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   2012| January-April  | Volume 19 | Issue 1  
    Online since March 19, 2012

 
 
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ORIGINAL ARTICLES
Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia
Ataur R Khan, Zaki N Al-Abdul Lateef, Mohammad A Al Aithan, Montaser A Bu-Khamseen, Ibrahim Al Ibrahim, Shabbir A Khan
January-April 2012, 19(1):26-32
DOI:10.4103/2230-8229.94008  PMID:22518355
Purpose: The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia. Materials and Methods: A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patient who had been prescribed optimum treatment and was properly advised on diet and exercise for his / her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, was considered as non-compliant. Results: The overall prevalence of therapeutic non-compliance of the participants was 67.9% (n = 318, 95% CI 63.59 - 72.02%). The non-compliance of males (69.34%) was higher than females (65.45%, P = .003). The non-compliance among the urban participants was significantly higher than (71.04 vs. 60.15%, P = .023) in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 - 7.19), urban population (OR =5.22, CI= 3.65 - 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 - 11.92), non-adherence to drug prescription (OR = 4.55 , CI = 3.54 - 5.56), non-adherence to exercise regimen (OR = 5.55, CI = 4.2 6 - 6.), insulin (OR = 1.29, CI = .71 - 1.87), and insulin with oral Metformin (OR = 1.20, CI = .65 - 1.75). Conclusion: The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients.
  27 12,235 1,644
Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement
Amitav Banerjee, Debmitra Sanyal
January-April 2012, 19(1):12-19
DOI:10.4103/2230-8229.94006  PMID:22518353
Background:The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor-patient relationship. Objective:(a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor-patient relationship; (b) to explore associations, if any, among these core dimensions. Materials and Methods: A cross-sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor-patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study. Results: In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor-patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 - 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor-patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 - 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001). Conclusion:Good doctor-patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.
  14 6,766 1,255
SHORT COMMUNICATION
Prevalence of mental disorders among high school students in National Guard Housing, Riyadh, Saudi Arabia
Abdulrhman M Al-Sughayr, Mazen S Ferwana
January-April 2012, 19(1):47-51
DOI:10.4103/2230-8229.94015  PMID:22518359
Background: Adolescents experience rapid biological, psychological, and social transitions that can be associated with mental health problems. During the high school period there are also more academic stressors. Objective: (1) To study the prevalence of mental disorders in high school (grade 12) students. (2) To study some related sociodemographic data. Materials and Methods: A cross-sectional study, using GHQ-28, that included 354 students randomly selected from grade 12 in four high schools - two male and two female high schools - in the National Guard Housing (Iskan), in Kashmalaan (suburb of Riyadh). Results: The overall prevalence of mental disorders was found to be 48% (41% in males and 51% in females); more than 80% of these cases were mild to moderate. Females showed significantly more severe disorders than males (P = 0.017) and students with excellent performance degrees showed a significantly lower rate of mental disorders than others (P = 0.021). However, our study did not show a significant association between psychiatric disorders and other social variables (family size, birth order, and polygamous family) or smoking. Conclusion: The adolescent age groups in our community had high rates of mental disorders, which required more attention from the family, as well as the educational and health institutes in our country.
  10 3,221 474
ORIGINAL ARTICLES
The major medical ethical challenges facing the public and healthcare providers in Saudi Arabia
Abdulaziz F Alkabba, Ghaiath M. A. Hussein, Adnan A Albar, Ahmad A Bahnassy, Mahdi Qadi
January-April 2012, 19(1):1-6
DOI:10.4103/2230-8229.94003  PMID:22518351
Background: Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. Materials and Methods: The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: "What top ten ethical challenges are Saudis likely to face in health care?" The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts' meeting. Results: The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients' Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics. Conclusion: Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges.
  6 9,857 1,217
LETTER TO EDITOR
Nicolau syndrome as an avoidable complication
Engin Senel
January-April 2012, 19(1):52-53
DOI:10.4103/2230-8229.94017  PMID:22518360
  5 4,225 386
MEDICAL EDUCATION
Reliability and validity of an Arabic version of the revised two-factor study process questionnaire R-SPQ-2F
Fadi M Munshi, Mohammad O Al-Rukban, Ibrahim Al-Hoqail
January-April 2012, 19(1):33-37
DOI:10.4103/2230-8229.94010  PMID:22518356
Objective: How students accomplish their learning and what they learn is an indicator of the quality of student learning. An insight into the learning approaches of a student could assist educators of the health profession in their planning for the first year of study. The aim of this study was to develop a reliable and valid Arabic version of the revised two-factor study process questionnaire. Materials and Methods: The translation of the revised two-Factor Study Process Questionnaire (R-SPQ-2F) into Arabic was done by an established forward-backward translation procedure. The Arabic version was then distributed to high school graduates applying for a place in the medical program at King Fahad Medical City. A total of 83 students voluntarily completed the questionnaire. The internal consistency and construct validity of the Arabic version of the R-SPQ-2F were computed. Results: The exploratory factor analysis revealed two components. The two factors were similar to the main scales described in the original English questionnaire. The main scales were the deep and surface approach. The items for the subscales (deep motive, deep strategy and surface motive, surface strategy) had a high internal consistency of more than 0.80. Conclusions: The results of this study should provide a valid and reliable instrument for the evaluation of the study approaches of Arabic speaking students.
  5 2,694 438
A survey of the attitude and practice of research among doctors in Riyadh Military Hospital primary care centers, Saudi Arabia
Saad H Al-Abdullateef
January-April 2012, 19(1):38-42
DOI:10.4103/2230-8229.94012  PMID:22518357
Objectives: To assess the attitude and practice of doctors in the Military Hospital Primary Care Centers in Riyadh (RMH) toward research and to identify the main barriers to conduct research. Materials and Methods: A cross-sectional study was conducted from March to April, 2010, at RMH primary care centers. The sample included all general practitioners (GPs) working in primary healthcare centers. A self-administered questionnaire was formulated from different sources and used as a tool for data collection. Results: The response rate was 75%. Among the respondents 96.9% agreed that research in primary care was important for different reasons. Most of the GPs had a positive attitude toward research: 68% had been influenced by research in their clinical practice and 66% had an interest in conducting research, and74.2% of the respondents had plans to do research in the future. Insufficient time was the most frequently cited barrier (83.5%) for participating in research, followed by the lack of support (58.8%). Conclusions: Many of the GPs had a positive attitude toward research, but had no publications or plan for new research. Lack of time, support, and money were the main constraints for carrying out research.
  4 2,268 382
ORIGINAL ARTICLES
Metabolic syndrome among obese Qataris attending primary health care centers in Doha, 2010
Mansoura F. S. Ismail
January-April 2012, 19(1):7-11
DOI:10.4103/2230-8229.94004  PMID:22518352
Objectives: To determine the prevalence of metabolic syndrome among obese patients using the IDF definition and to identify factors that are associated with it. Materials and Methods: A cross-sectional randomized study was conducted at four primary care centers inside Doha, Qatar. One hundred and thirty-six Adults, ≥ 18 Qatari obese patients, were chosen by systematic random sampling. They were interviewed and screened for the presence of metabolic syndrome, which was diagnosed according to the International Diabetes Federation criteria: An abdominal circumference ≥ 94 cm in males or ≥ 80 cm in females, plus any two of the following: HDL cholesterol < 1.03 mmol / mL (< 40 mg / dL) [males] or < 1.3 mmol / mL (< 50 mg / dL) [females], Triglycerides ≥ 1.7 mmol / mL (≥150 mg / dL), Blood pressure ≥ 130 / 85 mmHg or the patient receiving antihypertensive treatment and baseline glycemia > 5.6 mmol / mL (> 100 mg / dL), or previously-diagnosed type 2 diabetes mellitus. Results: The overall prevalence of the metabolic syndrome among obese patients was 46.3%. The prevalence was higher in females (50%) than in males (42.4%). It was seen to increase with increasing body mass index class, from class 1 to class 2. The prevalence of metabolic comorbidities of abnormal waist circumference, raised blood pressure, raised fasting blood glucose, high triglycerides, and reduced high density lipoprotein was 88.2, 42.6, 32.4, 31.6, and 27.9%, respectively. Based on the logistic regression multivariable analysis, increasing age and being diabetic were the only significant associated factors that influenced the risk of having the metabolic syndrome. Conclusion: The prevalence of the metabolic syndrome was high, and the highest comorbidities were abnormal waist circumference and high blood pressure. Diabetes and increasing age were the only significant risk factors of having this syndrome.
  3 2,815 445
Orthostatic hypotension before and after meal intake in diabetic patients and healthy elderly people
Tarig A Abdel-Rahman
January-April 2012, 19(1):20-25
DOI:10.4103/2230-8229.94007  PMID:22518354
Objectives: The symptoms of orthostatic hypotension may be ignored or go unnoticed and may predispose some diabetic or elderly people to repeated falls and trauma, leading to immobility and prolongation of rehabilitation. The present investigation is concerned mainly with testing the reaction of the cardiovascular system in response to physiological stimuli, such as, standing upright from a supine position before and after meal intake in diabetic patients and the healthy Saudi population. Materials and Methods: Seventy-five healthy and 49 diabetic patients were selected for this study. Parameters of heart rate, systolic and diastolic blood pressures, and electrocardiograms (ECG) were obtained for each subject by Dinamap (an automatic recorder), after 10 minutes of rest in the supine position and then after one and two minutes of standing. All parameters were taken before and after an intake of a standard meal. The results were compared between the diabetic and non-diabetic groups, and between the elderly diabetic and the healthy elderly ≥ 65 year olds, and between the young adults ≤ 40 year olds and the elderly ≥ 65 year olds. Results: The postural changes of blood pressure and heart rate between the diabetic and non-diabetic groups, and between the elderly diabetic and the healthy elderly groups, were not significant. However, a highly significant postural drop in blood pressure, and an increase in the resting heart rate were recorded before and after a meal intake in the elderly compared to the young adults. Conclusion: The highly significant postural drop in blood pressure and increase in the resting heart rate in the elderly diabetic and healthy elderly people can be attributed to a defect in the arterial baroreceptors control of blood pressure and parasympathetic control of heart rate in this population.
  2 2,973 435
CASE SERIES
A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer
T Jaya Chandra, Somnath Dash, G Srinivas, PV Prabhakara Rao
January-April 2012, 19(1):43-46
DOI:10.4103/2230-8229.94014  PMID:22518358
Introduction : The tuberculosis control program is based on a felt need-oriented basis. The diagnosis is mainly microbiological. However, sputum smear-negative Acid Fast Bacilli (AFB) cases with suspected radiological findings can be problematic in diagnosis. Objectives : To confirm the diagnosis of tuberculosis early, in smear-negative AFB cases by using a Fiberoptic Bronchoscope. Materials and Methods : We embarked on Fiberoptic Bronchoscopy (FOB) and Spot Scopy smear Microscopy (SSM) for 533 suspected Pulmonary Tuberculosis (PT) cases (sputum smear negative and radiologically suggestive) from February 2007 to May 2010. FOB was performed using a special device, a Trans Oro Pharyngeal Spacer (TOPS), as a conduit. Results : The yield for positivity for AFB was 341 (64%) out of 533 cases. Conclusion and Recommendation : The specimens collected by using the fiberoptic bronchoscope confirmed the disease in the smear-negative cases. Hence, FOB was recommended in smear-negative cases, to avoid delay in the treatment of tuberculosis.
  1 3,075 301
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010