Hypertension in diabetes is a common and important problem, which aggravates diabetic macro- and microvascular complications. Since both diabetes and hypertension are common diseases, their follow up in primary health care centers should emphasize the early detection of hypertension in diabetes. This study aims at studying the magnitude of hypertension in diabetic subjects registered in primary health care centers.
A sample of 1039 diabetic subjects registered at the primary health care in urban and rural Makkah region were interviewed. Information gathered included demographic and diabetes-related variables. Blood pressure and body mass index were determined for 1020 subjects.
Diabetic subjects who had high blood pressure readings amounted to 560 (54.9%), of whom with stage 1, 2, and 3 hypertension formed 25.5%, 7.0% and 2.5%, respectively. Subjects with undetected high blood pressure amounted to 225 (22.1%). There was significant association of high blood pressure with age, male gender, body mass index and low education.
The problem of hypertension in diabetes could be sizeable. Many patients may remain undetected. A diligent search for diabetic subjects with elevated blood pressure should be made through an efficient system of follow up in the PHCC centers.
Diabetes mellitus; Hypertension; Primary Health Care Centers
To determine the knowledge and attitudes of adolescents in the Eastern Province of Saudi Arabia towards cancer.
A pre-structured tested and revised questionnaire was administered to a randomly selected sample from four high schools (two males and two females) in Dhahran, Saudi Arabia.
Data were obtained from 572 adolescents. There was a marked variability in knowledge across informational items, particularly about the possible causes and how to avoid developing cancer.
Students possess some knowledge of cancer, although this knowledge was not uniform. There were misconceptions about cancer and its pervention. The researcher concludes that the development and implementation of school health education programs on cancer are needed in this population.
Cancer; Knowledge; Attitude; Saudi Arabia
Recent development and changes in health care services in Saudi Arabia have encouraged a search a search for comprehensive and established measurements of the quality of care. Patient satisfaction with nursing care in particular has ferquently been used as a sensitive and objective measure of quality of hosiptal services.
The objectives of this study are: (1) to assess the level of inpatient satisfaction with nursing care (PSWC) in the various wards of the hospital; (2) to assess the socio-demographic determinants of PSWC in addition to the effects of duration of hospital stay and type of wards on the level of satisfaction.
The sample consisted of randomly selected 450 inpatients with probability proportion to the size of the wards. The data was collected by personal interviews using a 21-item structured questionnaire pertaining to nursing services.
The results revealed that the instrument of measurement was valid and reliable. The overall mean satisfaction score was 2.4 (77%) and the highest mean satisfaction was for items on skillfulness and the lowest score was for communication items. Multiple regression analysis indicated that sex, age, marital status and duration of stay are the most imortant predictors of PSWC; female, young, married and short duration of hospital stay have the highest satisfaction score.
In conclusion, this study has highlighted the aspects of nursing care at King Khalid University Hospital (KKUH) which need re-examination by the management. The most importance findings have been that there is: (1) a shortage of nurses at the hospital; (2) limited communication between nurses and patients: most probably due to cultural and language barriers; (3) no proper oversight of patients personal hygiene; (4) dissatisfaction of male patients with most of the nursing care rendered. These results offer the hospial management the opportunity to work out stategies to connect the deficiencies highlighted.
Inpatient satisfaction; nursing care; King Khalid University Hospital; Saudi Arabia
Continuing medical education (CME) is an important and useful activity for updating knowledge in order to improve for outcome of health care. A CME update symposium on Infectious Diseases was therefore organized at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. Participants included clinicians, laboratory personnel and nursing staff from different hospitals and universities in Saudi Arabia.
To report the proceedings of the first CME on Infectious Diseases in the region and to evaluate it using a questionnaire-based feedback.
This CME was evaluated on specific feedback obtained on standardized evaluation forms provided during the symposium. The responses of 194 participants were statistically analyzed for the various components of the symposium.
Results and Conclusion:
Salient important issues covered during the program are presented. The CME included five sessions on: hospital acquired infections, immunology, mycotic diseases, malaria, lesihmaniasis and virology. Some lacunae were also identified. The evaluation of the scientific sessions showed a satisfaction level of 3.98 ± 0.59, on a scale of five. As this CME activity proved successful on many counts, it was concluded that it was worthwhile to conduct updates on infectious diseases on a regular basis.
Saudi Arabia; Symposium; Continuing Medical Education; Infectious Diseases
To determine the incidence, epidemiology, complications and management of Hydatidiform mole (HM) at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
A retrospective study was conducted covering a period of 15 years from May 1983 to May 1998. There were 90 cases of hydatidiform mole. The details of maternal characteristics, clinical presentation, tumor behavior, management and complication were studied.
There were 40,700 deliveries during the study period giving an incidence of hydatidiform mole (HM) of 2.2/1000 deliveries. The most common clinical feature was vaginal bleeding which was noted in 81 (90%) cases. Fifty-six (62%) cases had uterus larger than dates, while in 12 (13%) cases, the uterine size was smaller than dates. Ovarian enlargement was noted in 24 (27%) cases. Complications in the form of hemorrhage occurred in 19 (21%) cases and 9 (10%) cases were complicated by cated by sepsis. The complications were more common in patients presenting late to the hospital. There were 6 (6.7%) cases of invasive mole and 3 (3.3%) cases of choriocarcinoma during the follow-ups of the study group.
On the basis of this study, the incidence of hydatidiform mole is comparable to the incidence in some oriental countries. Earlier diagnosis and treatment of HM will probably result in the decrease of complications found in this study.
Hydatidiform mole (HM) complication
Alternative Medicine (AM) is gaining popularity worldwide.
This study was conducted to determine the prevalence and pattern of AM use in a military sector of the Saudi community.
Three hundred and ten adult patients, visiting their family physicians over 6 weeks from the 1st of June 1998, were selected by systematic random sampling. They were asked to report worrying health problems and their use of modern medicine (MM) and AM.
Forty-six percent of the patients had used AM before and about 19% had used it in the past 12 months. Alternative medicine practitioners were visited by 16.5% of the study population. Herbal medicine users represented 8.7% of the study population, honey (4.5%), the black grain Nigella sative (3%) and cautery was used by one person only. Women, housewives and the illiterate were more likely to use AM. About 86% of all the study population preferred MM. The main source of information about AM was relatives (77%). A large proportion of patients who reported depression used AM (53%) or visited AM practitioners (33%). The average cost per visit to an AM pratitioner (166 Saudi Riyals) was higher than that in the USA ($27.60=100 Saudi Riyals).
There is a need to educate the public through the media and health professionals on the appropriate use of AM; housewives and the illiterate should be targeted. A community-based household survey using interviewers not associated with the health system such as teachers (to avoid bias) is needed.
Alternative medicine; Saudi Arabia; Media education
Health counseling before marriage can be a most worthwhile and satisfying aspect of preventive medicine. It is important in genetic diagnosis and the prevention of hereditary, sexually transmitted and other infectious diseases.
To determine the acceptance of the concept of Premarital Health Counseling (PMHC), and to identify some factors, which may efect this acceptance among Saudis who attend Primary Health Care Center in Riyadh, Kingdom of Saudi Arabia (KSA), 1417H.
The present study is a cross-sectional one with a selected sample of Saudis who attended the Primary Health Care Centers in Riyadh during the year 1417H. A multistage sampling and equal allocation stratified sampling within was used to select 484 persons comprising an equal number of males and females, married and single above the age of 18 years. A pre-designed pre-tested questionnaire sheet was used to collect the required data, which were then tabulated and statistically analyzed.
The study indicated that 364 (75.2%) of the study population accepted the concept of Premarital Health Counseling. PMHC was positively affected by the advancing age, experience of marriage, educational level and well-understood Islamic-health related issues. Out f those who accepted the concept, 273 (75%) agreed on the exchange of PMHC certificates between couples to be married and 152 (42%) agreed on the implementation of legislation on PMHC. Also, 298 (82%) of them wanted PMHC to be confidential and 168 (46%) agreed to the concept despite its cost. As regards the location of PMHC, most of participants who agreed to PMHC would prefer it to be given at governmental establishments.
The study recommended the implementation of PMHC in Saudi Arabia, since it was accepted by the study population. However, further studies should be carried out to determine the details to be incorporated in the PMHC, their implementation and legislation on demographic basis of the Saudi community. Also, a community health education program for PMHC has to be devised in collaboration with Islamic leaders.
Attitudes; Premartial Health Counseling; Premarital counseling; Saudi Arabia
(1) To determine the incidence rate of non-fatal occupational injuries requiring admission into private hospitals in Al-Khobar city during a 12-month period among workers insured by the General Organization for Social Insurance (GOSI). (2) To describe the pattern, characteristics and outcome of these injuries. (3) To estimate their subsequent direct medical costs.
This is a cohort study design. The cohort consisted of workers at workplaces where insurance cover ensured admission into two private hospitals selected randomly in Al-Khobar city. A data-collecting sheet was used to collect the necessary data from both the patient and his medical file on admission into hospital.
The injury incidence rate was 7.1 per 1,000 full-time workers. All injured workers were males. Grouped by nationality, 1.5% were Saudis, 74.8% from the Indian subcontinent and 13.2% Filipinos. Main injury sites included hands and fingers (32.1%) multiple parts (20.7%), lower limbs (20.5%), eyes, head and neck (11.5%) and back (9.5%). Falls were the main cause of injury (33.4%), followed by tools-related injuries (23.9%), falling objects (14.5%) and car accidents (12.0%). The majority of admissions (77.8%) were for periods less than 1 week with only 7.1% for more than 3 weeks. Absence from work was more than 3 weeks and less than 1 week in 35.5% and 24.9% of the admissions, respectively. The majority of the cases (65.0%) visited clinics 2-7 times. Direct medical cost per admission was less than SR 2,000 in 63.9% of the cases in one hospital (1 USD = SR 3.75).
The incidence rate was lower than, but comparable to those rates estimated in more detailed surveys from other countries. Occupational injuries requiring admission into hospitals contributed to 18.3% of the total cases of injuries among insured people during year 1995 and were responsible for significant medical charges, human suffering and loss of productivity. Based on the results of this study, it is recommended that GOSI should study the reasons behind the current situation and find appropriate solutions.
Occupational injuries; hospital admissions; Al-Khobar; Saudi Arabia
The aim of this study is to assess the perception and satisfaction of primary health care (PHC) trainees regarding their hospital training in Internal Medicine and Pediatrics.
A cross-sectional study was conducted by means of a self-administered questionnaire distributed to the trainees who had finished Medicine and/or Pediatrics rotation in 4 PHC training centers in Riyadh, Al-Khobar, Jeddah and Al-Medina during January 1996.
Trainees were more satisfied with the Pediatric rotation than the Internal Medicine rotation. Significant relationship (p<0.05) was found between trainee satisfaction in Internal Medicine rotation and both the quality of training and the relevance of training to the needs of PHC trainees. On the other hand, in Pediatrics, the only variable which was related significantly to the trainees’ satisfaction was the duration of the rotation, which was found to be sufficient (p<0.05). Trainees’ dissatisfaction with the rotation was due to many factors, such as the imbalance between service work and educational sessions and the lack of awareness of other specialists about PHC as a career.
Attention and effort should be directed towards the improvement of hospital training through a close collaboration between the decision-makers for PHC training and the hospital consultants. Also the needs of trainees should be taken into account during planning of hospital training.
PHC trainees; training; Saudi Arabia
This is a study of psychiatric presentations to an Accident and Emer-gency (A & E) Department of a Saudi general teaching hospital.
Patients and Methods:
Consecutive series of psychiatric presentations over 6 months to the A & E Department of a general teaching hospital at Al-Khobar, East-ern Saudi Arabia, were prospectively investigated. Diagnoses were made according to ICD-10 Classification of Mental and Behavioral Disorders.
There were 273 visits, accounted for by 182 index subjects and 37 subjects who made 91 repeat visits (33.3%). The age range of the index group was 5 to 82 years, with 75% below 38 years of age. The majority of the index group (78%) and repeaters (97.3%) were Saudi. Most index subjects (52.7%) were married, but only 40.5% of repeaters were so. Family was the predominant source of referral of both index (53.8%) and repeat visits (60%). Mood disorders were the commonest diagno-ses at both index (31.7%) and repeat visits (39.6%). Most index subjects (57.7%) and repeated visits (56%) were managed at the A &E Department and given psychiatric outpatient appointment. Just over one-fifth (22%) of the index subjects and a little over a quarter (25.3%) of repeated visits were admitted to the psychiatric ward, Mood Disorders being predominant among both.
Adequate psychiatric training of primary health care physicians and the establishment of crisis intervention community psychiatric services are advocated.
Accidents and Emergency Department; Psychiatry; Saudi Arabia
Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine.
To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings.
A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives.
Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them.
The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.
Bacteremia; Fever; Gastroenteritis; Meningitis; Otitis Media; Pneumonia; Upper respiratory tract infection; Urinary tract infection
Worldwide malignant melanoma is the commonest tumor of the skin, though it occurs in many other organs. It is a serious disease, the prognosis of which is poor if not detected and treated early. The disease is on the increase in many countries e.g. USA,1 England and Wales,2 Australia,3 and many parts of the world.4–6 Saudi Arabia is a vast country which is undergoing rapid development with a changing social and economic environment. To the best of our knowledge, not many studies or reports of malignant melanoma have issued from the Eastern Region. It is therefore, important to report this case and review the incidence of the disease.
Malignant melanoma; Skin; Eastern Region; Foot; DCH (Dammam Central Hospital)
To identify the effect of a school health education program on the knowledge of secondary school girls in Jeddah, Saudi Arabia, of breast cancer and breast self-examination (BSE) and their practice of BSE.
A pre-tested, self-administered questionnaire was administered to secondary students before the commencement of the health education to assess their knowledge on breast cancer and their practice of BSE. The same questionnaire was handed 6 months later to a smaller group of these students as a post-test. As the post-test group was smaller than the pre-test group, an equal sample size from the pre-test group was drawn for comparison. Random sampling and further analysis was done using the SPSS program, and for the comparison of the two groups, the student t-test and chi square were used.
The post-test was answered by 1372 students. The sampled re-test group comprised 1400 students (N= 7663) forming a sample of 18.3%. The ages for both groups ranged between 16-25 years (mean = 18.4; SD=1.9). Saudi nationals formed 73.4% of both groups and the proportion of married students was 8.4%. Those who reported that they had relatives with breast mass were 11.2%. The mean knowledge indexes on breast cancer reached 19.7 for the pre-test group and 43.0 for the post-group (t=31.2; p<0.0001). Correct answers for BSE rose significantly among the post-test group. A proportion of 27.2% students from the post-group reported that they had been motivated to practice BSE at least 3 times during the last 6 month.
Conclusion and recommendation:
The outcome of the school health education program on breast cancer had been successful in raising the awareness of secondary school girls and in helping them to practice BSE more. Hence, it is recommended that the programme be implemented in all female secondary schools and colleges.
Breast cancer; breast self-examination; health education; student knowledge
To evaluate the prevalence of brucellosis in the Al-Medina region of Saudi Arabia and to determine the related factors.
A cross-sectional survey was carried out in 1997 with a random multistage cluster sampling of 500 households (4000 subjects). Tube Agglutination Test (TAT) and 2-mercapto-ethanol (2ME) analyzed blood samples.
The study revealed that the prevalence of brucellosis was 2.6%. The prevalence was shown to increase with age in rural communities and low socio-economic status. There are eight predisposing factors associated with brucellosis. These are the consumption of raw milk, and milk products, the keeping of livestock, milking of livestock, animal contact, butchering of raw meat, handling parturient animal and contact with placenta membrane. The overall prevalence of brucellosis among livestock as assessed by examining blood from a random sample of animals was estimated at 17.4%.
The findings of this work indicate that: (1) There is high prevalence of brucellosis in the Al-Medina region of Saudi Arabia. (2) Very little is being done to prevent or minimize infections. (3) Control and prevention of brucellosis in animals and humans should be the goal in Saudi Arabia
It is recommended that: (1) the surveillance be strengthened; (2) there be strict adherence to hygienic practices on farms; (3) there be cooperation and joint supervision at the boundaries with neighboring countries; (4) there be health education.
Prevalence; Brucellosis; Al-Medina region; Saudi Arabia
The purpose of this study was to determine the presence of physical, social, financial and marital stress on mothers of diabetic children and the possible relationship of this stress to the epidemiological characteristics of the mothers.
It was a case-control study in which 125 mothers of diabetic children were selected randomly from 10 general and private hospitals in Riyadh city. A control companion group of 110 mothers who were free of chronic illness, was drawn from primary health care centers in the same city. Mothers in both groups were interviewed using a structured questionnaire.
In the study group, 110 mothers were interviewed. Physical, social and financial stress was more common in mothers of diabetic children than in mothers in the control group. With the exception of marital stress, the differences were statistically significant. Physical stress was correlated positively with the frequency of blood tests and the working status of mothers. Social stress was correlated positively with the frequency of blood tests; but negatively with child's knowledge of diabetes mellitus. Financial stress was correlated positively with the presence of chronic illness but negatively with family income.
Mothers of diabetic children are at risk of being under various kinds of stress. Certain epidemiological factors are associated with the development of the stress. These factors have to be taken into consideration in the management of the disease.
Diabetic children; stress; KSA; epidemiology
Medical education has been and continues to be a priority in the Kingdom of Saudi Arabia since the establishment of the first medical school more than 30 years ago. As the kingdom moves into the new millennium through its 100th birthday, several issues pertaining to medical education are noted. These include selection and admission criteria to medical schools, suitability concerns, and the need for reform of the current undergraduate curriculum as well as allocation and utilization of available resources. The postgraduate medical training programs, particularly the university-based, need re-evaluation, and definition of their future role in graduate medical education. Medical educators must make sure that research in medical education should not only survive but also thrive. In this article, some suggestions for Saudi medical education in n the new millennium are put forth.
Medical Education; Curriculum; Saudi Arabia
Cough is one of the cardinal symptoms of respiratory tract disorders and could be a manifestation of a serious non-respiratory tract disease. Cough is generated by an integrated mechanism between the central nervous and respiratory systems. The triggering factor of the above integration is an initial irritant, which stimulates the cough reflex and, hence, the mechanism of cough will take place. Persistent cough in a non-smoking adult is considered one of the most common presentations to physicians practicing in hospital or primary care settings and can be caused by many disorders. The objective of this article is to highlight a practical approach for the primary care physicians to the initial management of cough.
Cough; Primary Care; Saudi Arabia
Hajj usually presents a unique medical crisis especially for the Emergency Department. This study will identify the surgical and medical cases that presented at the Emergency Department during Hajj and percentage admitted.
A prospective study of the pattern of surgical and medical cases that presented at the Emergency Department of the largest tertiary care hospital in Makkah city and holy lands during Hajj.
The study was conducted prospectively during the 1413 (1993) Hajj pilgrimage from 20.11.1413 to 20.12.1413. All Saudi and non-Saudi pilgrims presenting at the Emergency Department of Al-Noor Specialist Hospital were included.
From the 7,676 patients who came to the Emergency Department, 1426 were admitted. The commonest cause for surgical admission was trauma, while the commonest cause for medical admission was pneumonia.
More than 50% of cases could have been dealt with in the Outpatient Department or Primary Health Care Centers.
Hajj; Emergency Department; Primary Health Care
To study the relationship between student motivation for learning and 38 factors related to teaching, curriculum and administration.
A total of 231 male and female medical students in the first three pre-clinical years participated in the study by completing a questionnaire.
Results and Conclusions:
Factors that have been rated as strong promoters of motivation include: injecting relevant clinical information into lectures, encouraging student participation, revising previous lectures, using explanatory Arabic phrases, using the chalk board, providing specific course objectives, adopting one easy reference, concentrating on the core curriculum and showing respect to students. Factors that have been evaluated as inhibitors of motivation included: content overload, unscheduled quizzes, giving one quiz per subject in a semester, difficult exams and afternoon lectures.
Student motivation; Medical education; Teaching style; Medical curriculum; Saudi Arabia
Intravenous (IV) fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community.
A University teaching hospital in Eastern Saudi Arabia.
To determine the feasibility of the practice in our setting and increase clinicians’ awareness of it and encourage its general adoption.
A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations.
The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of IV line.
The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients’ mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids.
In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults.
Postoperative hydration; early oral fluids; postoperative intravenous fluids