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issn:2229-340
1.  REFERRAL FROM PRIMARY CARE TO HOSPITALS IN SAUDI ARABIA: 1) QUALITY OF REFERRAL LETTERS AND FEEDBACK REPORTS 
Background:
Referral between primary care and hospitals is of great importance for patient care and follow-up. This study was conducted because of the importance of the quality of referral letters and feedback reports.
Objectives:
To evaluate the quality of referrals from primary health care (PHC) centers to general hospital in four regions in Saudi Arabia.
Methods:
This was a cross-sectional study of a random sample of referrals from the PHC centers. The first sampling unit was the general hospitals to which the health centers refer. A random sample of health centers was then selected based on their distance from the hospitals. This was followed by randomly selecting 30 referrals from each health center. The referral letters and the corresponding feedback reports were then studied for quality by scoring the components of each. The data was entered in a personal computer using the Stat Pack Gold Statistical Package. The chi-square was used to compare the different scores across the regions and T-test was used to compare the cumulative scores.
Main outcome measures:
The quality of referral letters and feedback reports was defined according to the standardized components using a scoring system.
Results:
The most frequently mentioned items in the referrals were demographic data (100%), specialty referred to (93.3%) and reason for referral (82.7%). Other important items in the feedback reports including the name of the treating physician (81.8%), diagnosis (86.0%), and decision on follow-up (80%) were missing. The quality of referral letters was poor in 23%, with 81% as the corresponding figure for the feedback reports with some variation between the different regions.
Conclusions:
The quality of referral letters and feedback reports is poor and needs to be improved. This can be achieved through implementing the quality assurance programme.
PMCID: PMC3437083  PMID: 23008585
Referral letters; feedback reports; quality; primary care; Saudi Arabia
2.  FACTORS INFLUENCING PATIENTS’ UTILIZATION OF PRIMARY HEALTH CARE PROVIDERS IN SAUDI ARABIA 
Objective:
To determine the factors that significantly discriminate between Ministry of Health (MOH) and private primary health care patients in Riyadh City, Saudi Arabia.
Methodology:
Through a self-administered questionnaire, data were collected from 408 randomly selected patients in five MOH primary health care centers and five private dispensaries. Data collection was conducted from February 15 to March 15, 1998. Two-group stepwise discriminant analysis was utilized in analyzing the data.
Results:
Seven of the 33 factors were found to be statistically significant in discriminating between MOH and private patients. These factors were: (1) source of payment, (2) availability of other sources of income, (3) distance between residence and Primary Health Care (PHC) provider, (4) education, (5) preference for similar-gender doctors, (6) preference for Saudi doctors, and (7) perceived quality of medical staff.
Conclusion:
The study notes that PHC providers cannot control the sociodemographic characteristics of patients. Therefore, policy makers should focus on ensuring that PHC facilities have enough male and female doctors. Furthermore, the quality of the medical staff of these facilities should be upgraded to improve the overall quality of the services they provide. The conduct of further studies related to the utilization of health care providers is also recommended.
PMCID: PMC3437084  PMID: 23008586
Patients’ utilization; primary health care providers; stepwise discriminant analysis; quality of services
3.  TRENDS IN PERINATAL MORTALITY AT KING FAHD HOSPITAL OF THE UNIVERSITY, AL-KHOBAR, SAUDI ARABIA: A TEN YEARS STUDY 
Objective:
The aim of the study is to identify the major causes of perinatal mortality and to determine the main maternal factors which affect perinatal mortality at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.
Methods:
A retrospective study was conducted covering a period of ten years from January 1987 to December 1996. All 548 perinatal deaths, which occurred during that period, were analyzed according to Wigglesworth classification.
Results:
The study revealed a perinatal mortality rate of 19.2:1,000 births. Lethal malformations accounted for 116 (21.1%) of fetal deaths. Of the remaining 432 deaths, 214 (49.5%) occurred antenatally, 71 (16.5%) in labour and 147 (34%) within the first week of delivery. Amongst the normally formed babies, low birth weight was the commonest cause of death (29%) followed by the consequences of maternal diseases (14.8%). The cause of death was unknown in 17.3% of mature babies who died. Unbooked patients were responsible for 72% of the total perinatal deaths.
Conclusion:
Reduction of the perinatal mortality rate is possible when all women begin to value preconception counselling and attendance at antenatal clinics.
PMCID: PMC3437085  PMID: 23008587
Perinatal mortality; Antenatal care
4.  THE PREVALENCE OF INDICES OF HEPATITIS C AND B INFECTION, AND ELEVATED AMINOTRANSFERASE ENZYMES IN PATIENTS WITH ORAL LICHEN PLANUS (OLP) IN EASTERN SAUDI ARABIA 
Objective:
To determine the possibility of any association between HBV, HCV, elevated aminotransferase enzymes and Oral Lichen Planus (OLP)patients in Eastern Saudi Arabia.
Design:
Sera were collected from OLP patients, to be tested for HbsAg, anti-HCV and ALT/AST levels.
Settings:
All the patients who were diagnosed clinically in periodontal section, Dammam Central Hospital were from Eastern Saudi Arabia. The histopathological diagnosis was done in Histopathology Section, Dammam Regional Labs, the virological studies in the Virus Diagnosis Lab of Dammam Regional Labs and Blood Bank, and the aminotransferase tests done in the Dammam Central Hospital Labs.
Subjects:
34 serum specimens were collected from OLP patients, and 32 other samples from healthy populations of the same age and sex as the controls of the study.
Results:
Incidence of HBsAg, anti-HCV, HBsAg+HCV, and elevated aminotransferase enzymes among OLP patients were 8.8%, 14.7%, 2.9%, and 47.05% respectively and the results from the control subjects were 6.25%, 3.12%, 0%, and 3.12% respectively.
Conclusion:
There is a significant association between OLP and HCV infection. No clear evidence of this relationship appeared with HBV. All the aminotransferase elevated samples were positive to HCV, giving a clear evidence of the association of chronic HCV infection with the OLP. Aminotransferase elevated results could be used as a clue to clinical signs of asymptomatic hepatopathies, and as a marker to check the OLP cases for the relevant Hepatic Viruses. Despite the limited number of OLP patients in this study, the results could highlight the problem in this geographical area of the world. We recommend a comprehensive study to be carried out using this current study as a preliminary one.
PMCID: PMC3437086  PMID: 23008588
Oral Lichen Planus (OLP); Hepatitis C Virus (HCV); Hepatitis B Virus (HBV); Aminotransferase; Saudi Arabia
5.  HEREDITARY BLINDNESS: A GENEALOGICAL STUDY AMONG AL-GHARAHIR, A JORDAN VALLEY TRIBE 
Background:
Hereditary diseases form an omnibus problem in Arab societies in general and in rural Arab societies in particular.
Aim:
Study of hereditary blindness and its relation to endogamous marriage among the Gharaghir tribe in the Jordan valley.
Methodology:
The researchers carried out a fieldwork among the Gharaghir tribe in Al-Sawalha (the northern valley region, Deir Alla, the Hashemite Kingdom of Jordan) using participant observation, and intensive focussed interviews, in addition to the genealogical method. We gathered data on endogamous marriages, blindness, genealogy and the degrees of kinship between the spouses.
Results and Discussion:
The results show that blindness among the Gharaghir was found to be associated with endogamous marriage. Marriage among the established ancestors of the clans used to be exogamous and kinship was unilineal-patrilineal. Through the shift to endogamy (marriage between close kin) there was a shift from uniliny (patriliny) to bilineal descent. This may have increased the probability of a recessive gene transmission from both parental sides. This is evidenced by the high inbreeding coefficient of 0.0687, one of the highest recorded.
PMCID: PMC3437087  PMID: 23008589
Hereditary; blindness; endogamous marriage; spouses; Jordan
6.  CHOOSING A MEDICAL CAREER: WHAT INFLUENCES SECONDARY SCHOOL FEMALE GRADUATES? 
Objective:
To assess attitudes and reasons of secondary school female students for choosing medicine as a career.
Design:
A cross-sectional study with a sample of 191 female students, who responded to an administered questionnaire.
Results:
The mean age of the students was 18.3 ± 0.94. The mean general average test scores for female students who applied to medicine, MLT and Nursing was 94.02%, 91.26% and 86.78% respectively. Personal interest was the main reason in 85.7% of the applicants. Only 109 students (57.1%) of the study group have any knowledge about the profession of Medicine. One hundred sixty one of the students (84.3%) expected difficulties in their studies.
Conclusion:
The study showed that personal interest was the main reason behind the students′ choice. A sizable proportion had no knowledge of the specialty they opted for, while more than 80% of the applicants anticipated some difficulties upon entering the Medical College. The majority of MLT applicants were not interested in nursing as a specialty. The current strategy for educating secondary school female students about Medical College programmes should be strengthened.
PMCID: PMC3437088  PMID: 23008590
Attitudes; female students; career
7.  THE VALIDATION OF THE GENERAL HEALTH QUESTIONNAIRE (GHQ-28) IN A PRIMARY CARE SETTING IN SAUDI ARABIA 
Objective:
The objective of this study was to validate an Arabic version of the General Health Questionnaire (GHQ-28) in a primary care setting in Saudi Arabia.
Methodology:
A total of 60 Saudi patients selected by means of systematic random sampling were asked to fill out the GHQ-28 Arabic version. The psychiatrist interviewed all patients using the Arabic version of the Clinical Interview Schedule (CIS).
Results:
The best cut-off level for the GHQ-28 indicating best trade-off between sensitivity and specificity was 4/5, where the validity values were, sensitivity; 72%, specificity; 74%, positive predictive value; 72%, negative predictive value; 74% and misclassification rate; 27%. The correlation coefficient was r = +0.61 and the Spearman's Rank-difference correlation was rs = +0.57. The area under the ROC Curve was 69%. The cut-off point 4/5 in this study is the same as recommended by others in primary care settings. Although the validity parameters are relatively low, they are within the range found by other studies in USA, UK and developing countries. This supports the suggestion to develop an Arabic Screening Questionnaire based on the translated GHQ with the addition of culturally specific items.
Conclusion:
The GHQ-28 Arabic Version is a valid instrument that may be of great help to primary care doctors in improving detection of psychiatric morbidity and in epidemiological research.
PMCID: PMC3437115  PMID: 23008578
General Health Questionnaire; Primary Care; Saudi Arabia
8.  PROMOTION OF MENTAL HEALTH AS A FUNCTION OF DIFFERENT SERVICE AGENCIES 
Introduction:
There is a reliable evidence that personnel working in a variety of settings beyond mainstream mental health services can make an important contribution to the prevention of mental health problems.
Aim:
To assess the ability of personnel in different sectors including schools, school health unit and Primary Health Care (PHC) centers to recognize the risks and signs of deteriorating mental health among vulnerable people. The roles played by these personnel in the area of mental health were also defined.
Methods:
A descriptive approach was used to carry out this study in different service agencies located in Abha region. These included female secondary schools, female school health units and all PHC centers. Questionnaires were mailed to teachers, physicians and nurses. The questionnaires contained queries about warning signs of poor mental health and high-risk groups for mental disorders.
Results:
It was shown that 50% of school teachers in the sample were good at picking up signs of mental distress while others felt that they did not have the skills in this field nor was it their role to do so. The majority of physicians and nurses (66.03%) in school health unit and PHC centers identify family problems as predictor of mental disorders. From the stand point of the primary care provided by health centers, early diagnosis of cases and provision of treatment were considered unimportant compared to the role of case referral as stated by 15.38% and 53.84% of workers, respectively.
Recommendations:
It is recommended that the role of these services be expanded to develop skills in dealing with common mental problems.
PMCID: PMC3437116  PMID: 23008579
Mental health promotion; primary health care; school health unit; role of different service agencies in mental health
9.  A STUDY OF RIYADH HOSPITALS NON-URGENT SURGERY WAITING LISTS: FROM THE PHYSICIANS’ PERSPECTIVE 
Objective:
To examine and compare the factors causing long waiting lists for non-urgent surgery in public (Ministry of Health, military, and teaching) and private hospitals in the city of Riyadh, Saudi Arabia, and to examine the relationship between the personal characteristics of the respondents (surgeons) and the surgery-delay experience.
Material and Methods:
The instrument used in this study was a self-administered questionnaire. Out of 500 distributed questionnaires 320 valid responses were returned. Data were collected from 14 public and private hospitals in Riyadh City. Frequencies and percentages; Mann-Whitney; Kruskall-Wallis one way ANOVA; Chi-square; Phi; and Cramers’ V tests were used in the statistical analysis..
Results:
Results show that seven factors were significantly important in causing long waiting lists. A significant difference with regard to the seriousness of this problem was found between the two types of hospitals.
Conclusion:
This study shows that there is a significant difference in the seriousness of the problem between private and various types of public hospitals. Similar studies in different parts of the country are therefore recommended.
PMCID: PMC3437117  PMID: 23008580
Non-urgent surgery; waiting lists; and private; MOH; military; and teaching hospitals
10.  EFFECT OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR ON CHEMOTHERAPY-INDUCED ORAL MUCOSITIS IN NON-NEUTROPENIC CANCER PATIENTS 
Objective:
The study was designed to assess prospectively the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the management of chemotherapy-induced oral mucositis in non-neutropenic cancer patients.
Material and Methods:
In a prospective open study, adult cancer patients with chemotherapy-induced, neutropenia-independent oral mucositis were treated with GM-CSF (Schering Plough Corporation, Kenilworth, NJ) prepared as mouthwash solution (5 to 10 μgm /ml). GM-CSF was administered within 24 hours of occurrence of oral mucositis at a frequency of 4 to 6 times daily. Systemic GM-CSF was not permissible. Oral mucositis was graded according to the modified Radiation Therapy Oncology Group criteria.
Results:
Forty-nine patients were recruited but nine were subsequently excluded as they experienced neutropenia during GM-CSF therapy. The remaining 40 patients were all evaluable. Most patients had either Grade 3 or 4 gross (71%) or functional (70%) mucositis. The mean ± SEM gross oral mucositis scores for all 40 patients combined decreased from 3.3 ± 0.11 at baseline to 2.1 ± 0.12 (p<0.0001) after 2 days, 0.95 ± 0.11 (p<0.0001) after 5 days and 0.23 ± 0.07 (p <0.0001) after 10 days of therapy. Likewise, the mean ± SEM functional oral mucositis scores decreased from 3.03 ± 0.13 at baseline to 1.58 ± 0.13 (p<0.0001) after 2 days, 0.68 ± 0.11 (p<0.0001) after 5 days, and 0.15 ± 0.06 (p<0.0001) after 10 days of therapy. The duration of severe oral mucositis was also shortened as Grade 0 or 1 (gross mucositis grading score) was evident in 12 (30%), 29 (73%), and 40 (100%) patients by the 2nd, 5th and 10th day of therapy, respectively. Similarly, Grade 0 or 1 (functional mucositis grading score) reported in 19 (48%), 31 (78%), and 40 (100%) patients by the 2nd, 5th and 10th day of therapy, respectively. The use of GM-CSF mouthwash was not associated with any apparent ill effect.
Conclusion:
GM-CSF mouthwash as used in this study has a significant recuperative efficacy on the severity, morbidity, and duration of chemotherapy-induced oral mucositis. A large randomized, placebo-controlled study is warranted to ascertain that benefit and determine the optimal dosage and schedule.
PMCID: PMC3437118  PMID: 23008581
Chemotherapy; mucositis; G-CSF; GM-CSF
11.  HYPERLIPIDEMIA AND OBESITY AMONG DIABETICS AT JUBAIL MIILTARY HOSPITAL 
Objective:
Evaluate the pattern of dyslipidemia and obesity among diabetics, attending the Primary Care Clinic.
Subjects and Methods:
All diabetics (282) registered in the Primary Care Clinic of the Armed Forces Hospital at King Abdulaziz Naval Base, Jubail, Eastern Saudi Arabia, were interviewed by primary care doctors. Weight and height were recorded; fasting blood glucose and cholesterol levels were measured after 12-hour fasting.
Results:
The study revealed that among 89.7% type 2 and 10.3% type 1 diabetes mellitus, 22.7% had a normal Body Mass Index (BMI) 40.8% were overweight, and 36.5%, obese. Females had a significantly higher BMI than males (P<0.001). Total cholesterol was more than normal in 26%, LDL in 27% and Triglycerides in 11% but HDL lower than normal in 38%. However, mixed hyperlipidemia was seen in 5% of the study population.
Conclusion:
Obesity and dyslipidemia were high among diabetic patients and special attention is required in prevention and treatment.
PMCID: PMC3437119  PMID: 23008582
Diabetes mellitus; lipids; hypercholesterolemia; BMI; obesity
12.  CIGARETTE SMOKING BEHAVIOR AMONG SOUTH AFRICAN INDIAN HIGH SCHOOL STUDENTS 
Objective:
The aim of the study was to assess the knowledge, attitude and practice of cigarette smoking behavior (CSB) in a sample of Indian matriculation students.
Methodology:
All (N=325) Indian matriculation students, at high schools, in Northern Kwa-Zulu Natal, South Africa, were included in the study. A questionnaire was administered to assess knowledge, attitudes and practice of CSB.
Results and conclusion:
The study showed a prevalence of 16.9%. Most smokers (98.2%) had commenced the practice after the age of 10 years. The most common reason given for CSB was experimentation (83.6%). Main influence was family members followed by teachers and advertisements. The association between smoking and lung cancer was well-known by smokers (90.7%). There was very little awareness of anti-smoking programmes or organizations. Alarmingly, there was little formal health education on the dangers of smoking in schools. The implications of these results are discussed and recommendations on decreasing CSB are made.
PMCID: PMC3437120  PMID: 23008583
Smoking Behavior; attitudes; knowledge; students; experimentation and South Africa
13.  BREASTFEEDING PRACTICE IN DAMMAM AREA OF SAUDI ARABIA 
Objectives:
The main objective of this study was to determine the breastfeeding status for children under 24 months and assess the causes of breastfeeding failure among those mothers who do not breastfeed their babies.
Methodology:
This study was conducted on a sampled population of 1185 children under 24 months of age, using breastfeeding indicators recommended by World Health Organization, for assessing breastfeeding practices within a recall period of 24 hours, in the Dammam area of Saudi Arabia.
Results:
The exclusive breastfeeding rate and predominantly breastfeeding rates were 33% and 11.5%, respectively, under 4 months of age among these children. The timely complementary feeding rate was 31.7% only. All the values were far behind those recommended. The reasons given in order of their frequencies by the mothers for failure to breastfeed were insufficient milk, advice and example of other mothers and formula milk advertisement.
Conclusion:
This study recognizes the low level of exclusive breastfeeding among children under 4 months of age and lays emphasis on changing the behavior of mothers towards exclusive breastfeeding. This can be achieved by special integrated community-based approaches among potential mothers by supporting them after delivery and proper follow-up, to prevent failure of milk formation and discontinuation of breastfeeding.
PMCID: PMC3437121  PMID: 23008584
Exclusive breastfeeding; complementary feeding; breastmilk failure

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