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issn:2229-340
1.  HEALTH AND LIFESTYLE: A SAUDI PROFILE 
The negative effects on health by behavior such as cigarette smoking, lack of physical exercise, non-control of body weight and non-use of seat belts were empirically documented. Available findings of the various studies on lifestyle of the Saudi Arabian community were not encouraging. If the general health status of the Saudi population is to be improved, an enforcement of healthy lifestyles must be considered.
PMCID: PMC3437157  PMID: 23008551
Health promotion; Lifestyle; Kingdom of Saudi Arabia
2.  DETERMINANTS OF OUTCOME AMONG SMOKERS IN A SMOKING CESSATION PROGRAM 
Background:
Tobacco consumption is now one of the most serious problems in the world and is receiving renewed attention in the current health promotion.
Objectives:
This study was carried out to elucidate the psychosocial and behavioural aspects of smokers associated with participation, attrition and outcome in smoking cessation programs.
Methodology:
This prospective cohort design included three hundred and twenty six smokers from the antismoking center - King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia. The selected patients were subjected to a history taking, the assessment of causes of smoking, motives for quitting and belief problems arising from quitting; then they were made to join the clinic's antismoking program and were followed up after six months to assess the success of the program, which was measured by the rate of recidivism.
Results and conclusion:
The results showed that the important psychosocial and behavioural factors affecting the success in quitting smoking were: previous history of an attempt to stop tension, anxiety, anger, health beliefs and attitudes, importance of quitting, duration of smoking, period of last attempt to stop and the method used. These factors can be modified in order to increase the likelihood of success in quitting smoking.
PMCID: PMC3437158  PMID: 23008552
Smoking; Causes; Quitting; Beliefs; Cessation; Outcome
3.  UTILIZATION OF LABORATORY INVESTIGATIONS: STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE AMONG PRIMARY CARE PHYSICIANS 
Objectives:
The aim of the study was to assess the physicians’ knowledge, attitude and practice towards laboratory services in the primary health care (PHC) centers at Al-Khobar area.
Methodology:
Five primary health care centers were selected out of 9 (56%) from the Al-Khobar area. Twenty physicians (33%), in these primary health care centers were included. A questionnaire was given to all physicians to explore the knowledge, attitude and practice.
Results:
All physicians considered laboratory investigations an essential service that contributed to the management of their patients most of the time. Knowledge and practice of most (80% of them) regarding laboratory investigations was between fair to good but the attitude of 80% of them was poor since postgraduation experience was the only factor which influenced their practice.
Conclusions:
There has been an increase in number of Saudi physicians working in the Primary Health Care Centers. The quality of the current laboratory services was deficient according to 30% of physicians. They considered that investigations were essential for primary health care centers. And finally the utilization of laboratory tests in the Kingdom of Saudi Arabia was higher than many developing countries.
PMCID: PMC3437159  PMID: 23008553
Utilization; Knowledge; Attitude; Practice; Primary Health Care; Sampling
4.  FUTURE SPECIALTY AND PRACTICE INTENTIONS AMONG SAUDI MEDICAL STUDENTS 
Objective:
The objective of the study is the identification of the specialty intentions, the reason behind that choice and the preferred practice location of the study population.
Methodology:
A cross sectional study was conducted using a self administered questionnaire distributed at the end of the academic year 1994. One hundred and forty nine (149) male and 104 female graduating medical students representing the four medical colleges in Saudi Arabia were included
Results:
The four major clinical specialties were selected by more than half of the students; Internal Medicine (17%), Surgery(16%), Paediatrics (14%) and Obstetrics (11%). Twenty seven percent were not sure of their future career choice. Primary health care was chosen by only 1.6% of the students. More men chose Surgery but more women chose Obstetrics and Ophthalmology.
Discussion:
“Financial incentives”, “no night duties”, “social reasons” and “less responsibilities” were the less frequently mentioned reasons for career choice. The qualifications in view were mostly Canadian Board for 49% of the students and Arab Board for 48% of them. The most frequently preferred locations for postgraduate training were Saudi Arabia (56%) and Canada (40%). The majority intended to practice in hospitals (90%) and in cities (85%).
Conclusion:
The current drastic deficiency of trained Saudi Family Physicians will continue unless targeted strategies to produce more generalists are undertaken.
PMCID: PMC3437160  PMID: 23008554
Specialty choice; Practice location; Medical students; Saudi Arabia
5.  THE LEARNING SKILLS OF UNDERGRADUATES: A PROPOSAL FOR SAUDI MEDICAL EDUCATION 
Background:
The problems of medical education in Saudi Arabia emanate from its high course content and a lack of proper integration, exacerbated by the language barrier.
Objective/Proposal:
To encourage good lasting learning habits, it is envisaged the need to establish training courses for learning skills. This training would include the development of positive attitude and reliable approaches to learning, learning styles, and emotional skills. It would also develop specific skills such as the setting and achievement of objectives, self assessment, group work, accessing sources of knowledge, note-taking, reading skills, retention skills, examination techniques and computer literacy. Teaching techniques, the organization of the course, assessment procedure, and the use of resources also affect learning. However, changes in these areas can be beneficial only if students have the appropriate learning skills.
Recommendations:
Research needs to look at the specific ways of teaching learning skills, and the effect of the application of such skills.
PMCID: PMC3437161  PMID: 23008555
Education; Medical; Undergraduate; Learning skills; Saudi Arabia
6.  KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) OF PRIMARY HEALTH CARE PHYSICIANS AND NURSES TOWARDS HYPERTENSION: A STUDY FROM DAMMAM, SAUDI ARABIA 
Objective:
To evaluate the quality of management of hypertensive patients attending Primary Health Care Center (PHC) in Dammam city and to determine factors that possibly affect it.
Design:
A cross sectional study and direct interview.
Setting:
Dammam city.
Subjects:
All doctors and nurses from a randomly selected sample of Primary Health Care Centers during April 1994.
Main measures:
Measuring the knowledge, attitude and practice of doctors and nurses about hypertension management.
Results:
Hypertension is regarded as an important health problem in Saudi Arabia in the opinion of majority of doctors (80′0) and nurses (69%). Almost half of the doctors and nurses believe that nurses are sufficiently qualified to measure blood pressure of patients. Most of the doctors (96.7%) and nurses (86%) depend merely on face-to-face education of patients Thirty percent of doctors and 34% of nurses think that the care for hypertensive patients in their Primary Health Care Centers is inadequate.
Conclusions and recommendations:
Offering on job training of both physicians and nurses on hypertension management. Producing a well planned protocol on the national level. Implementing a total quality management and medical audit system to PHC centers.
PMCID: PMC3437162  PMID: 23008556
Hypertension; Primary care and practice; Saudi Arabia
7.  PARASITIC AND BACTERIAL INFESTATION AMONG FOOD HANDLERS IN JUBAIL, EASTERN REGION OF SAUDI ARABIA 
Objective:
To evaluate the prevalence of parasitic and bacterial infestations among food handlers.
Design:
Retrospective study.
Setting:
Food handlers working in the Military food serving facilities in Jubail (Eastern Province of Saudi Arabia).
Method:
The stool samples of 881 food handlers of different nationalities were examined at the Armed Forces Hospital laboratory using the concentration method.
Results:
A total of 194 (20%) of the workers tested positive for enteric microbial infestation. Helminths were the most prevalent, infecting 93 (10.56%) of the food handlers; followed by protozoa which affected 65 (7.38%) food handlers; and the smallest group was infected with bacteria in 44 (4.9%) of the food handlers. Not only single organism infection was seen (83.94%), but also double (14.51%) and triple (1.55%) infections. Among the Helminths, Ascaris lumbricoides was the most prevalent with 33 (47.14%) cases, Giardia lamblia was the most prevalent Protozoa with 23 (43.40%) cases, and Salmonella was the most prevalent bacteria with 34 (87.18%) cases. Expatriates from South Asia showed a significant rate of infection when compared to expatriates from Arabian countries. The Bangladeshi food handlers were of the greatest prevalence of infection with 151 (17.14%) cases, followed by Indian workers with 17 (1.93%) cases, and Pakistani workers with 11 (1.25%).
Conclusion:
The study stresses the importance of regular check-ups and prompt treatment of infected food handler.
PMCID: PMC3437163  PMID: 23008557
Food handler; intestinal parasite; food inspection; bacterial infection
8.  IMPACT OF TRAINING OF PRIMARY HEALTH CARE STAFF ON MATERNITY AND CHILD HEALTH SERVICES 
Introduction:
Training of primary health care (PHC) staff, at Hail region, is conducted as a part of a national program for training all PHC staff all over the Kingdom of Saudi Arabia. The program started in Hail region during the year 1412H. The objective of the program was to train all PHC staff, or at least a doctor and a nurse or a midwife in every health center, on Maternity and Child Health (MCH) services. This objective was achieved at Hail region by the end of the year 1414H.
Objectives:
The objective of this study is to evaluate the impact of training of PHC staff on maternal and child health services in Hail region.
Materials and Methods:
Collection of data about MCH services was done by using structured forms, pre-tested and distributed at the end of each year studied to all Primary Health Care Centres (PHCCs). These forms were collected, data were encoded into the computer and analyzed by using SPSS for Windows statistical package.
Results:
Evaluation of the program, at the end of the year 1415H, showed improvement in utilization of MCH services, and improved quality of care provided for mothers and children. This improvement was manifested by reduction of percentage of home deliveries without medical supervision, and increased numbers of risk factors discovered among pregnant mothers and children. However, the percentage of deliveries conducted at PHCCs were not increased, and pregnancy outcome showed slight reduction of S.B. rate.
Discussion:
Improvement in the knowledge of the trainees was marked. Also intellectual skills e.g., using growth charts were markedly improved. However, because of the short duration of the courses, manual skills were not improved significantly. So increased frequencies of risk factors discovered among registered pregnant mothers and children was evident, however, deliveries at PHCCs were not increased.
Conclusion:
Training of PHC staff had a positive impact on maternal health services at Hail region. However, more time must be allowed to the practical part of training at the hospitals.
PMCID: PMC3437164  PMID: 23008558
MCH; Services; Training; PHC
9.  DID THE NATIONAL CAMPAIGN FOR POLIOMYELITIS VACCINATION ACHIEVE ITS OBJECTIVES? A PILOT SURVEY IN AL-KHOBAR AREA 
Objectives:
To verify whether the first national campaign for poliomyelitis vaccination achieved its objectives.
Setting:
Al-Khobar area in the Eastern Province of the Kingdom of Saudi Arabia.
Materials & Methods:
Randomized samples have been obtained using the Bowleg's proportional allocation scheme. At the first stage, housing blocks of 8-10 houses were selected using random sampling procedure. At a second stage, 2 houses from each block were selected in a 1 or 4 order. Both Saudi and non-Saudi nationals living in these households were screened using pretested questionnaire administered at a face-to-face by trained interviewers. The questionnaire covered areas that included number of children vaccinated, reasons for non vaccination, whether or not the vaccinated child has received certificate of vaccination as well as placement of stickers on the door of the vaccinated households.
Result:
A total of 107 households were surveyed in Al-Khobar. The total populations surveyed was 527 people including 213 adults and 314 children (152 of the children were aged 5 years or less). In all the households surveyed, all eligible children age 5 years or less were vaccinated. All of the vaccinated children obtained a vaccination certificate.
Conclusion:
The overall percentage coverage in Al-Khobar was 100%. This denotes the success of the campaign. A nationwide survey is suggested to corroborate these findings.
PMCID: PMC3437165  PMID: 23008559
Poliomyelitis; Vaccination; Saudi Arabia
11.  Breast Cancer: Attitude, Knowledge and Practice of Breast Self Examination of 157 Saudi Women 
Introduction:
Breast cancer is the commonest cancer in Saudi females. Breast self examination (BSE) is a practical screening method for early detection of breast cancer.
Objectives:
The aim of the study is to find out knowledge and practice of BSE among Saudi women and their attitude towards breast cancer.
Methods:
157 Saudi women were randomly selected and interviewed in the general clinics of King Abdulaziz University Hospital, Jeddah, and a questionnaire was used to collect data.
Results:
The age range of the women was from 15 to 69 years with mean age of 32.5 years and median of 30 years. 80 (51%) out of 157 women were illiterate. 19 (12%) women were found to conduct BSE, 8 (5%) regularly and 11 (7%) irregularly. 145 (92%) showed willingness to seek medical advice if they discover lumps in their breasts. The motives of these women were, a desire to reach a diagnosis at an early stage in the hope of cure in 120 (76%) and fear of cancer in 25 (16%). 11 (7%) women were unwilling to seek medical advice and the motives of these women were fear of cancer in 5 (3%) and shyness in 6 (4%).
Conclusions & recommendations:
The proper technique of BSE should be taught to all Saudi women using all means of education either through books and magazines for literate women or through video films and self explanatory charts for illiterate women. A national campaign aimed at raising women's awareness about breast cancer and BSE is recommended.
PMCID: PMC3437138  PMID: 23008542
Breast cancer; Breast self examination; knowledge; attitude; practice and education
12.  Utilisation of Health Services by the Primary Health Care Centres-Registered Elderly People in Burraidah City, Saudi Arabia 
Objective:
To assess the pattern of and factors associated with geriatrics′ utilisation of health services.
Design:
A cross-sectional, study involving a random sample of 266 elderly subjects registered in the primary health care centres in Burraidah city, Saudi Arabia.
Setting:
The primary health care centres in Qassim Region, Saudi Arabia.
Methods:
Data was collected from PHC centres-registered elderly subjects at their homes. Information including utilisation of primary health centres, hospital admissions and duration of hospital stay were recorded.
Results:
The response rate was 96.7%. Twenty percent of the sample had not used any health services facility during the previous year. Two-thirds of subjects made visits to the primary health care centres, majority of them having made 6 visits or less. Significant factors positively associated with those visits were female, advancing age, and having a family. Three-quarters of the sample did not have hospital admissions. Significant factors positively associated with admissions were diabetes mellitus, hypertension, paralysis, advanced age, and living with a family.
Conclusions:
Geriatric health services utilisation by the study sample is affected by family ties and the high prevalence of chronic diseases. Subjects living alone or crippled by immobility may not be able to utilise available health services properly. Community based geriatrics services can help this vulnerable group.
PMCID: PMC3437139  PMID: 23008543
Geriatrics; Health services utilisation; Saudi Arabia
13.  Evaluation of Antenatal Referrals from Health Centres to the Maternity and Children's Hospital in Dammam city, Saudi Arabia 
Objective:
To evaluate antenatal referral rates from Primary Health Care (PHC) centres to the Maternity and Children's Hospital in Dammam and factors affecting it.
Methodology:
Four randomly Selected Primary Health Care Centres in Dammam city. A sample of 135 pregnant women referred to the hospital (cases) and 135pregnant women not referred (controls) were randomly selected. A double phase sampling scheme was adopted. Questionnaires regarding the characteristics of the general practitioners (GPs) were distributed to those GPs caring for antenatal patients in the 4 health centres.
Results:
There was a variation in the referral rates of the five generalpractitioners from 11.5 to 21.2 per 100 antenatal consultation. It was found thatS certain characteristics of the GPs had an important influence on the referral rates. High risk factors in pregnancy were present in some of the controls but they were not referred.
Conclusion & Recommendations:
There is a variation in the referral rates between the GPs. There is a need to monitor and improve the quality of the antenatal care and the referral process. Better training of the GPs and implementing shared obstetric care is recommended.
PMCID: PMC3437140  PMID: 23008544
General practitioner (GP); Referral Rates; Antenatal Risk Factors; Primary Health Care (PHC) Centres
14.  Analysis of 303 Road Traffic Accident Victims Seen Dead on Arrival at Emergency Room-Assir Central Hospital 
Background:
Although Rood Traffic Accident (RTA) is a noticeable common cause of death in Saudi Arabia, there is no published data showing the relative frequency of this disease as a cause of death.
Aim of the study:
This study attempted to find out the relative frequency of RTA as a cause of death. Also, to identify age groups at risk as well as make some inferences from the different types of injuries seen.
Methodology:
In a period of over a four and half years, 574 patients were seen dead on arrival at the Emergency Department of Assir Central Hospital, Abha, Saudi Arabia. Of these, 303 (52.8%) were victims of RTA.
Results:
The 303 victims revealed a male to female ratio of 14:1, Saudi nationals of 69% and age range of 3 months - 85 years (mean = 34.25 years). The peak age group was between 21 and 49 years and the peak period of presentation at the Emergency Department was between 12:00 noon and 18:00 hours. The month of ten in Hegira Calendar represented the peak period; a significant (P<0.05) seasonal variations was also seen, summer being the highest. Clinical assessment of the victims revealed that head and neck injuries were the commonest followed by chest injuries.
Conclusion:
RTA is the primary cause of death among dead on arrival cases affecting the most active and productive age group. The study recommended the implementation of pre -hospital emergency medical system.
PMCID: PMC3437141  PMID: 23008545
Road Traffic Accident; Saudi Arabia
15.  Preliminary Study on Acute Rheumatic Fever at High and Low Altitudes of Asir Region 
Objective:
The objective was to study the profile of acute rheumatic fever (ARF) at high and low altitudes (hot and temperate areas respectively) with particular attention to the influence of these differences on the frequency or severity of carditis.
Methodology:
Thirty eight children with initial attack of ARF, diagnosed between November 1987 and July 1995, were studied.
Result:
Twenty seven were living at altitude, temperate climate (group-1) while 11 were living at low altitudes of Tihama, hot climate (group-2). Twenty two were males and 16 were females. The mean age was 9.7 years. Arthritis was the commonest feature (86.8%) and carditis (68.4%) came second. Mitral regurgitation occurred in 96.2% of those with carditis, aortic regurgitation occurred in 19.2% and tricuspid regurgitation in 7.7%. Mitral stenosis and aortic stenosis were not encountered. A comparison between group-1 and group-2 showed the frequency of carditis to be 66.7% and 72.7% respectively and the frequency of severe carditis in those affected to be 27.8% and 25% respectively. Chorea, erythema marginatum and subcutaneous nodules were uncommon.
Conclusion:
The study indicates that altitude and climate may not affect the frequency nor severity of carditis.
PMCID: PMC3437142  PMID: 23008546
Acute rheumatic fever; carditis; altitude; Asir
16.  Health Profile of Balhareth area in Taif Region 
Objective:
To describe demographic, socio-economic, environmental factors and general health status of one of the rural and semi-urban areas around Taif city at the western province of the Kingdom.
Methodology:
A cross sectional multipurpose survey for 2 weeks composed of household and school surveys using questionnaires, anthropometric measurements and physical and dental examinations.
Results:
340 houses and 14 schools were surveyed. A higher percentage of young age population was found. Findings indicated a high illiteracy rate especially among females. Environmental status of the area was not optimum with a need for better services. Maternal data indicated a high fertility rate with high rate of unattended deliveries. Breast feeding was a common practice and children pattern of feeding was satisfactory. School survey revealed a lower weight and height compared to NCHS population and a high rate of dental caries.
Conclusion:
The area was not underprivileged and did not show specific endemic disease pattern. Improvements in the areas of sanitation, female education and school dental education is recommended based on the findings.
PMCID: PMC3437143  PMID: 23008547
Rural area; Saudi Arabia; Community Survey; Multipurpose survey
17.  Survival After Stroke in Saudis : A Hospital Based Study 
Background:
Prognosis of stroke has been studied in various population. Factors adversely affecting short term survival include impaired consciousness, leg weakness and increasing age.
Aim of the Study:
In this study, the prognostic effects of age, sex, hypertension, diabetes mellitus and presentation in coma on the survival pattern of stroke patients presenting to a referral hospital, are reviewed.
Methodology:
The medical records of all patients hospitalized with definite stroke at King Fahd Specialist Hospital, Buraidah, for the period between June 1986 and June 1991, were reviewed. The Cranial CT Scans were also reviewed.
Results:
One hundred and seventy four patients, 106 males and 68 females, with a mean age of 64 years who had definite stroke were studied to estimate overall survival and the various risk factors influencing it. The case records and cranial CT scans were reviewed.
Conclusion :
The factors adversely affecting survival in this study, were age above 60 (P<0.04), presentation in coma (P<0.003) and pre-existing heart disease (P<0.0009). There was no significant effect on survival due to sex, hypertension and/or diabetes mellitus.
PMCID: PMC3437144  PMID: 23008548
Stroke; Saudis; hospital
18.  Hemolytic-Uremic Syndrome in Asir Region 
Introduction:
Hemolytic-Uremic Syndrome (HUS) is a worldwide disease and a common cause of acute renal failure in childhood. Recently the number of cases in our area seems to be increasing.
Aim:
The objective of this study was to look at epidemiology, clinical course and complications of hemolytic-uremic syndrome in the Southern region of Saudi Arabia.
Method:
The medical records of 24 patients with typical post diarrhea HUS who were seen in Asir Central Hospital (ACH) between January 1989 and December 1994 were retrospectively reviewed.
Results:
Of the 24 patients 15 were boys and 9 were girls with sex ratio 1.7:1. Ages ranged from 7 months to 11 years with a mean of 38 months. Clustering of cases were during spring and autumn time. Shigella dysenteriae was the most commonly isolated micro-organism, found in the stools of 5 patients. Complications occurred in 8 patients (33%) in the acute phase, 5 (21%) had generalized tonic-clonic seizures, while 2 (8%) had depressed level of consciousness. Three of the patients who had generalized seizures developed permanent cortical blindness. One patient developed chronic renal failure. One patient (4%) died in the acute phase after prolonged generalised seizure and coma. The mean age of the group with complications was 3335 months while it was 41:03 months in the uncomplicated group and mean platelets count was 46±40 × 109/L and 58 ± 35 × 109/L, respectively.
Conclusion:
Males seem to be more affected than females and Shigella was the most commonly isolated organism. Cortical blindness was relatively more common than in other studies and patients with complications were generally younger and had lower platelet count than those without complications.
PMCID: PMC3437145  PMID: 23008549
Hemolytic-Uremic Syndrome; Shigella; Children; Saudi Arabia

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