Asthma is a common disease that is sometimes fatal. Its prevalence, morbidity and mortality are increasing. The objective of this paper was to evaluate the proficiency of primary care physicians in general knowledge, diagnosis, classification of severity and management of asthma along the guidelines of the Saudi National Asthma Protocol, and to analyze the association of their proficiency level with certain professional standards.
This was a cross-sectional study conducted in the Department of Family Medicine and the Main Air Base Clinic at the North-West Armed Forces Hospital in Tabuk City, Saudi Arabia from the 1st to the 29th of June 2001. All 44 primary care physicians working there at the time were enrolled in the study. A self-administered true/false questionnaire prepared by the Saudi National Asthma Scientific Committee was completed by all physicians. The Passing score was ≥ 50%.
Only 39% of the physicians passed the test as a whole, with 66% passed in general knowledge, 70% in diagnosis, 48% in the classification of severity and 59% in the management of asthma. There was an association between significant achievement and Family Medicine Board Certification as well as some knowledge of the National Asthma Protocol (p ≥ 0.05). No association was observed with attendance of asthma training courses. There was positive significant correlation between the knowledge score, the management scores and the total scores of physicians.
The level of awareness of the National Asthma Protocol among the primary care physicians was low (52%). Their proficiency in general knowledge, diagnosis, classification of severity and management was also low. A higher standard was associated with Family Medicine Board Certification. Further studies to identify the reasons for these deficiencies need to be carried out so that measures could be taken to rectify the situation.
Asthma; Family physicians; National Protocol for Asthma Diagnosis and Management; Evaluation
Knowing patients’ expectation for medication after each consultation is of the utmost importance in designing public education programs on the rational use of drugs.
To determine whether patients in Riyadh, Saudi Arabia, expect drugs after each primary care consultation.
Subjects and Methods:
A sample of 985 Saudi patients aged 15 and above was randomly selected. A cross-sectional survey was carried out at five randomly selected primary care centers, using a self-administered questionnaire distributed to patients before being seen by primary care doctors.
Most patients (87.8%) always expect drug prescriptions. Eighty nine percent (88.9%) had been prescribed drugs in the previous consultation. Sixty six percent (66%) had received 2-3 drugs during their previous consultation. The majority thought it was too much. Seventy percent (70%) took all their prescribed drugs. Patients with intermediate and high school education had the highest compliance rate (32%). Twenty two percent (22%) thought it was always necessary to use a drug for an illness. The level of education of the majority of patients ranged from illiterate to various levels of pre-university education.
Most Saudi patients expect drugs. General and specific health education should be given to both patients and doctors.
Patients’ expectation; Drug prescription; Primary health care; Saudi Arabia
The objectives of this study were to explore the perception of body weight among students in schools in Jeddah City and identify the main determinants of self-perceived obesity, weight management goals and practices.
Material and Methods:
Data were collected from a sample of Saudi school children of 42 boys’ and 42 girls’ schools in Jeddah city during the month of April 2000. Personal interviews were conducted to collect data on socio-demographic factors, food choices, perception of body weight, weight management goals and weight management practices, as well as the actual measurement of weight and height. Students were asked about their perception of their body weight [responses included: very underweight (thin), slightly underweight, about right weight, slightly overweight and grossly overweight (obese)]. Proportion, prevalence and 95% confidence intervals were calculated. Multiple logistic regression models were fitted to calculate the adjusted odds ratio (OR) for an attempt to lose weight and weight management practices.
The distribution of self-perception of body size was nearly similar to the measured body mass index (BMI) classification except for the overweight students, where 21.3% perceived themselves, as slightly overweight and 5.5% as very overweight although 13.4% were actually overweight and 13.5% were obese by BMI standards. Approximately half the students took at least 3 pieces of fruit or fruit juice servings, and a third ate at least 4 vegetable servings per day. A third of the students managed to lose weight. This coincides with the proportion of those actually overweight and obese. Around 28.0% of the students ate less food, fat or calories, 31.0% took exercise and 17.6% were engaged in vigorous exercise to lose weight or prevent weight gain. Staying for at least 24 hours without food which is a potentially harmful means of weight control was practiced by 10.0% of students. Females were less likely than males to be overweight and obese but more likely to perceive themselves as grossly overweight and more likely to try to lose weight. Factors associated with efforts to lose weight by eating less fat or fewer calories were older age, high social class, being actually obese and perceiving oneself as being obese. Staying for at least 24 hours without eating was mainly practiced by females, older age groups, and the actually obese. Exercise was done mainly by the older age groups, those with educated and highly educated mothers, obese and perceiving oneself as being obese. Vigorous exercise was mainly performed by males, younger age groups, taking < 3 pieces of fruit or fruit juice servings per day, eating < 4 vegetable servings per day, and those perceiving themselves as obese.
Overweight and obesity are prevalent among our youth and not all obese have a correct image of their body size. Highly recommended are intervention programs of education on nutrition starting in childhood through school age to promote and ensure healthy food choices, improve student's awareness of ideal body size and clinical obesity, encourage physical exercise but discourage potentially harmful weight control measures.
Overweight; perceived obesity; diet; physical activity; weight management; children; adolescents
To determine the extent of work-related violence against nurses in hospitals in Riyadh.
Materials and methods:
Through a cross sectional approach, a self administered questionnaire was offered to 500 active-duty nurses selected randomly. In addition to the demographic characteristics, the questionnaire inquired about exposure to workplace violence, hospital and department of employment at the time of exposure, characteristics of the assailant and nurses’ perception of the causes of violence.
Out of 434 respondents, 93 (21.4%) were males, and 341 (78.6%) females. The mean age was 36.1 ± 7.97 years. Workplace violence was experienced by 235 (54.3%) nurses. Of these 93.2% were exposed to harsh insulting language, 32.8% to verbal threat, 28.1% to attempts of physical assault, 17.4% to sexual harassment and 16.2% to actual physical assault. Nurses working in psychiatry and emergency units had the highest rate of exposure to violence (84.3% & 62.1% respectively) Nurses perceived shortage in security personnel (82%), shortage in nursing staff (63%), language barrier (36.3%) and unrestricted movement of patients in hospitals (21.5%) as causes of their exposure to violence.
improve security in hospitals by increasing the number of security officers on duty and increase the community's awareness of the problem.
Workplace violence; occupational risk; nursing hazards
This study aims at examining the pattern of psychiatric referrals with particular reference to (1) age and gender (2) source of referrals and (3) diagnosis of referred patients within a teaching hospital
Four hundred and twenty seven referrals (n=427) for psychiatric consultation within KKUH were selected prospectively by systematic randomization over a period of one year, and were compared with a general hospital (n=138) and primary health care (n=402) psychiatric referrals to a mental health facility.
The age of referred patients across the three settings differed significantly and the male patients were slightly over-represented in the teaching hospital referrals. Pediatric clinics in the teaching hospital constituted significant sources of psychiatric referrals as compared to the general hospitals. Schizophrenic disorders and acute psychoses were significantly less among teaching hospital referred patients, whereas anxiety and mood disorders were much more common among teaching hospital and primary care patients. The number of personality disorders diagnosed in teaching hospital settings was significant.
In Saudi Arabia, sources of psychiatric referrals and diagnostic patterns of mental disorders differ across the three levels, and this is comparable to international research on psychiatric referrals. Besides exploring other aspects of referral process, researchers at the three settings should carry out follow-up studies to assess the impact of psychiatric consultations on the global outcome of referred consultees.
Psychiatric referrals; primary care; general hospitals; teaching hospital; diagnostic pattern; psychiatric consultations; referred consultees; mental health facility
To obtain the views of faculty members of the College of Medicine, King Faisal University on Arabization of medical education.
A cross-sectional study was conducted in the College of Medicine, King Faisal University, Dammam, between January and June 2001 using a standardized 41-item questionnaire to obtain the views of faculty members in both basic science and clinical departments on issues relating mainly to scientific research. The responses were recorded on a 5-point scale: strongly agree, agree, undecided, disagree and strongly disagree. A couple of questions were used to probe the issue of publications in Arabic and translations into Arabic.
The response rate of faculty was 67% (74 of a total of 110 faculty members). The participating faculty members included 22 professors, 27 associate professors, 23 assistant professors and 2 lecturers belonging to 24 departments (6 basic sciences, 18 clinical). Thirty- four members (45.9%) were in favor of Arabization and 40 (54%) were against.
Faculty members form the backbone for the implementation of Arabization in medical education. The opinions obtained in this preliminary survey of the faculty of the College of Medicine at King Faisal University indicate that we are still far from achieving this goal in our medical education.
Undergraduate; medical education; Arabization; Saudi Arabia
Training in different specialties should prepare young physicians to assume responsibilities in primary care. Training for the acquisition of the proper attitude for health care, should be given in the course of the training in different specialties.
To assess the attitudes of medical interns who have undergone rotation in the Department of Family and Community Medicine of a large university hospital, towards the provision of primary care.
A cross-sectional study incorporating a structured questionnaire was carried out on a sample of 106 interns; and 20 consultants were selected as a reference group.
All medical interns almost unanimously endorsed continuous, coordinated, accessible and comprehensive care. In contrast, consultants less often supported the provision of such care for their own patients.
Unless consultants change their attitudes towards the attributes of primary care, the quality of patient care as well as physician training would suffer.
Attitudes; Medical Interns; Primary Health Care
This study was carried out to assess the prevalence of Group A Streptococcal (GAS) bacteria in the throat specimens of children with tonsillitis and pharyngitis compared to healthy children of the same age group.
The study was a prospective one. Throat swabs were obtained from 73 children aged 1-12 years diagnosed with acute tonsillitis and pharyngitis (sore throat and pyrexia >38.5°C) visiting a pediatric outpatient clinic between December, 1999 and April, 2000. In the same period throat swabs were obtained from 465 healthy primary school children aged 6-12 years. GAS from patients was tested for sentivity to penicillin, erythromycin, and cefaclor.
In children with tonsillitis and pharyngitis GAS was found in 29 out of 73 (40%). In healthy school children GAS was found in 15 out of 465 (3%).In the patients group GAS was sensitive to penicillin in 14(48%), erythromycin in 27(93%), and cefaclor in 28(96%)
Although the prevalence of GAS among healthy children was similar to international studies, the GAS infection was high among children with acute tonsillitis and pharyngitis. Sensitivity to penicillin was less than 50% and more than 90% for erythromycin and cefaclor. We recommend routine throat swab for children with acute tonsillitis and pharyngitis and the proper treatment of GAS positive patients to prevent further complications.
Group A streptococcus; tonsillitis; pharyngitis; antibiotic sensitivity; healthy; school children; Saudi Arabia
Helicobacter pylori (H. pylori) was identified in dental plaque, raising the possibility of future gastritis and peptic ulceration.
This trial was to study the association between presence of H. pylori in dental plaque and in the stomachs of patients with gastritis; the effect of oral hygiene and periodontal condition on the stomach.
Patients and Methods:
Seventy-five Saudi adult dyspeptic patients, together with 60 healthy persons as control. Two samples of dental plaque were taken from gingival crevice of deepest pocket. One sample was kept in Christensen's urea agar and incubated for H. pylori detection by rapid urease test. The second sample was kept in 5% sheep blood agar, chocolate agar and a selective medium to culture the H. pylori. Gastric urease test was done for the same patients.
(1) Plaque urease test results showed 89% positive patients. (2) Dental plaque Index:- Mild dental plaque accumulation in 24%, moderate in 41%, while severe accumulation was in 35% of the patients. (3) Gingival Index: Showed mild, moderate and severe gingivitis in 17%, 48% and 35% of patients, respectively. (4) Community periodontal index of treatment needs (CPITN): Showed gingivitis, mild periodontitis and moderate periodontitis in 50%, 23% and 27% of patients, respectively. (5)Gastric urease results: 87% of patients were positive. (6)All cultured samples results were negative
The ability to detect H. pylori in dental plaque samples offers a potential for a noninvasive test for gastric infection and would lend support for oral spread of H. pylori as the princi-pal mode of transmission. However, the presence of H. pylori in dental plaque and in the stomach (in gastritis patients) could permit not only a target for therapeutic procedures but also a monitor-ing tool for the efficacy of therapy.
Helicobacter pylori; Dental Plaque; Gastritis; Saudi patients
This study aims to review the clinical pattern of acne vulgaris cases referred to one hospital in the Eastern Province.
Two hundred cases diagnosed in the Dermatology Department at King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia were studied
Inflammatory acne was the predominant type observed in both males and females (76% and, 79%, respectively). Seborrhea (greasy skin) was the most frequently associated condition 22 (11%) followed by dandruff 8 (4%). The difference between males and females was not statistically significant (p-value = 0.46, 0.93, respectively). In female patients, premenstrual flare was observed in 12 (9.8%), irregular period 5 (4.1%), and hirsutism 3 (2.5%).
Acne vulgaris; seborrhea; dandruff; premenstrual flare; irregular period; hirsutism
To assess the prevalence of some dietary misconceptions among primary health care center-registered diabetic patients in Makka City, Saudi Arabia.
A sample of 1039 primary health care center- registered diabetic patients was interviewed using a structured questionnaire on diabetic diet -related misconceptions. A scoring system was used to document the frequency of misconceptions. The relationship of the misconceptions to socio-demographic and diabetes-related variables was assessed using chi-squared tests.
Most patients (68.7%) had a high diet misconception score. More than half of the sample had the misconception that carbohydrates were to be completely eliminated from the diet, and only dried bread and bitter foods were to be consumed. Data included the belief in the consumption of honey and dates; the omission of snacks; belief in the carcinogenicity of the sugar substitutes; and obesity as a sign of good health. The score was significantly higher among males (p<0.01), patients older than 35 years (p<0.02), and among patients whose level of education was low (p<0.01).
It is important to note that the rate of diet-related misconceptions among diabetics in Makka city is high. The study pointed to the target fraction of diabetic patients among whom these misconceptions prevailed. There is a need for constant motivation and appropriate education at frequent intervals to encourage better knowledge of the disease so that there is compliance to treatment.
Misconceptions; diabetes; diet; Saudi Arabia
To evaluate CME activities in Al-Qassim region in the Kingdom of Saudi Arabia
A study using a pre-structured questionnaire was conducted in Al-Qassim, targeting physicians working in the hospitals. The survey was conducted in two phases. The first phase was conducted at the inception of the department of professional education and the second one year later. Questionnaires were given to a sample of physicians working in the hospitals.
Mean CME hours in the region increased from 5.5(±5.9) to 14.2(±19.7), p=0.0001. 50% said that the CME should be presented differently. There was a need for regular courses (61%), departmental and bedside activities (52%) and visiting speakers (45%). Only 47% of the physicians were using the Internet.
There is a need to shift from credit counting to a process that can yield professional development through practical courses and departmental activities. The use of the Internet in CME activities should be encouraged.
Education; continuing; CME; professional; evaluation
Despite the dearth of allied health professionals in the Kingdom of Saudi Arabia (KSA), the demand for them has increased. Like any other geographic location, KSA, has its own pattern of diseases. Therefore, the curriculum of the health professionals should be appropriately designed to meet the health needs of hospitals and clinics.
To demonstrate that changes in the curriculum of Allied (Applied) Health Sciences in KSA are necessary, and how these changes should be implemented. This paper also recommends that these changes must: (1) be based on the current needs of the community, (2) satisfy the health requirements of the Saudi community as well as the realities of its health practices. The Allied Health Colleges must: (1) undertake a long-term review of the curriculum, (2) ensure that the curriculum reform is continuous, (3) target faculty development, (4) target student evaluation.
Allied (Applied) Health; Format of teaching; Continuous evaluation
Hospitals are important sites for the generation of hazardous waste. Each hospital has its own profile for the generation and transportion of waste according to its location. It is extremely important to manage hospital generated waste properly in order to avoid health and environmental risks.
This article reports the plan designed and used by the hospital waste management committee in King Fahad Hospital of the University , Alhkobar, Saudi Arabia, for the safe management of hospital generated waste starting from the collection areas to the final disposal procedure. The plan was in four stages: background information, identification of problems, intervention and monitoring. The possible solutions for problems encountered are suggested.
This plan which was efficient and cost effective can be used in other medical establishments.
Hospital waste; healthcare waste; medical waste; hospital management; environmental services
To investigate the association between some demographic factors and the levels of severity among asthmatic children.
One hundred and twenty five asthmatic children aged between 6 months and 15 years were studied in pediatric and asthma clinics at King AbdulAziz University Hospital (KAUH). The assessment of clinical severity was based on the global strategy guidelines for asthma assessment and management. Subjects were grouped by age: infants (≤1 year), toddlers (1-3 years), preschool or kindergarten (3-6 years), school (6-12 years), and adolescents (12-15 years). Demographic data (age and sex) were analyzed for any statistical significance.
Boys were 80 (64%) and predominated in all age groups except in infants. 10(8%) were infants, 22(17.6%) toddlers, 26 (20.8%) preschool or kindergarten, 49 (39.2%) school, and 18 (14.4%) adolescent. The levels of severity of asthma were intermittent 11 (8.8%), mild persistent 74 (59.2%), moderate persistent 33 (26.4%), and severe persistent 7 (5.6%). Frequency and severity of asthma were significantly higher in boys than girls (P<0.05) and at school age compared to other age groups (P<0.05).
Conclusion & recommendation:
This study demonstrated an increase in the frequency and severity of bronchial asthma in boys, particularly, those at school age. As stated in the literature, correlating demographic factors and clinical status can help in the prediction of the severity of asthma and possibly its outcome. This demands greater vigilance in the care of this group of asthmatics more than any others.
Asthma; asthma severity; asthma guidelines; gender; bronchial asthma; demographic data
Hypertension is one of the most prevalent chronic conditions in Saudi Arabia. It is the leading risk factor for cardiovascular diseases and a major reason for visits to clinic and prescription of medications. Inspite of this, the degree of its control is not to the optimum. This could be due to its impact on patients’ quality of life (QOL). Impaired physical and psychological well-being may lead to non-compliance or even the withdrawal of treatment . The aim of this study was to assess QOL of hypertensive patients registered in Al-Khobar.
The QOL of hypertensive patients was compared with QOL of a control group. A total of 404 subjects (202 cases and 202 controls) were interviewed. The cases and controls were matched for age and sex. Patients’ self-assessment of QOL was measured with an Arabic version of SF-36, a 36-item Short Form Health Survey Questionnaire encompassing two main dimensions, physical and mental.
The QOL of hypertensive patients was substantially impaired in comparison to the control group. The mean scores for the physical component summary scale (PCS) were 39.3 and 50.8 for cases and controls respectively. The mean scores for the mental component summary scale (MCS) were 43.7 and 50.8 for cases and controls respectively. The burden of hypertension was concentrated in the physical dimension of health. Older age, female gender, unmarried patients, patients with hypertension complications, comorbid DM, use of Aldomet and shorter duration of hypertension were independently related to poorer QOL. The variability of the two summary measures explained by selected demographic and clinical characteristics was 24.3% and 10% for the PCS and MCS respectively.
Conclusions and recommendations:
The QOL of hypertensive patients was substantially impaired in comparison to the control group. Notably, the total explained variation of QOL by the selected characteristics was small, suggesting that the determinants of QOL are multi-factorial. Further research to explore the determinants and indices of QOL in hypertensive patients is warranted. From a clinical perspective, QOL should be considered in the monitoring of hypertensive patients to estimate the burden of hypertension and monitor their outcome.
Quality of life; hypertension; primary health care; SF-36 questionnaire
This paper documents the evolution of the Medical Laboratory Technology (MLT) program established in 1989 (1408/1409 H) at the College of Medicine and Medical Sciences, King Faisal University. The rationale, objectives, the general outline of the program as well as methods of instruction and evaluation are discussed. The internship period and future plans are also addressed. Two hundred and seventy (270) students had been enrolled in the program since its inception until September 2000. Ten batches (138 graduates) have already successfully graduated. One hundred and fifteen (83.3%) graduated technologists are employed in the different health sectors and educational institutions in the Kingdom.
Medical Laboratory Technology; training; curriculum
To compare ear piercing practices and complications arising therefrom in British and Sudanese children and to seek possible ethnic, cultural and environmental differences.
Maelor General Hospital, Wrexham, UK and Wad Medani Children Hospital, Wad Medani, Sudan.
Parents of a hundred British children and an equal number of Sudanese parents were requested to fill a questionnaire on ear piercing. All children were examined for possible local or systemic complications.
All parents answered the questionnaire. Eighty-eight (88%) of the British children were girls while all Sudanese children (100%) were girls. Eighty (80%) of the British children had had their ears pierced before they were 6 years old while 90% of Sudanese children had had their ears pierced below that age. The procedure was performed in both groups by non-medical staff. Local inflammation and allergic contact reactions were the commonest complications in both groups. Keloids were only encountered in the Sudanese children. A case of tetanus was encountered in the Sudanese group.
Conclusion and recommendations:
Ear piercing in both communities is performed at a very early age. This procedure is not without complications and the medical profession should advise safety in this practice. Earrings selected should be of non-allergenic material. Regular application of an antiseptic to the site should be encouraged. The community should be made aware of the hazards and complications of ear piercing. With the awareness of these complications and guided with a set of rules, people may continue the practice (she may have it done). Health authorities in Sudan should formulate guidelines that will ensure hygienic measures and reduce complications.
Ear piercing; Sudanese children; British children; complications
The provision of healthcare generates waste which can be detrimental to health and environment. Staff who provide healthcare ought to be aware of the proper handling and the system of management of healthcare waste used by different hospitals.
Materials and Methods:
A survey of doctors, nurses and allied medical staff for their awareness of the hospital generation and handling of waste was conducted. A self-administered questionnaire was used.
Lack of awareness, ignorance of policy and procedure on the handling of healthcare waste and failure to attend educational activities were major defects found among healthcare staff in the study.
There is a need for a plan to improve the awareness of healthcare workers about hospital generated waste and its proper handling.
Hospital waste; Medical waste; Healthcare waste; Hospital management; Environmental services
Doctor-patient communication is a skill essential for the satisfaction of the patients’ needs and expectations. It involves an art that every practicing physician should have. The situations in health care delivery that demands good doctor-patient communication are many. Diabetes care, the management of hypertension, explaining serious disease diagnoses, prognosis, and investigative procedures are some of the common situations where good doctor-patient communication is very essential. Doctor-patient communication assumes a special status in Saudi Arabia where as a result of mixed ethnicity of the manpower in the health service and the expatriate community, there is a vast diversity of languages, health traditions and beliefs. The skill of doctor-patient communication can be developed and improved by the application of the principles of the patient-centered approach, the utilization of patient-oriented evidence that matters, and its inclusion in the undergraduate curriculum in the first few years of medical school. There should be continuous medical education programs for practicing doctors on the skills of doctor-patient communication through seminars and workshops. This would be a further step towards the improvement of the consumer's well-being.
Doctor-patient communication; Saudi Arabia
Searching for references is part of everyday life in medicine. Since the arrival of the Internet, it has provided great promise for clinicians because of its ready provision of access to large amounts of knowledge and information. But because of the overload of information, searching for particular information has now become a tedious time-consuming and frustrating task. This article describes effective ways, tips, tools, detailed search techniques and strategies for searching for medical information. It also lists some useful resource and database sites that can help in the search for accurate information.
Internet Search; search tools; World Wide Web