Smoking patterns among primary health care attendees, Al-Qassim region, Saudi Arabia.

Prevalence, sociodemographic patterns and medical co-morbidity of smoking among a cross-section of primary health care (PHC) clients in Saudi Arabia were examined. We used a 44-item semistructured questionnaire to collect data from 1752 patients at 25 randomly selected PHC centres. Percentage of smoking was 52.3%. Although 85% were adult smokers, 8.6% began smoking before age 12. Smokers gave overlapping reasons to smoke including peer pressure; non-smokers gave religious and health logics against smoking. Of all smokers, 92.8% wanted to learn cessation strategies, 11.8% were ignorant of hazards and 32.4% reported manifestations of nicotine withdrawal. Besides alcohol use (13.4%), 81.8% had co-morbid physical disease.

Smoking patterns among primary health care attendees, Al-Qassim region, Saudi Arabia

Prevalence, sociodemographic patterns and medical co-morbidity of smoking among a cross-section of primary health care [PHC] clients in Saudi Arabia were examined. We used a 44-item semistructured questionnaire to collect data from 1752 patients at 25 randomly selected PHC centres. Percentage of smoking was 52.3%. Although 85% were adult smokers, 8.6% began smoking before age 12. Smokers gave overlapping reasons to smoke including peer pressure; non-smokers gave religious and health logics against smoking. Of all smokers, 92.8% wanted to learn cessation strategies, 11.8% were ignorant of hazards and 32.4% reported manifestations of nicotine withdrawal. Besides alcohol use [13.4%], 81.8% had co-morbid physical disease

Integration of mental health care into primary care. Preliminary observations of continuing implementation phase.

OBJECTIVE: The authors mainly focus on the initial observations of the implementation phase of a health project that aims to integrate mental health into primary care. METHODS: In the light of specific aims and objectives of both planning and curriculum development phases, 2- weeks of intensive psychiatric training consisting of basic theoretical and clinical concepts of psychiatry was imparted to a group of general practitioners and paramedical staff. In addition to assessing their pre-and post-training knowledge, attitude, and practice toward psychiatry, 2 internal Consultant Psychiatrists and participants evaluated the training course providing appropriate feedback to the organizers and trainers for modifying several adopted training methods, as well as a curriculum for subsequent courses. RESULTS: The 2-week psychiatric training of the medical personnel resulted in identifying several pros and cons of implementing this project at primary health care centers. Additionally, the immediate and the post-training evaluations of trainees by numerous methods were characterized by favourable changes in their attitude, knowledge and enhanced motivation to practice psychiatry at primary health care centers. CONCLUSION: The implementation of this project by training the first 3 groups of health personnel was successful, as evidenced both by the healthy encouraging comments of the evaluators and the post-training favourable positive responses of the trainees. The incorporation of mental health into primary care by offering condensed psychiatric courses to general practitioners should be the top training agenda as it is in line with the World Health Organization recommendations.

Attention deficit hyperactivity disorder. Epidemiologic, pathophysiologic, diagnostic and treatment perspectives.

Although attention deficit hyperactivity disorder is a common child psychiatric disorder, the epidemiology and pathophysiology of attention deficit hyperactivity disorder is variable in different studies. Attention deficit hyperactivity disorder and comorbid disorders in children aided both by attention deficit hyperactivity disorder diagnostic criteria and assessment scales entails a comprehensive neuropsychiatric interview plus collection of information from different sources. Although psychosocial and behavioral therapies are of great therapeutic values, the psychopharmacological drugs are often used in the treatment of patients with attention deficit hyperactivity disorder. With a combined approach, a substantial proportion of patients with attention deficit hyperactivity disorder (90%) show good recovery. The patients with attention deficit hyperactivity disorder need careful evaluation and appropriate long-term treatment in order to prevent subsequent negative consequences. In rapidly developing countries, the researchers should carry out studies, which explore different aspects of attention deficit hyperactivity disorder in children, adolescents and adults.

Psychiatric referrals. In primary care and general hospitals in Qassim Region, Saudi Arabia.

OBJECTIVE: From different perspectives, psychiatric symptoms have special significance in psychiatry. This study comparatively describes the psychopathological symptoms as noted in primary care (402) and general hospital (138) referrals. METHODS: Five hundred and forty psychiatric referrals, retrieved randomly, were reviewed extensively for collecting relevant data. RESULTS: Both hospital and primary care referrals were observed to have a variety of psychological and somatic symptoms of variable frequencies, which were suggestive of several psychopathological domains. Functional psychotic (19.5% versus 10%), mood (27.5% versus 23%) and psychosomatic (7% versus 2%) symptoms were significantly noted in hospital referrals as compared to primary care referrals while the later were observed to have significantly more somatic (34.5% versus 22.5%) and neurological (8% versus 4%) symptoms. Only a small proportion of primary care referrals (33/402, 8%] have symptoms of childhood psychiatric disorders. CONCLUSION: Psychiatric symptomatology differs in primary care and general hospital referrals. Both the general practitioners and clinicians are expected to record psychiatric symptoms in a comprehensive manner. Hence, they need condensed training courses on psychiatric symptomatology.

Measles immunization in Saudi Arabia: the need for change.

This paper describes the measles immunization programme in Saudi Arabia and the change from the single-dose schedule with the Schwartz vaccine to the double-dose schedule with the Edmonston-Zagreb vaccine. The recent measles-mumps-rubella school campaign is also described.

Psychiatric co-morbidity in primary care and hospital referrals, Saudi Arabia.

Psychiatric and physical morbidities among patients referred from primary health care (PHC) centres and general hospitals (GH) in Al-Qassim region were compared. Thus, 540 psychiatric referrals (GH = 138; PHC = 402) were selected randomly. Fifteen GH patients but no PHC patients were referred for admission. Psychiatrists made more diagnoses of dementia, affective and anxiety disorders, mixed anxiety-depression and somatoform disorders than clinicians and general practitioners (GPs). Clinicians made significantly more diagnoses of acute psychoses and somatoform disorders than GPs. Physical morbidity was noted in 38.4% and 17.2% of GH and PHC referrals respectively.

Integration of mental health care into primary care. Preliminary observations of continuing implementation phase.

OBJECTIVE: The authors mainly focus on the initial observations of the implementation phase of a health project that aims to integrate mental health into primary care. METHODS: In the light of specific aims and objectives of both planning and curriculum development phases, 2- weeks of intensive psychiatric training consisting of basic theoretical and clinical concepts of psychiatry was imparted to a group of general practitioners and paramedical staff. In addition to assessing their pre-and post-training knowledge, attitude, and practice toward psychiatry, 2 internal Consultant Psychiatrists and participants evaluated the training course providing appropriate feedback to the organizers and trainers for modifying several adopted training methods, as well as a curriculum for subsequent courses. RESULTS: The 2-week psychiatric training of the medical personnel resulted in identifying several pros and cons of implementing this project at primary health care centers. Additionally, the immediate and the post-training evaluations of trainees by numerous methods were characterized by favourable changes in their attitude, knowledge and enhanced motivation to practice psychiatry at primary health care centers. CONCLUSION: The implementation of this project by training the first 3 groups of health personnel was successful, as evidenced both by the healthy encouraging comments of the evaluators and the post-training favourable positive responses of the trainees. The incorporation of mental health into primary care by offering condensed psychiatric courses to general practitioners should be the top training agenda as it is in line with the World Health Organization recommendations.

Measles immunization in Saudi Arabia: the need for change

This paper describes the measles immunization programme in Saudi Arabia and the change from the single-dose schedule with the Schwartz vaccine to the double-dose schedule with the Edmonston-Zagreb vaccine. The recent measles-mumps-rubella school campaign is also described

Psychiatric co-morbidity in primary care and hospital referrals, Saudi Arabia

Psychiatric and physical morbidities among patients referred from primary health care [PHC] centres and general hospitals [GH] in Al-Qassim region were compared. Thus, 540 psychiatric referrals [GH = 138; PHC = 402] were selected randomly. Fifteen GH patients but no PHC patients were referred for admission. Psychiatrists made more diagnoses of dementia, affective and anxiety disorders, mixed anxiety-depression and somatoform disorders than clinicians and general practitioners [GPs]. Clinicians made significantly more diagnoses of acute psychoses and somatoform disorders than GPs. Physical morbidity was noted in 38.4% and 17.2% of GH and PHC referrals respectively

Follow-up of Saudi children vaccinated with Haemophilus influenzae type B vaccine.

BACKGROUND: Saudi children vaccinated with a primary series of Hib vaccine (HbOC) at six weeks, three and five months have shown higher antibody titers compared to recent data from the U.S. The aim of this study was to evaluate the persistence of antibodies and to measure the immunogenicity of a booster dose of Haemophilus influenzae type b (Hib) vaccine in Saudi children. PATIENTS AND METHODS: In the first phase of the trial, 210 children were divided into three groups. Group 1 received HbOC, DPT and the WHO formula of oral poliovirus vaccine (OPV); group 2 received HbOC, DPT and the FDA formula of OPV; and group 3 (control) received DPT and the WHO formula of OPV, without HbOC. Haemophilus influenzae geometric mean antibody levels after primary immunization were reported previously. In this study, blood samples were collected at 18 months (before the booster dose) and one month later to measure antibody levels against Haemophilus influenzae polysaccharide. RESULTS: Following the booster doses, there was an increase in the geometric mean titers (GMTs) from 2.57 microg/mL to 39.4 microg/mL in group 1, and from 1.2 microg/mL to 48.9 microg/mL in group 2. In group 3, the GMT remained at 0.3 microg/mL. There was no significant difference in Hib GMTs after the booster dose between children given Hib vaccine with the FDA formula of DPT and OPV and those given the WHO formula. CONCLUSION: Based on the high immunogenicity of the Hib vaccine in Saudi children, a booster dose is not necessary at the initial stages of immunization, and should instead be given to children in the second year of life. This option, however, needs further evaluation and close monitoring.

Drug addiction: a general review of new concepts and future challenges.

Relevant papers published in peer reviewed journals in the past 2 decades were identified and screened to abstract pertinent information. Substance dependence/addiction, involving both a common brain reward mechanism and longer-lasting molecular and cellular changes, is a preventable chronic, relapsing brain disease and as such a public health problem. Physical and psychological dependence, characterized by withdrawal syndrome, are now given less weight compared with compulsive behaviour and uncontrolled use of drugs in the comprehension of addiction. The challenging components of drug addictions, including counteradaptation, sensitization, abstinence, craving and relapse need further neurobiological and non-neurobiological exploration and understanding, which may be possible through the use of advanced imaging and genetic techniques and animal models of drug addiction together with relevant human studies.

Childhood enuresis. Epidemiology, pathophysiology and management.

The goal of this article is to review childhood enuresis, which is a common behavioral condition reported in millions of children worldwide. An online computer search was made, and the literature up to 1997 was screened in order to include relevant data for this review. The prevalence of childhood enuresis varies across reviewed studies. This was attributed to a variety of sociodemographic and cultural dynamics of societies. Similarly, the pathophysiology of this ubiquitous symptom is determined by multiple risk factors including biological, psychological, social, and cultural, but the developmental/maturational delay influenced by genetics remains the most plausible explanation. Although a variety of pharmacological and non-pharmacological treatment modalities are traced in the literature, there is yet no agreement on a single strategy. A general agreement about behavioral therapy as the first choice of treatment of this minor malady began to emerge. Additionally, tricyclic antidepressants are the most frequently prescribed drugs for the treatment of childhood enuresis. Enuresis is a pediatric public health problem and concerted efforts at all levels, ie, professional, promotional, educational and public should be made to address its multiple domains such as preventive, etiological and curative.

Socioclinical profile of children with asthma in Al-Majmaah Health Province.

OBJECTIVE: Although asthma in children constitutes a major health problem, there is a dearth of literature on different aspects of asthma in rapidly developing countries. This cross-sectional research aims to study the socioclinical profile of asthmatic children and the impact of asthma symptoms on their life style. METHODS: The sample of this study, drawn from pediatric clinics of a general hospital and primary health care centers during a period of six months, comprised of children under 13 years of age who met the operational diagnostic criteria for asthma. The data collected from multiple sources on a semistructured questionnaire was analyzed by using different statistical tests. RESULTS: The results showed that male children represented 69% of the sample and children under one year of age manifested significantly severe degree of asthma. The frequency of asthma symptoms decreased in most of the studied children with increasing age. Further, they have insignificant family history of asthma (48.5%) but a significant smoking at home in severely affected children (59%). Moreover, most of them (88%) were mainly characterized by a combination of asthmatic symptoms of variable severity that adversely affected their sleep pattern and significantly resulted in school absences and increased days stay in hospital. CONCLUSION: The revealed socioclinical profile of studied children with asthma has adverse impact on certain components of their life style, which shows the need for re-activating relevant treatment modalities including health education and changing certain habits like parental smoking at home, which adversely affects asthma.

Childhood enuresis. Epidemiology, pathophysiology and management.

The goal of this article is to review childhood enuresis, which is a common behavioral condition reported in millions of children worldwide. An online computer search was made, and the literature up to 1997 was screened in order to include relevant data for this review. The prevalence of childhood enuresis varies across reviewed studies. This was attributed to a variety of sociodemographic and cultural dynamics of societies. Similarly, the pathophysiology of this ubiquitous symptom is determined by multiple risk factors including biological, psychological, social, and cultural, but the developmental/maturational delay influenced by genetics remains the most plausible explanation. Although a variety of pharmacological and non-pharmacological treatment modalities are traced in the literature, there is yet no agreement on a single strategy. A general agreement about behavioral therapy as the first choice of treatment of this minor malady began to emerge. Additionally, tricyclic antidepressants are the most frequently prescribed drugs for the treatment of childhood enuresis. Enuresis is a pediatric public health problem and concerted efforts at all levels, ie, professional, promotional, educational and public should be made to address its multiple domains such as preventive, etiological and curative.

Drug addiction: a general review of new concepts and future challenges

Relevant papers published in peer reviewed journals in the past 2 decades were identified and screened to abstract pertinent information. Substance dependence/addiction, involving both a common brain reward mechanism and longer-lasting molecular and cellular changes, is a preventable chronic, relapsing brain disease and as such a public health problem. Physical and psychological dependence, characterized by withdrawal syndrome, are now given less weight compared with compulsive behaviour and uncontrolled use of drugs in the comprehension of addiction. The challenging components of drug addictions, including counteradaptation, sensitization, abstinence, craving and relapse need further neurobiological and non-neurobiological exploration and understanding, which may be possible through the use of advanced imaging and genetic techniques and animal models of drug addiction together with relevant human studies

Psychotropic drugs prescriptions in Al-Qassim region, Saudi Arabia.

Psychotropic drugs prescriptions for patients attending psychiatric outpatient clinics were studied. Of the 52,168 prescriptions written in 1996, 18,265 were systematically, randomly selected and evaluated. Incomplete prescriptions were found; the data missing included duration of treatment (18.75%), sex (9.25%), age (8.75%) and diagnosis (7.50%). Antipsychotics (33.1%), antidepressants (23.2%), anticholinergics (22.0%) and anticonvulsants (12.9%) were the most frequently prescribed drugs. Polypharmacy (85%) was the predominant mode of practice. The most common diagnoses were mood (23.1%), anxiety (17.7%) and schizophrenic (16.2%) disorders. Medical education and quality monitoring programmes are suggested to improve the quality of psychotropic prescriptions and modify multiple pharmacotherapy practice.