This study aims to assess the behaviors of diabetic males towards their foot care at Al-Manhal Center of Family Practice, Aseer Region, KSA.
A cross-sectional study was conducted for male diabetics in the Aseer region, KSA, during the first quarter of the year 2004. A questionnaire and physical examination of the foot were used to assess their behaviors towards foot care.
All the male diabetic patients (107) who attended during the study period were assessed. Mean age was 58 years, mean duration of DM was 10 years. Good diabetic control was 24%, 37% did not know the negative effect of DM on the feet,9-22% had different symptoms of diabetic foot, 53% checked their feet regularly, 31% had fungal infection while an absence of pulse was detected in 7%.
This study revealed that many diabetics had negative behaviors towards foot care. There is a need for intensive health education and regular assessment in order to detect, prevent and manage diabetic foot as early as possible.
Diabetes; Foot Care; Behaviors; Family Practice; Aseer Region
Determining the stages of change in physical activity (PA) helps to determine effective promotion of PA interventions. The aim of the study was to assess the readiness of students of King Saud University (KSU) to be more physically active and relate this to their self efficacy, perceived benefits and perceived barriers to PA.
A cross-sectional descriptive study was conducted at KSU, Riyadh, between March and May 2007, using a self-administered questionnaire. The total sample size was 302 randomly chosen male and female students.
More than half of the students (55.3%) reported that they participated in PA in the action (for <6 months) and maintenance (for ≥ 6 months) stages. The remaining students did not engage in PA as they were in precontemplation, contemplation, preparation and relapse stages. More males were found in the maintenance stage, but more females were found in the inactive stages (precontemplation, contemplation and preparation). Only 24.4% of the students were engaged in PA as much as three times or more/week and 9.9% engaged in PA regularly through out the year. About 39% of which, significantly, more were males did vigorous PA for 20 minutes or more. However, 4.6% described themselves as hyperactive. More females used the stairs, did house work and considered themselves moderately active. Nearly 50% had a low total score of perceived barriers while 85% had high perceived benefits and 63.6% had moderate self efficacy of PA. The main barriers perceived were time and resources. The score relating to barriers decreased significantly across stages of change, but the pattern was reversed with regard to the perceived benefits and self-efficacy (p<0.05).
Physical inactivity is common among KSU students. A considerable proportion of them was not ready to become more physically active. The study highlights the need to adapt PA promotion programs to states of readiness for PA. University and public policies as well as environmental changes are necessary to encourage active living within the context of Islamic rules and Saudi culture.
Stages of Change; Self Efficacy; Benefits and Barriers; Physical Activity; University Students
Breast cancer is the commonest international malignancy among women. Its increased prevalence over recent years in our part of the world has prompted women to randomly seek medical advice. Many patients are delayed for weeks to months prior to receiving medical treatment. This review explores the causes of delay and proposes possible solutions.
Materials and Methods:
This review was undertaken at King Fahd Hospital of the University, a tertiary care center with the capacity of 420 beds. It accommodates a large number of referrals from the Eastern Province, other regions of the Kingdom, in addition to many walk-in patients. Most of the patients referred with breast cancer are directed to the breast clinic for treatment. There was random re-tracing of patients’ steps from the discovery of the suspicious breast mass to the delivery of care.
The total number of diagnosed breast cancer cases at this center between 1997-2007 was 303, with a total number of 975 registered visits. Random retracing of these patients’ records identified three points of delay: community related, primary heath care and tertiary care. It was found that the patients spent 6-15 weeks and around 32-38 hand offs before receiving the final care.
This unnecessary delay creates anxiety and mistrust of the operating health system leading patients to seek alternative medicine or treatment abroad.
A multidisciplinary one-stop breast oncology clinic may be the solution to the above problem. It may allow the fast tracking of breast cancer patients through a highly specialized and welltrained multidisciplinary team that offers the highest quality of care, thereby optimizing the chances of cure with the least delay and possible morbidity.
Breast cancer; management; delay
Synovial sarcoma is a malignant mesenchymal neoplasm which commonly occurs in the extremities of adults, in close association with joint capsules, tendon sheaths, bursae and fascial structures. Only a few cases of synovial sarcoma occurring in the abdominal wall have been reported. A case of a primary synovial sarcoma arising from the anterior abdominal wall fascial aponeurosis is presented.
Synovial sarcoma; abdominal wall tumor
Although rare, dysgerminomas are important irrespective of incidence because they affect women of reproductive age (i.e., <45 years). Dysgerminomas make up two thirds of all malignant ovarian neoplasms in women younger than 20 years. All dysgerminomas are considered malignant, but only one third of dysgerminomas behave aggressively. Their exact etiology has not been determined. Few reports are found in the review of the literature on the incidence of dysgerminoma and other germ cell tumors in families. Some of these reports focus on the genetic abnormalities associated with germ cell tumor and the responsible gene. Two cases of dysgerminomas diagnosed in two sisters aged 14 and 19 years old are presented here with their radiological studies.
Dysgerminoma; Germ Cell Tumor; Familial incidence; Imaging
There is an international move from traditional curriculum towards the learner – centered, and patient-oriented curriculum. In spite of its advantages, problem-based learning requires a larger number of teaching staff and space. This study was done to compare the problem-based learning (PBL), lectures and modified PBL methods.
Thirty-three fifth year medical students who were taking the Family Medicine rotation participated in the study at the College of Medicine, King Saud University. Three instructors participated in the teaching of three topics to the three groups of students. Students acted as control for themselves across the three instructional methods, namely; lectures, PBL and modified PBL. The main outcomes were students’ recall of knowledge, problem solving skills and topic comprehension.
In the initial assessment, there was a significant difference in favor of PBL and the modified PBL regarding comprehension of the topic as tested by the short answer questions (p = 0.0001), problem solving skills as tested by the modified essay question (p = 0.002). Non-significant results were observed at the second stage of assessment. The modified PBL method was the preferred one for 39% of the students, followed by the PBL (36%) and lastly the lectures (25%).
This empirical study suggests some advantages for the PBL method and the modified PBL over the lecture method. Larger studies are needed to confirm our results of this important issue as the modified PBL is an affordable option for schools that can not meet the staff and space requirements of the PBL curriculum.
Instructional methods; lectures; modified PBL; PBL; Saudi Arabia
To estimate the prevalence of hypertension through a screening campaign in the Eastern Province of Saudi Arabia, and examine its association with lifestyle factors.
Research Design and Methods:
In 2004, all Saudi residents in the Eastern Province, aged 30 years and above were invited to participate in a screening campaign for the early detection of diabetes and hypertension. Blood pressure was recorded by trained nurses using a mercury sphygmomanometer, based on the recommendations of (JNC- VII). A positive screening test for hypertension was defined as systolic and/or diastolic blood pressure of ≥ 140 and 90 mm Hg, respectively. Subjects who had positive screening tests were asked to come on the following day for a confirmation of the reading. Hypertension was considered if there was a persistent reading of systolic and/or diastolic blood pressure of ≥ 140 and 90 mmHg after confirmation, or when there was history of a previous diagnosis.
21% of the sample was positive from previous history or screening. After confirmation, the prevalence of hypertension dropped to 15.6%, pre-hypertension was 3.7%, whereas the prevalence of undiagnosed hypertension was 2.8%. The prevalence rose with age. It was higher in women than in men of all age groups and in all sectors of the eastern province, although the mean systolic and diastolic BP was higher in men than women. It was higher with lower education, in widows and divorcees than others (P<0.0001).
The yield of the screening for abnormal blood pressure was high. Systematic follow-up of subjects with abnormal screening results is vital.
Hypertension; Screening; Saudi Arabia
Apart from having a negative impact on work flow in practice, prescription errors may pose a threat to patient safety. Such errors have been reported in the pharmaceutical services in spite of the clear guidelines issued by the parent organization.
This study was to explore the degree of conformity to the prescribing guidelines at Primary Care level in the Saudi National Guard Health Affairs in Riyadh.
Prescriptions were collected during audits done fortnightly through a simple random selection from a sampling frame of all prescriptions given within the period. Information about each prescription was entered in a database by the pharmacists and each prescription was classified according to its conformity to the guidelines. Information was presented on 330 prescriptions for eleven audits carried out from September 2004 to February 2005.
87% of the prescriptions did not conform to the given guidelines. Less than 1% of the inconsistencies were potentially harmful to the patient, 77.8% had possible negative effect on the pharmacist's work, while 21.3% were unimportant. Patient information was deficient in 16.9% of cases, drug information in 49.6% and archiving/record information related non-conformities constituted 33.5%.
Conformity to prescribing guidelines is quite low in spite of the significant input of resources by the parent organization. This burden on work flow, utilization of time and service delivery needs to be studied and addressed by ensuring that there are periodic audits in the work routines of primary health care, and a feedback given to the care providers.
Prescription; prescribing; general practitioner; primary health care; pharmacy; non-conformity; audits
This study was designed to assess various dietary factors and the nutritional status of hospitalized patients with colorectal cancer.
Materials and Methods:
A case-controlled study of fifty newly-admitted patients at King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia diagnosed with colorectal cancer were interviewed to collect data on various dietary factors and their nutritional status. Their data were compared with a sex-matched control group aged fifty.
The consumption of meat high in fat, fried eggs and whole fat dairy products, and diet low in fibers 2-3 times or above per week increased the risk of colorectal cancer, while the consumption of whole wheat products, vegetables and fruits, and diet low in animal fats at the same rate per week may play a protective role against colorectal cancer in both men and women when compared to controls.
The higher consumption of meat and fat from animal sources could increase the risk of colorectal cancer. The high consumption of whole wheat bread, fruits and vegetables with high fiber content could play a protective role against the risk of colorectal cancer in the Saudi society. Additional studies are needed in different regions of the Kingdom of Saudi Arabia to verify or refute these results.
Colorectal cancer; life style; diet; nutrition; case-control study
The aim of this study was to determine the incidence of singleton preterm breech babies born in a teaching hospital, and to study the influence of the mode of delivery on perinatal outcome in preterm births with breech presentation.
A retrospective analysis from the medical records of patients who had preterm singleton breech delivery (24 – 36 weeks gestation) was undertaken in a tertiary care hospital in the Eastern province of Saudi Arabia between January 1992 and December 2001. All the patients with intrauterine fetal death, multiple pregnancies and lethal congenital fetal malformations were excluded from the study. Intrapartum and neonatal morbidity and mortality in vaginal versus cesarean delivery groups were the main outcomes measured.
Of 24,708 deliveries that occurred in the hospital during the period of study, there were 195 preterm singleton breech deliveries, giving an incidence of 0.08%. One hundred and forty-eight (75.9%) patients delivered vaginally and did not have any medical or obstetric complications. Forty-seven (24.1%) patients underwent caesarean section. While the neonatal morbidity was similar in the two groups, the neonatal mortality was significantly higher for vaginal delivery than cesarean section (p<0.00069).
In view of the significantly higher neonatal mortality found in vaginal delivery, the present study favors abdominal delivery for a singleton preterm breech fetus.
Breech presentation; premature breech delivery; caesarean section for preterm breech; neonatal mortality
Psychosocial problems are common health concerns in children. Therefore, it is essential for pediatricians to be able to identify psychiatric disorders. This depends on the knowledge, practice and attitudes towards psychiatric disorders in childhood.
A constructed questionnaire of items about knowledge, practice and attitudes of pediatricians toward psychiatric disorders in childhood was used. Four hundred and fifty questionnaires were distributed and collected from pediatricians in seven main governmental hospitals in Riyadh over a period of three months (between March 1 and May 30 2005). Findings were analyzed statistically.
About 88.8% of the samples had not had any training in child psychiatry during their residency. Forty-eight percent were hesitant in diagnosing psychiatric disorders in children, 76.5% were not confident enough to treat these children, 48.5% were not confident enough to follow them up after being managed by a child psychiatrist and 49.9% were not confident to treat common side effects of psychotropic medications. About 88.8% of the pediatricians thought that pediatricians needed training in child psychiatry during pediatric residency programs.
A significant number of pediatricians reported a lack of training in child psychiatry during residency programs. This has an adverse impact on their knowledge, attitudes and possibly practices in dealing with childhood psychiatric disorders.
Knowledge; Attitudes; Child; Psychiatric disorder
To find out the level of knowledge and vaccination status of some expatriate ethnic groups of blue color workers.
Hepatitis B (HBV) infection is relatively common throughout the world, but more prevalent in low socioeconomic and underprivileged classes. The chronic infection may lead to severe consequences including Hepatocellular carcinoma (HCC).
A cross-sectional, community-based survey of some ethnic expatriate groups of blue color workers (n=665) living in four main areas along the Northern Borders of Saudi Arabia was completed in 2005. We examined knowledge of HBV and vaccination status and compared them with some socio-demographic factors.
The mean age of the participants was 45.61 years (±8.44), 53% of whom were Non-Arabs (Non Arabic speaking). Of the total, 41.6% gave seven or more correct answers out of 12 questions addressing knowledge about the transmission and sequelae of HBV. Almost 40% of the respondents had not been vaccinated while the remaining respondents had had three full doses of vaccination. A high level of knowledge (≥ 7 correct answers) was significantly associated (p<0.05) with higher level of education, vaccination status, ethnic groups, occupation, age, marital status, and the time spent in Saudi Arabia. Income and type of accommodation were not associated (p>0.05) with level of knowledge. However, vaccination status was associated (p<0.05) with almost all socio-demographic factors.
Hepatitis screening programs for expatriates in the Kingdom of Saudi Arabia started 10 years ago and are expected to have a great impact on the combat against HBV infections and their complications. However, beyond screening, health promotion, vaccination campaigns, and access to vaccine for the underprivileged classes are some necessary measures towards achieving success.
Hepatitis B virus; vaccination status; expatriates; blue color workers
Student admission into the College of Medicine at King Saud University (KSU) is dependent on the achievement of a grade point average (GPA) of ≥3.5 /5 by the end of the premedical year. This study was undertaken to ascertain whether pre-selected medical students who achieve a relatively low GPA (≤3.75/5) in the premedical year are at risk of having academic difficulties in subsequent years.
A cross-sectional study of all students admitted to the College of Medicine at KSU during 5 academic years (1994 to 1998) was conducted in 2004. The likelihood of completing the program by 2004 and the dropout frequency were compared in the two groups based on their GPA in the premedical year: High GPA (>3.75) and Low GPA (≤3.75).
During the study period, 739 students were admitted to the college. Of these, 619 (84%) were in High GPA group, and 120 (16%) in the Low GPA group. Of the students with High GPA, 545 (88%) out of 619 graduated compared with 79 (66%) of 120 in the Low GPA group (OR 3.822 [95% CI: 2.44, 5.99]: P<0.0001). Overall, 28 students (3.8%) dropped out, but there was a significantly greater frequency of dropping out in the Low GPA group (10/120; 8.3%) compared with the High GPA group (18/619; 2.9%: OR 3.035 [95% CI: 1.37, 6.75], P=0.01).
Our results support the prerequisite of a minimum GPA in the premedical year before proceeding to the higher levels. The GPA of premedical year is a useful predictor of students who need close monitoring and academic support. The use of GPA in the premedical year for admission into medical colleges should help optimize the use of resources and reduce student wastage.
Medical student selection; GPA; Pre-medical year; drop-out; academic performance
Congenital mesoblastic nephroma (CMN) is a rare renal tumor. It can be detected antenatally especially with judicious use of ultrasonography.
A premature female neonate 28 weeks’ gestation, complicated by polyhydramnios, was born to a 28-year-old woman. An abdominal mass was detected antenatally. At the end of the first week of life, the newborn had hypertension that was controlled by hydralazine. Ultrasonography and CT scan showed a right-sided renal heterogeneous solid mass. Right nephrectomy was performed and the histology showed CMN.
Congenital mesoblastic nephroma; Polyhydramnios; Neonatal hypertension
This paper takes a public health approach to briefly examine: (i) the concept of community health care need assessment; (ii) the roles of academic institutions in health needs assessment; (iii) Jazan study to address the health care needs in Jazan region, Saudi Arabia. The methods included an analysis of the literature, distillation of experience from the recently Jazan Health Need Assessment Survey, and WHO reports. The most important perceived health problems in Jazan region are shortage of health care providers, increased prevalence of communicable diseases and poor environmental health. The academic institutions, Ministry of Health and other health care institutions need to work together to look for innovative approaches, especially to increase the awareness of the society on public health issues, and give more support to increase national and regional funding for community based studies.
The findings of the assessment of the health needs of Jazan presented in this review could be utilized as a baseline and reference information for policy formulation, subsequent planning and cost effective intervention programs. It could also be utilized for the curriculum development or review for a community oriented medical schools.
Health Needs; Assessment; Jazan
Psychosocial problems are highly prevalent among children and adolescents. One approach to facilitating recognition and referral of these problems is to use parent-completed screening questionnaire as part of routine primary care.
Aim and methods:
The purpose of this study was to determine the prevalence and type of psychosocial problems in a random sample of children attending the pediatric clinic at KKUH at the time of the study. A 2-part questionnaire was designed for the study. The first part contained basic biographic data in addition to items which reflect the socioeconomic status of the family. The second part of the questionnaire comprised the inventory, which is a modified version of the Pediatric Symptoms Checklist (PSC).The inventory consisted of 38 items classified into five categories. The total score of the inventory ranged from 0-114.
Three-hundred-twelve questionnaires were completed. The average of the total score was only 22.3 out of 114. The lowest score was 0 and the highest 84. The average scores of behavioral symptoms (BS) were the highest (7.03 out of 27) while that of the learning problems (LP) was the lowest (1.5 out of 18). The average score for mood symptoms (MS) was 5.6 out of 24, that for personality characteristics (PC) was 4.5 out of 24 and that for somatic symptoms (SS) was 4.3 out of 24.
This study revealed the feasibility of screening for behavioral problems of children in an outpatient setting. It is necessary to implement screening procedures for psycho-behavioral problems, and train pediatricians to screen children presenting at clinics.
psychosocial problems; children; pediatric clinic; pediatric psychosocial symptom inventory (PEPSI)
To determine the prevalence of psychological disorders and somatization among primary care patients from a semi-urban area of the Kingdom of Saudi Arabia.
Screening of consecutive patients with the 12-item and 28-item versions of the General Health Questionnaires and assessments of physical symptoms associated with somatization, using the HSCL-12. Eight primary care health centres in Assir, Saudi Arabia.
About half of the sample had one or more psychological disorders. The prevalence of somatization detected by the GHQ-28 was 16%. The prevalence of somatization indicated by GPs’ identification of medically unexplained symptoms was 14%. Women displayed higher levels of somatization than men.
This study reported prevalence of psychological disorders that was as high as found in the more modern areas of Saudi Arabia such as Riyadh. The view that individuals in less open areas are protected from psychological disorders associated with stress and lifestyle pressure seems to be unsubstantiated. The results highlight the potential value of screening for psychological disorders using such simple instruments as the GHQ
Psychological disorders; somatization; primary health care; Saudi Arabia
The consumption of the stimulant leaf Khat (Catha edulis Forsk) is widespread in several countries of East Africa and the Arabian Peninsula. The leaf comes from a small evergreen shrub that can grow to the size of a tree. Young buds and tender leaves are chewed to attain a state of euphoria and stimulation. Khat leaves contain cathinones, an active brain stimulant that is similar in structure and pharmacological activity to amphetamines. Like amphetamines, Khat ingestion in low doses results in decreased appetite, euphoria, increased intellectual efficiency, and hyperalertness.
High doses and chronic use of Khat can cause more serious adverse neurological, psychiatric, cardiovascular, dental, gastrointestinal and genitourinary effects. Besides damaging health, Khat has adverse socio-economic consequences effects on many other aspects of life including the loss of thousands of acres of arable land and billions of hours of work.
The purpose of this review is to describe briefly the adverse consequences of habitual chewing of Khat on health, and help educate the general public. The study is based on literature review that includes internet search and journals.
Khat; Health; Social; economy; Saudi Arabia
To explore parental attitudes towards the prescription of psychotropic medication for their children.
A questionnaire built to collect socio-demographic data of parents and their attitudes was distributed among parents.
One thousand and ten questionnaires were filled by parents. Fathers who completed the questionnaire were double the number of mothers. Eight hundred and eighteen parents (84.3%) agreed to the dispensing psychotropic medication to their children if necessary. About 83.5% preferred to start with psychotherapy before trying medication. Fathers are more than twice likely than mothers to agree to the use of psychotropic drugs. Older parents more easily agreed to give their children psychotropic drugs. Parents who used psychotropic drug themselves were more likely to agree to the use of psychotropic drug by their children. Having a child with a psychiatric illness is the most significant factor in making parents accede to giving children psychotropic medication. Other factors such as pressure from schools and the side effects of drugs could also modify decision of parents.
Although most parents agreed to give their children psychotropic drugs if necessary, they preferred to start with psychotherapy sessions before giving them the drugs. Fear and worries about such issues as side effects of drugs or addiction should be considered. Pressure from school should also be considered when deciding on drug therapy.
Parents; children; attitudes; psychotropic medication
Death certification is a vital source of information used in mortality statistics worldwide to assess the health of the general population. This study focuses on the consistency of information between the death reports and the clinical records (files) of deceased patients in two hospitals: the King Khalid University Hospital (KKUH) and King Fahad National Guard hospital (KFNGH) in Saudi Arabia.
A random sample of the records of 157 deceased patients’ registered in 2002 in the two hospitals was retrospectively reviewed independently to determine the underlying cause of death and compare them with death reports. It was also to check the accuracy of the translation from English in to Arabic.
It was found that the underlying cause of death was misdiagnosed in 80.3% of the death reports. When the two hospitals were compared, no significant difference was observed (p>0.05). In addition, 81.8% of the accurate (correct) death reports in both hospitals were of patients who had died of a malignant disease. However, the translation of the underlying cause of death in KFNGH was correct in 86.1% of the death reports, while in KKUH it was only 25%, which is highly statistically significant (p<0.0001).
With the limitation of studying only a small number of cases, these results indicate a discrepancy between the file and death reports in relation to the cause of death. Also, the translation of the cause of death was inconsistent in the two hospitals. Hence, there is a real need to adopt suitable measures to improve the quality of death certification.
Death certification; Accuracy; Assessment & Death reports