Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia.

BACKGROUND: Child abuse is a significant issue across many countries. Despite the situation's innate understanding, many children are not reported to authorities and continue to experience abuse, sometimes even death. Healthcare professionals must be alert for abuse in any child who appears with injuries that are out of the ordinary because it is easy for indicators of child abuse to go unnoticed in a busy emergency department. The current study aims to evaluate and detect the challenges in diagnosing and reporting cases of child abuse among healthcare practitioners in emergency, pediatrics, and family medicine. METHODS: A self-administered online disseminated questionnaire was used for data collection during the period from October 1 to December 30, 2022. A cross-sectional study was conducted on emergency, pediatrics, and family medicine healthcare practitioners working in hospitals in healthcare centers in Riyadh, Saudi Arabia. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for (IBM Corp., Armonk, NY) Windows. RESULTS: The study sample constituted 200 physicians working in the front lines of healthcare like emergency, pediatrics, and family medicine primary care services, 50.5% were males and 49.5% were females. 36.5% of participants were 31-39 years old. 42% were family medicine physicians, 36.5% were pediatricians, and 21.5% were emergency medicine. About 43% of participants attended an educational workshop on child abuse. Nineteen percent of participants are very familiar with the diagnosis of child abuse and 36% of participants reported one to three cases of child abuse in the emergency department in the last year, 5% reported four to six cases and 56.5% reported none. Forty-seven percent of participants reported diagnosing one to five cases of child abuse throughout their whole career, 13% reported 11-15 cases, 6.5% reported six to 10 cases and 28.5% reported none. Causes of underdiagnosis of child abuse by healthcare providers were reported as 63% inexperience, 59% inadequate time for physical examination, 59% lack of diagnosis protocol, 51% lack of confidence in communicating with parents, 36% physicians' cultural background, and 38% lack of confidence in the diagnosis. 93.5% of participants think that healthcare practices need further education for child abuse. CONCLUSION: In conclusion, physicians in Saudi Arabia who participated in the study had good knowledge to diagnose a case of child abuse. Inexperience, inadequate time for physical examination, lack of diagnosis protocol, lack of confidence in communicating with parents, and physicians' cultural background were the main identified challenges for diagnosing child abuse. Familiarity with cases of child abuse was significantly associated with physicians' age, specialty, and level of training.

Gastroesophageal Reflux Disease and Hiatal Hernia After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has shown good results in terms of weight loss and improvement of obesity-comorbidities, even though its effect on inducing new-onset gastroesophageal reflux disease (GERD) is still a matter of debate. This study aims to estimate the incidence of GERD and hiatal hernia post LSG and to identify associated risk factors of GERD development. METHODS: This is a retrospective cohort study of all patients who underwent LSG surgery at the National Guard medical hospitals (Riyadh and Al-Ahsa) between January 2016 and February 2019. Patients who had undergone LSG, who had a history of GERD or hiatal hernia preoperatively, or who had intraoperative hiatal hernia repair were excluded. Mean, standard deviation, and independent t-test was used for numerical variables, while frequencies, percentages, and chi-square test were used for categorical variables. RESULTS: There were 142 patients included in this study, with the mean age being 39,38 ± 12.68 years, and 64.8% of patients were female. Patients were followed up for 24 months. The incidence of GERD post-operation was 33.% (n=47) and hiatal hernia was 3.5% (n=5). Significantly associated risk factor for post-operative GERD were as follows: age (p=0.026), gender (p=0.038), and hypertension (p=0.014). CONCLUSION: Incidence of GERD was shown to be relatively high, while hiatal hernia was low; besides age, gender and hypertension, none of the other variables was associated with the development of GERD.

Public awareness of first-aid management of seizures in Saudi Arabia.

BACKGROUND: First aid measures in cases of epileptic seizures are crucial. Misconceptions about seizure first-aid measures are probably common. Most of the previous data focused on teachers and healthcare providers. The objective of this study was to assess the awareness of seizure first-aid measures and their associated factors in a community sample in Saudi Arabia. METHODS: A cross-sectional study was carried out using an online questionnaire between July 2020 and February 2021. Those who had never heard of epilepsy and healthcare workers were excluded. Overall and individual scores were calculated for first-aid measures during and after the seizures as well as calling the ambulance. RESULTS: A total of 1542 participants were included in the study. The overall awareness score of seizure first-aid measures was 57.3%. The awareness of the need to call the ambulance in special circumstances was the highest individual score (78.3%), followed by measures after the seizure (54.2%), and finally measures during the seizure (48.4%). For the latter, the awareness of injury prevention measures was the highest (74.9%), while the awareness of treatment options was the lowest (12.2%). Overall awareness score was significantly higher in older age (p = 0.015), female gender (p < 0.001), divorced status (p = 0.014), knowing someone with epilepsy (p < 0.001), attending a course or workshop about seizure first-aid (p < 0.001), watching a video on seizure first-aid on any platform (p < 0.001), and having basic life support training (p < 0.001). CONCLUSIONS: The awareness of seizure first-aid measures is still inadequate among the public in Saudi Arabia. The current finding underscores the importance of simulation videos on social media and/or field-training campaigns to improve the public awareness of seizure first-aid measures.

Internalized Weight Stigma: Prevalence and Association With Psychiatric Disorder Among Overweight and Obese Individuals.

Background and objective Unlike weight stigma, internalized weight stigma (IWS) may be a common but still underreported problem. With the recent emergence of studies investigating its various aspects in Arab-speaking countries, there is still scant data on its incidence and severity in the literature. In light of this, the aim of this study was to evaluate the prevalence of IWS and its association with psychiatric disorders and sociodemographic factors among overweight and obese individuals in a sample from a Saudi population. Methods A cross-sectional study was conducted among a Saudi population using a convenience sample technique and 868 individuals were enrolled to participate in this study. They were asked to fill out an electronic questionnaire about IWS, demographics, and other parameters such as Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7. The association was tested using an independent t-test and chi-square test. Results The overall prevalence of internalized stigma in this study was 57%. Higher levels of internalization were more prevalent among younger respondents. We found that females were more prone to internalize weight stigma, at a slightly higher rate than males (59.26% vs. 53.66%), but this difference was not statistically significant. The other sociodemographic factors associated with higher internalization were as follows: being widowed, married, retired, or housewife. Those with higher IWS levels were individuals with higher BMI and with previous experiences of weight stigma. In addition, higher internalization was associated with the development of severe depression and anxiety (p<0.001). Conclusion The prevalence of IWS among overweight and obese individuals was found to be high, and it is highly associated with the development of severe depression and anxiety. There is a need to raise awareness about obesity stigma to help tackle IWS in overweight and obese individuals and to promote their quality of life.

Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management.

Scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. There have been outbreaks not only in the developing world, but also in the developed world among refugees and asylum seekers. Once infested with scabies mites, symptomatic patients, as well as asymptomatic carriers, quickly spread the disease through direct skin-to-skin contact. Typically, symptoms of scabies are characterized by an erythematous, papular, pruritic rash associated with burrows. Treatment of scabies involves using topical or systemic scabicides and treating secondary bacterial infections, if present. Given the prevalence and contagiousness of scabies, measures to prevent its spread are essential. Through application of the novel Identify-Isolate-Inform (3I) Tool, emergency medical providers can readily identify risk factors for exposure and important symptoms of the disease, thus limiting its spread through prompt scabicide therapy; isolate the patient until after treatment; and inform local public health authorities and hospital infection prevention, when appropriate. Ultimately, these three actions can aid public health in controlling the transmission of scabies cases, thus ensuring the protection of the general public from this highly contagious skin infestation.

Physician practice in food allergy prevention in the Middle East and North Africa.

BACKGROUND: A number of scientific organisations have developed guidelines for the primary prevention of allergic disease through nutritional interventions. However, even if the best evidence-based guidelines are available, these guidelines do not necessarily lead to adherence and improved health outcomes. METHOD: To determine how closely the practice of physicians in select Middle Eastern and North African countries compares with the current recommendations on the primary prevention of allergy a survey study was performed using a structured questionnaire and convenience sampling. RESULTS: A total of 1481 physicians responded, of which 66.1% were pediatricians. A total of 76.6% of responding physicians routinely identify infants who are at risk for developing allergy. In infants at risk for developing allergy, 89.1% recommend exclusive breastfeeding for at least 4 months. In contrast to current recommendations, 51.6% routinely recommend avoidance of any allergenic food in the lactating mother. In infants at risk of developing allergy who are completely formula fed, standard infant formula was recommended by 22.5% of responders. Of the responding physicians, 50.6% would recommend delaying the introduction of complementary food in infants at risk of allergy compared to those not at risk, whereas 62.5% would recommend postponing the introduction of potentially allergenic foods. Only 6.6% stated they follow all current recommendations on food allergy prevention. CONCLUSION: The results of this survey suggest that a substantial part of responding physicians from select Middle Eastern and North African (MENA) countries do not follow current recommendations on primary prevention of allergic disease through nutritional interventions.