Adherence of primary health care physicians to hypertension management guidelines in the Aseer region of Saudi Arabia.

Although there has been significant progress in the management of hypertension, rates for control of this chronic disease in the Kingdom of Saudi Arabia (KSA) has been shown to be very low. This study was aimed to assess the knowledge of primary health care (PHC) physicians and the extent of their adherence to the recommendations of clinical practice guidelines concerning care of hypertensive patients. The assessment was made in the Aseer region of KSA using a modified version of the World Health Organization "Physician Inquiry Questionnaire." Only 5.6% of the participants measured blood pressure (BP) with the patient in sitting and other postures. Variable sphygmomanometer cuff sizes for different patients were used by 56.5% of the participants, while 74.8% correctly recorded the diastolic BP at Koratkoff sound, phase- 5. Among non- diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 76.7% and 81.4% respectively, of the PHC physicians. Among diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 36% and 17.1% of the PHC physicians, respectively. Most physicians inquired about cardiovascular risk factors. Several important items of patients' clinical examination were not completely covered by physicians, e.g., fundus examination (75.2%). PHC physicians missed a few investigations and laboratory tests, e.g., ECG (87.9%), serum creatinine (88.2%) and lipid profile (89.8%). Less than one- fifth of the physicians correctly chose the thiazide diuretics as the preferred initial anti- hypertensive agent (19.9%). Almost two- thirds of the physicians (65.2%) emphasized the importance of BP self- measurement, 89.8% encouraged patients to use a reminder system while 96.3% motivated patients for BP control. Measures for lifestyle modification included weight reduction (98.8%), sodium restriction (97.5%), physical exercise (96.3%) and behavioral improvement (87.6%). Our study suggests that continuing medical education and training courses on guidelines for hypertension management should be arranged for PHC physicians in Aseer.

Adolescents' mental health in Abha city, southwestern Saudi Arabia.

Using stratified random sampling technique, 1552 adolescent school age boys and girls in Abha city, southwestern Saudi Arabia, were screened for mental health using Arabic validated version of SCL-90-R. The overall prevalence of mental disorders amounted to 15.5%. The most frequent mental symptoms were phobic anxiety (17.3%), interpersonal sensitivity (14.7%), and obsessive compulsive (14.5%). In logistic regression analysis, some sociodemographic conditions (father education, mother working status, ranking among brothers and sisters, and type of school) were significantly affecting mental health. General practitioners and other primary care workers need to be educated to better engage young people, to recognize mental disorders, and to deliver simple treatments, including supportive counseling, and cognitive behavior therapy. There is a need for a national program in the country to integrate youth mental-health interventions with all existing youth programs, including those in health and education.

Prevalence of psychological symptoms in Saudi secondary school girls in Abha, Saudi Arabia.

BACKGROUND AND OBJECTIVES: Adolescence is characterized by rapid physiological, social and cognitive changes. Aim of the present work is to study mental health of Saudi adolescent secondary school girls in Abha city, Aseer region, Saudi Arabia. METHODS: A cross-sectional study was conducted in 10 secondary schools for girls using the Arabic version of the symptom-revised checklist 90 (SCL 90-R), a mental health questionnaire that was administered to the girls by fourth-year female medical students. RESULTS: The most prevalent mental symptoms in the 545 female students were phobic anxiety (16.4%), psychoticism (14.8%), anxiety (14.3%), and somatization (14.2%). The prevalence of depression, paranoid ideation and interpersonal sensitivity amounted to 13.9%, 13.8% and 13.8%, respectively. The least prevalent mental symptoms were hostility (12.8%) and obsessive-compulsive behavior (12.3%). Overall, psychological symptoms (in terms of a positive global severity index) were found in 16.3% of the girls. In a multivariate logistic regression analysis, no significant relationship was found with sociodemographic factors. CONCLUSION: Psychological symptoms and disorders are prevalent in secondary school girls and health professionals need to be able to recognize, manage and follow-up mental health problems in young people. Further research is needed to explore the magnitude of the problem at the national level.

Prevalence of Depression, Anxiety and Stress as Measured by the Depression, Anxiety, and Stress Scale (DASS-42) among Secondary School Girls in Abha, Saudi Arabia.

OBJECTIVES: To determine the prevalence of symptoms of depression, anxiety and stress among secondary school girls. METHODS: A cross- sectional study was carried out on secondary school girls in Abha city, Aseer Region, Saudi Arabia, using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-42). RESULTS: Of 545 female students recruited in this study, 73.4% had the symptoms of at least one of the three studied disorders; 50.1% had at least two disorders. The prevalence of symptoms of depression, anxiety and stress was 41.5 %, 66.2% and 52.5% respectively. The majority of symptoms were mild to moderate in severity. The scores for depression, anxiety, and stress were positively and significantly correlated. No significant association was found between the girls' sociodemographic characteristics and the scores of the three studied disorders. CONCLUSION: One of the most important aspects of a primary care physician's care of females is to screen for and treat common mental disorders.

Barriers against application of evidence-based medicine in general hospitals in aseer region, kingdom of saudi arabia.

OBJECTIVE: To explore the attitudes of doctors in the general hospitals and their application of evidence-based medicine (EBM) and to identify the barriers that hinder its use. SUBJECTS AND METHODS: This study included 346 doctors in the general hospitals of Aseer. A questionnaire was designed to assess their awareness as well as the barriers that hinder their practice of EBM. A visual analogue scale was used to assess their attitude. RESULTS: The attitudes of doctors toward aspects of EBM were generally positive. However, their use of EBM sources and application were generally poor. The main reasons for retrieving evidence were to keep them up-to-date (72.8%) and to help make clinical decisions (70.2%). The least mentioned reason for evidence retrieval was research (41.9%). Review of textbooks was the main method of evidence retrieval (71.1%), while a database search was the method least used (22.8%). The main barriers to the practice of EBM practice were "lack of facilities" followed by "lack of time", while the barrier least mentioned was the "lack of interest". CONCLUSIONS: Although doctors have positive attitudes toward EBM, their knowledge and application of EBM need much improvement. The main barriers to their application of EBM are the lack of facilities and the lack of time. RECOMMENDATIONS: The necessary infrastructure for the application of EBM should be made available for all medical staff. There is a need for special courses and hands-on workshops in general hospitals to address the necessary knowledge and skills of EBM are essential.

Hypertension care at primary health care centers: a report from Abha, Saudi Arabia.

It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC) and Al-Numais (NPHCC), to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in comparison to NPHCC (p < 0.05). The commonly missed procedures were chest x-rays, electrolytes and ECG. Hypertension was well controlled in 63% of the patients, 58% were found to have obesity, 9% suffered from hypertension-related complications while almost 50% had good compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and provision of laboratory services and all these factors need to be addressed to improve care.

Dietary habits and exercise practices among the students of a Saudi Teachers' Training College.

OBJECTIVE: To assess the dietary habits and exercise practices among Saudi male students of a Teacher's Training College. METHODS: A cross-sectional study was conducted during the academic year 2005/2006 in Abha, Aseer Region, Kingdom of Saudi Arabia. The study sample was drawn using the systematic random sampling technique. A self-administered questionnaire was used for data collection. RESULTS: Out of a total sample of 500 students, 456 questionnaires were returned giving a response rate of 91.2%. Approximately 10% of the students reported some type of organic disease, while psychiatric disorders were reported by 4.6% of the students. Nearly half of the students had a body mass index of more than 25 kg/m2. Practice of exercise was not prevalent in 14% of the students, while 69.3% were engaged in exercise only twice per month. Half of the students ate lunch and dinner, while snacks after lunch was taken by 76.1% of them. Addition of salt (55.5%), consumption of ghee (91.4%), and watching television while eating (85.3%) was noted among the students. Breakfast was the most commonly missed meal. Approximately 11.4% students did not take vegetable and 28.9% did not take fish at all while softdrinks were consumed by more than 85% of the students ranging from 1-4 times to more than 7 times per week. CONCLUSION: There is an urgent need to assess barriers to the healthy life style and to design an effective intervention program to improve the lifestyle of the future teachers.

Psychiatric morbidity among Saudi secondary schoolteachers.

OBJECTIVES: To measure the prevalence and severity of depression, anxiety, and stress among male secondary schoolteachers. METHOD: A cross-sectional study was conducted during the academic session 2004/5, covering the teachers of 65 boys` secondary schools in Abha Educational Area, Aseer Region, Saudi Arabia. A study sample of 195 teachers was obtained using the random sampling technique. Data were collected using the Arabic version of the 42-item Depression, Anxiety, Stress Scale (DASS-42). RESULTS: Out of a total 195 teachers, 189 questionnaires were returned, yielding a response rate of 96.9%. Twenty-five percent had depression 43% had anxiety, and 31% of the participants had stress. Depression, anxiety, and stress were strongly, positively, and significantly correlated. CONCLUSION: Male secondary schoolteachers in Abha educational area in Saudi Arabia experienced a high prevalence of depression, anxiety, and stress. Additional studies are needed to find out the causes of this problem.

Obesity and related behaviors among adolescent school boys in Abha City, Southwestern Saudi Arabia.

Using stratified sampling technique 2696 adolescent school boys (aged 11-19 years) in Abha City, Southwestern Saudi Arabia were interviewed and examined for weight and height using standardized techniques. The overall prevalence of obesity and overweight in the present study amounted to 16%. Using logistic regression analysis, lack of exercise practice in the previous week in general [aOR = 1.352, 95% confidence interval (CI) = 1.066-1.941] or in the class (aOR = 1.446, 95% CI = 1.083-1.931) were significantly associated with obesity. The present study showed that obesity among adolescent school boys in Abha City is a public health problem. There is a need for a national program in the country to prevent and control obesity among adolescents. The program should incorporate: dietary management of obesity, promotion of physical activity, health education campaigns and consideration of the possibility of providing facilities for practicing physical activity and exercise in the community.

Depression, anxiety and stress among Saudi adolescent school boys.

AIMS: This study reports on research to determine the prevalence rates and severity of depression, anxiety and stress among Saudi adolescent boys. A cross-sectional study, of secondary school boys at Abha, Aseer Region, Saudi Arabia was conducted. METHODS: The systematic sampling method was used to select a class at each level in a school. All the students were informed in detail about the study. The Arabic version of Depression, Anxiety and Stress Scale (DASS) was used to establish school-boy levels of depression, anxiety and stress. RESULTS: Results indicated that of 1723 male students recruited to this study, 59.4% had at least one of the three disorders, 40.7% had at least two and 22.6% had all the three disorders. Moreover, more than one third of the participants (38.2%) had depression, while 48.9% had anxiety and 35.5% had stress. Depression, anxiety and stress were strongly, positively, and significantly correlated. CONCLUSION: It was concluded that there is an urgent need to pay more attention to the mental health of adolescent secondary school boys in Saudi Arabia. Further studies are needed to explore knowledge and attitude of students, parents and teachers concerning mental health.

Prescribing patterns for acute respiratory infections in primary health care, aseer region, saudi arabia.

OBJECTIVE: The objective of this study was to identify the patterns of prescribing for Acute respiratory infections in patients attending primary health care centers in the Aseer region, southwestern Saudi Arabia. MATERIALS #ENTITYSTARTX00026; METHODS: This study was conducted at primary health care centers in the Aseer region during November 2003. A master sheet designed by the investigator was distributed to all the working physicians in the primary health care center in the Aseer region. The master sheet included the age, sex, complaints, signs, clinical diagnosis and the type of medications prescribed. Physicians were asked to include all patients attending on 17(th) November 2003, and send the master sheet to the Technical Supervision Unit at Primary Care Department, General Directorate of Health Affairs. Data of the master sheet was entered and analyzed by using SPSS. RESULTS: The total number of patients attending with acute respiratory infections(ARIs) was 3000 which represented 25% of the patients attending primary health care centers that day. Children formed 60% of the total number of cases. Regarding symptoms and signs, it was found that 70% had a cough, 59% had a runny nose, and 43% had a sore throat . The common cold was the most common diagnosis (42%). Antipyretics, antihistamines, antibiotics and antitussives were prescribed for 78%, 48%, 45% and 25% respectively. Statistical analysis using logistic regression revealed that the higher the temperature, the more severe the throat congestion and the presence of exudates on pharynx, the higher the likelihood to prescribe antibiotics. CONCLUSION: In this study, it was found that the prescription of all drugs for ARIs was still high in spite of the fact that these conditions are self-limiting. To rationalize prescribing for ARI, implementation of the national protocol for diagnosis and treatment of ARIs is mandatory. Further studies to explore the physician's knowledge, attitudes and behavior concerning prescribing for ARI is strongly recommended.

Intra-rator variability of primary care physicians in management of hyperlipidaemia.

BACKGROUND: Recent studies support the link between hyperlipidaemia and increased prevalence of cardiovascular diseases (CVDs). In Saudi Arabia, CVDs became a serious problem following rapid urbanization. The health care system in Saudi Arabia makes the primary care accessible to all. AIM: To assess the ability of primary care physicians to be consistent with themselves in the management of hyperlipidaemia. DESIGN OF THE STUDY: Cross-sectional. SETTING: Family medicine department affiliated with tertiary hospital. METHOD: Using 63 patient problem vignettes, each physician was asked, whether a patient required no treatment, dietary or drug treatment. Exact vignette cases were shown again to each physician two weeks later. The Kappa statistical test was used to measure the physician's intra-rator variability. RESULTS: Forty-seven physicians were recruited to participate in this study. The Kappa statistics suggested an excellent intra-rator agreement by only four physicians, but a large majority, 28 physicians (62.2%) had fair to good agreement while thirteen physicians (28.9%) had poor agreement with themselves. CONCLUSION: It is suggested that doctors must undergo adequate training and continuous evaluation of their skills in the management of hyperlipidaemia. Use of vignettes, might be a good method in assessing continuous medical education.

Quality of referral letters to Abha Psychiatric Hospital, Asir region, Kingdom of Saudi Arabia.

OBJECTIVE: This study aims to explore the quality of referral letters from different health institutions to Abha Psychiatric Hospital, the only psychiatric center in Asir region, Kingdom of Saudi Arabia. METHODS: In this descriptive study, a total of 582 consecutive referral letters to Abha Psychiatric Hospital, during the first half of 1998, were evaluated for the components that are supposed to be found in the consentient referral letter to a psychiatric service. Each letter quality was indicated as good or poor according to the used scale. RESULTS: Thirty-six percent of the referral letters were poor. The clinical information relating to the psychiatric history was significantly poor compared to other clinical information (p<0.05). Asir Central Hospital (tertiary level) referral letters were better in quality than those of secondary hospitals (p<0.001). Referral letters with diagnosis or impression of legal concern showed a better quality compared to others (p<0.001). CONCLUSION: The quality of clinical information relating to the psychiatric history in the referral letters to psychiatric service, needs to be improved to ensure better patient care and more appropriate use of resources.