To measure changes in the attitude of Primary Health Care (PHC) physicians towards mental illnesses after a short-term training course. In addition, to ascertain if this change would persist 6 months after the training course.
This is an intervention type study. Out of 296 PHC physicians working in Eastern Saudi Arabia, 191 were randomly selected and divided randomly into two groups. The Study groups were tested for pre and post exposure (immediate and 6months later), to the psychiatric training course. The Control group was not involved in the intervention. The course was run over a 4-day period in June 1999. A 26-item self-administered questionnaire to assess the PHC physicians’ attitudes was used.
The study group consisted of 45 trainees, 24 (53%) of whom were men. The control group, 121 out of 166 physicians, responded to the questionnaire, with an 83% response rate, men forming 49%. The data analysis indicated a significant improvement in the PHC physicians’ attitude after the course (P<0.0001). Six months later, as compared with their immediate post-test, the positive attitudes persisted within the study group (p-value=0.274). Multiple regressions indicated that the duration of undergraduate psychiatric training was the only contributor factor.
This training course resulted in a positive change in the trainees’ attitudes. Besides, it showed that the undergraduate psychiatric training had a favourable effect on the PHC physicians’ attitude. Therefore, there should be frequent mental health training programs for PHC physicians. Moreover, physicians who spent longer period in undergraduate psychiatric training should be given the priority to work in PHC settings.
Mental illness; training course; evaluation; attitude; PHC physicians; Saudi Arabia
To investigate the prevalence of possible hearing impairment and hypertension in long distance bus drivers compared to the city bus drivers in Abha city.
This was a cross-sectional study involving 62 long distance bus drivers and 46 city bus drivers from October 2001 to March 2002. A specially-designed questionnaire was administered to the drivers to explore some of their socioeconomic backgrounds. A pure tone air conduction audiometry and blood pressure measurements were performed.
Long distance bus drivers’ workload is significantly higher than that of city drivers (total weekly hours 64.0±14.3 compared to 46.7±5.5). Hearing impairment was significantly more among long distance drivers in the frequencies of 250, 500, 1000 and 2000 Hz especially in the left ear even after age corrections. The prevalence of mild hearing loss and hypertension were also higher among the long distance drivers (19.4% vs 4.5% and 38.7% vs 13% respectively).
Conclusion and recommendations:
This study showed more hearing affection and a higher prevalence of hypertension among long distance bus drivers than their counterparts operating in the city. Their hearing acuity should be tested before they start work and regularly afterwards. The stresses and strains of the job should be further studied and relieved; and regular health checks including blood pressure monitoring are to be instituted.
Hearing impairment; workload; hypertension; bus drivers
Faith healers usually offer unorthodox therapies to their clients who present with an array of physical and psychological symptoms suggestive of the evil eye, jinn possession, and magic.
This exploratory pilot study aims to analyse the pattern of narrated symptoms and treatments given by faith healers practising in the Al-Qassim region, Saudi Arabia.
Forty five faith healers who consented to this study were given a predesigned, self-administered, semistructured questionnaire to collect the relevant data.
Notably, most faith healers have a poor repertoire of psychiatric symptoms, which could not specifically differentiate the three spiritual disorders. They tend to recommend an array of therapies rooted in religious concepts for the treatment of their clients who, they claim, show substantial improvement in their mental suffering.
The revealed symptomatology of each disorder alone may not be specific but it certainly helps them not only to identify these disorders but also to prescribe unconventional therapies. Future research should look systematically into the diagnostic and treatment methods for these disorders.
Faith healers; spiritual disorders; unorthodox therapies; jinn possession; evil eye; magic
To monitor the progress in the practice of early breastfeeding of newborn babies within half an hour to one hour after delivery, and to identify the reasons for not breastfeeding the babies in the labor room.
Patients and methods:
This is a descriptive study conducted in the labor and delivery rooms of King Khalid University Hospital during the months(5) of Jumada I and (11) Dhulqada 1422H. A total of 602 women were included in the study. A structured form was used to assess the extent of feeding and the reasons for not breastfeeding in the first ½ to 1 hour after birth. The frequency and the percentage were used to compare the data.
It was encouraging to find that 60% of the women breastfed their babies within ½ an hour to 1 hour after birth. Of the reasons for not breastfeeding the babies early, two were of the greatest concern. The first is that 13% of the women were either too tired to breastfeed or refused to do so at this early stage. Secondly, the majority of the mothers who had had cesarean sections did not breastfeed their babies.
Mothers and their families play a very vital role in building the health of the nation. This can be achieved by early breastfeeding, which contributes to the rearing of healthy babies, increase in intelligence and the building of strong future generations. The health care professional must have continuous education and be frequently updated on breastfeeding standards.
Breastfeeding; newborn; King Khalid University Hospital; labor room
Evidence based medicine (EBM) considered one of the most important developments in the practice of medicine in recent years, has evolved as a tool for improving the quality of health care. Several studies have shown EBM to be safe and cost-effective. Physicians have welcomed EBM and shown a positive attitude toward it and have expressed desire to learn more about it. This is consistent in most studies done in different countries. However, some studies found considerable misunderstanding about terms and websites used in EBM. The major barriers to the practice of EBM perceived by physician in different studies include insufficient time and evidence, patients’ preference and financial constraints. Training has been found to be conducive to the implementation and promotion of EBM. Some Arab countries are already implementing EBM and plan to include it in the undergraduate curriculum. In Saudi Arabia EBM was introduced in the late 90's and a National EBM Advisory Board was formed.
Evidence based medicine; Physician; Practice; Attitude; Barriers
A follow-up study, to compare the short-term outcome of preterms, in two hospitals in Al Qassim region, Saudi Arabia.
Preterms admitted in two hospitals, 47 in hospital A and 36 in hospital B, were followed from admission until one month after discharge. Preterms were compared on gestational age, birth weight, birth head circumference and length of stay. Outcome measures were weight gain per day, feeding patterns on discharge and feeding patterns one month after discharge compared with the feeding of normal infants (200 infants) at the age of 6 weeks.
No difference was found between the two hospitals on admission in gestational age, mean birth weight, birth head circumference and length of stay. Mean weight gain per day was significantly higher in hospital A, 9.56 (± 19.7) gm, compared to 1.22 (± 29.47) gm in hospital B. (P=0.049). But the proportion of exclusive breast fed infants, one month after discharge was higher in hospital B, 37.5% compared to 13.2% in hospital A. (p=0.0224).
Our study showed that there is a clear hospital level difference in the same region, in the short-term outcome. This emphasizes that outcome should be continuously followed and that differences should be evaluated in perinatal audit procedure.
Preterm; breastfeeding; weight; Saudi
Teachers are at the risk of developing minor psychiatric morbidity (MPM) because of the stressfulness of their job. This may lead to a significant decrease in their teaching effectiveness and to the development of serious health problems, if not detected early and managed appropriately. The objectives of this study were to determine the prevalence of MPM among female teachers in girls’ secondary schools in Tabuk, and to analyze certain important associated demographic characteristics.
This was a cross-sectional study. First, a proportional cluster sample was selected randomly from the three sectors of schools in Tabuk, from which female teachers (198 out of a total of 517) in the selected schools were included in the study. Data on MPM and demographic characteristics were collected by means of the General Health Questionnaire 30 (GHQ30), a validated and extensively used instrument for identifying MPM
Out of 198 participants, 187 completed the GHQ30 giving a response rate of 94.4%. The prevalence of MPM among them was 59.4% (111 participants). The variables with a statistically significant association with MPM were as follows: young age, nationality, positive participant psychiatric history, family history of medical and/or psychiatric problems, and divorced and widowed. No statistically significant associations were found with participants’ medical problems or their mental status, either single or married, housing type, monthly income, the number of children in a family, and the number of family members.
The finding of a high prevalence of MPM (59.4%) indicates that all participants may be at risk. Hence, appropriate and timely management, as well as social support are needed. Studies focusing on the causes and how to manage them will also be required.
Minor psychiatric morbidity; female teachers’ stress; GHQ – 30;
To study the clinical, EEG and CT profile in a hospital population of adolescents with newly diagnosed recurrent seizures.
The clinical profiles obtained from history including detailed descriptions of the seizures, examination, electroencephalographic (EEG) and computed tomography (CT) findings were recorded prospectively for all 14 to18-year-old patients who were referred to the electrodiagnostic service at King Fahd Hospital of the University, Al- Khobar, Eastern Province, Saudi Arabia from 1st January 1996 to 31st December 1997. The data were entered into a standard dbase file and analyzed using a personal computer. The results were compared with 2 previous concomitant subsets of data obtained from 263 children ≤13 years (72%) and 73 adults > 18 years (20%) over the same study period.
Twenty-nine patients (14 males and 15 females, a mean age of 15.7 years) with newly diagnosed recurrent seizures were studied. A positive family history of seizures was found in 10.3%. The main seizure types were partial in 11 (37.9%), partial with secondary generalization in 6 (20.7%) and generalized in 12 (41.4%). The types of epileptic syndromes included localization-related 15 (51.7%), generalized 12 (41.4%) and undetermined 2 (16.9%). The EEG was abnormal in 21 (72.4%) with epileptiform activity, focal in 11 (52.4%), generalized in 9 (42.8%) and none-epileptiform activity in 1 (4.8%). The cranial CT findings were normal in 21 patients (72.4%) and abnormal in 8 (27.6%) patients, with focal lesions in 6 (75%) and generalized cerebral atrophy in 2 (25%). The frequency of adolescents presenting with newly-diagnosed seizures was 8% of the total study population of 365 patients including children and adults.
The results showed that partial and partial with secondary generalization seizures and the localization-related epileptic syndrome are the most frequent seizure and epileptic syndrome types in adolescents. The least frequent of newly diagnosed seizures in adolescents compared to children and adults confirms the bimodality of peak frequency in the young and old that has been observed in the west.
seizures; epilepsy; EEG; computed tomography; Saudi Arabia
Depressive disorders are common in Psychiatry Outpatient Clinics.
All new patients attending the Psychiatry Clinics at King Fahd Hospital of the University (KFHU), in the Eastern Province were included in the study.
To investigate the frequency and pattern of depressive disorders among Psychiatric Out-patients attendees in the KFHU.
A semi-structured psychiatric interview and clinical mental state examination were used in the assessment of all consecutive new patients attending the clinic during the study period. The Psychiatric diagnoses were made according to the 10th Edition of International Classification of Mental and Behavioral Disorders (ICD-10).
The frequency of depressive disorders was 19.3%. The majority of the patients were between 20-49 years of age and females predominated in the ratio of 1.7:1. Almost 70% were formally unemployed (including 66 housewives). Depressive disorder of the moderate nature was the commonest.
Depressive disorders are common in Psychiatry outpatients. The socio-demographic characteristics of depressive disorder in the Kingdom of Saudi Arabia are similar to those abroad in many respects.
Frequency; Pattern; Depression; Saudi teaching hospital
This study estimates the prevalence of obesity among Type 2 diabetic patients who are followed in mini clinics (hypertension, diabetes) in Primary Health Care Centers (PHCC) in Al-Khobar.
Retrospective study reviewing all diabetic patient files registered in PHC centers in the Al- Khobar area from May 2000 to October 2001.
Of the 382 diabetic patients followed in PHC, 88.7% were type 2 diabetics, and according to WHO classification of obesity 0.7% were underweight. Only 21.8% of type 2 diabetic patients were in their ideal range of body weight. While 31.2% were overweight (BMI in the range of 25.0-29.9 kg/m2), 39.9% of the type 2 diabetic patients were found to be obese (BMI= 30 - 39.9 kg / m2), and 6.3% had morbid obesity (BMI ≥ 40 kg / m2).
High prevalence of overweight and obesity in type 2 diabetics is associated with other serious complications. This study emphasizes the importance of training health care providers for the proper follow-up of patients.
Type 2 diabetes; obesity; primary care
Hypothyroidism is a common endocrine disorder with characteristic clinical symptoms and signs. Typical symptoms of hypothyroidism are lethargy, cold intolerance, slowing of intellectual and motor activity, decreased appetite, weight gain, and dry skin. A 39-year-old female presented to the clinic with dysarthria as the chief symptom. Subsequent questions revealed that other symptoms were confined to the otolaryngeal region, which were episodes of mild dysphonia, dysphagia, sleep apnea, and snoring. Laboratory data revealed marked hypothyroidism and positive tests for antithyroglobulin and antimicrosomal antibodies. After administration of thyroxin, the dysarthria and the other symptoms rapidly disappeared. Dysarthria may be the presenting symptom of hypothyroidism and can be resolved after hormone replacement therapy.
(1) To study the patterns of breastfeeding of last children, duration, factors and reasons for it. (2) To study the factors affecting breastfeeding among mothers who are breastfeeding and the reasons for continuing or failure to continue, at the primary health care centers (PHC) in Riyadh.
A cross-sectional study was conducted by distributing 1000 questionnaires in 10 PHC centers. The breastfeeding practices were categorized on WHO terms.
Most of the studied last children (95.1%) were breastfed. Exclusive breastfeeding rate from birth was 62.9%, for up to four months was 13.2% and for six months was 3.3% . The mixed breastfeeding rate from birth was 32.2%, up to age of four months was 53.1% and for children more than six months old it was 20.3%. The mean age of the introduction of solid food was 4.6 ±1.4 months. Artificial feeding rate was 4.9% at birth , 30.3% up to four months and 49.7% for children more than six months old. The most frequent reason for the continuation of breastfeeding was Quranic instruction (55.1%) and its failure was inadequate milk (60.8%). The exclusive breastfeeding and the duration of breastfeeding had statistically significant association with the mothers’ residence, marital status, number of children alive, occupation and the level of education. In addition, there was significant association of exclusive breastfeeding and the non-introduction of artificial feeding at the hospital but not with health education on breastfeeding at the centers .
To promote the education of mothers on breastfeeding, promote the training of PHC center health professionals and modify the policy of hospitals in the Kingdom on the feeding of newborns.
Breastfeeding; exclusive; duration; continuing
To find out the level of health awareness related to pregnancy and the sources of information among parous women visiting the Primary Health Centers in Al- Khobar.
This is a cross-sectional study conducted at three Primary Health Centers in Al-Khobar during a two-week period in April 2001. Five hundred and eighty one parous women who were eligible for the study were interviewed with the help of a questionnaire.
A large proportion of the women were well informed about certain health issues of pregnancy such as dietary intake of essential foods like dairy products (74.7%), Protein-rich foods (71.4%) and fruits (68.2%), the hours of daily rest necessary (81.9%), the need for exercise (83.6%), the importance and timing of antenatal visits, the risk of smoking in pregnancy (99.3%) and proper spacing of babies (97.7%). However, many women had no knowledge of the importance of taking high-fiber foods (55.1%) to avoid constipation, the required dietary changes in early pregnancy to prevent nausea and vomiting, and the ill-effects of maternal smoking on the fetus, Rubella infection and advancing maternal age on the fetus. They were also not aware of the importance of the various antenatal procedures such as blood examination, breast-care during pregnancy and immunizations to prevent Tetanus and Rubella infection. A higher literacy level of the women was significantly correlated with better knowledge on certain health parameters. Physicians and nurses constituted poor sources of health information (35.6%).
There is a need to restructure the Health Education programmes relating to pregnancy delivered through PHCs and the mass media for better knowledge among women of childbearing age can decrease pregnancy-related problems and improve perinatal outcome.
Health education; Pregnancy; health knowledge
To explore patient's expectations before consulting their general practitioners (GPs) and determine the factors that influence them.
A cross sectional survey was carried out in five primary care centers representing different areas of Riyadh city, Saudi Arabia using a self-administered questionnaire distributed to patients before consulting general practitioners. A sample of 944 Saudi patients was randomly selected.
74.6% preferred Saudi doctors, and 92.6% would like to have more laboratory tests for the diagnosis of their illnesses. More than two third of the patients (78.0%) felt entirely comfortable when talking with GPs about the personal aspects of their problems. About half thought that the role of GP was mainly to refer patients to specialists, while 55.2% believed that the GP cannot deal with the psychosocial aspect of organic diseases. The commonest reason for consulting GPs was for a general check up.
The GP has to explore patients’ expectations so that they can either be met or their impracticality explained. GPs should search for patient's motives and reconcile this with their own practice. GP should be trained to play the standard role of Primary Care Physician.
Patients’ expectation; communication skills; general practice; Saudi Arabia
Stool analysis plays an important role in pre-employment tests for the screening of intestinal parasites in new workers.
to explore the spectrum of intestinal parasites in stool samples of workers and their families during the pre-employment tests over a one-year period at King Abdulaziz University Hospital (KAUH).
Subjects were selected sequentially from routine single stool analysis forms labeled for pre-employment tests. Stool specimens were examined using the formalin ether technique at the parasitology laboratory at KAUH.
Two hundred and ninety two different stool samples of the workers and their families were studied. Their ages ranged from 3 to 72 year old (mean 32 ± 8.5 SD) and females formed 58.6% of the number. Intestinal parasites were detected in 161 workers (55%). The prevalence of intestinal parasites in Saudi workers was significantly lower than non-Saudi nationals, 15.8% versus 57.9% (p<0.001). Of all the positive cases, pathogenic intestinal parasites were found in 40 % of them and the commonest were Trichuris trichuria (39.1%), Hookworm (34.2%), Entamoeba histolytica (16.1%). Non-pathogenic parasites were found in 19.5% and the commonest were Blastocystis hominis (34.8%), Endolimax nana (29.8%), Entamoeba coli (15.5%). One type of parasite was found in 75 (46.6%) and multiple different parasites were found in 86 (53.4%). There was a high significant correlation between the detection of pathogenic and non-pathogenic parasites (p<0.001).
Infestation of stools with pathogenic and non-pathogenic intestinal parasites is a common finding in more than half of the new workers and their families. The correlation between non-pathogenic and pathogenic parasites reflects mutual risk factors, and their potential hazards cannot be overlooked. Effective stool screening and eradication strategies for intestinal parasites in new workers should be rigorously enforced.
Pathogenic intestinal parasites; nonpathogenic parasites; pre-employment; stool analysis
This study was to review the common and unusual symptoms of hypothyroidism.
A retrospective study was done of forty thousand patients attending Sultan Qaboos University Health Center (SQU), within a period of three years. Sixty-three patients proved to have either clinical or subclinical hypothyroidism and were screened for the different symptoms & signs of hypothyroidism.
The well-known symptoms and signs of hypothyroidism reported in the medical textbooks were uncommon in this study. Symptoms such as dysarthria and dysphagia not usually mentioned in the medical textbooks were reported.
Early diagnosis by screening both middle-aged as well as older patients is advantageous.
The objective of this study was to assess the satisfaction of tourists who utilized health care services of five selected primary health care centers in Abha, Aseer region of Saudi Arabia in the summer of the year 2000.
This study was conducted during July of 2000 in five primary health care centers (PHCCs) in Aseer region, Saudi Arabia. Self-administered questionnaire designed by the investigators was distributed to all tourists who fulfilled the following criteria: aged above 15 years, can read and write and has intent on participating voluntarily. The questionnaire concerned satisfaction with different health care services delivered by the PHCCs and suggestions for the improvement of the services. Data was entered and analyzed using SPSS.
A total of 413 tourists fulfilled the selected criteria. The mean age of the participants was 29.2 years; 81.4% were males, 37.3% were highly educated and 32.7% came from western province. PHCCs services were accessible to 87% and the working hours at PHCCs were suitable for 88.6% of the tourists. More than three-quarters of the visitors came for cure. Satisfaction with the different health services on a 5-point scale ranged from 4.63 points for availability of medications to 4.85 points for cooperation of treating doctors. Seventeen suggestions and comments were reported by 26% of the participants. Most of these suggestions and comments were about providing an adequate number of female doctors and medications.
This study revealed that most of the tourists who utilized the selected PHCCs in Aseer region were satisfied with most of the different PHCCs services. However, many tourists gave valid suggestions and comments which should be considered for the improvement of the quality of care in these PHCCs in the future.
Satisfaction; tourists; PHCCs; Aseer Region
The recognition that information and communication technologies should play an increasingly important role in medical education is a key to educating physicians in the 21st century. Computer use in medical education includes, Internet hypermedia/multimedia technologies, medical informatics, distance learning and telemedicine. Adaptation to the use of these technologies should ideally start from the elementary school level. Medical schools must introduce medical informatics courses very early in the medical curriculum. Teachers will need regular CME courses to prepare and update themselves with the changing circumstances. Our infrastructure must be prepared for the new developments with computer labs, basic skill labs, close circuit television facilities, virtual class rooms, smart class rooms, simulated teaching facilities, and distance teaching by tele-techniques. Our existing manpower including, doctors, nurses, technicians, librarians, and administration personal require hands-on training, while new recruitment will have to emphasize compulsory knowledge of and familiarity with information technology. This paper highlights these subjects in detail as a means to prepare us to meet the challenges of the 21st century.
Medical education; communication; technologies; medical informatics; distance learning; telemedicine