Relationship Between Socio-Demographics, Study Skills and Distress Among Pakistani School Students: A Cross-Sectional Study in Riyadh, Saudi Arabia.

Purpose: The increasing prevalence of distress among students is of global concern. Several factors such as school and family environment and ineffective study skills could influence mental health. The study explored the rate of distress symptoms among school students' and its relationship with their study skills, stressors and demographic factors. Methods: In this cross-sectional analytical study, a sample of 215 students from a community school participated in the study. Three questionnaires, demographic questionnaire, Study Skills Inventory and the Kessler Psychological Distress Scale, were used for data collection. Data were analyzed using Student's t-test, ANOVA, Pearson's correlation coefficient and stepwise linear regression. Results: Response rate was 70% (n = 150). A high proportion of respondents (75%) was distressed (mean 27.28 ± 8.77). Correlation analysis showed that distress (K10 score) was negatively related to study skills (SSI total score) (r = -0.247, p = 0.002). The rate of distress symptoms was higher among female students (79%) compared to their male counterparts (72%). The factors associated with distress included negative association of teachers' level of help to develop competencies (p = 0.000, ß = -0.278, R2 = 0.249), unfavorable school environment (p = 0.000, ß = 0.285, R2 = 0.123), inability to cope with studies (p = 0.005, ß = 0.205, R2 = 0.038), family problems (p = 0.014, ß = 0.184, R2 = 0.173) and lower study skills (p = 0.031, ß = -0.164, R2 = 0.270). The overall regression analysis explained 33.6% of the variance (corrected R2 = 0.336). Conclusion: Higher than expected levels of distress (75%) was found in immigrant school students. Poor study skills have a significant relationship with distress. Learning environment and related stress factors were associated with distress among students. Based on the findings, it is recommended that stakeholders in education address the hidden curriculum, as it is usually unacknowledged and might affect students' wellbeing, and move from student centered to an interpersonal relation-centered education.

Correlates of emotional intelligence: results from a multi-institutional study among undergraduate medical students.

BACKGROUND: Emotional Intelligence (EI) is the ability to deal with your own and others emotions. Medical students are inducted into medical schools on the basis of their academic achievement. Professionally, however, their success rate is variable and may depend on their interpersonal relationships. EI is thought to be significant in achieving good interpersonal relationships and success in life and career. Therefore, it is important to measure EI and understand its correlates in an undergraduate medical student population. AIM: The objective of study was to investigate the relationship between the EI of medical students and their academic achievement (based on cumulative grade point average [CGPA]), age, gender and year of study. METHODS: A cross-sectional survey design was used. The SSREIS and demographic survey were administered in the three medical schools in Saudi Arabia from April to May 2012. RESULTS: The response rate was 30%. For the Optimism subscale, the mean score was M = 3.79, SD ± 0.54 (α = 0.82), for Awareness-of-emotion subscale M = 3.94, SD ± 0.57 (α = 0.72) and for Use-of-emotion subscale M = 3.92, SD ± 0.54 (α = 0.63). Multiple regression showed a significant positive correlation between CGPA and the EI of medical students (r = 0.246, p = 0.000) on the Optimism subscale. No correlation was seen between CGPA and Awareness of Emotions and Use of Emotions subscales. No relationship was seen for the other independent variables. CONCLUSION: The current study demonstrates that CGPA is the only significant predictor, indicating that Optimism tends to be higher for students with a higher CPGA. None of the other independent variables (age, year of study, gender) showed a significant relationship.

Use of complementary and alternative medicine for children: a parents' perspective.

OBJECTIVES: The present study aims to detect the frequency and types of complementary and alternative medicine (CAM) therapies used for children and to explore parental motivating factors for using CAM for their children in Riyadh, Saudi Arabia. PARTICIPANTS AND METHODS: This is a cross-sectional study that involved 462 families selected through a multistage cluster-sampling technique covering Riyadh region, Saudi Arabia. The sample was selected from 40 clusters, distributed proportionally according to the size of the population in the catchment area of primary health care centres (PHCCs). A structured questionnaire that contains items fulfilling the research objectives was used to collect data by research assistants. RESULTS: The study included 926 parents, comprising 351 fathers and 575 mothers; 37.3% of them reported the use of CAM for their children including reciting the Quran, honey and Ferula asafoetida (26.1%, 21.5% and 18.8%, respectively). CAM was used six times higher for children of parents using CAM for themselves than children of parents who did not use CAM themselves (odds ratio (OR)=6.03, 3.9-9.37). Multivariate logistic regression showed that parental use of CAM (OR=3.0, 2.2-4.0), keeping CAM remedies at home (OR=2.3, 1.8-3.1), perceived success of CAM in practice (OR=1.8, 1.3-2.4) and preference of use of natural materials (OR=1.7, 1.2-2.5) were independent predictors of use of CAM for children. CONCLUSIONS: In this study, around one-third of the parents used CAM for their children. Quran (Muslims' holy book) was the most common CAM type used for children. Parents' use of CAM for themselves is the most important predictor of its use for children. An in-depth study to investigate CAM use for specific diseases in children is recommended.

A history of childhood maltreatment among spouses predicts violence against women.

BACKGROUND AND OBJECTIVES: Violence against women (VAW) is a worldwide problem that adversely affects women physically, psychologically, sexually, and financially. The aim of this study was to investigate (1) the rate of self-reported physical violence from husbands among women who presented to outpatient clinics of a major teaching hospital (2) the variables associated with VAW and (3) the pattern and the consequences of abuse on the victims' health. DESIGN AND SETTINGS: This cross-sectional study was conducted over a 6-month period, commencing in December 2009 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. METHODS: Women attending outpatient clinics regularly at KKUH, Riyadh, Saudi Arabia, were eligible for the study. The WHO VAW Instrument was used with some modifications to accommodate for the local culture. RESULTS: A total of 222 Saudi women whose age ranged from 15 to 70 years were enrolled in the study. The rate of physical violence in the current study was 12.2%. Statistically significant associations were found between the self-reporting of VAW and the physical abuse of their husbands during childhood (odds ratio [OR]=8, 95% confidence interval [CI]: 2.2, 28.5, P=.002). Similarly living in rented houses resulted in higher likelihood of the wife being abused (OR=4.23, CI: 1.706, 10.49, P=.002). The likelihood increased if there was a history of wives being abused as a child (OR=3.563, CI: 1.438, 8.824, P=.008) and if their husbands were unemployed (OR=5.29, CI: 1.6, 17.57, P=.012). Furthermore, women who described family life as bad or disastrous were found more likely to be physically abused (OR=5.8, CI: 2.3, 14.5, P=.001). CONCLUSION: VAW is a significant social and public health problem in the Saudi society. Health professionals may need to consider the diagnosis, when the risk factors identified in the current study are found.

Effective teaching in medical schools. Guiding principles.

Clinical teachers have high qualifications in their specialty, but some of them do not have training, or proficiency in teaching, and education. Therefore, they may face the challenge of effective teaching in their daily practice. The objective of this study is to present some basic guiding principles for novices and expert academic health professionals. An overview from the perspective of the authors on critical fields in education was conducted. Seventeen principles (supported by one or more relevant examples) are discussed. To improve the quality of their teaching practice, academic health professionals need to study the pedagogy of education, and to seek feedback from colleagues who have already studied and practiced the principles of learning and teaching.

Traditional healers in Riyadh region: reasons and health problems for seeking their advice. A household survey.

OBJECTIVES: The objectives were to study sociodemographic characteristics of complementary and alternative medicine (CAM) visitors, rate of their visits, health problems, and reasons for the visits. DESIGN: This was a cross-sectional study. SETTING: This study was conducted in Riyadh city and its suburbs. SUBJECTS: The sample size was calculated to be 462 families, selected according to the World Health Organization multistage random cluster sampling technique and was divided into 40 clusters. The 40 clusters were distributed proportionally according to the size of population in the catchment area. INTERVENTION AND OUTCOME MEASURES: A well-structured questionnaire that contains the items that fulfill the research objectives was used to collect the data by trained research assistants. RESULTS: The study includes 1408 individuals; 61% were female. About 42% of the participants consulted traditional healers (TH) sometime before and 24% within the past 12 months. There were more visits to TH in elderly people (> or =60 years), females, married, divorced, or widows and illiterate people. Common types of traditional healing included reciting the Holy Quran (62.5%), herb practitioners (43.2%), cautery (12.4%), and cupping (4.4%). Cautery was used more in suburban areas than in the city. The nationalities of the TH were Saudis (86%), Sudanese (3%), Yemenis (1%), Indians (1%), and others (9%). The common medical problems for seeking TH help were abdominal pain, flatulence, low back pain, sadness, depression, and headache. The common reasons for visiting TH were belief of success of CAM (51%), preference of natural materials (29%), and nonresponse to medical treatment (25%). Factors independently associated with consultation of TH were dissatisfaction with physician diagnosis (odds ratio [OR] = 122), failure of medical treatment (OR = 80), success of TH (OR = 79), long waiting time for physicians (OR = 20) and knowledge that some herbs are harmful (OR = 1.4). CONCLUSIONS: In this study, about half of the participants have visited TH. Abdominal pain was the most common presenting health problem. CAM is a reality and it deserves more investigation and appropriate legislation and control.

A practical discussion to avoid common pitfalls when constructing multiple choice questions items.

This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions (MCQs) used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types (i) related to testwiseness, (ii) related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations.

Prevalence and pattern of alternative medicine use: the results of a household survey.

BACKGROUND AND OBJECTIVES: Alternative medicine (AM) encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. SUBJECTS AND METHODS: A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. RESULTS: Of 1408 individuals participating in the study, 39% were men. The mean (+/-SD) age for the study population was 35.5 (+/-13.9) years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM (50.3%), followed by honey (40.1%), black seed (39.2%) and myrrh (35.4%). The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. CONCLUSIONS AND RECOMMENDATIONS: There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system.

Evaluation of three instructional methods of teaching for undergraduate medical students, at king saud university, saudi arabia.

BACKGROUND: There is an international move from traditional curriculum towards the learner - centered, and patient-oriented curriculum. In spite of its advantages, problem-based learning requires a larger number of teaching staff and space. This study was done to compare the problem-based learning (PBL), lectures and modified PBL methods. METHODS: Thirty-three fifth year medical students who were taking the Family Medicine rotation participated in the study at the College of Medicine, King Saud University. Three instructors participated in the teaching of three topics to the three groups of students. Students acted as control for themselves across the three instructional methods, namely; lectures, PBL and modified PBL. The main outcomes were students' recall of knowledge, problem solving skills and topic comprehension. RESULTS: In the initial assessment, there was a significant difference in favor of PBL and the modified PBL regarding comprehension of the topic as tested by the short answer questions (p = 0.0001), problem solving skills as tested by the modified essay question (p = 0.002). Non-significant results were observed at the second stage of assessment. The modified PBL method was the preferred one for 39% of the students, followed by the PBL (36%) and lastly the lectures (25%). CONCLUSION: This empirical study suggests some advantages for the PBL method and the modified PBL over the lecture method. Larger studies are needed to confirm our results of this important issue as the modified PBL is an affordable option for schools that can not meet the staff and space requirements of the PBL curriculum.

Outpatient management of type 2 diabetic patients: a review of evidence-based literature.

Diabetes mellitus is a common, serious, and treatable disease. Good control is associated with fewer complications. The impact of the disease on the patient, family and the community psychologically and physically is staggering. This paper aims to update the reader on certain issues related to the management of diabetes. Recent criteria for the diagnosis are presented followed by non-pharmacological and pharmacological management, glycemic monitoring, prevention, continuity of diabetes care and the control of co-morbidities. Throughout, as far as possible, the best available evidence was used.

The criteria and analysis of good multiple choice questions in a health professional setting.

Assessment of health workers as students and professionals has a profound impact on their learning and is an essential safety valve before certification. It is used for their training, their placement, their certification, and their promotion. The multiple choice question MCQ type of tests represents one of the most important examination tools that is commonly used in this assessment. The MCQs can be reliable, valid, and cost-effective in assessing medical knowledge. This paper portrays the different purposes of assessment in the medical field. The paper discusses in detail the criteria of a good assessment tool. Interpretation of MCQ test results is the final section of the paper.

Community-based family medicine course: does it have impact on students' learning achievements, attitude and career choice?

OBJECTIVE: To assess the impact of a six-week Family Medicine (FM) course on students' self-assessment of their own knowledge, skills and their attitude towards innovative learning methods and career choice before and after the course, and their evaluation of different aspects of the course curriculum. DESIGN: An observational study, where the study subjects were requested to fill out a standardized five-point Likert scale questionnaire at the start and at the end of the course. The questionnaire explored their knowledge and attitude in addition to their general evaluation of the course. One hundred forty-seven fourth year medical students who undertook FM clinical rotation were the study subjects. The course had some innovative features. For example, students were involved in the selection of the course content by identifying their learning needs. RESULTS: A comparison of pre and post-test observations showed a statistically significant improvement in students' assessment of their knowledge (p < 0.0001) and clinical skills (p = 0.012). A significant positive change was also observed in their choice of FM as a future career (p = 0.008). The intervention was not effective (non-significant difference) on (i) students' attitude towards innovative learning methods (p = 0.314) and (ii) students' attitude towards patients and certain ethical issues (p = 0.99). As the curriculum stemmed from collaboration of learners and teachers, the students were satisfied with the content. RECOMMENDATIONS: There is a need to improve the training in the HC by recruiting family practitioners (FP) who have had residency training for the specialty and to train the other physicians in how to supervise and guide medical students. Topics on ethical issues should be introduced into the college curriculum.

Students' perceptions towards a family medicine attachment experience.

OBJECTIVE: To explore the students' perceptions about their experience in a family medicine (FM) preceptorship in order to provide a sound basis for offering guidance to family medicine undergraduate education. METHODS: During one full academic year at King Saud University, College of Medicine, Riyadh, Saudi Arabia, a self administered questionnaire was distributed to all students (n = 177) at the end of each 6 weeks family practice attachment course. Students were asked to rate their attachment by responding to a five-points Likert type scale questionnaire and other Yes/No questions reflecting different important points in teaching and training. RESULTS: The teaching quality and the ability of the General Practitioners (GPs) preceptors to relate to students are rated very highly. Despite that, the majority of students (59.3%) feel their aims were not met during the attachment. Students indicate that there should be more teaching of practical procedure skills, more time allocated for discussion and a greater student involvement in the consultation. CONCLUSION: There is much to be retained in FM preceptorships that involves the caring and communication aspects of learning patient care. The study showed that practical procedure skills are desirable features of a preceptorship programme and that an emphasis on doing vs. observing is preferred by students. Some conditions designed to improve preceptorships are outlined and basic practicalities of adding a preceptorship to a practice are considered.

Screening for somatization and depression in Saudi Arabia: a validation study of the PHQ in primary care.

OBJECTIVES: Somatization, the tendency to seek treatment for medically unexplained physical symptoms, is an important issue in primary care practice. This study examines the somatoform, depression, and anxiety modules of the Patient Health Questionnaire (PHQ), a screening instrument for the identification of somatoform and other mental disorders. We also utilized the PHQ to measure the prevalence of somatization and co-morbid depression in Saudi Arabian primary care patients. METHODS: This is a cross sectional study of 431 male and female Saudi Arabian primary care patients with a two stage design for purposes of validation of the somatoform, depression and anxiety modules of the PHQ. The self administered Patient Health Questionnaire was given to 431 primary care patients and, of this group, the first, consecutive 173 patients (40 percent) were interviewed by mental health professionals using the Structured Clinical Interview (SCID-R) as the criterion standard for validation of the PHQ in the Saudi population. The PHQ was then used to measure the prevalence of somatization and depression in the remaining 258 patients. RESULTS: The somatoform and depression modules of the PHQ were found to be valid in a Saudi population using the criterion standard of SCID based psychiatric interviews. Agreement between the PHQ and psychiatric interviews was (kappa = .65) for both somatoform disorders and depression but the anxiety module was weak in terms of sensitivity (.37) and agreement with the criterion standard (k = .37). Clinically significant rates of somatization (19.3 percent) and depression (20 percent) were identified in this population. CONCLUSIONS: The prevalence of somatization and co-morbid depression in a primary care population in Saudi Arabia is similar to published rates in the U.S. and worldwide. It is possible to screen primary care patients for mental disorders in international settings and the PHQ is valid instrument for that purpose.

Compliance with appointments and medications in a pediatric neurology clinic at a University Hospital in Riyadh, Saudi Arabia.

OBJECTIVE: The objectives of the study are to estimate the rate of epileptic patients' compliance with appointments and medications in a pediatric neurology clinic. Also to study the factors associated with non-compliance and to determine the parents' perceived reasons for non-compliance with appointments. METHODS: It is a prospective study in which 147 epileptic children who attended the neurology clinic during the first 12-months of the study period were included. Patients were recruited into the study after their parents were interviewed using a detailed questionnaire; their compliance with appointments was monitored prospectively over at least a one year from their recruitment into the study. The parents of the other 70 patients who did not attend the clinic were telephoned. Only 32 replied and were asked about the reasons for non-attendance to the clinic. RESULTS: Eighty-six percent of the patients' parents stated that they were complying with the medications while only 53% of them did not miss any appointment to the clinic during the study period. Compliers with appointments were more likely to comply with their medications too. Children with grand-mal epilepsy and absence seizures were found to be more likely to comply with taking medications than patients with febrile, rolandic and myoclonic seizures (P=0.01). Health belief model factors associated with non-compliance were 1. Children encountering side effects from their medications 2. Parents who were not satisfied with the provided services 3. Parents who thought that alternative medicine is more effective than traditional medicine 4. Parents who think that their children are not susceptible. Patients' perceived main reasons for non-compliance were wrongly registered appointments (27.5%), forgetfulness (22.5%) and busy parents. CONCLUSION: Failure to keep the clinic appointment is an indicator of poor compliance with medications. A telephone call is recommended to reduce the role of clinic non-compliance. Developing a questionnaire form to investigate parents health belief model could be used routinely by social workers and then health education could be tailored for each patient and parent.

Compliance with appointment and medications in a pediatric neurology clinic at a University Hospital in Riyadh, Saudi Arabia.

OBJECTIVE: The objectives of the study are to estimate the rate of epileptic patients` compliance with appointments and medications in a pediatric neurology clinic. Also to study the factors associated with non-compliance and to determine the parents` perceived reasons for non-compliance with appointments. METHODS: It is a prospective study in which 147 epileptic children who attended the neurology clinic during the first 12-months of the study period were included. Patients were recruited into the study after their parents were interviewed using a detailed questionnaire; their compliance with appointments was monitored prospectively over at least a one year from their recruitment into the study. The parents of the other 70 patients who did not attend the clinic were telephoned. Only 32 replied and were asked about the reasons for non-attendance to the clinic. RESULTS: Eighty-six percent of the patients` parents stated that they were complying with the medications while only 53% of them did not miss any appointment to the clinic during the study period. Compliers with appointments were more likely to comply with their medications too. Children with grand-mal epilepsy and absence seizures were found to be more likely to comply with taking medications than patients with febrile, rolandic and myoclonic seizures (P=0.01). Health belief model factors associated with non-compliance were 1. Children encountering side effects from their medications 2. Parents who were not satisfied with the provided services 3. Parents who thought that alternative medicine is more effective than traditional medicine 4. Parents who think that their children are not susceptible. Patients` perceived main reasons for non-compliance were wrongly registered appointments (27.5%), forgetfulness (22.5%) and busy parents. CONCLUSION: Failure to keep the clinic appointment is an indicator of poor compliance with medications. A telephone call is recommended to reduce the role of clinic non-compliance. Developing a questionnaire form to investigate parents health belief model could be used routinely by social workers and then health education could be tailored for each patient and parent.

Microbiology and antimicrobials sensitivity of supprative otitis media.

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