Search Results (168)

As urban areas expand, the sustainable management of municipal water becomes a critical challenge, especially in arid and semi-arid regions facing severe water scarcity. Accurate assessment of urban plant water requirements (PWR) is essential for developing sustainable landscape architecture and resilient green infrastructure. In this study, a new quantitative equation (PWR_q) was developed as a regional proof of concept to adjust reference evapotranspiration estimates for hyper-arid conditions. A Tree Morphology Coefficient (K_tm) is introduced to combine canopy features (form, height) and leaf traits (size, density) with an updated drought-resistance coefficient (K_dr). Field measurements of 277 mature trees, representing 27 native and introduced species in Riyadh and Jeddah, Saudi Arabia, were analyzed. The framework explicitly includes an empirical multiplier to account for extreme urban heat island (UHI) effects and aerodynamic canopy scaling. Instead of direct empirical validation, the PWR_q model was benchmarked against established reference indices: Water Use Classification of Landscape Species (WUCOLS) and Simplified Landscape Irrigation Demand Estimation (SLIDE), showing strong alignment with established categorical indices and structural traits. The results confirm that the morphology-based method effectively makes previously subjective classifications objective. Notably, the quantitative assessment found that the dominant introduced species require about 3.5 times more water than native species. As a proof of concept, future research should empirically validate these findings against direct physical measurements, such as sap flow sensors or lysimeters. The proposed framework presents a practical, objective decision-support tool for municipal policymakers and landscape architects to optimize species selection, implement nature-based solutions (NBS), and achieve long-term sustainability in urban greening. Full article

Background: Population-based cancer registry surveillance is essential for monitoring breast cancer burden and guiding cancer control planning; however, national surveillance evidence from Saudi Arabia remains limited. Using the Saudi Cancer Registry (SCR), we describe the distribution of age at diagnosis, geographic location, registry stage, histology, and grade among Saudi women diagnosed with breast cancer between 2007 and 2022. Methods: We performed a retrospective descriptive study of all Saudi female breast cancer cases registered in the SCR from 1 January 2007 to 31 December 2022 (N = 40,755). Variables were coded according to SEER guidelines; STATA 16 was used for analyses. Results: The average age at diagnosis among 40,755 cases was 51.85 years. The highest case volume was from Makkah (25.5%), Riyadh (23.6%), and the Eastern Province (15.9%). The national age-standardized incidence rate (ASR) increased from 18.2 to 49.7 per 100,000 women between 2007 and 2022. Invasive ductal carcinoma (no special type) was the most common histology (76.7%). Overall, 42.7% of cases were localized, 36.5% regional, 14.2% distant, and 6.6% unstaged. Stage distribution differed significantly by age group (χ²  =  98.1, p < 0.001) and by region (χ²  =  312.6, p < 0.001). Conclusions: National cancer registry data show marked regional differences in breast cancer incidence and a persistent proportion of late-stage diagnoses. These findings may inform early detection planning and region-specific cancer control strategies. Full article

Background/Objectives: This study aimed to estimate self-reported prevalence of HIV and gonorrhea among primary healthcare attendees in Riyadh and to identify key demographic, behavioral, and clinical predictors, acknowledging that diagnoses were based on participant self-report rather than laboratory confirmation. Methods: A cross-sectional survey was conducted between March and July 2023 across 48 primary healthcare centers in Riyadh. A total of 14,239 adult participants (aged ≥18 years) completed an electronically administered questionnaire that included self-reported prior diagnoses of HIV and gonorrhea. Multivariable logistic regression models were used to identify independent predictors of self-reported HIV and gonorrhea. Results: The self-reported prevalence of HIV was 2.6% (95% CI: 2.35–2.87%), and gonorrhea was 3.1% (95% CI: 2.83–3.40%). Several factors were independently associated with higher odds of self-reported infection. Younger age (<50 years) increased risk (HIV: AOR = 2.19; gonorrhea: AOR = 1.57), as did female sex (HIV: AOR = 1.67; gonorrhea: AOR = 1.59), higher education (HIV: AOR = 1.29; gonorrhea: AOR = 1.23), married status (HIV: AOR = 1.76; gonorrhea: AOR = 1.49), and insurance coverage (HIV: AOR = 2.01; gonorrhea: AOR = 1.88). Behavioral and clinical factors included smoking (HIV: AOR = 4.79; gonorrhea: AOR = 2.41), hypertension (HIV: AOR = 2.58; gonorrhea: AOR = 1.49), obesity (HIV: AOR = 11.55; gonorrhea: AOR = 9.02), hypercholesterolemia (HIV: AOR = 2.24; gonorrhea: AOR = 2.53), and heart disease (HIV: AOR = 11.31; gonorrhea: AOR = 8.77). The notably high associations for obesity and heart disease should be interpreted with caution, as they may be influenced by detection bias or residual confounding within the healthcare-seeking sample. Conclusions: This study provides key insights into the self-reported burden and predictors of HIV and gonorrhea in Saudi Arabia. While identifying significant demographic and metabolic risk profiles, the high magnitude of certain clinical associations must be interpreted with caution due to potential detection bias and residual confounding. Given the reliance on self-reported data, these findings should be viewed as an epidemiological baseline rather than absolute prevalence. Prioritizing clinical context over statistical values and strengthening integrated, laboratory-based surveillance within primary care will be essential for improving early detection and evidence-based prevention strategies in the region. Full article

Background/Objectives: Diabetic retinopathy (DR) is a major microvascular complication of type 1 diabetes mellitus (T1DM) and remains an important cause of preventable visual impairment. Region-specific data on the incidence and clinical predictors of DR among patients with T1DM in Saudi Arabia remain limited. This study aimed to determine the incidence of DR and identify associated demographic and systemic risk factors among patients with T1DM at a tertiary care center in Riyadh, Saudi Arabia. Methods: This retrospective cohort study included 449 patients with T1DM aged ≥9 years who were followed at King Abdulaziz Medical City, Riyadh, between 2015 and 2025. Patients were selected using a consecutive non-probability sampling technique. Data were extracted from the BESTCare 2.0A electronic medical record system and supplemented, when required, by phone-based interviews to verify selected clinical and demographic variables. Patients were classified as controls without DR or cases with DR, including non-vision-threatening DR and vision-threatening DR (VTDR), according to the International Clinical Diabetic Retinopathy Severity Scale. Multivariable logistic regression, Cox proportional hazards models, and temporal trend analysis were performed, with statistical significance set at p < 0.05. Results: The overall incidence rate of DR was 92.66 per 1000 person-years, with similar rates among males and females. In multivariable logistic regression, older age at T1DM diagnosis, longer diabetes duration, hypertension, hyperlipidemia, and albuminuria were independently associated with DR. Mean HbA1c and HbA1c variability were not independently associated with DR after adjustment. In Cox regression, older age at T1DM diagnosis was associated with higher hazards of both DR and VTDR, while hypertension was associated with VTDR. Among patients with DR, younger age at T1DM diagnosis was associated with higher odds of proliferative disease in exploratory severity analysis. Conclusions: DR was common among patients with T1DM in this tertiary-care cohort and was mainly associated with disease duration, age at diagnosis, and systemic vascular comorbidities. These findings support the importance of routine ophthalmologic screening and integrated management of systemic risk factors in patients with T1DM. Full article

This study explores a photovoltaic/thermal (PV/T)-based electrolysis system designed for dual production of hydrogen fuel and domestic hot water (DHW), providing a sustainable energy solution amid rising global emissions. A dynamic rule-based control mechanism with hysteresis thresholds on hydrogen-storage state of charge (SoC) is implemented to balance electrolyzer operation with intermittent solar availability, maintaining PV/T power outputs while preventing storage overfilling and minimizing start–stop cycling. The system is assessed across 27 geographically diverse cities spanning a wide range of solar irradiation and energy price structures. Annual hydrogen yields range from 20 kg/yr in high-latitude locations (Helsinki, Stockholm) to 33.5 kg/yr in high-irradiation regions (Riyadh, Abu Dhabi), while the levelized cost of hydrogen (LCOH) spans from 6.47 USD/kg (Riyadh) to 22.86 USD/kg (Helsinki). Economically, the system achieves its strongest performance in solar-rich, high-energy-cost environments: Rome records the highest net annual cash flow (858.9 USD/yr) and shortest payback period (2.47 years), followed by Davos, Madrid, Brasília, and Canberra. In contrast, locations with subsidized energy tariffs—such as Algiers, Kyiv, and Tehran—yield low or negative net cash flows, rendering the system economically unviable without policy support. Environmental analysis reveals annual CO₂ avoidance ranging from 0.33 ton/yr (Stockholm) to 2.97 ton/yr (Riyadh), with a global mean of 1.095 ton/yr and a combined total of approximately 29.6 tons/yr across all examined sites. A machine learning model is developed to generalize performance predictions across unseen locations, achieving leave-one-out (LOO) R² values of 0.953 (net cash flow), 0.935 (LCOH), and 0.947 (LCO-DHW), with mean absolute errors below ±1 USD/kg and ±0.03 USD/kWh. The findings confirm that, under fixed capital cost assumptions, local electricity price and solar irradiation are the dominant drivers of economic viability, while grid carbon intensity and solar resource jointly govern environmental performance, with markets offering irradiation above 1500 kWh/m²·yr and electricity prices exceeding 0.2 USD/kWh representing the most promising deployment targets. Full article

Background: Speech-language pathology (SLP) and audiology services are essential components of multidisciplinary rehabilitation, particularly for individuals with developmental, neurological, and communication-related disorders. National-level data describing the distribution and utilization of these services in Saudi Arabia remain limited. This study aimed to examine national patterns of rehabilitation service utilization, with a focus on SLP and audiology services in comparison to other rehabilitation specialties. Methods: A retrospective cross-sectional analysis was conducted using publicly available national open data released by the Saudi Ministry of Health (MOH). Aggregated rehabilitation service encounters (n = 1,872,328 to 1,930,695) from 2023–2024 were analyzed by specialty, geographic region, sector (MOH clusters versus private sector), and pediatric age groups. Descriptive statistics were used to characterize utilization patterns and regional variation. Results: Rehabilitation services were widely delivered across both public and private sectors, with physiotherapy representing the largest share of encounters. SLP and audiology services contributed a smaller proportion of total rehabilitation encounters compared to other specialties. Service distribution varied regionally, with higher volumes concentrated in major urban areas including Riyadh, Makkah, and the Eastern Region. Pediatric service encounters were highest in early childhood (ages 3–7), with SLP and audiology services forming a consistent component of rehabilitation during this period. Conclusions: This study provides a descriptive overview of rehabilitation service utilization in Saudi Arabia, highlighting the distribution of SLP and audiology services relative to other specialties and across regions. Findings emphasize the importance of addressing regional variation, supporting workforce development, and enhancing national rehabilitation data systems to inform planning and ensure comprehensive access to communication and hearing services. Full article

Background: Critical care nurses are frequently exposed to traumatic clinical events and occupational stress, increasing the risk of post-traumatic stress disorder (PTSD), compassion fatigue, and compromised psychological well-being. However, the interrelationships among these variables in Saudi Arabia remain unclear. This study investigated the associations between PTSD symptoms, compassion fatigue, and psychological well-being among critical care nurses. Methods: A descriptive cross-sectional study was conducted between October and December 2025 with 210 critical care nurses from the Eastern and Riyadh regions of Saudi Arabia. Data were collected using the PTSD Checklist for DSM-5 (PCL-5), the Professional Quality of Life Scale, and the WHO-5 Well-Being Index. Data analysis included descriptive statistics, t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and multiple linear regression. Results: The mean PCL-5 score was 27.44, with 38.1% of participants meeting the cutoff for probable PTSD. Compassion fatigue was moderate. The mean WHO-5 score was 54.60, indicating moderate well-being, though a substantial proportion reported poor well-being. Psychological well-being was negatively correlated with both PTSD symptoms and compassion fatigue, while PTSD symptoms were strongly positively correlated with compassion fatigue. Both PTSD and compassion fatigue independently predicted lower well-being, explaining 21% of the variance. Sociodemographic variables were not significant predictors after adjustment. Conclusions: Critical care nurses experience moderate PTSD symptoms and compassion fatigue, adversely affecting psychological well-being. These findings underscore the interconnected nature of trauma-related distress and professional quality of life, highlighting the need for routine psychological screening, trauma-informed support, and resilience-focused interventions. Full article

Economic inequities in healthcare access persist globally, yet the impact of income on palliative care (PC) utilization in Middle Eastern contexts remains empirically understudied. This cross-sectional study of 200 cancer patients in Riyadh, Saudi Arabia, employed a socioeconomic stratification analysis to examine income-stratified differences in PC awareness and access. Using chi-square and linear-by-linear association tests, results revealed pronounced income gradients; awareness increased from 41.9% in the low-income group to 71.9% in the high-income group (p = 0.001), demonstrating a significant dose–response trend. Access disparities were even more striking, with only 35.5% of low-income patients utilizing services compared to 76.1% of high-income patients (p < 0.001), representing a 40.6 percentage-point gap. After multivariable adjustment, after controlling for age, gender, education, and geographic living region, the results of logistic regression analysis showed that cancer patients with high income were more than three times as likely to access PC services compared with lower-income cancer patients (OR = 3.32; 95% CI: 1.83–6.02; p < 0.001). Geographic stratification further indicated that income disparities were significantly amplified in peripheral regions compared to the Central region (p = 0.072 for interaction), where service scarcity exacerbates economic barriers. These findings underscore that economic barriers operate through awareness gaps and structural obstacles like transportation and opportunity costs. Addressing these inequities requires multifaceted strategies, including financial support and geographic service expansion, to ensure equitable PC distribution under the Vision 2030 framework. Full article

This research explores public awareness, perceptions, and behavioral attitudes toward renewable energy in Saudi Arabia, drawing on data from a sample of 217 respondents predominantly based in the Riyadh region. The demographic profile reveals a diverse age distribution, with a notable concentration of younger participants, particularly those aged 16–25, who constituted 40.1% of the sample. Employing a descriptive survey design, the research explores key themes including environmental attitudes, economic considerations, personal behavior, media influence, and educational engagement. The findings indicate strong public support for the national transition to renewable energy, with 73.4% of the respondents expressing confidence in its potential as a primary energy source. Many of the respondents recognized both the ecological and financial advantages of renewable technologies, such as reduced emissions and job creation. The participants widely acknowledged the environmental and economic benefits of renewable technologies, such as reduced pollution and job creation. However, concerns persist regarding fossil fuel dependency, energy transition costs, and the adequacy of current educational and media efforts. The statistical analysis revealed significant associations between awareness levels and favorable attitudes toward investing in renewables. The results underscore the importance of targeted educational initiatives, strengthened communication strategies, and enhanced institutional transparency to reinforce public engagement and facilitate Saudi Arabia’s sustainable energy goals under Vision 2030. Full article

This study examines the gap concerning occupants’ perceived thermal comfort and objectively measured indoor conditions in a green university building in Riyadh. The purpose is to assess occupant satisfaction with thermal conditions, compare subjective responses with physical measurements, and derive design and operational implications for educational buildings in hot-arid climates. The primary aim was to assess occupant satisfaction with indoor thermal conditions and to measure key environmental parameters to provide a thorough assessment of thermal comfort. A cross-sectional approach was used, combining subjective data from the Center for the Built Environment (CBE) Occupant Indoor Environmental Quality (IEQ) survey with objective measurements of air temperature, relative humidity, mean radiant temperature, and air velocity, which were documented over five consecutive working days during the mid-winter period in Riyadh. These parameters were explored using the CBE Thermal Comfort Tool to calculate Predicted Mean Vote (PMV) and Predicted Percentage Dissatisfied (PPD) indices. Statistical analyses examined the relationship between occupant-reported comfort and measured environmental conditions. Results showed that only 36% of occupants reported satisfaction with thermal comfort, while 48% expressed dissatisfaction. In contrast, objective measurements indicated stable indoor conditions within recommended comfort ranges (average temperature 23 °C, humidity 30–34%, MRT 24 °C, air velocity 0.5–1.0 m/s), with PMV values near neutral (−0.2 to 0.0) and PPD below 6%. The observed discrepancy highlights the influence of regional climate, individual adaptability, and perceived control. These findings emphasize the need to integrate both subjective feedback and objective measurements to develop occupant-centered strategies that enhance comfort and well-being in sustainable educational buildings in hot-arid climates. Full article

Autonomous battery electric vehicles (BEVs) have the potential to reshape urban mobility systems, yet their sustainability impacts remain underexplored in Gulf-region cities where traffic dynamics, land-use structures, and environmental conditions differ substantially from Western contexts. This study introduces a Saudi-specific assessment framework that integrates monetised externalities with empirically calibrated traffic dynamics to evaluate how automation influences safety, congestion, land use, emissions, and noise. To the best of our knowledge, this is the first Riyadh-calibrated monetised external-cost evaluation of autonomous BEVs that couples externality valuation with simulation-validated time-varying traffic dynamics (SAR per vkm and SAR per pkm), enabling realistic peak-period sustainability assessment. The framework’s key contribution is linking external-cost modelling with spatiotemporal traffic behaviour derived from Riyadh’s 2023 mobility patterns, providing a more realistic basis for sustainability evaluation. Using national datasets from transport, energy, and statistical authorities, the model estimates substantial reductions in external costs when transitioning from human-driven to autonomous BEVs, driven primarily by lower crash exposure and smoother traffic flow. To validate these findings under real operating conditions, a dynamic analysis incorporating hourly and seasonal traffic variability was developed, revealing that automation delivers its strongest improvements during peak-demand periods where congestion externalities are highest. The integrated results demonstrate the relevance of autonomous BEVs for dense rapidly growing Saudi cities and provide actionable insights for future mobility planning. The study highlights the policy importance of coordinated transport, land-use, and energy strategies to ensure that automation contributes meaningfully to national sustainability goals under Vision 2030. Full article

Since the 1970s, accelerated urban development in Doha has contributed to a disjointed and inefficient city structure. While the Doha Metro has begun to address spatial and mobility-related challenges, planners continue to call for a more integrated, strategic approach to ensure safe, accessible, and efficient transit connectivity. In response, the Qatar National Development Framework provides a long-term vision for sustainable urban transformation, with a central aim of embedding the Metro system within the existing urban context and aligning expansion with Transit-Oriented Development (TOD), which promotes dense, multifunctional, pedestrian-oriented neighborhoods along transit corridors. Within this context, this study investigates how TOD strategies can enhance quality of life in mixed-use environments, focusing on the area surrounding Al Mansoura metro station and the adjacent Najma and Al Mansoura districts. Using the Integrated Modification Methodology (IMM), the analysis assesses spatial structure across density, spatial diversity, and connectivity, and derives evidence-based recommendations to improve livability and support sustainable revitalization. To broaden regional applicability, the study also compares Al Mansoura with Olaya in Riyadh—two mid-to-late 20th-century, high-density mixed-use districts undergoing TOD-driven transition—highlighting how spatial form, infrastructure legacy, and urban governance shape TOD outcomes and inform adaptable TOD frameworks for Gulf cities. Full article

Background/Objectives: Influenza A (IAV) and influenza B (IBV) viruses pose significant public health threats, with varying epidemiology and immune responses. Limited subtype-specific cytokine data exist for influenza in Saudi Arabia. This study conducted molecular surveillance on 380 NPAs from patients at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia, during winter seasons (2020–2023). Methods: NPA samples were collected from hospitalized patients presenting with fever (>38 °C) and respiratory symptoms. RNA was extracted using the QIAamp Viral RNA Kit, followed by RT-PCR for IAV (H1N1, A/H3N2) and IBV detection. Quantitative real-time PCR profiled mRNA expression of 17 cytokines/chemokines in IAV-positive (n = 65) and IBV-positive (n = 20) samples, normalized to GAPDH using the 2^−ΔΔCq method. Appropriate statistical tests were applied (p < 0.05 significant). Results: Results showed 17.11% IAV positivity (7.89% A/H1N1, 9.21% A/H3N2) and 5.26% IBV. A/H3N2 predominated, increasing from 6.67% (2020/21) to 12.30% (2022/23). Males had higher IAV rates (25.88% vs. 10.00% females, p < 0.05), while IBV was higher in females (6.67% vs. 3.53%). Age-wise, 0–4 years had peak IAV (28.42%, p < 0.05); IBV peaked at 5–14 years (10.91%). IAV elicited higher mRNA expression IFN-α, IL-10, IL-13, and CCL-2 (p < 0.05); IBV showed elevated IL-1α, IL-6, and IL-33 (p < 0.05). Within IAV, A/H1N1 had higher IL-4, IL-10, IL-13, and IL-17; A/H3N2 elevated TNF-α, IL-6, IL-22, CCL-3, and CCL-4 (p < 0.05). Conclusions: These findings highlight subtype-specific inflammatory profiles and demographic disparities in Saudi Arabia, informing targeted interventions. Post-COVID resurgence underscores surveillance needs amid travel and gatherings. Insights into cytokine dynamics aid prognosis and therapeutics, emphasizing regional molecular monitoring for vaccine optimization and outbreak prevention. Full article

Background: Electronic Medical Records improve decision-making but add administrative burdens for healthcare providers, such as physicians and nurses. While the rate of adoption is high in Saudi Arabia, the concrete temporary impact and reasoning behind their adoption are understudied. Objectives: This study is a Mixed-Methods Study designed to ascertain the number of hours of EMR use among physicians and nurses, the predictors of using EMRs for extended periods, perceived barriers and clinical impacts. Methods: A sequential mixed-methods study was performed in three hospitals in Riyadh, Dammam, and Makkah. Quantitative data from 503 clinicians were analyzed using inferential statistics, followed by thematic analysis of 10 semi-structured interviews. Results: A total of 503 professionals (162 physicians, 341 nurses) participated. The majority were females (67.2%), aged 30 to 40 years (44.9%), and non-Saudi (62%). Nurses reported a significantly higher daily EMR workload than physicians with 5.43 h (45.25%) versus 4.34 h (36.17%), with a mean difference of 1.09 h (t = −5.76, p = 0.001). Ordinal logistic regression identified female gender, non-Saudi nationality, nursing position, and lack of advanced education (Masters/Doctorate) as high-significance predictors of prolonged usage (all p < 0.005). Additionally, years of experience (p = 0.001) and EMR training (p = 0.003) were significant factors. Perceived barriers were moderate but significantly predicted by professional position (p = 0.004), work region (p = 0.017), and training duration (p = 0.001). Qualitatively, thematic analysis revealed four major barrier categories: system performance, infrastructure issues, lack of IT support, and increased workflow burdens. While EMRs improved professional practice and patient safety by solving handwriting issues and structuring data, they forced work routine adjustments that significantly reduced bedside patient interaction and assessment time. Full article

Background: Recently introduced nicotine pouches (NPs) are smokeless nicotine products. They are held between the lips and gums for 30 min to absorb nicotine into the bloodstream through the oral mucosa. Attractiveness may increase nicotine use, especially among young people and teens. The objective of this study is to investigate the health issues and psychological effects associated with nicotine pouch use among individuals in Saudi Arabia. Methods: A cross-sectional online survey using Google Forms. It was conducted between 13 February and 4 November 2025, in the Riyadh province of Saudi Arabia, restricted to users of nicotine pouches willing to answer a questionnaire on the occasion of buying them (at regional tobacco stores/supermarkets) or online via WhatsApp or the Telegram platform. Statistical analysis was conducted using SPSS Version 27, with a p < 0.05 indicating significance. Results: The current study included data of 489 participants, with a total of 395 participants using nicotine pouches. The most commonly reported symptoms were difficulty breathing and shortness of breath (both 40.5%), changes in taste or smell (36.7%), headache and stomach ulcers (33.4% each), and rapid or irregular heartbeat (28.4%). Most common psychological symptoms at any severity level (slightly to extremely) were appetite changes (78.7%), difficulty concentrating or focusing (75.4%), difficulty sleeping (74.9%), and increased anxiety or irritability (73.4%). Depression (72.2%), anger management (71.1%), and stress (70.4%) were also common. Regression analyses revealed that educational attainment was a significant predictor of both physical and psychological health outcomes. Conclusions: The findings show the most common physical symptoms were difficulty breathing and shortness of breath, followed by taste or smell changes, headaches, stomach ulcers, and rapid or irregular heartbeat. Appetite changes, concentration issues, sleep disturbances, and anxiety or irritability were common across all severity levels. Depression, anger issues, and stress were common. Full article