of the public health sector.

Background

Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses’ views and experiences of caring for malnourished patients in Saudi Arabia (KSA).

Methods

Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis.

Results

The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: ‘Potentials for nurses to provide good nutrition and physical activity’, and ‘Having the ability but not the power to promote proper nutrition and physical activity’. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women’s weight gain in KSA society.

Conclusions

The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses’ views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.

BACKGROUND: Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses' views and experiences of caring for malnourished patients in Saudi Arabia (KSA).

METHODS: Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis.

RESULTS: The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: 'Potentials for nurses to provide good nutrition and physical activity', and 'Having the ability but not the power to promote proper nutrition and physical activity'. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women's weight gain in KSA society.

CONCLUSIONS: The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses' views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.

BACKGROUND: The Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II) Questionnaire assesses nutritional risk among elderly people living at home. Our aim was to produce a Swedish language version of the SCREEN II and to examine response patterns, data completeness and the relationship between malnutrition and general health.

METHODS: The SCREEN II was translated into Swedish using dual panel methodology, and then followed up with field test interviews of 24 seniors (median age, 83 years). We used the survey data (n = 565) to assess item and score distribution, missing responses, and the relationship to the subject's general and nutritional health.

RESULTS: The Swedish SCREEN II was considered easy to understand, respond to, and relevant (n = 21; 88% of subjects found it so in all three respects) and its median completion time was 5 minutes. The level of survey item data completeness was 94-99%, and 82% of surveys had computable total scores. Of those subjects with completed forms, 35% had no nutritional risk; 35% had moderate risk; and 30% were at high risk. The malnutrition risk increased with poorer perceived health.

CONCLUSIONS: Our study results are similar to those using previous SCREEN II versions, indicating that the scale adaptation was successful and providing initial support for use of the Swedish SCREEN II questionnaire.