To evaluate the prevalence of diabetic retinopathy (DR) in the urban and rural areas of Al Hasa region of Saudi Arabia and to determine risk factors related to DR.
Materials and Methods:
This study was conducted on patient attending primary health care centers between July 2007 and June 2009. A retrospective chart review was conducted on subjects with diabetes mellitus greater than 18 years old. Ophthalmologists examined DR status through dilated pupils by using direct, indirect, and slit lamp bio-microscopy. Frequencies, percentage, and their 95% confidence intervals (CIs) were calculated. Odd’s ratio was used to associate DR with possible risk factors. A P value less than 0.05 was considered statistically significant.
The prevalence of DR among 473 diabetic subjects was 30% (95% CI: 25.80–34.20). The odd ratios (ORs) of DR among diabetic residing in an urban area was significantly higher than diabetics residing in rural areas [OR = 1.94 (95% CI of OR 0.82–2.89)]. DR was associated to the duration of diabetes (adjusted OR = 1.70), uncontrolled blood sugar level (adjusted OR = 1.96), hyperlipidemia (adjusted OR = 2.04), and hypercholesterolemia (adjusted OR = 2.80).
DR appears to be a public health problem in the Al Hasa district of Saudi Arabia, and a planned approach is required to avoid severe visual impairment in patients with diabetes mellitus. Primary prevention and early detection could be implemented through primary health centers and non-ophthalmologists.
Diabetes Mellitus; Diabetic Retinopathy; Prevention of Blindness; Primary Health Care Centers
There is little data surrounding the survival of patients with chronic obstructive pulmonary disease (COPD) who are admitted to the critical care unit with exacerbation of symptoms. We conducted a study to measure the in-hospital and intensive care unit (ICU) outcomes of patients admitted with COPD exacerbation, and identified the related prognostic factors.
We performed a retrospective cohort study of patients who were admitted to the adult ICU between January 2006 and July 2011 for COPD exacerbation in King Abdulaziz National Guard Hospital, Al-Hasa, Saudi Arabia.
During the study period, a total of 119 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. The mean age was 72 ± 13 years, and 44 (37%) were females. The main cause of respiratory failure was infection, which occurred in 102 (86%) patients. Thirty-nine (33%) of the admitted patients were mechanically ventilated, and the median duration was 2.6 (1–42) days. The median lengths of the ICU and hospital stays were 3 (1–40) and 9 (2–43) days, respectively. The ICU mortality was 6%, and hospital mortality was 11%. Low Glasgow Coma Scale on admission, intubation, duration of mechanical ventilation, current smoking, tracheostomy, cardiopulmonary arrest, and the development of acute renal failure were associated with higher hospital mortality.
Early ICU and hospital mortality is low for COPD patients who have been admitted to the ICU with exacerbation. Low Glasgow Coma Scale scores on admission, intubation, prolonged use of mechanical ventilation, and the development of acute renal failure were identified as risk factors associated with increased hospital mortality.
intensive care unit; chronic obstructive pulmonary disease; mortality rates; acute respiratory failure
Diabetes mellitus (DM) requires continuous medical care, patients’ self-management, education, and adherence to prescribed medication to reduce the risk of long-term complications. The aim of this study was to assess the benefits of an education program on diabetes, patient self-management, adherence to medication, anxiety, depression and glycemic control in type 2 diabetics in Saudi Arabia.
Materials and Methods:
This was a prospective study, conducted among 104 diabetic patients at a major tertiary hospital in Riyadh, Saudi Arabia, between May 2011 and October 2012. Education materials given to diabetic patients included pamphlets/handouts written in Arabic, the national language. Special videotapes about DM were made and distributed to all participants. In addition, specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged. Patients were interviewed using a structured interview schedule both during the baseline, and after 6 months of the program. The interview schedule included, socio-demographics, clinical characteristics, diabetes self-management, adherence to medication, anxiety, and depression. Glycemic control was considered poor, if hemoglobin A1c (HbA1c) was ≥ 7%.
The mean age of the study population was 57.3 ± 14.4 years. Seventy one were males (68.3%) and 33 (31.7%) were females. After six months of the diabetes education program, there were significant improvements in patients’ dietary plan (P = 0.0001), physical exercise (P = 0.0001), self-monitoring of blood glucose (SMBG) (P = 0.0001), HbA1c (P = 0.04), adherence to medication (P = 0.007), and depression (P = 0.03).
Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan, physical exercise, SMBG, adherence to medication, HbA1c and depression.
Anxiety; depression; diabetes education; diabetes self-management; Saudi Arabia
Diabetes, hypertension and coronary artery disease are emerging threats to the health status in Saudi Arabia. These diseases are attributed largely to unhealthy dietary habits and lack of physical activity. Health education through primary health care (PHC) centers can play a significant role in changing behaviors and reducing the burden of non-communicable diseases.
We present the results of analysis of a moderately large dataset on dietary practices, physical activity and exposure to health education among patients visiting the PHC centers in Qassim region of Saudi Arabia. We examined this cross-sectional data to identify the relationships between these three variables after controlling for the effects of age, sex, marital status, education and disease status.
Our results suggest that women, older people, divorced and widowed persons and those with low education are more likely to have poor dietary habits and lack of physical activity. Patients suffering from chronic illnesses are more likely to be exposed to health education from PHC centers, which help to significantly improve their dietary practices and, to some extent, increase physical activity at all ages. Our analysis indicates that health education provided through the PHC centers plays a modest but significant role in improving lifestyles and dietary practices.
We conclude that better emphasis on high quality health education would significantly reduce the burden of non-communicable diseases in our target population.
Given that diabetes is an extremely common disorder in Saudi Arabia, the National Diabetes Registry was designed by King Saud University Hospital Diabetes Center in collaboration with King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in the year 2001. The aim of the registry is to identify risk factors related to diabetes and to provide statistics to public health programs and health care professionals for use in planning and evaluation. The registry was designed to provide information on the extent and nature of specific types of diabetes, diabetes complications, and treatment of diabetes in the Kingdom.
The registry has been available since 2001, with major collaborations from 26 hospitals as part of Phase I in which 100,000 patient data is to be collected on a regional level from Ar-Riyadh before extending the program to other regions of Saudi Arabia.
The web application was designed using relational database techniques along with on-line help topics to assist users to get acquainted with application functionalities. All Internet forms were designed with validation checks and appropriate messages to ensure quality of data.
The security measures established within the application ensure that only authorized users can gain access to the functionalities of the registry at allowed times. Administrative features were designed to manage the registry-related operations easily.
The diabetes registry has been in operation for almost 10 years, and around 67,000 patients have been registered to date. The Web-application offers an anytime-anywhere access to the registry’s data, removing geographical boundaries and allowing the national registry to provide real-time data entry, updates, reporting, and mapping functionalities more easily.
Merging related information in the form of databases can provide improved health care operations through instant access to data, ease of managing complex data structures, and creation of reports to be used by health care planners and hospital administrators.
centralized; diabetes; Internet; registry; Web-based
We have reported a case of a 40-year-old male diabetic patient, resident of a rural area, who visited the outpatient clinic of the diabetic center in Alnoor Specialist Hospital, Makkah, Saudi Arabia. He came to seek medical advice for a single wound in the back of the shoulder since 1 month. After examination, a larva was eliminated and sent to laboratory for confirmation. It was confirmed as the third-stage larva of Sarcophaga species after macroscopic and microscopic examination. This is the first case of a patient having diabetic wound myiasis with the larva of Sarcophaga species reported in the Makkah region of Saudi Arabia.
Diabetes mellitus; larva; myiasis; Sarcophagi
Hypertension is one of the most prevalent chronic conditions in Saudi Arabia. It is the leading risk factor for cardiovascular diseases and a major reason for visits to clinic and prescription of medications. Inspite of this, the degree of its control is not to the optimum. This could be due to its impact on patients’ quality of life (QOL). Impaired physical and psychological well-being may lead to non-compliance or even the withdrawal of treatment . The aim of this study was to assess QOL of hypertensive patients registered in Al-Khobar.
The QOL of hypertensive patients was compared with QOL of a control group. A total of 404 subjects (202 cases and 202 controls) were interviewed. The cases and controls were matched for age and sex. Patients’ self-assessment of QOL was measured with an Arabic version of SF-36, a 36-item Short Form Health Survey Questionnaire encompassing two main dimensions, physical and mental.
The QOL of hypertensive patients was substantially impaired in comparison to the control group. The mean scores for the physical component summary scale (PCS) were 39.3 and 50.8 for cases and controls respectively. The mean scores for the mental component summary scale (MCS) were 43.7 and 50.8 for cases and controls respectively. The burden of hypertension was concentrated in the physical dimension of health. Older age, female gender, unmarried patients, patients with hypertension complications, comorbid DM, use of Aldomet and shorter duration of hypertension were independently related to poorer QOL. The variability of the two summary measures explained by selected demographic and clinical characteristics was 24.3% and 10% for the PCS and MCS respectively.
Conclusions and recommendations:
The QOL of hypertensive patients was substantially impaired in comparison to the control group. Notably, the total explained variation of QOL by the selected characteristics was small, suggesting that the determinants of QOL are multi-factorial. Further research to explore the determinants and indices of QOL in hypertensive patients is warranted. From a clinical perspective, QOL should be considered in the monitoring of hypertensive patients to estimate the burden of hypertension and monitor their outcome.
Quality of life; hypertension; primary health care; SF-36 questionnaire
Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities due to multiple factors, including musculoskeletal (MSK) manifestations. The purpose of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development.
We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Baseline variables were examined to determine predictors for the development of MSK complications. Analyses were carried out using the Statistical Package for Social sciences.
We included 252 diabetic patients; 45 (17.9%) had MSK manifestations. Of these 45 patients, 41 (91.1%) had type 2 diabetes. The most common manifestations were carpal tunnel syndrome (n=17, 6.7%), shoulder adhesive capsulitis (n=17, 6.7%), and diabetic amyotrophy (n=12, 4.8%). A significant association was found between the development of MSK manifestations and manual labor, overweight, and vascular complications. On logistic regression analysis, the presence of vascular complications in general (B-coefficient=1.27, odds ratio=3.57, P<0.05, 95% confidence interval=1.31–9.78), and retinopathy in particular (B-coefficient=1.17, odds ratio=3.21, P<0.05, 95% confidence interval=1.47–7.02) can predict the development of MSK manifestations in about 82% of the cases.
Musculoskeletal manifestations are under recognized in adult diabetic patients, occurring in 18% of the cases. Physicians should consider examining the periarticular region of the joints in the hands and shoulders whenever a diabetic patient presents with MSK symptoms.
arthritis; diabetes mellitus; manifestations; musculoskeletal; rheumatological
The purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia.
A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey’s purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database.
Twenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system.
Hospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.
Pharmacy services; Formulary management; Clinical practice; Pharmacist consultation; Drug information; Medication use
To examine the presence of dissociation among Arab mothers with disabled children in Saudi Arabia, and to explore if this is linked to their mood difficulties, in addition to certain other demographic variables.
We conducted a prospective study during the period of June 2011 to February 2012, on 86 mothers (study group) caring for children with physical, mental or sensory disabilities treated at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. Patients’ selection was conducted using convenience sampling, non-probability technique. A total of 32 mothers (control group) with healthy children were also included. The Dissociative Experiences Scale (DES-11 Arabic) was used to measure dissociation whereas; the hospital anxiety and depression scale (HADS) was used to measure the mood symptoms of mothers. The demographic data of mothers and children were also collected.
The mean age of the children with disability was 5.6.±3.1 and healthy children 6.3±3.7 (range 1-14) years. The mean age of mothers in the study group (n=86) was 33.9±6.1 while the control group was 35.2±7.3 years. Results showed that the study group had higher level (Mean=39.9; SD=24.033) of dissociative experience than control sample (Mean=21.08; SD=14.487) (p=0.0001). Compared to control, mothers of disabled children scored significantly higher HADS-anxiety (p=0.042) and HADS-depression (p=0.021). In addition, results also showed that dissociation had significant correlation with mother's depression and anxiety. However, no significant correlations were found between dissociation and child's and mother's age.
Mothers of disabled children in Saudi Arabia showed significantly more dissociative experiences than controls, which is correlated to their anxiety and depression. Clinical implications are discussed.
Dissociation; Mood; Depression; anxiety; mothers of disabled children; Saudi Arabia
Oral Isotretinoin is the most effective choice in the treatment of severe acne, It is the most widely prescribed teratogenic drug in the USA and Canada. Due to large number of its adverse effects and the necessity of long term use, patients have difficulties in complying with the treatment and some may refuse taking the drug.
To assess knowledge, concerns and awareness of acne patients in Qassim region, Saudi Arabia, about Isotretinoin, including the factors that may affect compliance.
Subjects and Method:
This non-interventional cross-sectional survey was conducted through distribution of questionnaires over two months period from 8th May to 23rd July 2009 in acne patients from the Qassim region. The returned questionnaires were analyzed using SPSS version 17.0. The P <0.05 was accepted as cut-off point for statistical significance.
Three hundred fifty six acne patients were included in the study, 57.6% were female and 42.3% were male; 76.7% knew about Isotretinoin and its uses, the main source of information (for both genders) was the physician, followed by other acne patients. Sixty three percent of subjects knew about the adverse effects of the drug. Dryness and teratogenicity were the most well-known adverse effects and 85.9% didn't have any objection in using the drug. Adverse effects followed by duration of the treatment were the top concerned issues. Out of those who were using the drug, dryness of the lips and face were the most disturbing adverse effects.
A majority of acne patients have the knowledge about Isotretinoin and its adverse effects. This study highlighted the importance of health education for better acceptance of this drug. Patients should be instructed about proper moisturization methods while using this drug.
Isotretinoin; Teratogenicity; Acne vulgaris; Adverse effects
The aim of the present study was to estimate the prevalence of erectile dysfunction in men with diabetes mellitus attending a primary care clinic in King Khalid University Hospital, Riyadh, Saudi Arabia.
A cross sectional study was carried out on men with diabetes mellitus followed in a primary care clinic of King Khalid University Hospital in Riyadh, Saudi Arabia, from 13 November 2005 to 13 June 2006. A total of 186 diabetic patients were interviewed. Data collection forms were completed by a member of the medical staff, a family medicine consultant, during the consultation of diabetic patients in the primary care clinic. Erectile dysfunction was categorized as absent erectile dysfunction (normal function), partial erectile dysfunction, and complete erectile dysfunction. The data was analyzed using the Statistical Package of Social Science (SPSS) version 11.5. A p-value of less than 0.05 was considered statistically significant.
A total of 186 men with diabetes mellitus were interviewed during the study period. The majority of diabetic patients (95%) had type 2 diabetes. Most of the patients (68.8%) were on oral hypoglycemic agents, 24.7% on insulin injection, and 6.5% on diet only. The present study showed that 11.2% of the diabetic patients were suffering from complete and severe erectile dysfunction, while 64% of the patients complained of partial erectile dysfunction which was affecting their marital relationship. The cardiovascular risk factors in the 186 diabetic patients were hypertension 34.9%, smoking 13.4%, obesity 40%, and dyslipidemia 16.6%.
Complete (severe) and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.
Erectile dysfunction; diabetes; primary care
Background: The poor glycaemic control among the patients with type 2 diabetes constitutes a major public health problem and a major risk factor for the development of diabetes complications.
Aim of the Study: To study the compliance rate of the patients with type 2 diabetes to the prescribed medications, to find out its correlation with different socio-demographic factors and other patient characteristics and to find out the reasons behind the non-compliance, if any.
Settings and Design: This cross sectional study was conducted on the patients with type 2 diabetes, who Attended the Diabetic Clinic of a Medical College in Kolkata, India.
Methods and Material: The patients of type 2 diabetes who attended the diabetes clinic between April to August 2012 were recruited in the study by systematic random sampling and they were interviewed by using the help of a structured interview schedule. The patients who reported taking less than 80% of their prescribed anti-diabetes medicines in the preceding week and had HbA1C of < 7% were considered to be non-compliant.
Statistical Analysis Used: The data was analyzed by using the SPSS software. The Chi-square test was used to assess the association of the compliance with the different study variables. A binary logistic regression analysis helped in identifying the factors which contributed to the non-compliance.
Results: The compliance rate to the anti-diabetic drugs was found to be 57.7%. A univariate analysis showed that it decreased significantly with increasing age and that it was also significantly lower among males, illiterates, those with a poor per capita monthly income and those who had a longer duration of diabetes. It varied significantly with the type of drugs, being lowest with an oral drug and insulin combination (43.4%). No knowledge on the complications of diabetes was significantly associated with a lower compliance. The binary logistic regression also helped in identifying these as the significant contributory factors. The common reasons behind the non-compliance were forgetfulness (44.7%) and financial constraints (32.7%).
Conclusion: It can be concluded that the compliance to anti-diabetic drugs was quite poor among the participants. Increasing age, the male sex, illiteracy, a low monthly income and a longer duration of diabetes were significantly associated with the non compliance. A more concerning fact was the significant association of the non-compliance with the types of drug regimens and a lack of knowledge on the complications of diabetes, which emphasized the role of a repeated patient education regarding the basic aspects of diabetes.
Type 2 diabetes; Anti-Diabetic drugs; Compliance
BACKGROUND AND OBJECTIVE:
Few studies have been conducted in Saudi Arabia to assess the level of awareness and knowledge of the population about diabetes mellitus (DM) risk factors and preventative measures. The objective of this study was to measure this knowledge among attendees of a primary care center in eastern Saudi Arabia.
A sample of 300 male and female Saudis aged 18 years and older from the catchment area of the Aqrabya Primary Care Center were randomly selected for this cross-sectional survey. Data were collected through a structured face-to-face interview using a pre-piloted Arabic instrument. Regression analysis was used to identify the predictors of knowledge.
The 288 participants interviewed included 100 males and 188 females. The mean (SD) age was 44.7 (12.6) years for males and 33.8 (12.4) years for females. Fewer than 50% of participants knew about DM risk factors and preventive measures. In a regression model that included age, sex and education, education had a statistically significant positive association with knowledge of risk factors (odds ratio 12.5, 95% CI 6.26-25.2, P<.001) and preventive measures (odds ratio 7.6, 95% CI 4.01-14.2, P<.001), and age had a statistically significant negative association with knowledge of DM risk factors (odds ratio 0.377, 95% CI 0.207-0.685, P=.001) and prevention (odds ratio 0.407, 95% CI 0.231-0.717, P=.001). The main risk factor stated by participants was obesity (35.8%), while the main preventive measure mentioned was weight reduction (37.9%).
Attendees had poor knowledge of DM risk factors and preventive measures. The level of education and age were important predictors of knowledge. Programs for health education of the community about DM risk factors and preventive measures are needed.
The prevalence of childhood bronchial asthma in Saudi Arabia has increased in less than a decade from 8% to 23%. Innovations in the management of asthma led to the development of evidence based clinical practice guidelines and protocols to improve the patients’ outcomes. The objectives of this study are to examine the compliance of the healthcare providers in the Pediatrics Emergency Department, in King Khalid University Hospital, with the recommendations of the Pediatrics Asthma Management Protocol (PAMP), and to explore the reasons behind non-adherence.
This study is designed in 2 parts, a patients’ chart review and a focus group interview. The medical records of all the children who presented to the Pediatric Emergency Department (PED) and were diagnosed as asthmatic, during the period from the 1st of January 2009 to the 31st of March 2009, were reviewed to investigate the compliance of healthcare providers (physicians and nurses) with 8 recommendations of the PAMP which are considered to be frequently encountered evidence-practice gaps, and these are 1) documentation of asthma severity grading by the treating physician and nurse 2) limiting the prescription of Ipratropium for children with severe asthma 3) administration of Salbutamol through an inhaler and a spacer 4) documentation of parental education 5) prescription of systemic corticosteroids to all cases of acute asthma 6) limiting chest x-ray requisition for children with suspected chest infection 7) management of all cases of asthma as outpatients, unless diagnosed as severe or life threatening asthma 8) limiting prescription of antibiotics to children with chest infection. The second part of this study is a focus group interview designed to elicit the reasons behind non- adherence to the recommendations detected by the chart review. Two separate focus group interviews were conducted for 10 physicians and 10 nurses. The focus group interviews were tape-recorded and transcribed verbatim. Theory-based content analysis was used to analyze interviews into themes and sub-themes.
Results and discussion
A total of 657 charts were reviewed. The percentage of adherence by the healthcare providers to the 8 previously mentioned recommendations was established. There was non-adherence to the first 5 of the 8 aforementioned recommendations. Analysis of the focus group interview revealed 3 main themes as reasons behind non-compliance to the 5 recommendations mentioned above and those are 1) factors related to the organization, 2) factors related to the asthma management protocol 3) factors related to healthcare providers.
The organizational barriers and the lack of an implementation strategy for the protocol, in addition to the attitude and beliefs of the healthcare providers, are the main factors behind non-compliance to the PAMP recommendations.
Chlamydia trachomatis infection is a worldwide-distributed sexually transmitted infection that may lead to infertility.
This study aims to report the prevalence of Chlamydia trachomatis infection among infertile women in Saudi Arabia.
Patients and methods
A community-based study carried out at the obstetrics and gynecology clinic at Jazan General Hospital, Saudi Arabia. The study group included 640 Saudi infertile women who were aged between 18 and 40 years and who attended the gynecology clinic for infertility examination throughout 1 year of study (from July 1, 2011 to June 30, 2012). The randomized control group included 100 Saudi fertile women who attended the obstetrics clinic for routine antenatal care. All recruited women were screened for chlamydia infection by enzyme-linked immunosorbent assay (ELISA) for detection of serum-specific antibodies and then retested by the McCoy cell culture technique.
The prevalence of Chlamydia trachomatis infection among infertile women was high, at 15.0%. The rate of chlamydia infection detected by ELISA was 9.84%, and it was 12.03% by the culture method (P = 0.2443).
The high prevalence of Chlamydia trachomatis infection among Saudi infertile women demands a national screening program for early detection among infertile couples. ELISA is available as a simple screening test alternative to the culture method.
Chlamydia trachomatis; ELISA; McCoy cell culture; infertility; sexually transmitted infection
To assess the prevalence of some dietary misconceptions among primary health care center-registered diabetic patients in Makka City, Saudi Arabia.
A sample of 1039 primary health care center- registered diabetic patients was interviewed using a structured questionnaire on diabetic diet -related misconceptions. A scoring system was used to document the frequency of misconceptions. The relationship of the misconceptions to socio-demographic and diabetes-related variables was assessed using chi-squared tests.
Most patients (68.7%) had a high diet misconception score. More than half of the sample had the misconception that carbohydrates were to be completely eliminated from the diet, and only dried bread and bitter foods were to be consumed. Data included the belief in the consumption of honey and dates; the omission of snacks; belief in the carcinogenicity of the sugar substitutes; and obesity as a sign of good health. The score was significantly higher among males (p<0.01), patients older than 35 years (p<0.02), and among patients whose level of education was low (p<0.01).
It is important to note that the rate of diet-related misconceptions among diabetics in Makka city is high. The study pointed to the target fraction of diabetic patients among whom these misconceptions prevailed. There is a need for constant motivation and appropriate education at frequent intervals to encourage better knowledge of the disease so that there is compliance to treatment.
Misconceptions; diabetes; diet; Saudi Arabia
Canadians are often confronted with health conditions that impede their lifestyles. To overcome health related limitations individuals often seek assistance from chiropractors or other allied health care professionals. However, despite the recognized benefits of at home exercise programs, patients continue to remain non-compliant to prescribed routines. Non-compliance to home based routines reduces the probability of successful outcome for therapeutic intervention. The advent of the rehabilitation focus in the Chiropractic profession warrants an examination of factors influencing compliance to home exercise prescribed by the chiropractor. The physiological and psychological benefits are well established. If compliance is high, results will typically be positive (i.e. reduced symptoms of pain, reduced anxiety related to condition, and therapeutic goals attained). However, if compliance is low, therapeutic outcomes will often plateau or worse, reverse. Why does non-compliance seem to prevail? The purpose of this paper is to define exercise compliance, identify factors influencing compliance and to suggest intervention strategies that may improve adherence to home-based exercise prescription by chiropractors.
chiropractic; rehabilitation; exercise
Diabetes mellitus associated with high prevalence and incidence of CHD is a common problem in Saudi Arabia.
To assess the percentage of major modifiable risk factors for CHD among diabetic patients.
This is a retrospective study conducted on 495 diabetic patients (292 males and 203 females) attending the Miniclinic at Al-Rabwah PHC center in Riyadh. Their records for the months of April and May 2001 were reviewed. Data collected from the patient's files included body mass index (BMI), blood pressure, total cholesterol, triglyceride, and smoking status. In addition, information on the duration of diabetes was obtained and fasting blood sugar was done.
The percentage of overweight males was 43.2% as against 22% females, the figure for males being highly significant (p<0.0001). Obesity which was 27.9% in males and 64.1% in females, was highly significant in females (p<0.0001). For cholesterol (≥ 5.2 mmol/l) was 49.5% in males versus 68.5% in females (p=0.0036). High triglyceride (≥ 1.7%) was 50% in both genders. 13.4% of males were hypertensive as against 44.3% female hypertensives which was highly significant in females (p<0.0001). 19.5% of the males smoked. There was no significant difference between risk factors for CHD and duration of diabetes except that there were more smokers among those who had had diabetes for less than 10 years. Most of the diabetics with poor glycemic control (FBS> 8.3mmol/l) tended to be smokers, were more obese, had high triglyceride and high total cholesterol.
The findings indicated that diabetic patients have high percentage of risk factors for CHD and more females than males are at risk. Therefore, early intervention is required if the incidence of CHD among diabetic patients is to be reduced.
Risk factor; Coronary heart disease; Diabetes Mellitus; Primary Health Care Center
Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen, leading to undesirable outcomes. This study aimed to examine and identify factors influencing dietary, fluid, medication and dialysis compliance behaviours in patients undergoing hemodialysis.
This was a cross-sectional study which employed purposive sampling design. A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011. Self-reported compliance behaviours and biochemical measurements were used as evaluation tools.
Compliance rates of dietary, fluid, medication and dialysis were 27.7%, 24.5%, 66.5% and 91.0%, respectively. Younger, male, working patients and those with longer duration on hemodialysis were found more likely to be non-compliant. Lacks of adequate knowledge, inadequate self-efficacy skills, forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid, dietary, medication and dialysis, respectively.
Healthcare professionals should recognise the factors hindering compliance from the patients' perspective while assisting them with appropriate skills in making necessary changes possible.
BACKGROUND—Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed.
METHODS—A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors.
RESULTS—Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment.
CONCLUSION—Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.
Keywords: adverse drug reactions; non-compliance; drug related medical emergencies; elderly
The objective of this study is to assess the quality of hypertension care in Al-Asyah primary health cares (PHC) center, Al Qassim Region, Saudi Arabia through an auditing of structure, process, and outcome.
Subjects and methods:
All files of registered hypertensive patients in the PHC center were reviewed as recommended by WHO, National Quality Assurance protocol, protocol of management of hypertension and criteria in the Sixth report of Joint National Committee on detection, evaluation and treatment of high blood pressure (JNCVI), to evaluate the structure, process, and outcome of hypertension care.
All hypertensive patients registered in Al Asyah PHC center ( 201 patients ) were included in this study. The prevalence of HTN among adults (≥15 years) was7.4% and increased with age. Patients were mostly Saudi (94.5%) with a mean age of 58.6 ± 13.9 years. Most of the patients were diagnosed as essential HTN (98.5%) at Al Asyah PHC center (87.1%). The mean duration of the HTN was 7.7 years, and 48.8% had a family history of HTN and 35.3% had diabetes mellitus. Most patients were obese or overweight (53.7% and 31.3% respectively), blood pressure of 79.6% of the patients was well controlled, and 45.3% of these patients had at least one complication. Ischemic heart disease, left ventricular hypertrophy, stroke, and myocardial infarction were the most common recorded complications.
This study proves that all essential resources needed for hypertension care are available, but the results of process and outcome indicators show the need for the improvement of the referral system as well as good continuous constant health education programs to encourage the patients, their families and the community to observe more healthy lifestyles.
Hypertension care; Audit process; outcome; Qassim; PHC
BACKGROUND AND OBJECTIVES:
Since cervical cancer is reportedly the seventh most frequent cancer in women in Saudi Arabia and the eighth most frequent cancer among women aged between 15 and 44 years, we wanted to determine the prevalence of abnormal cervical cytology among subfertile women attending the reproductive medicine unit of a tertiary care center in Saudi Arabia.
This was a retrospective, cross-sectional, hospital-based study. A Pap smear was done for 241 of 493 (48.9%) subfertile women from January 2008 through February 2009.
The Pap smear was normal in 166 of 241 patients (67.9%), abnormal in 71 (29.5%), and unsatisfactory for evaluation in 4 (1.7%). According to the revised Bethesda system, epithelial cell abnormality was found in 7 (2.9%), inflammation in 55 (22.8%), and infection in 9 (3.7%) patients. Epithelial cell abnormalities were further classified as atypical squamous cells of undetermined significance (ASC-US) (n=3, 42.8%), atypical squamous cells of high grade (ASC-H) (n=1, 14.3%), low-grade squamous intraepithelial lesion (LSIL) (n=2, 28.5%), and glandular cell abnormalities (AGS) (n=1, 14.3%).
The high prevalence of abnormal cervical cytology in our subfertile women accentuates the need for screening in patients eligible for in vitro fertilization. In addition, a well-organized screening program for cervical cell abnormalities at the national level should be implemented to allow identification of subfertile women at risk so that potentially life-saving measures can be undertaken early.
A deficiency of arylsulfatase A (ASA) causes metachromatic leukodystrophy (MLD), a lysosomal storage disorder characterized by accumulation of sulfatide, a severe neurological phenotype and early death. The efficacy of enzyme replacement therapy (ERT) has previously been determined in ASA knockout (ASA−/−) mice representing the only available animal model for MLD. Repeated intravenous injection of human ASA (hASA) improved the nervous system pathology and function, but also elicited a progressive humoral immune response leading to treatment resistance, anaphylactic reactions, and high mortality. In contrast to ASA−/− mice, most MLD patients express mutant hASA which may entail immunological tolerance to substituted wildtype hASA and thus protect from immunological complications. To test this notion, a cysteine-to-serine substitution was introduced into the active site of the hASA and the resulting inactive hASA-C69S variant was constitutively expressed in ASA−/− mice. Mice with sub-to supranormal levels of mutant hASA expression were analyzed. All mice, including those showing transgene expression below the limit of detection, were immunologically unresponsive to injected hASA. More than 100-fold overexpression did not induce an overt new phenotype except occasional intralysosomal deposition of minor amounts of glycogen in hepatocytes. Furthermore, long-term, low-dose ERT reduced sulfatide storage in peripheral tissues and the central nervous system indicating that high levels of extracellular mutant hASA do not prevent cellular uptake and lysosomal targeting of substituted wildtype hASA. Due to the tolerance to hASA and maintenance of the MLD-like phenotype, the novel transgenic strain may be particularly advantageous to assess the benefit and risk of long-term ERT.
Background and Purpose:
Elderly Diabetics (DM) who present with Acute Coronary Syndrome (ACS) constitute a very high risk group. We present the pattern of management of elderly patients (>65 years) in the Kingdom of Saudi Arabia (KSA) in comparison to the international data extrapolated from a Multicenter International Diabetes-Acute Coronary Syndromes (MIDAS).
Materials and Methods:
DM patients presenting with unstable angina or non-ST-segment elevation myocardial infarction (MI) at the time of admission to the hospital were collectively enrolled into the MIDAS study. A total of 3624 patients were enrolled; 142 were from Saudi Arabia. Primary clinical outcome measure was in-hospital death or MI. We present the data of KSA based on the age of the patients in comparison to the international registry.
Baseline characteristics were typical for DM presenting with ACS, with mean age of 67 ± 15 years, males, constituted 36% of patients while 94% of patients were DM type 2. There was marked underutilization of glycoprotein IIb/IIIa inhibitors in those aged over 65 years with a decrease from 22.5 to 12.7 in KSA (Odds ratio 0.56) patients. The percentage of early coronary angiography approach in KSA was less than that of the international data with further reduction of the percentage in Saudi elderly population (from 49.3% to 25.5% with Odds ratio 0.52).
In elderly Saudi diabetic patients admitted with ACS, there is tendency for underutilization of GP IIb/IIIa, early coronary angiography, and revascularization that needs to be addressed.
Acute Coronary Syndrome; diabetics; elderly; GP IIb/IIIa; Multicenter International Diabetes-Acute Coronary Syndromes; NSTEMI; Saudi