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1.  Three years of antibacterial consumption in Indonesian Community Health Centers: The application of anatomical therapeutic chemical/defined daily doses and drug utilization 90% method to monitor antibacterial use 
Context:
Irrational use of antibacterial drugs in Community Health-Care Centers (CHCs) may lead to increased resistance, morbidity, and mortality.
Aims:
The aim of this study was to determine patterns of antibacterial use at CHCs in a district of Indonesia and use this as data for an antibiotic policy.
Settings and Design:
The observational-descriptive study was conducted in a district of Indonesia to obtain antibacterial use from 2008 to 2010.
Subjects and Methods:
The data obtained from the report on the use of medicines were classified and processed using the anatomical therapeutic chemical (ATC) and defined daily doses (DDD) method, with DDD/1000 patients as a unit measurement. The number of patients was obtained from attending patients in that research period. The most abundant antibacterial drugs use segment was identified by the drug utilization 90% (DU90%) method.
Statistical Analysis Used:
Descriptive analysis were performed in this study.
Results:
Fourteen kinds of antibacterial drugs were used in 61 CHCs. The total of antibacterial drug use during the period 2008–2010 was 871.36 DDD/1000 patients/day. Declining antibacterial use was observed between 2008 and 2010. Six kinds of antibacterial drugs were the most commonly used. The data show that the average use per visit was as high as 24.41 DDD.
Conclusions:
Amoxicillin, sulfamethoxazole and trimethoprim are antibacterials that have to be reconsidered by physicians for use in the Bandung CHC. The high use of antibacterial drugs, as described in the study, can be used as reference to develop an antimicrobial stewardship program and increase awareness of resistance, adverse drug reaction and drug interaction of antibacterial drugs.
doi:10.4103/2230-8229.155385
PMCID: PMC4415124  PMID: 25983606
Anatomical therapeutic chemical; antibiotic; defined daily doses; drug utilization 90%; Indonesian Community Health-Care Center; pharmacoepidemiology
2.  Family medicine training in Saudi Arabia: Are there any variations among different regions? 
Aims:
The aim was to compare Eastern, Makkah, and Asir regions in term of residents’ perception of the achievement of training objectives, and to assess various rotations based on residents’ perception.
Settings and Design:
This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions.
Methodology:
A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents.
Statistical Analysis Used:
Cronbach's alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used.
Results:
Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6%) residents completed the questionnaire. There were 51 (47.7%), 27 (25.2%), and 29 (27.1%) residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2%) were married, and more than half (54.2%) of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine.
Conclusions:
Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as perceived by the family medicine residents were psychiatry and otolaryngology while lowest were orthopedics and ophthalmology. Sharing of experience and further studies are needed to improve the program rotations.
doi:10.4103/2230-8229.155387
PMCID: PMC4415125  PMID: 25983607
Clinical training; family medicine; postgraduate training
3.  Why medical students do not like to join rural health service? An exploratory study in India 
Introduction:
Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. Odisha, a state in India faces a major shortage of doctors particularly in rural and remote areas. In order to address this challenge, it is essential to understand medical students’ career plans, specialization preferences, choices of job location and sector, and views on working in rural and remote areas. This study explored the immediate and long-term career plans of final year medical students, their intended practice locations and underlying reasons for the choices.
Methodology:
A cross-sectional survey was conducted in all the medical colleges (three government and three private) in the state of Odisha. Through the systematic sampling method, data were gathered from 390 final year students. A semi-structured questionnaire was administered to the students and data were analyzed using SPSS version 20.
Results:
Of the 390 students, 290 (74.35%) were from a government college. The most preferred immediate career goal was postgraduation studies (45.9% of students in government medical schools and 54% in private). About 17% of government students and 9% of private students showed willingness to work in rural areas, in the long run. Nearly 44.5% mentioned opportunities for career growth, followed by the possibilities for higher education (26.8%) as major the factors for preferring an urban posting. Similarly, higher pay scales, better working conditions were major factors for preferring the private sector. Most of the students maintained that good housing, better salaries, and adequate facilities at the workplace would attract more students toward rural service.
Conclusion:
Since public funded medical students are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue. Approaches such as extended clinical apprenticeship in rural health facilities, long-term community engagement during medical studentship could be considered.
doi:10.4103/2230-8229.155390
PMCID: PMC4415126  PMID: 25983608
Career choice; health workforce; medical students; public sector; rural health
4.  Medical grand rounds in Riyadh, Saudi Arabia: Current attitudes and barriers 
Background:
Medical grand rounds (MGRs) are considered key educational tools in most academic medical institutions. In this multi-center cross-sectional survey, we tried to determine the current attitudes of local medical practitioners to MGRs, as well as perceived barriers.
Methodology:
A total of 120 physicians from the National Guard Hospital, King Fahad Medical City, King Khalid University Hospital and King Faisal Specialist Hospital participated in the survey. The questionnaire consisted of statements on attitudes and perceived barriers against participating in MGRs, as well as participants’ levels of agreement.
Results:
Most participants attend MGRs regularly (94.2%), claiming that it is mandatory (88%). Participants also agreed that MGRs were important tools for continuing medical education (89.2%) and that they provided an opportunity to both present materials and interact with their colleagues in other divisions (86.7% and 81.6%, respectively). The vast majority of respondents agreed that “topic review/update” and “inviting guest speakers” were the two most preferred suggestions for improving MGRs (94.2% and 92.5%, respectively). Major barriers included constraints of time (43.3%) and topics that were not patient-related (40.8%).
Conclusion:
MGRs in the major Tertiary Hospitals in Riyadh are well attended, and the majority of the local practitioners believe in the positive effect of MGRs in delivering quality and up to date medical knowledge. Time and physician-specific issues were identified as major barriers that needed to be addressed in order to maximize participation of medical staff.
doi:10.4103/2230-8229.155396
PMCID: PMC4415127  PMID: 25983609
Attitudes; barriers; grand rounds; Riyadh; Saudi Arabia
7.  Prevention of occupational Back Pain 
This paper reviews scientific research on occupational back pain and focuses on prevention of this problem. It discusses some of the challenges of translating the evidence of this multi-factorial condition into policy. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but which affects the individual's capacity to work. Back pain affects the vast majority of people at some point in their lives and is very costly to both the health care system and the industry. Evidence suggests that heavy lifting, driving, and vibration of the whole body are linked to occupational back pain. Once the risk factors for occupational back pain are identified, an otherwise chronic and disabling condition can be prevented in the majority of patients. As explained in this article, three levels of prevention for occupational back pain have been reported as effective. Failure to implement preventive measures may lead to a high incidence of occupational back pain.
doi:10.4103/2230-8229.155370
PMCID: PMC4415130  PMID: 25983601
Back pain; occupation; prevention
8.  Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city 
Background:
Studies have revealed a powerful relationship between adverse childhood experiences (ACEs) and physical and mental health in adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into organic disease later in life.
Objective:
The aim was to estimate the effect of childhood experiences on the physical health of adults in Baghdad city.
Subjects and Methods:
A cross-sectional study was conducted from January 2013 to January 2014. The study sample was drawn from Baghdad city. Multistage sampling techniques were used in choosing 13 primary health care centers and eight colleges of three universities in Baghdad. In addition, teachers of seven primary schools and two secondary schools were chosen by a convenient method. Childhood experiences were measured by applying a modified standardized ACEs-International Questionnaire form and with questions for bonding to family and parental monitoring. Physical health assessment was measured by a modified questionnaire derived from Health Appraisal Questionnaire of Centers for Disease Control and Prevention. The questionnaire includes questions on cerebrovascular diseases, diabetes mellitus, tumor, respiratory and gastrointestinal diseases.
Results:
Logistic regression model showed that a higher level of bonding to family (fourth quartile) is expected to reduce the risk of chronic physical diseases by almost the half (odds ratio = 0.57) and exposure to a high level of household dysfunction and abuse (fourth quartile) is expected to increase the risk of chronic physical diseases by 81%.
Conclusion:
Childhood experiences play a major role in the determination of health outcomes in adulthood, and early prevention of ACEs. Encouraging strong family bonding can promote physical health in later life.
doi:10.4103/2230-8229.155374
PMCID: PMC4415131  PMID: 25983602
Adverse childhood experiences; Baghdad; family bonding; physical health; violence
9.  Is it reliable to measure the forearm blood pressure in children? 
Background:
When the upper arm (UA) is inaccessible or a standard-sized blood pressure (BP) cuff is unavailable, some healthcare workers use the forearm (FA) to measure BP with a mercury sphygmomanometer.
Objective:
The objective was to determine the accuracy of BP measurement in the arm and FA.
Design:
Prospective, randomized study.
Setting:
Department of Pediatrics, JNMC, Sawangi (Meghe)
Participants:
A total of 72 children aged 5–15 years.
Measurements:
Mercury and Automatic (OMRON Tokyo, 108-0075 Japan) BP measurements were recorded from the arm and FA at 2 min intervals.
Results:
In our study, 72 children of both sexes were enrolled. The mean age of the children was 10.13 ± 2.82 years, and 48% were females. Pearson's correlation coefficient between FA and UA systolic BP (SBP) measured by mercury was 0.782, and for diastolic BP (DBP) it was 0.824. Similarly, Pearson's correlation coefficient between FA and UA SBP measured with an automated device (OMRON) was 0.843, and for DBP it was 0.846. The average readings for the SBP and DBP were higher in the FA than in the UA by approximately 3 mmHg. There was a statistically significant difference in both SBP and DBP.
Conclusions:
The FA is an acceptable method of BP monitoring when the UA cannot be accessed. The pressure from FA is probably higher than it would be from UA.
doi:10.4103/2230-8229.155376
PMCID: PMC4415132  PMID: 25983603
Blood pressure; forearm; OMRON; upper arm
10.  Nigella sativa: A potential natural protective agent against cardiac dysfunction in patients with type 2 diabetes mellitus 
Objectives:
To study the effect of Nigella sativa supplementation on cardiac functions in Type 2 diabetic patients treated with oral hypoglycemic agents.
Background:
Diabetes mellitus is associated with a high risk of cardiovascular morbidity and mortality. A number of reported beneficial effects of N. sativa on cardiovascular function were the inspiration for this study.
Materials and Methods:
Sixty patients with uncontrolled diabetes (hemoglobin A1c [HbA1c] >7%) and with no known cardiovascular complications were recruited from the outpatient diabetes clinic. They were assigned, by convenience, to two groups; the control group received activated charcoal as placebo while the test group received 2 g/day of powdered N. sativa for 1-year. All patients continued with their standard oral hypoglycemic agents. Echocardiography was used to evaluate the diastolic function, systolic function, and left ventricular mass (LVM) before the intervention and after 6 and 12 months of the treatment.
Results:
HbA1c decreased significantly in the N. sativa group but did not change in the control group. Echocardiographic assessment in the control group showed impairment in diastolic function after 12 months, but there were no significant changes in fractional shortening (FS) or ejection fraction (EF). Furthermore, left ventricular (LV) dimensions at diastole and systole, LVM, and LVM index were significantly increased. In N. sativa group, no significant changes were found in diastolic function or LVM. LV dimension at systole was decreased while FS and EF were significantly increased after 6 and 12 months.
Conclusion:
N. sativa supplementation may protect the hearts of type 2 diabetic patients from diastolic dysfunction while improving LV systolic function.
doi:10.4103/2230-8229.155380
PMCID: PMC4415133  PMID: 25983604
Diabetes mellitus; diastolic function; echocardiography; left ventricular mass; Nigella sativa; systolic function
11.  Clinical presentation and causes of the delayed diagnosis of breast cancer in patients with pregnancy associated breast cancer 
Objective:
The objective was to assess the clinical presentation, delay of diagnosis, and the causes of delay in the diagnosis of patients with pregnancy-associated breast cancer (PABC) and patients with non-PABC.
Patients and Methods:
This was a face-to-face interview with women who had histologically confirmed BC. All respondents were interviewed at our hospital.
Results:
We interviewed 56 patients, 36 with non-PABC and 20 with PABC. Of the 20 patients with PABC, BC was diagnosed in 12 (60%) during pregnancy and 8 (40%) during postpartum. 18 of the patients (90%) with PABC presented mainly with a mass 3 (15%) with pain and ulcer, 5 (25%) with skin redness and thickening, 6 (30%) with nipple retraction and 4 (20%) with discharge 12 (60%) patients with PABC had delayed diagnosis and 8 (40%) of this delay was due to physicians’ reassurance, and 2 (10%) because of fear of cancer. Similarly, 35 (97%) patients with non-PABC presented with breast mass, 3 (8.3%) with infrequent pain 4 (11.11%) with inflammation 2 (5.55%) with ulcer 2 (5.55%) with nipple discharge and4 (11.11%) with thickening of the skin compared with PABC patients. Only 4 (11.11%) in non-PABC had delayed diagnosis, and for half of them the delay was due to the fear of cancer. Two patients with PABC and non-PABC were afraid of cancer 16.66% and 5.55%, respectively. However, 8 (60%) of patients with PABC had delayed diagnosis compared to 0% of patients with non-PABC.
Conclusion:
In this study, the majority of patients with PABC or non-PABC presented with a breast lump. Other symptoms were more common in patients with PABC than in patients with non-PABC. An increased awareness of clinicians may help reduce delay in the diagnosis of patients with PABC.
doi:10.4103/2230-8229.155383
PMCID: PMC4415134  PMID: 25983605
Breast; cancer; delay; pregnancy
12.  Knowledge about bronchial asthma management in primary health care physicians in Al-Khobar City, Saudi Arabia 
Context:
The prevalence of bronchial asthma (BA) is increasing in the Kingdom of Saudi Arabia. Primary health care (PHC) centers follow the national protocol, which is based on the severity of the disease for the management of asthma. The Saudi initiative for asthma (SINA) management adopted from the global initiative for asthma guidelines, which was recommended by several recent studies, is based on the control level of asthma.
Aims:
To assess the knowledge of PHC physicians and family medicine (FM) residents in Al-Khobar, about the management of BA.
Methodology:
A cross-sectional study was conducted in all PHC centers and the university FM clinic in Al-Khobar. All PHC physicians and 3rd and 4th year FM residents were included in the study. A self-administered questionnaire developed according to SINA guidelines was used to assess theoretical knowledge of BA, and a predesigned checklist was used to assess the different inhaler techniques. Scoring was established and collected data were analyzed.
Results:
Only 8% of the sample had good theoretical knowledge of BA; 41% had poor knowledge. The knowledge of the residents was better than that of the PHC physicians. The mean knowledge score was significantly better among those using guidelines compared to the rest. About 23% had good knowledge of inhaler techniques. Knowledge of PHC physicians and FM residents about dry powder inhalers was deficient, and PHC physicians had little knowledge of metered dose inhalers with spacers.
Conclusion:
The knowledge of physicians about the management of BA was deficient. The national guidelines based on the level of control for asthma management should be updated and physicians given periodic training.
doi:10.4103/2230-8229.149567
PMCID: PMC4317988  PMID: 25657604
Bronchial asthma; devices; primary health care
13.  Physical violence against pregnant women by an intimate partner, and adverse pregnancy outcomes in Mazandaran Province, Iran 
Background and Aim:
Violence against women during pregnancy is linked to poor outcome of pregnancy, which is reported to have widespread in Iran. The aim of this study was to determine the prevalence of physical violence against women by an intimate partner during pregnancy, and to assess the impact of this physical violence on pregnancy outcomes.
Materials and Methods:
A prospective cohort study was conducted on the characteristics of pregnant women in urban areas and related violence. The modified standard World Health Organization Domestic Violence Questionnaire was used to classify pregnant women and domestic violence. A total of 1461 pregnant women were selected using cluster sampling. The association between sociodemographic with intimate partner violence (IPV) and IPV with pregnancy outcomes was determined using logistic regression.
Results:
Of these, 206 (14.1%) (confidence interval = 12.3-15.9) reported physical IPV during pregnancy. The adjusted odds ratio for IPV in illiterate women or those with primary level of education (0.001), secondary level education (0.003), and in low income households (0.0001) were significantly higher than in those women with university level education and in higher income households. After adjusting for suspected confounding factors, the women with a history of violence by partners had 1.9 fold risk of premature rupture of membranes, and a 2.9 fold risk of low birth weight compared to women who did not experience any violence from their partners.
Conclusion:
The results of this research indicated that the prevalence of IPV was high among pregnant women. Therefore, it is necessary to emphasize the screening of pregnant women at Primary Health Centers to prevent physical abuse.
doi:10.4103/2230-8229.149577
PMCID: PMC4317989  PMID: 25657606
Family violence; pregnancy outcome; pregnancy social epidemiology
14.  Drinking water quality and public health in Southwestern Saudi Arabia: The need for a national monitoring program 
Aim of the Study:
The aim was to investigate the bacteriological quality of drinking water, and explore the factors involved in the knowledge of the public about the quality of drinking water in Najran region, Saudi Arabia.
Study Design:
A cross-sectional descriptive study.
Materials and Methods:
A total of 160 water samples were collected. Total coliforms, fecal coliform, and fecal streptococci were counted using Most Probable Number method. The bacterial genes lacZ and uidA specific to total coliforms and Escherichia coli, respectively, were detected using multiplex polymerase chain reaction. An interview was conducted with 1200 residents using a questionnaire.
Results:
Total coliforms were detected in 8 (20%) of 40 samples from wells, 13 (32.5%) of 40 samples from tankers, and 55 (68.8%) of 80 samples from roof tanks. Twenty (25%) and 8 (10%) samples from roof tanks were positive for E. coli and Streptococcus faecalis, respectively. Of the 1200 residents participating in the study, 10%, 45.5%, and 44.5% claimed that they depended on municipal water, bottled water, and well water, respectively. The majority (95.5%) reported the use of roof water tanks as a source of water supply in their homes. Most people (80%) believed that drinking water transmitted diseases. However, only 25% of them participated in educational programs on the effect of polluted water on health.
Conclusions:
Our results could help health authorities consider a proper regular monitoring program and a sustainable continuous assessment of the quality of well water. In addition, this study highlights the importance of the awareness and educational programs for residents on the effect of polluted water on public health.
doi:10.4103/2230-8229.149581
PMCID: PMC4317990  PMID: 25657607
Coliforms; drinking water; fecal streptococci; Pseudomonas aeruginosa; polymerase chain reaction; wells
15.  Medical and biomedical research productivity from the Kingdom of Saudi Arabia (2008-2012) 
Background:
Biomedical publications from a country mirror the standard of Medical Education and practice in that country. It is important that the performance of the health profession is occasionally documented.
Aims:
This study aimed to analyze the quantity and quality of biomedical publications from the Kingdom of Saudi Arabia (KSA) in international journals indexed in PubMed between 2008 and 2012.
Materials and Methods:
PubMed was searched for publications associated with KSA from 2008 to 2012. The search was limited to medical and biomedical subjects. Results were saved in a text file and later checked carefully to exclude false positive errors. The quality of the publication was assessed using Journal Citation Report 2012.
Results:
Biomedical research production in KSA in those 5 years showed a clear linear progression. Riyadh was the main hub of medical and biomedical research activity. Most of the publications (40.9%) originated from King Saud University (KSU). About half of the articles were published in journals with an Impact Factor (IF) of < 1, one-fourth in journals with no IF, and the remaining one-fourth in journals with a high IF (≥1).
Conclusion:
This study revealed that research activity in KSA is increasing. However, there is an increasing trend of publishing in local journals with a low IF. More effort is required to promote medical research in Saudi Arabia.
doi:10.4103/2230-8229.149583
PMCID: PMC4317991  PMID: 25657608
Biomedical publications; Kingdom of Saudi Arabia; medical colleges; PubMed; research productivity
16.  Factors associated with public awareness of the Crown Health Program in the Al-Jouf Region 
Objectives:
A community-based intervention, the Crown Health Project (CHP), was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012.
Methods:
A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics (e.g., age, gender, education, occupation, urban/rural residence) and CHP awareness (its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities). Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable.
Results:
Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying “health education” as the main goal of the CHP (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1–5.5), “noncommunicable diseases” as the main diseases targeted (OR, 4.8; 95% CI, 3.6–6.4) and “attention to health” as the purpose (OR, 6.0; 95% CI, 4.0–8.9).
Conclusion:
The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf.
doi:10.4103/2230-8229.149586
PMCID: PMC4317992  PMID: 25657609
Community-based health education; noncommunicable diseases; Saudi Arabia
17.  Assessment of the nutritional status of the elderly and its correlates 
Background:
The percentage of elderly is growing rapidly and malnutrition is not uncommon in the elderly.
Objectives:
The present study was carried out to assess the nutritional status of the elderly using the Mini Nutritional Assessment (MNA) tool, and to study the various epidemiological factors influencing their nutritional status.
Materials and Methods:
This cross-sectional study was done from July 2012 to August 2013 in Boko-Bongaon Block, Kamrup District, Assam, India. The elderly, those over 60 years of age, who met the inclusion criteria participated in the study. A total of 30 clusters were selected and 12 elderly from each cluster were taken to achieve the desired sample size of 360. Nutritional status was assessed by the MNA tool and a 24-h dietary recall method.
Results:
Out of the total of 360 elderly persons, 15% were found to be malnourished and 55% were at risk of malnutrition. The association between nutritional status and older age group, female gender, dependent functional status, dependent financial status and inadequate calorie intake was found to be significant.
Conclusion:
The present findings reveal that malnutrition is not an uncommon problem in the elderly, and further studies are needed in this regard.
doi:10.4103/2230-8229.149588
PMCID: PMC4317993  PMID: 25657610
Calorie intake; elderly; Mini nutritional assessment tool; nutritional status
18.  Admissions for drug-related problems at the Emergency Department of a University Hospital in the Kingdom of Saudi Arabia 
Background and Aim:
Medication Errors can result in drug-related problems (DRPs). Insight into the frequency, type, and severity of DRPs could help reduce their incidence. The aim of the present study was to estimate the prevalence of admissions as a result of DRPs at the Emergency Department (ED) of a university hospital in the Kingdom of Saudi Arabia.
Materials and Methods:
Files of suspected cases of DRPs reporting to ED in the year 2012 were scrutinized. Suspicion arose from the hospital record system based on Diagnosis Code Numbers (ICD-9-CM, Professional 2010) and from triggers, such as some drugs, laboratory tests, and signs and symptoms pointing to DRPs.
Results:
Of 5574 admissions, 253 (4.5%) were DRPs and were categorized as: Overdose toxicity and side effects of drugs 50 (19.8%), drug-interactions 29 (11.5%), accidental and suicidal drug ingestions 26 (10.3%), drug abuse 18 (7.1%), drug allergy 10 (4%), super-infections 8 (3.2%), and noncompliance to treatment 112 (44.3%). About 70% of DRPs were preventable; 67 (26.5%) required hospital admission for 7-102 days and 10 (4%) died.
Conclusions:
Noncompliance to treatment, overdose toxicity, drug interactions, and drug abuse are important causes of hospital admissions as a result of DRPs. Awareness of prescribers to the problem and their education would help to prevent them and improve patient care.
doi:10.4103/2230-8229.149590
PMCID: PMC4317994  PMID: 25657611
Drug-related problems; Emergency Department; Saudi Arabia; University Hospital
19.  Evaluation of the educational environment of the Saudi family medicine residency training program 
Objectives:
The study was conducted to evaluate the educational environment (EE) in Family Medicine Training Programs.
Materials and Methods:
A cross-sectional survey, The Postgraduate Hospital Educational Environment Measure (PHEEM), was distributed to all residents at the four training centers in the central region. Cronbach's alpha was used to test the reliability. The mean and standard deviation (SD) for each item, the overall score and the three domains were calculated. A multiple linear regression model was developed with PHEEM scores as an outcome. The Mann–Whitney–Wilcoxon test was used to compare each item based on the selected factors.
Results:
The overall score was 67.1/160 (SD: 20.1). The PHEEM's domains scores: 24.2/56 (SD: 7.13) for perception of role autonomy; 25.3/60 (SD: 8.88), for perception of teaching; and 17/44 (SD: 5.6), for perception of social support. Training center and Level of training were the significant outcome predictors. Centre 1 (Joint Program) significantly had better scores than Centre 2. The instrument showed great reliability with a Cronbach's alpha of 0.92.
Conclusions:
There are many problems in the training program. Urgent actions are needed to improve the residents' learning experience particularly during rotations. Also, the curriculum should be restructured, and effective training methods introduced using the Best Evidence in Medical Education to meet the expectations and learning needs of family physicians.
doi:10.4103/2230-8229.149591
PMCID: PMC4317995  PMID: 25657612
Educational environment; family medicine training; residency
20.  Metabolic syndrome and associated risk factors 
doi:10.4103/2230-8229.149593
PMCID: PMC4317996  PMID: 25657613
21.  Brief Arabic tobacco craving questionnaire: An investigation into craving and heavy smoking in Saudi Arabian males 
Background and Objectives:
Research in the United States has shown that craving tobacco is associated with smoking, yet no investigation has been done into the relationship between craving and the use of tobacco in Saudi Arabian smokers. The aim of this cross-sectional study was to examine the craving of tobacco by Saudi males and its influence on daily smoking. Subjects were recruited under the auspices of the Tobacco Control Program in Jeddah City and Riyadh.
Methods:
The American English version of the tobacco craving questionnaire (TCQ-12) is a valid measure of four distinct aspects (factors) of tobacco craving. The TCQ-12 was translated into Arabic tobacco craving questionnaire (ATCQ-12) and administered to a sample of 322 male smokers. Predictive validity was determined by examining the relationship between the factors and the number of cigarettes smoked per day (CPD).
Results:
In a general linear multivariate analysis of variance model, CPD increased significantly as either ATCQ-12 Factor 1 (emotionality) or Factor 3 (compulsiveness) increased. A significant Factor 1 by Factor 3 interaction indicated that Factor 1 was a better predictor of heavy smoking, but only when Factor 3 was low. Factor 3 was a better predictor of heavy smoking, but only when Factor 1 was low.
Conclusions:
The ATCQ-12 is a rapid measure of craving and valid predictor of CPD and heavy smoking. Craving in anticipation of smoking as relief from a negative mood (emotionality) is an indicator of psychological withdrawal symptoms, while craving in anticipation of the inability to control tobacco use (compulsiveness) is an indicator of physical dependence.
doi:10.4103/2230-8229.149573
PMCID: PMC4317997  PMID: 25657605
Heavy Smoking; Saudi Arabian; tobacco craving
22.  The prevalence of smoking and its associated factors among military personnel in Kingdom of Saudi Arabia: A national study 
Aim:
The aim was to measure the prevalence of smoking and identify its potential predictors among military personnel in Kingdom of Saudi Arabia (KSA).
Materials and Methods:
This cross-sectional study was carried out among military personnel in the five military regions of KSA between January 2009 and January 2011. The sample of 10,500 military personnel in the Saudi Armed Forces was equally divided among the five regions with a ratio 3:7 for officers and soldiers. A multistage stratified random sampling was used to recruit participants in the four services of the armed forces in the five regions. Information on sociodemographic characteristics with a detailed history of smoking was collected by means of a self-administered questionnaire. Bivariate analysis was used to identify the factors associated with smoking, and multiple logistic regression analysis to discover its potential predictors.
Results:
About 35% of the sample was current smokers, with higher rates among soldiers. The eastern region had the highest rate (43.0%), and the southern region the lowest (27.5%). Navy personnel had a higher risk of being current smokers (40.6%), and the air defense the lowest risk (31.0%). Multivariate analysis identified working in the navy, and low income as positive predictors of current smoking, while residing in the southern region, older age, years of education, being married, and having an officer rank were negative (protective) factors.
Conclusion:
Smoking is prevalent among military personnel in KSA, with higher rates in the Navy and Air Force, among privates, younger age group, lower education and income, and divorced/widowed status. Measures should be taken to initiate programs on smoking cessation that involve changes in the environment that is likely to promote this habit.
doi:10.4103/2230-8229.142966
PMCID: PMC4214002  PMID: 25374464
Military; officers; Saudi; smoking; soldiers
23.  The impact of Vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: An emerging public health problem 
Background:
Vitamin D deficiency has been declared a public health problem for both adults and children worldwide. Asthma and related allergic diseases are the leading causes of morbidity in children. The objective of this study was to investigate the potential role of Vitamin D deficiency in childhood asthma and other allergic diseases such as allergic rhinitis and wheezing.
Materials and Methods:
This cross-sectional study was conducted in Primary Health Care Centers (PHCs), from March 2012 to October 2013. A total of 2350 Qatari children below the age of 16 were selected from PHCs, and 1833 agreed to participate in this study giving a response rate of (78%). Face-to-face interviews with parents of all the children were based on a questionnaire that included variables such as socio-demographic information, assessment of nondietary covariates, Vitamin D intake, type of feeding, and laboratory investigations. Their health status was assessed by serum Vitamin D (25-hydoxyvitamin D), family history and body mass index.
Results:
Most of the children who had asthma (38.5%), allergic rhinitis (34.8%) and wheezing (35.7%) were below 5 years. Consanguinity was significantly higher in parents of children with allergic rhinitis (48.6%), followed by those with asthma (46.4%) and wheezing (40.8%) than in healthy children (35.9%) (P < 0.001). The proportion of severe Vitamin D deficiency was significantly higher in children with wheezing (23.4%), allergic rhinitis (18.5%), and asthma (17%) than in healthy children (10.5%). Exposure to the sun was significantly less in Vitamin D deficient children with asthma (60.3%), allergic rhinitis (62.5%) and wheezing (64.4%) than in controls (47.1%) (P = 0.008). It was found that Vitamin D deficiency was a significant correlate for asthma (odds ratio [OR] =2.31; P < 0.001), allergic rhinitis (OR = 1.59; P < 0.001) and wheezing (relative risk = 1.29; P = 0.05).
Conclusion:
The study findings revealed a high prevalence of Vitamin D deficiency in children with asthma and allergic diseases. Vitamin D deficiency was a strong correlate for asthma, allergic rhinitis and wheezing.
doi:10.4103/2230-8229.142967
PMCID: PMC4214003  PMID: 25374465
Allergic rhinitis; asthma; children; predictors; Qatar; Vitamin D; wheezing
24.  Respiratory health of a population of welders 
Objective:
The aim was to identify respiratory symptoms and respiratory function of welders in comparison to a “nonexposed group.”
Materials and Methods:
Information was collected by means of a questionnaire completed during an interview, and spirometry of all subjects.
Results:
This study involved 41 welders and 41 comparable nonexposed group. Sixteen (39%) welders reported bringing up phlegm from the chest first thing in the morning, compared with seven individuals (17.1%) in the nonexposed group. The difference is significant (Chi-square = 3.87 odds ratio (OR) 3.11 [1.0-9.9], P = 0.0182). Eleven welders had chronic bronchitis, which they had experienced most days for as long as 3 months, compared with one person in the nonexposed group. The difference was statistically significant, and OR was 1.7 (95% confidence interval 1.19-2.53). On the other hand, the difference in cough, shortness of breath and lung function was statistically insignificant when the welders were compared with the nonexposed group.
Conclusion:
This study showed more respiratory complaints, particularly chronic bronchitis, among welders compared with the nonexposed group, which is believed to be the result of welding emissions. Spirometry showed no impairment in lung function in both the welders and the nonexposed group.
doi:10.4103/2230-8229.142969
PMCID: PMC4214004  PMID: 25374466
Health; respiratory; welders
25.  Prevalence and pattern of lipid disorders in Saudi patients with angiographically documented coronary artery disease 
Objective:
The aim of the study was to assess the prevalence and patterns of dyslipidemia in Saudi patients with angiographically documented coronary artery disease (CAD).
Materials and Methods:
This is a cross-sectional, hospital-based study, which was conducted on all Saudi patients who underwent coronary angiography under the author's personal care and were found to have > 50% coronary stenosis. Fasting lipid profile was measured in all patients during the admission for the coronary angiography.
Results:
Two hundred and ninety-five patients were included in the study. The mean age (±Standard deviation) was 55.1 ± 11, ranging from 17 to 86 years. The majority of patients were males: 229 (77.6%). Mean total cholesterol was 175.6 ± 47.6 mg/dl, mean low-density lipoprotein cholesterol (LDL-C) was 111.3 ± 40.3 mg/dl, mean high density lipoprotein cholesterol (HDL-C) was 38.27 ± 9.5 mg/dl and mean triglyceride level was 141.8 ± 74.8 mg/dl. 21 (7.1%) patients had normal coronary arteries, 107 (36.3%) had one vessel disease, 78 (26.4%) had two vessel disease and 89 (30.2%) had three vessel disease. There was a significant correlation between the extent of CAD and age (P = 0.003), sex (P = 0.0002), total cholesterol (P = 0.02) and low HDL-C (P < 0.001. 21 (7.1%) patients were asymptomatic, 110 (37.3%) had stable angina, 127 (43.1%) had none ST elevation acute coronary syndrome, 20 (6.8%) had ST elevation myocardial infarction and 17 (5.7%) had heart failure. There was also a significant correlation between age (P = 0.03), sex (P < 0.001), LDL-C (P = 0.005) and low HDL-C (P < 0.001) and the severity of CAD.
Conclusion:
Dyslipidemia is a very prevalent risk factor in Saudi patients with CAD. Low HDL-C was the most frequent lipid abnormality, which significantly impacts on the extent of the CAD.
doi:10.4103/2230-8229.142970
PMCID: PMC4214005  PMID: 25374467
Acute coronary syndrome; coronary artery disease; dyslipidemia; non ST elevation myocardial infarction; ST elevation myocardial infarction

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