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issn:2229-340
1.  Effectiveness of presence of physician and midwife in quantity and quality of family planning services in health care centers 
Background and Aim:
Iran's health sector has been engaging the services of physicians and midwives in healthcare centers since 2005, with the hope of improving the quantity and quality of family planning services. The aim of this study was to assess the effect of serving physicians and midwives on the quantity and quality of family planning services in the healthcare centers of Iran.
Materials and Methods:
The present cross-sectional study (Jan 2010 until Sep 2011) was carried out on 600 eligible families who were clients of healthcare centers of Tabriz, Azarshahr and Osku, cities of Northwest Iran from 2006 until 2011, in two groups (before and after). Some of the characteristics of the participants and the data on the quality and quantity of family planning services provided were grouped in a checklist of 16 variables by comparing the patients’ past medical histories.
Results:
In comparison with 3 years prior to engaging physician and midwife services in health care centers, the Couple Year Protection (CYP) and the quantity of family planning service indexes significantly increased among eligible families. The family size of participants declined significantly after family physicians and midwives became available in the healthcare centers (P < 0.005).
Conclusion:
Our findings showed some improvement in the quantity of services without any noticeable changes in the quality of services provided as a consequence of this huge intervention. Therefore, it is suggested that there should be proper oversight of the duties of the health team in order to keep a close watch on primary healthcare, design of proper mechanisms for collecting and maintaining performance reports and statistics, and continuously monitor and control the quality of services.
doi:10.4103/2230-8229.128761
PMCID: PMC3966090  PMID: 24695960
Family planning; fertility; health services; healthcare services; reproductive ages; women of reproductive age
2.  Consanguinity pattern and heritability of Vitiligo in Arar, Saudi Arabia 
Context:
Epidemiological studies have shown that vitiligo is a complex trait, involving combinations of pathogenic effects of multiple susceptibility genes as well as environmental risk factors.
Aim:
To observe whether consanguinity increased the incidence of vitiligo in Saudi patients from Arar.
Patients and Methods:
This study included 69 Saudi patients with vitiligo and their families. These patients, selected from the experience specialist dermatology center in Arar, from April 2011 to 2012, were interviewed by a dermatologist to confirm the diagnosis and complete a questionnaire.
Results:
A total of 69 patients, 40 males and 29 females were selected. Their mean age was 34.5 ± 11.8 years with the median age of 23 years. The mean age at onset of disease was 27.9 ± 12.9 years. The mean duration of the disease was 9.7 ± 5.3 years. The frequency of focal, vulgaris, universal, and acrofacial subtypes was 22 (31.9%), 21 (30.4%), 8 (11.6%), and 18 (26.1%), respectively. A positive family history of vitiligo was obtained in 45 (65.2%) cases. A comparison of the frequency of vitiligo among siblings in relation to the general population was more in accord with the multifactorial model.
Conclusion:
Consanguinity in marriage increases the incidence of the disease. Therefore, genetic counseling and premarital examination would be important contributions to lower the prevalence of vitiligo.
doi:10.4103/2230-8229.128767
PMCID: PMC3966091  PMID: 24696629
Arar; consanguinity pattern; genetic; vitiligo
3.  Awareness of an obstetric population about environmental tobacco smoking 
Background and Objectives:
The reported rate of women's smoking is typically low. However, many pregnant women are exposed to environmental tobacco smoke (ETS), which could affect their own health and the health of their growing fetus. The aim of this study was to estimate the magnitude of the problem of exposure to ETS and assess the awareness of postpartum women to ETS and its possible effects.
Designs and Settings:
This was a cross-sectional study conducted on 1182 postpartum women at a university hospital in Riyadh, Saudi Arabia, between 1st January and 30th June, 2012.
Materials and Methods:
A structured questionnaire was used for data collection. Factors associated with the level of understanding of the possible effects of ETS exposure were analyzed.
Results:
The majority of the participating women knew that exposure to ETS had adverse effects on maternal and fetal health (>80%), but their knowledge of the specific effects on fetal health was limited. The level of mothers’ education was found to be associated with better knowledge of effects on mother and fetal health (P < 0.01).
Conclusion:
This study revealed that pregnant women in our sample had limited knowledge of the specific effects of ETS on fetal health. This shortcoming in knowledge needs to be addressed by improving health.
doi:10.4103/2230-8229.128768
PMCID: PMC3966092  PMID: 24696630
Environmental tobacco smoking; knowledge; pregnant woman; smoking
4.  A cross-sectional online survey of compulsive internet use and mental health of young adults in Malaysia 
Background:
The last decade has seen the emergence of the internet as the prime communication medium changing the way people live and interact. Studies from various countries have reported on internet addiction and its association with mental health, but none have come from Malaysia.
Objectives:
We aimed at assessing the frequency of the use of various internet applications and exploring the association of compulsive internet use with mental health and socio-demographic factors.
Materials and Methods:
A cross-sectional online survey was carried out among participants registered for the monthly opinion poll survey of University Tunku Abdul Rahman, Malaysia. The questionnaire contained socio-demographic information, the use of various internet applications on a five-point Likert scale, compulsive internet use scale (CIUS) and 12 item general health questionnaire (GHQ-12). Correlations and linear regression analyzes were carried out.
Results:
Of the 330 respondents, 182 were females and 148 were males. The mean age was 23.17 (SD = 3.84). Mean CIUS score was 19.85 (SD = 10.57) and mean GHQ score was 15.47 (SD = 6.29). Correlation coefficients of CIUS score with age, years of use and daily hours of internet use were −0.118 (P = 0.03), −0.014 (P = 0.81) and 0.242 (P < 0.001) respectively. Multiple linear regression analysis showed that age (β = −0.111, P = 0.033) and marital status (β = −0.124, P = 0.018) were negatively associated with CIUS scores whereas daily hours of internet use (β = 0.269, P = 0.001) and GHQ score (β = 0.259, P = 0.001) were positively associated with the CIUS score.
Conclusions:
Compulsive internet use was correlated with GHQ score. More research is needed to confirm our results. Psychologists may consider assessing internet addiction when evaluating young psychiatric patients.
doi:10.4103/2230-8229.128770
PMCID: PMC3966093  PMID: 24696631
Internet addiction; mental health; well-being
5.  Prevalence of hypertension and associated cardiovascular risk factors in Central India 
Objectives:
To study the difference in the prevalence of hypertension and associated risk factors in urban and rural populations and the association of hypertension with various determinants.
Materials and Methods:
A community-based cross-sectional study was conducted in 48 villages and 15 urban wards of Jabalpur District of Central India. Nine hundred and thirty-nine individuals aged 20 years and above (624 from rural areas and 315 from urban areas) were included in the study. The prevalence of hypertension and associated cardiovascular risk factors was assessed in the urban and rural populations. A pretested questionnaire was used to collect data on socio-demographic, behavioral, and dietary factors. Anthropometric measurements of weight, height, waist and hip circumference, and blood pressure measurements were taken using the standard methodology. The glucose oxidase–peroxidase and cholesterol oxidase–cholesterol peroxidase methods were used to measure plasma glucose and serum cholesterol, respectively. Bivariate analysis was followed by multivariate analysis to detect the odds of getting hypertension with various risk factors for the urban and rural populations separately. Hypertension was defined as per Joint National Committee (JNC) - VII criteria.
Results:
The response rate was 97%. Overall prevalence of hypertension was 17%, with 21.4% in the urban population and 14.8% in the rural population. Significantly higher mean values of weight, height, body mass index (BMI), hip circumference (HC), waist circumference (WC), waist hip ratio (WHR), systolic blood pressure (SBP), fasting blood sugar (FBS), and serum cholesterol levels were mapped in the urban population in comparison with the rural population. Multivariate logistic regression analysis identified increasing age, parental history of hypertension, tobacco smoking, tobacco chewing, physical inactivity, high estimated per capita salt consumption, and BMI ≥27.5 kg/m2 as independent predictors for hypertension in the urban population, while in the rural population, increasing age, physical inactivity, central obesity, tobacco chewing and tobacco smoking were independent predictors for hypertension.
Conclusion:
The prevalence of hypertension and other cardiovascular risk factors was high in both urban and rural communities. Therefore, there is a need for comprehensive health promotion programs to encourage lifestyle modification.
doi:10.4103/2230-8229.128775
PMCID: PMC3966094  PMID: 24695988
Blood pressure; cardiovascular risk factors; epidemiology; hypertension; lifestyle; screening
6.  Indoor air quality levels in a University Hospital in the Eastern Province of Saudi Arabia 
Aim of the Study:
The complex hospital environment requires special attention to ensure a healthy indoor air quality (IAQ) to protect patients and healthcare workers against hospital-acquired infections and occupational diseases. Poor hospital IAQ may cause outbreaks of building-related illness such as headaches, fatigue, eye, and skin irritations, and other symptoms. The general objective for this study was to assess IAQ inside a large University hospital at Al-Khobar City in the Eastern Province of Saudi Arabia.
Materials and Methods:
Different locations representing areas where most activities and tasks are performed were selected as sampling points for air pollutants in the selected hospital. In addition, several factors were studied to determine those that were most likely to affect the IAQ levels. The temperature and relative percent humidity of different air pollutants were measured simultaneously at each location.
Results:
The outdoor levels of all air pollutant levels, except volatile organic compounds (VOCs), were higher than the indoor levels which meant that the IAQ inside healthcare facilities (HCFs) were greatly affected by outdoor sources, particularly traffic. The highest levels of total suspended particulates (TSPs) and those less than 10 microns (PM10) inside the selected hospital were found at locations that are characterized with m4ore human activity.
Conclusions:
Levels of particulate matter (both PM10 and TSP) were higher than the Air Quality Guidelines (AQGs). The highest concentrations of the fungal species recorded were Cladosporium and Penicillium. Education of occupants of HCF on IAQ is critical. They must be informed about the sources and effects of contaminants and the proper operation of the ventilation system.
doi:10.4103/2230-8229.128778
PMCID: PMC3966095  PMID: 24696632
Air pollutants; air quality guidelines; biological pollutants; hospital environment; indoor air quality; outdoor air pollution; traffic activity; university campuses
7.  Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India 
Introduction:
Iodine is an essential component of the hormones produced by the thyroid gland that are essential for mammalian life. Although goiter is the most visible sequelae of iodine deficiency, the major impact of hypothyroidism as a result of iodine deficiency is impaired neurodevelopment, particularly early in life. According to the World Health Organization, it is the single most preventable cause of mental retardation and brain damage. The simplest, most effective and inexpensive preventive method is the consumption of iodized salt.
Objectives:
The objective of the following study is to estimate the prevalence of goiter in children in the rural areas of Mysore and Coorg districts in India and estimate iodine levels in salt samples.
Materials and Methods:
A cross-sectional study in the age group of 6-12 years, using population proportionate to size systematic sampling method. The total sample size was 10,082: out of which 5337 was from Mysore and the rest from Coorg district. Clinical examination of the thyroid gland was done and salt samples collected for the estimation of Iodine.
Results:
The total prevalence of goiter was 19.01% in children of 6-12 years in Coorg district and 8.77% in Mysore district and it was more in females than in males.
Conclusions:
It was observed that iodine deficiency disorders is endemic in both districts, with a prevalence of 19.01% in children aged 6-12 years in Coorg district and 8.77% in Mysore district. Analysis of salt samples suggested that most of the samples were inadequately iodised (73.92% in Coorg and 45.92% in Mysore).
doi:10.4103/2230-8229.128783
PMCID: PMC3966096  PMID: 24696633
Cross sectional study; dox plot; iodine deficiency; prevalence
8.  Unmet need for family planning among married women of reproductive age group in urban Tamil Nadu 
Context:
Unmet need for family planning (FP), which refers to the condition in which there is the desire to avoid or post-pone child bearing, without the use of any means of contraception, has been a core concept in the field of international population for more than three decades.
Objectives:
The very objective of this study is to determine the prevalence of “unmet need for FP” and its socio-demographic determinants among married reproductive age group women in Chidambaram.
Materials and Methods:
The study was a community-based cross-sectional study of married women of the reproductive age group, between 15 and 49 years. The sample size required was 700. The cluster sampling method was adopted. Unmarried, separated, divorced and widows were excluded.
Results:
The prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as 27%. The major reason for unmet need for FP among the married group was 18%, for low perceived risk of pregnancy, 9%, feared the side effects of contraception 5% lacked information on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons. Higher education, late marriage, more than the desired family size, poor knowledge of FP, poor informed choice in FP and poor male participation were found to be associated with high unmet need for FP.
Conclusion:
Unmet need for younger women was spacing of births, whereas for older women, it was a limitation of births. Efforts should be made to identify the issues in a case by case approach. Male participation in reproductive issues should be addressed.
doi:10.4103/2230-8229.128786
PMCID: PMC3966097  PMID: 24696634
Family planning; informed choice; male participation; unmet need
9.  Age-appropriate feeding practices and nutritional status of infants attending child welfare clinic at a Teaching Hospital in Nigeria 
Background:
Appropriate infant feeding is the key to optimum infant and child development and survival. This study investigates age-appropriate infant feeding practices and nutritional status of infants attending the immunization and child welfare clinic at Aminu Kano Teaching Hospital.
Materials and Methods:
Using a cross-sectional descriptive design, a sample of 300 sets of infants (age ≤12 months) and caregivers was systematically selected and studied. The data were analyzed using the MINITAB® 12.21 (USA) statistical software.
Results:
All the infants studied were still on breast milk. Most of the mothers demonstrated correct body positioning (89.9) and attachment (78.7%) during breastfeeding, and effective suckling was demonstrated in 77.0%. Interestingly, none of the infants was either exclusively breastfed for 6 months or currently on exclusive breastfeeding. Furthermore, only 64 (58.2%) of the 110 infants that were more than 6 months of age had appropriately been started on complementary feeding from 6 months of age. Overall, most caregivers (88.7%) had “fair” to “good” infant feeding practices. The practices were significantly associated with their level of education, and their relationship with the infants. Up to 40.0% and 73.7% of the infants had varying degrees of wasting and stunting respectively. Infant feeding practices and the age of the infants emerged as the only factors significantly associated with stunting, while both the caregivers’ practices and age of the infants emerged as significant predictors of wasting in the infants.
Conclusion and Recommendations:
Barely 3 years to the 2015 target of the millennium development goals (MDGs), infant feeding and nutritional status still poses a serious threat to the dream of realizing the MDG-4. The Ministry of Health and relevant developing partners in this region should as a matter of urgency, formulate and implement a strong community-based public health intervention program to improve the knowledge and practices of mothers on infant feeding.
doi:10.4103/2230-8229.128766
PMCID: PMC3966099  PMID: 24696628
Age-appropriate feeding; infant feeding practices; Kano-Nigeria; nutritional status
10.  Primary care physicians’ knowledge and perceived barriers in the management of overweight and obesity 
Objectives:
To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia.
Setting:
Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia.
Design:
A cross-sectional study.
Materials and Methods:
One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese.
Results:
One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity.
Conclusion:
Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.
doi:10.4103/2230-8229.121972
PMCID: PMC3957166  PMID: 24672270
Barriers; knowledge; obesity; overweight; primary health care physicians; Saudi Arabia
11.  Attitude of primary care physicians toward patient safety in Aseer region, Saudi Arabia 
Objective:
The objective of this study was to assess the attitude of physicians at primary health-care centers (PHCC) in Aseer region toward patient safety.
Materials and Methods:
This study was conducted among working primary health-care physicians in Aseer region, Saudi Arabia, in August 2011. A self-administered questionnaire consisting of three parts was used; the first part was on the socio-demographic, academic and about the work profile of the participants. The attitude consisting of 26 questions was assessed on a Likert scale of 7 points using attitude to patients safety questionnaire-III items and the last part concerned training on “patient safety”, definition and factors that contribute to medical errors. Data of the questionnaire were entered and analyzed by Statistical Package for the Social Sciences (SPSS) version 15.
Results:
The total number of participants was 228 doctors who represent about 65% of the physicians at PHCC, one-third of whom had attended a course on patient safety and only 52% of whom defined medical error correctly. The best score was given for the reduction of medical errors (6.2 points), followed by role of training and learning on patient safety (6 and 5.9 points), but undergraduate training on patient safety was given the least score. Confidence to report medical errors scored 4.6 points as did reporting the errors of other people and 5.6 points for being open with the supervisor about an error made. Participants agreed that “even the most experienced and competent doctors make errors” (5.9 points), on the other hand, they disagreed that most medical errors resulted from nurses’ carelessness (3.9 points) or doctors’ carelessness (4 points).
Conclusion:
This study showed that PHCC physicians in Aseer region had a positive attitude toward patient safety. Most of them need training on patient safety. Undergraduate education on patient safety which was considered a priority for making future doctors’ work effective was inadequate.
doi:10.4103/2230-8229.121976
PMCID: PMC3957167  PMID: 24672271
Aseer region; attitude; patient safety; primary health-care centers
12.  The prevalence of pterygium in Alkhobar: A hospital-based study 
Objective:
To analyze the epidemiology of pterygium in a hospital-based population in Alkhobar, which is located in the eastern province of Saudi Arabia.
Materials and Methods:
This was a retrospective, non-randomized, and consecutive case study. Out of 88,666 patients who were seen in the ophthalmology clinic between January 1995 through the end of December 2010, 116 patients were diagnosed with advanced pterygium. The medical records of these patients were evaluated.
Results:
The overall prevalence of pterygium was found to be 0.074%. There was no significant difference by either gender, side, or by laterality (P > 0.05). A significant increase was noticed in the prevalence of pterygium with increasing age and nasal location (P < 0.05).
Conclusion:
The overall prevalence rate of pterygium in Alkhobar is low when compared with results reported from other areas of the world.
doi:10.4103/2230-8229.121980
PMCID: PMC3957168  PMID: 24672272
Alkhobar; hospital-based; prevalence; pterygium; Saudi Arabia
13.  Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center 
Objective:
The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients.
Materials and Methods:
A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18.
Results:
Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP.
Conclusion:
We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.
doi:10.4103/2230-8229.121987
PMCID: PMC3957169  PMID: 24672273
Medical; medications; outpatients; polypharmacy
14.  Prevalence of smoking among male secondary school students in Jeddah, Saudi Arabia 
Objectives:
This study was conducted to examine the prevalence of smoking and habits of smoking among male secondary school students in Jeddah, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes toward it.
Materials and Methods:
A cross-sectional study was conducted in Jeddah, using a two-stage cluster sampling, randomly selecting 4 out of 85 government male secondary schools. Data were obtained through a self-administered questionnaire eliciting responses to questions on personal background, smoking behavior, knowledge, behavior, and attitude toward smoking. A total of 695 students responded to the questionnaires with 87.4% response rate.
Results:
Of the studied group, 258 (37%) currently smoked, and of these, 83.7% had started smoking at the age of 14 years or less. The most common reason for smoking was the influence of family, especially the presence of someone at home who smoked (65, 9%) and friends who smoked (42.5%). Many of the students search for information on the risks of smoking (66.3%), and only (45.3%) knew about the bad effects of passive smoking on others. Two-third of the students who smoked wanted to quit smoking (63.2%), especially if suitable help was offered, whereas (60.9%) had tried to quit. While 50% of students smoked for recreation and entertainment, and (33.6%) had difficulty avoiding smoking in no smoking areas.
Conclusion:
A well-planned integrated antismoking campaign is urgently required, especially among students and teachers. The study revealed that the prevalence of smoking was high. This will contribute to an increase in smoking-related health problems in the future if proper preventive measures are not taken.
doi:10.4103/2230-8229.121993
PMCID: PMC3957170  PMID: 24672274
Smoking; male students; secondary school; prevalence; behavior
15.  Computer literacy of physicians among the hospitals of Makkah region 
Background and Objectives:
A confidential inquiry by the Directorate General of Health Affairs, Makkah region, Saudi Arabia, found physicians in different hospitals were reluctant to enter patients’ related information in electronic medical record systems. One of the major issues raised was that they didn’t have the required computer literacy. Our aim, therefore, was to conduct a survey to highlight the computer literacy among the physicians of Makkah region.
Materials and Methods:
This cross-sectional survey was performed from May to July 2009. A structured questionnaire of four A4 size paper was distributed among the physicians of the Makkah region working in seven different hospitals. The questionnaire contained questions on background knowledge of computers, i.e., (a) basic computer vocabulary knowledge (BCVK) (10 questions), (b) basic computer skills (BCS) (22 questions), (c) basic communication and internet skills (BCIS) (12 questions).
Results:
Response rate of 368, i.e., 81.6% of sample size (n = 451) was attained. The maximum response came from King Abdul Aziz Hospital (Taif), i.e., 79%. Overall BCVK, BCS and BCIS were the highest among the physicians of Alnoor Specialist Hospital, i.e., 71.3%, 91.4%, 87.7%, respectively. All the hospitals had a satisfactory level of BCVK, but levels of BCS and BCIS were above satisfactory except King Abdul Aziz Hospital (Jeddah) that showed a satisfactory level in BCIS.
Conclusion:
Majority of the physicians had a good or an excellent level of computer background knowledge that gave a prediction toward the issues of their non-promising attitude and beliefs about electronic data entry.
doi:10.4103/2230-8229.121998
PMCID: PMC3957171  PMID: 24672275
Computer literacy; computerized medical record; cross-sectional survey
16.  Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study 
Background:
A high prevalence of low serum testosterone (LST) in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes.
Materials and Methods:
This was a cross-sectional study, conducted among 1,089 men (aged 30-70 years) with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patients’ demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male (ADAM) questionnaire. Venous blood sample was collected to test for total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), serum lipids, and glycosylated hemoglobin (HbA1c). LST was defined as TT <3 ng/ml.
Results:
Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism (HG), and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index (BMI), smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST.
Conclusions:
The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST.
doi:10.4103/2230-8229.122006
PMCID: PMC3957172  PMID: 24672276
Diabetes mellitus; low serum testosterone; prevalence
17.  Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population 
Aim:
The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population.
Materials and Methods:
The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate’s correction and ANOVA tests.
Results:
A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by linea alba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (P < 0.05) was established between tobacco and melanin pigmentation, frictional keratosis, traumatic ulcerations and leukoplakia. In those who wore dentures a statistically significant relation (P < 0.05) was found between candidiasis, traumatic ulceration and frictional keratosis.
Conclusion:
The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.
doi:10.4103/2230-8229.122009
PMCID: PMC3957173  PMID: 24672277
Denture wearers; oral mucosal pathology; smokers
18.  Quality of life in dialysis patients from the United Arab Emirates 
Background:
The quality of life (QOL) has emerged as an important parameter for evaluating the quality of health-care for patients with renal failure. The literature suggests that many factors impact QOL. The QOL of dialysis patients in the United Arab Emirates (UAE) has not been studied before. This research examined the QOL of patients in the UAE on dialysis using two QOL tools.
Materials and Methods:
A descriptive comparative survey design was used to study 161 dialysis patients. The participants completed the 36-Item Short Form Health Survey (SF-36) and the QOL index dialysis version tool. Comparative analyses of the results for both tools were done using descriptive statistics. Multiple linear regression analysis determines the effect of the variables on the QOL scores.
Results:
The questionnaires return rate was 93%. The overall QOL for dialysis patients was rated low when self-assessed using the SF-36 (58.9) compared to QOL index (77.2). The multiple regression analysis revealed that having a chronic illness had the strongest impact on the total scores of both tools. The comparison between the statistically significant variables for both samples revealed contradictory results from the two tools used. This meant that the two tools measured QOL differently.
Conclusion:
The two QOL tools scores impacted very differently on most socio-demographic variables on the two samples. More studies are required to explore the concept of QOL in the Arab dialysis population.
doi:10.4103/2230-8229.114772
PMCID: PMC3748644  PMID: 23983562
Dialysis; Islamic religion; quality of life; United Arab Emirates
19.  Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital 
Background:
Discharging patients against medical advice is a problem of every age-group. However, because of their physiological vulnerability, the risk for the neonatal population is greater when discharged against medical advice (DAMA). This article is a study of the prevalence of the problem, the possible causes and/or risk factors.
Materials and Methods:
A retrospective review of 10 years of medical records of neonates discharged against medical advice from a Neonatal Intensive Care Unit (NICU) at a university hospital.
Results:
The overall prevalence of DAMA was 1.6%. Most of the 51 infants who were taken out of hospital against medical advice (AMA) were term (72.5%) with a mean gestational age of 37.78 ± 2.5 weeks, of normal birth weight, with a mean of 2736 ± 661 g, Saudis (96%), those delivered vaginally (69%), and those that were provisionally diagnosed with transient tachypnea of newborn (TTN) and/or query sepsis (49%). There was no difference between males and females (M/F = 1.2). There was an association between DAMA and the timing of DAMA (27.5% of DAMA at weekends and 67% of DAMA from May to October).
Conclusion:
DAMA of neonates is particularly critical. The causes and risk factors are many and difficult to predict. In addition to several other factors, its prevalence is influenced negatively by some socio-cultural beliefs.
doi:10.4103/2230-8229.114774
PMCID: PMC3748645  PMID: 23983563
Discharge against medical advice; neonatal; neonatal intensive care unit
20.  Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes 
Background:
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%.
Results:
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).
Conclusions:
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.
doi:10.4103/2230-8229.114766
PMCID: PMC3748651  PMID: 23983558
Anxiety; depression; diabetes education; diabetes self-management; Saudi Arabia
21.  The association between watching television and obesity in children of school-age in Saudi Arabia 
Background:
There is little information on the association between watching Television (TV) and obesity in the Arabian Peninsula.
Aim of the Study:
The aim of this study was to explore the association between the watching of television and obesity in Saudi children of school-age.
Materials and Methods:
A case-controlled study was conducted with students between the ages of 9 and 14 years who attended the school health clinic in King Abdulaziz Housing for National Guard (Iskan), Riyadh, Saudi Arabia, during the study period (February to April 2012). During each clinic, children were selected by simple random sampling (five obese and five non-obese). For data collection, two trained physicians interviewed the participants using a 20-item Arabic questionnaire. Well-trained nurses collected the anthropometric measurements of weight and height.
Results:
The study included 397 students. Higher (body mass index) BMI was associated with a higher number of televisions at home (P < 0.001), watching TV for more than three hours per day at the weekend (P = 0.047), eating more than three snacks per day (P = 0.005), watching TV at night (P = 0.026), and siblings’ decisions on how much TV to watch (P = 0.025). The prevalence of childhood obesity was significantly lower among those whose mothers determined how much TV they could watch (P = 0.03). In logistic regression analysis, the increase in the child's age, the presence of more than one TV at home, having his or her own TV, and an increase in the number of hours of watching TV over the weekend were significantly associated with an increased risk of childhood obesity. Personal computers and the Internet were not significantly associated with an increased risk of childhood obesity.
Conclusion:
The present investigation revealed that watching TV represents an important risk factor for obesity in children of school-age.
doi:10.4103/2230-8229.114767
PMCID: PMC3748652  PMID: 23983559
Obesity; Saudi Arabia; school-age children; television
22.  Blood pressure and its associated factors among primary school children in suburban Selangor, Malaysia: A cross-sectional survey 
Background:
Little is known about the relationship of blood pressure (BP) with adiposity indicators, dietary habits, physical activity, and sleep in school children in Malaysia. We aimed to study about the distribution of BP and its associated factors in primary school children.
Materials and Methods:
A survey was carried out on a random sample of 335 children in five primary schools. BP was measured with a mercury sphygmomanometer. Anthropometry was done by standard methods. Demographic information, dietary habits, physical activity, and duration of sleep were collected by interviews. World Health Organization classification based on body mass index (BMI) and waist circumference (WC) cut-offs were used to define overweight/obesity. Elevated BP was defined according to US reference standards.
Results:
A total 335 children (144 boys and 191 girls) were examined. Their mean age was 9.18 years (standard deviation [SD] = 0.28). Overall mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) were 99.32 mmHg (SD = 10.79) and 67.11 mmHg (SD = 10.76), respectively. Mean BMI and WC were 16.39 (SD = 3.58) and 57.77 cm (SD = 8.98), respectively. The prevalence of pre-hypertension was 12.23% (95% confidence intervals [CIs] 8.73, 15.75) and hypertension was 13.4% (95% CIs 9.78, 17.09). Mean SBP and DBP was higher among overweight and obese children than normal children. By multivariate linear regression analyses, BMI (β = 0.250, P = 0.049) and WC (β = 0.308, P = 0.015) were positively associated with SBP; age (β = 0.111, P = 0.017), BMI (β = 0.320, P = 0.012) were positively associated with DBP but total (weekly) hours of sleep (β = −0.095, P = 0.037) was negatively associated with DBP.
Conclusion:
BP was associated with BMI and WC. Health promotion activities should be initiated in primary schools.
doi:10.4103/2230-8229.114769
PMCID: PMC3748653  PMID: 23983560
Blood pressure; body mass index; cross-sectional survey; obesity; school children; waist circumference
23.  The pattern of medical errors and litigation against doctors in Saudi Arabia 
Background:
Adverse events are frequent in clinical practice, but only a few studies in Saudi Arabia have addressed them. The current study was designed to review the lawsuits against healthcare professionals by analyzing records of the cases dealt with by the Medico-legal Committees (MLC) in various provinces in Saudi Arabia, in order to determine the pattern of medical errors and litigations in the country.
Materials and Methods:
A pre-designed data sheet was used to collect data from the records of the Medical Violation Committee (MVC) and the Medical Jurisprudence Committee (MJC). The data sheets consisted of information on details of the cases, details on where the error had occurred, and details of the errors.
Results:
The review of records revealed 642 cases, most of which were from hospitals run by the Ministry of Health (MOH). The operating room was where most of the errors (20.4%) had occurred, followed by the emergency room (18.1%). Surgery was at the top of the specialties (25.1%). Most of the deaths occurred in surgery and obstetrics (about 25% for each), followed by other medical specialties (17%). About half of the lawsuit cases studied (46.5%) involved patients belonging to a relatively young age group (20–50 years).
Conclusion:
Most of the medical error litigations involved surgeons and obstetricians especially in MOH hospitals. The process of litigations and documentation need to be improved, and access to the records for research and education need to be made easier. In addition, there is a need for more prospective field studies.
doi:10.4103/2230-8229.114771
PMCID: PMC3748654  PMID: 23983561
Litigations; medical errors; patient safety; Saudi Arabia
24.  Economic costs of diabetes in Saudi Arabia 
Background:
Diabetes imposes a large economic burden on the individual, national healthcare systems, and countries.
Objective:
To determine the economic impact of diabetes mellitus on Saudi healthcare system, both now and in the future.
Materials and Methods:
This research study uses a prevalence-based approach that combines the demographics of the population (classified by nationality, sex and age group) with and without diagnosed diabetes in 1992 and 2010. The economic impact of diabetes is estimated in this study, using secondary sources of information provided by Ministry of Health, Ministry of Finance and Central Department of Statistics and Information databases.
Results:
People diagnosed with diabetes, on average, have medical healthcare expenditures that are ten times higher ($3,686 vs. $380) than what expenditures would be in the absence of diabetes. Over 96% of all medical healthcare expenditures attributed to diabetes are incurred by persons of Saudi nationality, with the remaining 4% incurred by persons of non-Saudi nationality. The population age 45-60 incurs 45% of diabetes-attributed costs, with the remaining population under age 15 incurs 3.8%, age 15-44 incurs 27.5%, and age 60 and above incurs 23.8%.
Conclusion:
The actual national healthcare burden because of diabetes is likely to exceed the $0.87 billion estimated in this study, because it omits the indirect costs associated with diabetes, such as absenteeism, lost productivity from disease-related absenteeism, unemployment from disease-related disability, lost productivity due to early mortality by disease. The social cost of intangibles such as pain and suffering and care provided by non-paid caregivers as well as healthcare system administrative costs, cost of medications, clinician training programs, and research and infrastructure development is also omitted from this research study. Further studies are needed to confirm the present findings and to improve our understanding of economic costs of diabetes and its related complications.
doi:10.4103/2230-8229.108174
PMCID: PMC3663158  PMID: 23723724
Diabetes mellitus; economic costs; healthcare system; Saudi Arabia
25.  Family biosocial variables influencing the use of insecticide treated nets for children in Eastern Nigeria 
Background:
Effective reduction of malaria morbidity and mortality in Nigerian children under the age of five depends to a large extent on family biosocial factors. Although, the awareness of insecticide treated bed nets (ITNs) is reportedly high and increasing in Nigeria there remain large gaps between awareness, possession and use by families with children under the age of five in Nigeria.
Aim:
To determine the family biosocial variables that influence the use of insecticide treated nets for children in Eastern Nigeria.
Materials and Methods:
A descriptive hospital-based study was carried out from June 2008-June 2011 on a cross-section of 415 mothers with children under the age of five, who were treated for confirmed malaria, and met the selection criteria were interviewed using a pretested, structured researcher-administered questionnaire. The questionnaire tool elicited information on family socio-demographic variables, inter-spousal discussion, communication, concurrence and participation in the use of insecticide treated bed nets; and reasons for non-utilization. The period of usage in the previous 6 months was assessed and graded using a scoring system of 0-4. Scores of 1-4 indicated usage while score of 0 meant non use.
Results:
The rate of ITNs use was 53.0%. The family variables that significantly influenced utilization were secondary education and above of parents (mother: P = 0.009; father: P = 0.001), monogamy (P value = 0.024), family size of 1-4 (P value = 0.016) and parents living together (P = 0.001); others included parents’ occupation (mother: P = 0.003; father: P = 0.04) and inter-spousal discussion (P value = 0.001), communication (P value = 0.001), concurrence (P = 0.000) and participation (P = 0.000). The commonest reason for non- use was inconvenience during sleep (P = 0.04).
Conclusion:
This study shows that the rate of ITN use was marginally good. Specifically, this rate was significantly influenced by some family variables. The families of children under the age of five should, therefore, be the focus of intensive health promotion campaign to influence the use of ITNs to produce ITN family friendly communities.
doi:10.4103/2230-8229.108178
PMCID: PMC3663159  PMID: 23723726
Children; family biosocial variables; hospital; ITNs-use; malaria; Nigeria

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