Two decades of treatment seeking for substance use disorders in Saudi Arabia: trends and patterns in a rehabilitation facility in Dammam.

BACKGROUND: Treatment provision and treatment seeking for substance use disorders is a relatively new phenomenon in the Middle East. The present study aims to study these trends among first admissions to the specialized addiction treatment Amal Hospital of Dammam over its first two decades (1986-2006). The main outcome measures were: annual inception number (AIN), relative frequency of substances (RFS), relative frequency of drug combinations (RFDC), mean number of substances (MNS), and sociodemographic changes. RESULTS: A total of 12,743 patients were admitted between 1986 and 2006. The majority were aged 20-39 years (83%), never married (60%), and with low education (81%). In the second decade, subjects were significantly older and less unemployed than in the first decade (28.9 years versus 30.2 years; 27% versus 19%). The mean AIN rose from 509 in the first decade to 765 in the second decade. In the same periods, the RFS increased for amphetamines and cannabis (from 12.1 and 17.5% to 48.1 and 46.5%, respectively), decreased for heroin, sedatives and volatile substances (from 51.1, 15.1, and 6.1% to 22.5, 7.3, and 2.5%, respectively), and remained stable for alcohol (from 27.1 to 26.7%). The overall RFDC increased from 25.5 to 43.2% with significant pair-wise increases of cannabis/amphetamine, alcohol/cannabis and alcohol/amphetamine, and heroin/alcohol. The mean number of substances per subject increased from 1.32 to 1.56%. CONCLUSIONS: Significant shifts have occurred in the types and patterns substances use among treatment-seeking subjects. These findings underscore the need for community-based epidemiologic studies and for the establishment of a comprehensive drug information system in Saudi Arabia.

Comparative evaluation of multiple choice question formats. Introducing a knowledge score.

OBJECTIVE: Over the last 6 years different multiple choice question (MCQ) formats have been used in postgraduate examinations for trainees in psychiatry. In phase 1 - K-type True/False (T/F) items with negative marking; in phase 2 combined T/F and type-A one-best answer (OBA) questions without negative marking; in phase 3 exclusively OBA without negative marking. The study compares the gross scores (GS) obtained with different MCQ formats, and introduces knowledge score (KS). METHODS: The study was conducted in the Saudi Council for Health Specialties, Riyadh, Kingdom of Saudi Arabia from 1996 to 2002. The mean percentile scores obtained by all postgraduate trainees sitting any Part I or Part II Saudi Board Examination in Psychiatry were subjected to a comparative analysis. RESULTS: A total of 110 candidates sat 18 examinations returning 143 papers containing a total of 32,375 MCQ options. Phase 1 generated lowest overall mean GS (47.8%), phase 3 occupied an intermediate position (53.1%) and phase 2 produced the highest score (68.3%). The KS, to the contrary, generated strikingly similar results for all the 3 phases (47.8, 50.5 and 49.5%) indicating that the marked differences in the GS were probably related to benefits obtained from guessing in the absence of negative marking. In this respect, the OBA produced considerably higher KS scores than the T/F, presumably due to its facilitating extra benefits from cueing, partial knowledge and judgement. CONCLUSION: Different MCQ formats generate dissimilar quantitative results. The OBA format seems superior to the T/F format in crediting judgement and application of knowledge. In non-negatively marked MCQ tests, the suggested KS provides results comparable to those of negatively marked tests. Pass marks in MCQ tests should be calibrated according to the used format.

Mental health training in primary care. Impact on physicians knowledge.

OBJECTIVE: The objective of this study was to measure changes in the Primary Health Care (PHC) physicians` knowledge towards mental illnesses after a short-term training course. METHODS: The interventive study consisted of a sample of 31 PHC physicians randomly selected from different PHC centers in Eastern Saudi Arabia. The physicians were exposed to a 4-day intensive training course in mental illnesses in June 1999. They were assessed using multiple choice questions testing before (pre-test) and after (post-test) to assess their knowledge regarding mental illnesses. RESULTS: The analysis of the accumulated data indicated that there was a significant improvement in the PHC physicians` knowledge of mental illnesses after the course (p<0.0001). The effect of recall bias was excluded in the post-test evaluation. In addition, multiple regression analysis indicated that the undergraduate psychiatric training courses had a positive contribution in both pre- and post-tests. CONCLUSION: The authors surmised that a mental training course could improve the knowledge base of PHC physicians. Furthermore, by giving substantial weight to the undergraduate and internship psychiatric training might improve the delivery of mental health services at the PHC level.