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issn:2229-340
1.  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
2.  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
3.  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
4.  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
5.  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
6.  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
7.  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
8.  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
9.  Metabolic syndrome and associated risk factors 
doi:10.4103/2230-8229.149593
PMCID: PMC4317996  PMID: 25657613
10.  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
11.  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
12.  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
13.  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
14.  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
15.  Metabolic syndrome: Risk factors among adults in Kingdom of Saudi Arabia 
Background:
Metabolic syndrome (MetS) is a cluster of established cardiovascular risk factors that collectively increase predisposition to major chronic diseases, including heart diseases and diabetes mellitus. Citizens of developing countries such as Saudi Arabia are at risk for MetS as a result of industrialization and accessibility to fast foods. In this epidemiologic study, the kingdom-wide prevalence of MetS is determined.
Materials and Methods:
A total of 4578 Saudis aged 15-64 was randomly selected from 20 regions in Saudi Arabia. Anthropometrics were collected, and fasting blood samples collected to ascertain fasting blood glucose and lipid profile. Components of full MetS as defined by the International Diabetes Federation were used for screening.
Results:
The overall prevalence of MetS is 28.3%. Prevalence was significantly higher in males than in females (31.4 vs. 25.2%; P = 0.001). Prevalence of MetS was the highest in the northern and central region, and showed a parallel increase with age, and inversely with educational status. Region was also a significant contributor to MetS. Conclusion: Despite accumulating evidence of an epidemic, MetS remains largely unresolved in the kingdom. Aggressive public campaign should be launched, and policies implemented to control any future damage of MetS in the kingdom.
doi:10.4103/2230-8229.142971
PMCID: PMC4214006  PMID: 25374468
Diabetes mellitus; metabolic syndrome; Saudi Arabia
16.  The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis 
Background:
Osteoporosis is a major public health problem affecting the elderly population, particularly women. The objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis.
Materials and Methods:
Participating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL “ECOS-16” questionnaire.
Results:
T-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant.
Conclusion:
Addition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.
doi:10.4103/2230-8229.142972
PMCID: PMC4214007  PMID: 25374469
Bone mineral density; geriatrics; nonweight-bearing exercises; osteoporosis; quality of life; weight-bearing exercises
17.  Prevalence of suspected tuberculosis in the Kingdom of Saudi Arabia according to conventional and molecular methods 
Background:
Although the prevalence of suspected tuberculosis (TB) in the Kingdom of Saudi Arabia remains high, there has been a modest decrease in recent years. In this multi-center cross-sectional study, the prevalence of TB was determined by various techniques with the aim of identifying differences and indicating where there is uniformity in findings.
Materials and Methods:
A total of 3404 samples were collected from Saudi TB patients from different regions in Saudi Arabia: Riyadh, Dammam, Jeddah, Madinah, Hail, Qassim, Jazan, and Taif. Different techniques including Ziehl–Neelsen (ZN), Mycobacteria growth indicator tube (MGiT), Lowenstein–Jensen (LJ), and polymerase chain reaction (PCR) were used to screen for the presence of Mycobacterium tuberculosis (MTB).
Results:
ZN stain showed that Riyadh and Dammam had the highest prevalence of MTB with 22% and 21%, respectively, while prevalence was lowest in Jazan and Hail with an incidence of 2% and 3%, respectively. MGiT culture showed that Riyadh, Dammam, and Jeddah had the highest prevalence with a rate of 26%, 22%, and 22%, respectively. LJ culture showed the highest prevalence in Riyadh and Dammam with 22% and 21%, respectively. Of all the techniques, the highest detection rate was by PCR which was 10.46% while ZN stain technique was 6.64%, for MGiT culture it was 8.34%, and for LJ culture it was 7.7%.
Conclusion:
This study is the first in which different methods have been used for detection in the various regions of Saudi Arabia. Collected data are important not only for patients and physicians but for future epidemiological studies to monitor the spread of MTB infection in Saudi Arabia.
doi:10.4103/2230-8229.142973
PMCID: PMC4214008  PMID: 25374470
Methods; Saudi Arabia; screening; tuberculosis
18.  Suitability assessment of health education brochures in Qassim province, Kingdom of Saudi Arabia 
Background:
Health education is the cornerstone of primary health care. Health education materials distributed to the community should, therefore, be suitable and effective. The purpose of this study was to evaluate the health education brochures, designed and disseminated by Ministry of Health institutions in the Qassim province.
Materials and Methods:
The study was a cross-sectional review of health education brochures. We used a structured evaluation form, comprising general information on the brochures and a modified Suitability Assessment of Materials (SAM) score sheet. The SAM consisting of 22 criteria in six groups, includes content, literacy demands, graphics, layout/typography, learning stimulation/motivation, and cultural appropriateness. SAM criteria categorize written material into “superior,” “adequate” and “not suitable.” Two qualified consultant family physicians evaluated the brochures. Data were analyzed using Epi Info version 3.4 statistical package.
Results:
We evaluated 110 brochures, the majority of which addressed chronic health conditions such as mental health, diabetes mellitus and hypertension. Seventy-four (67.3%) brochures were evaluated as “adequate,” 34 (30.9%) as “not suitable” and 2 (1.8%) as “superior.” “Cultural appropriateness” was the highest scoring factor, with 92 (83.6%) brochures falling into either the “superior” or “adequate” category. With regard to “content,” 88 (80.0%) brochures fell into either the “superior” or “adequate” category. This was the second highest scoring factor. Graphics was the factor that scored the least. Seventy-five (68.2%) brochures were rated in this factor as “not suitable.”
Conclusions:
Although two-thirds of our brochures were considered “adequate,” the majority needed improvement to their graphics and learning stimulation factors. We recommend that guidelines for designing health education brochures should be formulated to improve the quality of health education brochures.
doi:10.4103/2230-8229.142974
PMCID: PMC4214009  PMID: 25374471
Brochure; health education; Qassim; Saudi Arabia; suitability
19.  An unusual case of chronic prostatitis caused by Haemophilus influenzae in an elderly Saudi patient: A case report and literature review 
Haemophilus influenzae has been reported on rare occasions as the cause of prostatitis and urinary tract infections. Here, we report a rare case of chronic prostatitis in a 52-year-old male with benign prostatic hypertrophy and discuss the possible underestimation of the true incidence of H. influenzae in genitourinary infections. This organism was identified only by its growth on chocolate agar, a medium that is not commonly used for urine cultures.
doi:10.4103/2230-8229.142975
PMCID: PMC4214010  PMID: 25374472
Chronic prostatitis; elderly; Haemophilus influenzae
20.  Obesity and gastric balloon 
Background:
The obesity epidemic, which is among the most common nutritional disorders, is rising rapidly worldwide. It leads to several health problems such as metabolic disorders, stroke, and even cancer. Efforts to control obesity with exercise and diet have a limited value in obese patients and different approaches to do this have been tried. In this paper, we share our experience with bioenteric intragastric balloon (BIB) in treating obesity: Its safety, tolerability, and its efficacy in weight reduction.
Materials and Methods:
From January 2009 to September 2012, a total of 190 gastric balloons was inserted on patients at the endoscopy unit in King Fahd Hospital of the University, Al-Khobar. This is an evaluation of the first 100 patients. All the patients had a body mass index of over 30 kg/m2 and were within the age range of 17-55 with a mean age of 32 years. After consent, preballoon investigation tests and anesthesia evaluation, BIB was inserted under monitored anesthesia care sedation in the endoscopy suite. The balloon was filled with 500-700 mls of stained saline. All patients' were given an analgesic and antiemetic for a week and antisecretory proton pump inhibitor's for 6 months. Diet and the importance of the exercise were part of the preballoon insertion phase and protocol. The balloon was removed after 6-12 months.
Results:
The weight loss response to BIB in the 100 patients are classified into four groups: In the uncooperative, noncompliant patients - the maximum weight loss was 7 kg, while in the most compliant patients the weight loss reached up to 39 kg. In addition, there was significant improvement into diabetes mellitus, hypertension, dyslipidemia, and fatty liveras. Its safety and tolerability were extremely acceptable.
Conclusion:
Our data indicates that in well-selected patients, BIB is an effective device, which with minimum complications helps to achieve body weight loss and resolve many obesity related morbidities in cooperative and dedicated obese patients.
doi:10.4103/2230-8229.142977
PMCID: PMC4214011  PMID: 25374473
Dedicated patients; gastric balloon; obesity
22.  The effect of lifestyle modification on severity of constipation and quality of life of elders in nursing homes at Ismailia city, Egypt 
Background:
Constipation has a significant impact on the quality of life (QOL). Lifestyle modification is widely accepted and recommended by experts as first-line therapy.
Aim:
This study aimed at using education on lifestyle modification to improve the QOL of the elderly in nursing homes suffering from functional constipation (FC).
Materials and Methods:
This study was conducted in nursing homes in Ismailia city, Egypt. It involved 23 elderly patients suffering from FC, who were randomly selected according to the sample equation. They fulfilled the inclusion criteria of being ≥60 years age and according to Rome II criteria. Participants completed personal characteristics and lifestyle questionnaire, the Patient Assessment of Constipation Symptom questionnaire (PAC-SYM) to assess the severity of symptoms, and the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) to assess pre- and post-intervention. The intervention was conducted in three sessions, of 30 min each, 2 weeks apart using group discussions to educate the sample about dietary pattern, fluid intake, regular physical activity, and the use of laxatives. Statistical analysis: Data were analyzed using a statistical package for social sciences (SPSS version 20).
Results:
The lifestyle modification education on constipation significantly reduced the severity of symptoms as measured by PAC-SYM, including its total score and subscores (P < 0.001). It also improved the QOL of elderly suffering from constipation as measured by PAC-QOL and reduced total scores of dissatisfaction (P = 0.001) with the exception of the psychosocial subscale. It also significantly increased the satisfaction subscale of PAC-SYM (P < 0.001).
Conclusion:
Education on lifestyle modification leads to an improvement in the severity of the symptoms of constipation and the QOL of the elderly in nursing homes.
doi:10.4103/2230-8229.134766
PMCID: PMC4073557  PMID: 24987278
Elderly; functional constipation; quality of life; severity
23.  Trends in ultrasound examination in family practice 
Background:
Ultrasound examination is very frequently used for the evaluation of abnormalities in various organs of the body. Our aim was to determine whether the requests by family physicians (FPs) for ultrasound examinations were appropriate. Our secondary objective was to enumerate positive and negative ultrasound reports for various diagnostic indications.
Materials and Methods:
This cross-sectional study was conducted during the period of month between June and August 2010, at the Family Medicine Department of North West Armed Forces Prince Salman Hospital, Tabuk. We reviewed the ultrasound requests of all patients included in this study and the findings of the procedure. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL), version 16.0.
Results:
The requests and reports of 815 patients for ultrasound were reviewed. Females comprised 58.7% of the referred cases. The mean age of the sample at referral was 30 ± 18.5 for females and 34 ± 20.7 for males. Only 46% of the request forms contained conclusive information and instructions. Abdominal/pelvic ultrasounds were the most frequently requested; Nearly 71.2% of the ultrasound scans were normal. Abdominal/pelvis ultrasound was more likely to be reported as normal than ultrasound scans of other regions (P = 0.007). Patients aged 41-60 years were more likely to have an abnormal ultrasound (P = 0.02).
Conclusion:
Our findings suggest that FPs have to be educated about imaging referral protocols in order to achieve better outcomes.
doi:10.4103/2230-8229.134767
PMCID: PMC4073558  PMID: 24987279
Diagnosis; family practice; indications; requests; ultrasound
24.  A comparative study of job satisfaction among regular and staff on contract in the primary health care system in Delhi, India 
Background:
Job satisfaction is a pleasant emotional state associated with the appreciation of one's work and contributes immensely to performance in an organization. The purpose of this study was to assess the comparative job satisfaction among regular and staff on contract in Government Primary Urban Health Centers in Delhi, India.
Materials and Methods:
The study was conducted in 2013, on a sample of 333 health care providers who were selected using a multistage random sampling technique. The sample included medical officers (MOs), auxiliary nurses and midwives (ANMs), pharmacists and laboratory technicians (LTs)/laboratory assistants (LAs) among regular and staff on contract. Analysis was done using SPSS version 18, and appropriate statistical tests were applied.
Results:
The job satisfaction for all the regular staff that is, MOs, ANMs, pharmacists, LAs, and LTs were relatively higher (3.3 ± 0.44) than the contract staff (2.7 ± 0.45) with ‘t’value 10.54 (P < 0.01). The mean score for regular and contract MOs was 3.2 ± 0.46 and 2.7 ± 0.56, respectively, and the same trends were found between regular and ANMs on the contract which was 3.4 ± 0.30 and 2.7 ± 0.38, regular and pharmacists on the contract was 3.3 ± 0.50 and 2.8 ± 0.41, respectively. The differences between groups were significant with a P < 0.01.
Conclusion:
Overall job satisfaction level was relatively low in both regular and contract staff. The factors contributing to satisfaction level were privileges, interpersonal relations, working-environment, patient relationship, the organization's facilities, career development, and the scarcity of human resources (HRs). Therefore, specific recommendations are suggested to policy makers to take cognizance of the scarcity of HRs and the on-going experimentation with different models under primary health care system.
doi:10.4103/2230-8229.134768
PMCID: PMC4073559  PMID: 24987280
Career development; contract staff; human resource policy
25.  Barriers to breast cancer screening among a sample of Egyptian females 
Background:
Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas.
Objective:
The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women.
Materials and Methods:
A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers.
Results:
In this sample of Egyptian women, the most frequently identified potential barriers to BC screening were the following: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts.
Conclusion:
Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services.
doi:10.4103/2230-8229.134771
PMCID: PMC4073560  PMID: 24987281
Breast cancer; barriers; Egypt; screening

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