This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Western values influence cognitive behavioural therapy (CBT) as it was primarily developed and practised in the West. As understanding the cultural context has been linked to better therapy outcomes, it has been suggested that CBT might need modification to non-Western clients’ cultural backgrounds. Previously we developed a cost-effective approach to adapt CBT for clients in China and Pakistan. In this study, we applied the same methodology for local clients suffering from depression and anxiety in the Kingdom of Saudi Arabia and Bahrain. This study aimed to understand the views of patients with depression and anxiety, caregivers and mental health professionals about CBT to develop guidelines for culturally adapting CBT for depression and anxiety. We conducted semi-structured interviews with the patients (n = 42), caregivers (n = 11), and psychiatrists and psychologists (n = 16). The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The themes emerging from the analyses of interviews by each interviewer were compared and contrasted with those of other interviewers. The results highlighted barriers of access to and strengths of CBT while working with these patient groups. Patients and their caregivers in both countries use a bio-psycho-spiritual-social model of illness and seek help from multiple sources. Therapists emphasized the need for using local idioms, culturally appropriate translation and minor adjustments in therapy. There were no thematic differences between the two sites. These findings will be used to culturally adapt a CBT manual, which will be tested in a randomized controlled trial.Key learning aimsAfter reading this article, readers will be able to:(1)Understand the need for cultural adaptation of CBT.(2)Identify the necessary steps to adapt CBT for the Muslim Arab population.(3)Understand the modifications required to deliver culturally adapted CBT for the Muslim Arab population.

Background. Dental students face a variety of challenges as they enter the dental profession. The study aimed at assessing dental students’ opinions about their perceived future career challenges in the dental profession and the associated factors. Materials and Methods. This cross-sectional study of 637 students representing different public and private dental colleges was conducted in Saudi Arabia. The participants responded to a pretested questionnaire conducted online. Results. There were 59.7% (n = 380) of males and 40.3% (n = 257) of females, and the mean age of the students was 21.80 (±2.14) years. The majority of participants thought that they will have difficulties in establishing their private clinic (63.9%) and finding a government job (>60%). Senior students were more likely to perceive getting a government job (OR = 1.79, P=0.02), securing an admission into specialty program (OR = 2.75, P=0.001), and establishing a private dental clinic (OR = 2.51, P=0.001) as future career challenges than junior students. Similarly, female gender was associated with increased perception of challenges about finding a government job (OR = 1.911, P=0.002), getting an admission into specialty program (OR = 1.5, P=0.038), and establishing a private clinic (OR = 2.02, P=0.001). In addition, low academic score and low level of father’s education were associated with increased odds of perceiving challenges of finding a government job and getting an admission into specialty programs. Conclusions. Establishing a private clinic and getting a government job were the most common career challenges. Senior students, female students, and students with low academic scores had increased likelihood of facing employment and academic-related difficulties.

Objectives To examine the effect of Nystatin oral rinse on oral Candida species and Streptococcus mutans carriage. Materials and methods Twenty healthy adults with oral candidiasis participated in the single-arm clinical trial and received Nystatin oral rinse for 7 days, 4 applications/day, and 600,000 International Units/application. Demographic-socioeconomic-oral-medical conditions were obtained. Salivary and plaque Candida species and Streptococcus mutans were assessed at baseline and 1-week and 3-month follow-ups. Twenty-four salivary cytokines were assessed. Candida albicans isolates underwent Nystatin susceptibility test. Results Half of participants (10/20) were free of salivary C. albicans after using Nystatin rinse. Salivary S. mutans was significantly reduced at 3-month follow-up (p < 0.05). Periodontal status reflected by bleeding-on-probing was significantly improved at 1-week and 3-month follow-ups (p < 0.05). Plaque accumulation was significantly reduced at 1-week follow-up (p < 0.05). Interestingly, the responses to Nystatin oral rinse were not associated with race, gender, age, oral hygiene practice, adherence to Nystatin rinse, or sweet consumption (p > 0.05). No C. albicans isolates were resistant to Nystatin. Furthermore, salivary cytokine eotaxin and fractalkine were significantly reduced at 3-month follow-up among participants who responded to Nystatin rinse (p < 0.05). Conclusions The study results indicate that oral antifungal treatment had an effect on S. mutans salivary carriage. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora other than S. mutans and Candida. Clinical relevance Due to the potential cariogenic role of oral Candida species, antifungal approaches shed new light on the prevention and management of dental caries from a fungal perspective.