The prevalence and correlates of depressive symptoms from an Arabian setting: a wake up call.

It has been shown that medical students have a higher rate of depressive symptoms than the general population and age- and sex-matched peers. This study aimed to estimate the prevalence of depressive symptoms among the medical students of a large school following a traditional curriculum and its relation to personal background variables. A descriptive-analytic, cross-sectional study was conducted in a medical school in Riyadh, Saudi Arabia. The medical students of King Saud University in Riyadh, Saudi Arabia, were screened for depressive symptoms using the 21-item Beck Depression Inventory. A high prevalence of depressive symptoms (48.2%) was found, it was either mild (21%), moderate (17%), or severe (11%). The presence and severity of depressive symptoms had a statistically significant association with early academic years (p < 0.000) and female gender (p < 0.002). The high prevalence of depressive symptoms is an alarming sign and calls for remedial action, particularly for the junior and female students.

Pattern of intestinal parasitic infection among food handlers in riyadh, saudi arabia.

OBJECTIVE: Identify the types and prevalence of intestinal parasites among food handlers, and test the effectiveness of the current pre-employment screening policy. METHODS: A cross sectional survey was carried out in the catchment areas of seven primary health care centres (PHCCs) to represent various sections of Riyadh city. A total of 700 food handlers working in restaurants were randomly selected from the study area. All study subjects were asked to complete a data collection form and to bring a fresh stool specimen on the specified day to the designated PHCC. RESULTS: About 66% of the selected subjects complied in bringing fresh stool specimens. Fifty nine (12.8%) of the specimens were positive for parasites. There was a significant association between the food handler's nationality and the likelihood of a positive specimen result, being highest among the Bangladeshis (20.2%) and Indians (18.5%) and the lowest among the Arabs (3.4%) and the Turks (10%). The commonest intestinal parasites isolated were Giardia lamblia (33.8%), followed by Enterobius vermicularis (27.4%). The current screening policy does not seem effective, as there was an absence of significant association between holding a valid PEHC and the test result, with 81% of the positive results from persons holding valid pre-employment health certificates (PEHCs). CONCLUSIONS: Though it is obligatory for food handlers to hold a PEHC in Saudi Arabia, the prevalence of intestinal parasites remains high. Possible solutions include health education on hygiene, more frequent stool tests, and assessment of the current annual screening procedure.

Students evaluation of a traditional and an innovative family medicine course in Saudi Arabia.

This study compares students' evaluation of a traditional and an innovative undergraduate family medicine (FM) courses. The old curriculum was traditional and teacher-centered. Changes in-line with the innovative learning concepts were introduced. While innovative course (IC) students had significant improvement in both their attitude towards innovative learning methods and self-assessment of knowledge, traditional course students had improvement only in self-assessment of knowledge. Students in both courses did not show post-cycle improvement in perception of their own skills and were dissatisfied with the Health Center (HC) tutors' training. The need to recruit trained family physicians at the affiliated HC became evident. IC students valued the exercise of adding their generated learning needs as part of the curriculum. Other lessons learned were presented. We hope that findings of this study would encourage medical colleges in the region to critically review their FM courses.

The prevalence of abnormal results of annual investigations among diabetic patients with different risk factors.

BACKGROUND: The basic theme of this study was to promote the use of risk approach and encourage selectivity in requesting laboratory investigations. The objective was to estimate the proportion of abnormal results obtained from routinely requested annual investigations among the whole study population, and the odds ratios of abnormal test results among patients with certain risk factors. PATIENTS AND METHODS: A total of 459 diabetic patients aged 12 years and over, attending the primary care clinics of a university hospital in Riyadh, Saudi Arabia, were included in the study. In this cross-sectional study, analysis of the association between patients demographic characteristics and clinical findings (independent variables), and the results of the annual investigations were conducted. A multiple logistic regression analysis was carried out to identify certain independent variables associated with abnormal investigations. RESULTS: The proportion of patients who had abnormal electrocardiogram (ECG) was 23%, chest x-ray (CXR) 26%, and liver function test (LFT) 9%. High systolic blood pressure (BP) and age were found to be important determinants of abnormal ECG and CXR. Patients who had high systolic BP (>140 mm Hg) were found to be 2.39 times more likely to have abnormal ECG (OR=2.39), and their odds ratio of abnormal CXR was 2.33. Furthermore, for each 10-year increment in age, there was a 43% increased likelihood of abnormal ECG and 29% increase of abnormal CXR. Smokers were nine times more likely to have abnormal LFT (OR=9.26, 95% CI=2.29 to 37.5). The disease duration and obesity were not found to have an independent association with the possibility of having abnormal results. CONCLUSION: The study results led to some tentative suggestions on guidelines for clinicians in their decision either to request annual investigations for all diabetic patients, or to restrict some investigations to certain groups of patients. This was discussed and compared with the findings from the literature and other authorities recommendations.

The pattern of alternative medicine use among patients attending health centres in a military community in riyadh.

BACKGROUND: Alternative Medicine (AM) is gaining popularity worldwide. OBJECTIVES: This study was conducted to determine the prevalence and pattern of AM use in a military sector of the Saudi community. METHODS: Three hundred and ten adult patients, visiting their family physicians over 6 weeks from the 1(st) of June 1998, were selected by systematic random sampling. They were asked to report worrying health problems and their use of modern medicine (MM) and AM. RESULTS: Forty-six percent of the patients had used AM before and about 19% had used it in the past 12 months. Alternative medicine practitioners were visited by 16.5% of the study population. Herbal medicine users represented 8.7% of the study population, honey (4.5%), the black grain Nigella sative (3%) and cautery was used by one person only. Women, housewives and the illiterate were more likely to use AM. About 86% of all the study population preferred MM. The main source of information about AM was relatives (77%). A large proportion of patients who reported depression used AM (53%) or visited AM practitioners (33%). The average cost per visit to an AM pratitioner (166 Saudi Riyals) was higher than that in the USA ($27.60=100 Saudi Riyals). CONCLUSION: There is a need to educate the public through the media and health professionals on the appropriate use of AM; housewives and the illiterate should be targeted. A community-based household survey using interviewers not associated with the health system such as teachers (to avoid bias) is needed.

Audit of prescribing patterns in Saudi primary health care: What lessons can be learned?

BACKGROUND: The prescription of drugs is one of the most important factors in the rising costs of health services. The lack of proven benefit, and the definite cost and side effects of many prescriptions, have been found in many studies. The aim of the present study is to assess the prescribing pattern of primary health care (PHC) physicians in Riyadh city, the capital of Saudi Arabia. PATIENTS AND METHODS: Prescriptions issued from eight PHC centers over two weeks (six months apart) were analyzed. The health centers were randomly selected to represent the geographical parts of Riyadh city. RESULTS: A total of 17,067 prescriptions were analyzed. The most frequently prescribed drugs were antihistamines (25%), paracetamol (20.3%) and antibiotics (14.7%). Upper respiratory tract infection (URTI) was the diagnostic label used on more than half of the prescriptions. On the other hand, drugs for chronic illnesses such as diabetes mellitus (DM) and hypertension were written in a minority of the prescriptions. Antibiotics were prescribed for 26% and antihistamines for 28% of patients with URTI. Although it is well known that a large proportion of patients seen in PHC have a significant psychological or psychiatric disorder, no diagnoses of mental disorders were made. CONCLUSION: There is a pressing need for education of both patients and doctors regarding the benefit of treatment and control of chronic illnesses, and the limited contribution that the doctor or an antibiotic can make to many self-limiting conditions like URTI. Doctors should be educated on more appropriate and cost-effective prescribing. The detection and management of psychological disorders need special emphasis.

The validation of the general health questionnaire (ghq-28) in a primary care setting in saudi arabia.

OBJECTIVE: The objective of this study was to validate an Arabic version of the General Health Questionnaire (GHQ-28) in a primary care setting in Saudi Arabia. METHODOLOGY: A total of 60 Saudi patients selected by means of systematic random sampling were asked to fill out the GHQ-28 Arabic version. The psychiatrist interviewed all patients using the Arabic version of the Clinical Interview Schedule (CIS). RESULTS: The best cut-off level for the GHQ-28 indicating best trade-off between sensitivity and specificity was 4/5, where the validity values were, sensitivity; 72%, specificity; 74%, positive predictive value; 72%, negative predictive value; 74% and misclassification rate; 27%. The correlation coefficient was r = +0.61 and the Spearman's Rank-difference correlation was rs = +0.57. The area under the ROC Curve was 69%. The cut-off point 4/5 in this study is the same as recommended by others in primary care settings. Although the validity parameters are relatively low, they are within the range found by other studies in USA, UK and developing countries. This supports the suggestion to develop an Arabic Screening Questionnaire based on the translated GHQ with the addition of culturally specific items. CONCLUSION: The GHQ-28 Arabic Version is a valid instrument that may be of great help to primary care doctors in improving detection of psychiatric morbidity and in epidemiological research.

Hysteria: A clinical and sociodemographic profile of 40 patients admitted to a Teaching Hospital, 1985-1995.

This is a retrospective clinical study of 40 inpatients diagnosed as suffering from hysteria, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), admitted to King Khalid University Hospital at Riyadh over a period of 10 years (1985-95). The female:male ratio was 3:1, 80% were less than 30 years of age and 60% were single. Hysterical conversion was the most common type (95%), whereas hysterical dissociation was rare (2.5%). A stressful situation preceded the onset of symptoms in 62.5% of the cases. Twenty-five percent of the patients were clinically depressed. The typical histrionic personality was rare.

Guidelines for the management of diabetic patients in the health centers of saudi arabia.

This paper presents general guidelines for the management of diabetic patients within the primary health care (PHC) system in the Kingdom of Saudi Arabia (KSA). It intends to enhance PHC physicians' knowledge and improve clinical practice to ensure better management of people with diabetes mellitus. A stepwise (Algorithm) management approach for different categories of diabetic patients, including diet, exercise, and drugs, is suggested. The peculiarities of Family Medicine, e.g., adopting the biopsychosocial model, the holistic approach, and relations with the hospital are considered.

Smoking habits of secondary school boys in rural Riyadh.

OBJECTIVE: To estimate the prevalence of smoking among Saudi rural secondary school students and to explore their attitudes towards smoking. DESIGN: A cross-sectional study was conducted during May and June 1993, using a modified and translated version of the World Health Organization (WHO) standard questionnaire for the survey of smoking. Six rural male secondary schools near Riyadh were randomly selected, and 358 students representing half of the classes were included. RESULTS: Current smokers represented 17% of the students. The most common reasons for smoking were desire (32%), idleness (28%), imitation (22%) and enjoyment (20%). The majority knew about and understood the hazards of smoking. Around half of the smokers had started the habit before the age of 15. The media were the primary source of knowledge about smoking hazards for 66% of students; doctors (45%) and educators (30%) had a less significant role. Religion was the most important reason for not smoking among non-smokers. Financial reasons were less important (11%), probably reflecting the relatively cheap price of cigarettes. CONCLUSION: The size of the smoking problem is big enough to be considered a warning of an impending epidemic. Schools should have a greater role in health education. The government should adopt a policy of regular increases in cigarette taxes to cover part of the cost of treating smoking-related diseases.

The effect of patients' attendance rate on the consultation in a health centre in Saudi Arabia.

An observational study in which patients attending a health centre in Riyadh during a typical working week were invited to participate was undertaken, in order to study the variability of patients' attendance rates at a health centre and identify any association with the length and content of consultations. Four hundred and sixty females and 442 males representing 63% of patients seen during the study period agreed to participate. There was an uneven patient attendance rate during the working hours of the study week with 10.16 consultations per doctor per hour in the evening compared with 5.58 in the morning. By international standards the average consultation time was short (5.09 minutes). Contrary to what was expected, the proportion of patients who had long consultation times (> 10 minutes) or were offered health education did not increase during the light work periods. Long compared with short consultations were more likely to include health education issues but did not differ significantly in the rate of prescription, investigation or referral. Recommendations as a result of the study include (i) suggestions to spread the work evenly and (ii) performing assessment and audit studies with the purpose of encouraging longer consultations and including health education more frequently.

The selection of appropriate health education topics for publication in the press.

OBJECTIVE: To compare the perceptions of patients, doctors, and journalists concerning the priority of health education topics in the media. DESIGN: A cross sectional Knowledge, Attitude, and Practice (K.A.P.) study. A self-administered questionnaire was used during 2 weeks in September 1990; it included questions on sociodemographic characteristics and on each group's perceived opinion of priority health topics for discussion in the media. SETTING: Two university hospitals and six newspapers offices in Riyadh Saudi Arabia. PARTICIPANTS: 300 randomly selected outpatients aged 12 years and over, and 77 doctors. 31 journalists from six local newspapers also participated. MAIN OUTCOME MEASURE: The ratio of respondents in the three study groups who believed there was a need for health education in 22 topics. RESULTS: For most of these topics, statistically significant differences were found between the perceptions of the three groups. Doctors put more emphasis on preventive issues, while patients perceived new therapeutic and diagnostic methods as important more commonly than the other two groups. CONCLUSION: A team consisting of doctors, journalists, and patients should be formed to select health education topics in the media. Priority should be given to topic preferences shared by both doctors and the public.

PIP: A health survey on 22 health topics was conducted among 300 patients, 77 doctors in primary health care centers in hospitals, and 31 journalists in Riyadh, Saudi Arabia, during September 1990. The self-administered questionnaire had been pretested among 30 doctors and 100 patients. Male and female patients were equally balanced by gender and about 50% were students. Most doctors and journalists were male. Priority for health topics to be covered in the media was given more by doctors than journalists or patients. Group A topics were smoking, exercise, venereal disease and AIDS, hypertension and diabetes, heart and circulatory disease, contamination and environmental cleanliness, nutrition, first aid, compliance with traffic regulations, endemic diseases in Saudi Arabia, breast feeding, treatment of childhood diarrhea, and rational use of home drugs. Group B topics (acne and cancer) were considered more important by journalists, followed by patients; doctors considered group B topics least important. Group C topics (modern diagnostic techniques, new drugs, and new means of treatment) were given more importance by patients, followed by journalists. Menstrual problems were scored lowest by journalists and highest by doctors. The findings were considered tentative, pending a more representative sample. This sample of respondents was well-educated. Patients gave less priority to smoking (44%) than cancer (66%) and acne and hair loss (71.3%). Physicians gave greater emphasis to smoking (98.7%) than acne and hair loss (58.4%) and cancer (53.2%). 28.6% of doctors and 66.3% of patients gave emphasis to modern diagnostic techniques; new drugs followed a similar pattern with 69.0% of patients and 16.9% of doctors favoring this topic. New means of treatment were accorded similar priorities by doctors and patients. Quality of health services was given a priority of 72.7% among doctors, 65.3% among patients, and 58.9% among journalists.