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   2016| January-April  | Volume 23 | Issue 1  
    Online since December 21, 2015

 
 
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ORIGINAL ARTICLES
Diabetic retinopathy and the associated risk factors in diabetes type 2 patients in Abha, Saudi Arabia
Razia A Ahmed, Shamsun N Khalil, Mohammad AA Al-Qahtani
January-April 2016, 23(1):18-24
DOI:10.4103/2230-8229.172225  
Objectives: To assess the proportion and grades of retinopathy and its risk factors in diabetes type 2 patients. Materials and Methods: This was a cross-sectional study of 401 type 2 diabetic patients. A questionnaire and checklist were used to collect the data. Retinopathy was diagnosed and graded by fundus photographs and slit lamp examination. The duration of diabetes, age of patients, age at onset of diabetes, body mass index, hemoglobin A1c level, blood pressure, and complications were noted. Results: The mean age of male and female patients was 54.93 and 54.25 years; 57.6% were males. The mean age of onset and mean duration of diabetes were 43.91 and 13.4 years, respectively. The proportion of retinopathy was 36.4%. Grades of retinopathy were: Mild 57.5%, moderate 19.9%, severe nonproliferative 11%, and proliferative retinopathy 11.6%; 7.2% of patients had maculopathy. Retinopathy was significantly associated with older age, younger age at onset, longer duration of disease, poorly controlled blood sugar, hypertension, insulin use; the presence of neuropathy and nephropathy appeared as a significant risk. Younger age at onset, longer duration, and insulin use appeared as the strongest predictors for diabetic retinopathy. Conclusions: More than a third (36.4%) of the diabetic patients attending a diabetic center had retinopathy. The control of the risk factors may reduce both prevalence and consequences of retinopathy.
  3,288 576 7
Socioeconomic factors affecting patients' utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia
Abdulaziz M Alsubaie, Khaled A Almohaimede, Abdulrahman F Aljadoa, Osamah J Jarallah, Yasser I Althnayan, Yousef A Alturki
January-April 2016, 23(1):6-11
DOI:10.4103/2230-8229.172223  
Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services.
  2,501 495 1
Social anxiety disorder in Saudi adolescent boys: Prevalence, subtypes, and parenting style as a risk factor
Jaafar Y Ghazwani, Shamsun N Khalil, Razia A Ahmed
January-April 2016, 23(1):25-31
DOI:10.4103/2230-8229.172226  
Background: Available information on social anxiety disorder (SAD) in adolescents in Saudi Arabia is limited. The objective of the study was to estimate the prevalence, severity, and subtypes of SAD, and parenting style risk factors associated with SAD in the adolescent. Materials and Methods: This cross-sectional study was conducted in two secondary schools for boys in Abha, Saudi Arabia during the Academic year 2013. To collect the data, a questionnaire eliciting information on background characteristics and parenting style as well as the Liebowitz Social Anxiety Scale Test (LSAS), for the evaluation of SAD, were used. Results: A total of 454 students participated in the study. The age of the participants ranged between 15 and 20 years with a mean of 17.4 years. The prevalence of SAD was 11.7%. Around 36% and 11.4% of the students respectively had severe and more severe forms of SAD. Parenting style such as parental anger, criticism particularly in front of others, exaggerated protection, maltreatment and family provocation emerged as a significant risk factor for SAD. The independent predictors of SAD were a parental provocation and physical or emotional maltreatment by the parent (odds ratio [OR] = 3.97, 95% confidence interval [CI]: 1.90-8.31 and OR = 2.67, 95% CI: 3.17-5.19, respectively). Conclusion: The prevalence of SAD in secondary school students at Abha is high. Parenting style risk factors for SAD are modifiable. In this context, a national program to improve mental health in this age group is crucial.
  2,519 420 1
Control of type 2 diabetes in King Abdulaziz Housing City (Iskan) population, Saudi Arabia
Thamer A Alsulaiman, Hejab A Al-Ajmi, Saeed M Al-Qahtani, Intisar M Fadlallah, Nashwa E Nawar, Reem E Shukerallah, Sadaf R Nadeem, Nora M Al-weheedy, Khalid A Al-sulaiman, Adel A Hassan, Ayman A Shahin, Tamer M Kolib
January-April 2016, 23(1):1-5
DOI:10.4103/2230-8229.172221  
Objective: To assess the level of control and prevalence of type 2 diabetes in King Abdulaziz Housing City (Iskan) population of Saudi Arabia. Materials and Methods: Retrospective cross-sectional study conducted in a primary-care setting. All Type 2 diabetics referred to our diabetes center between January 2011 and January 2015 were identified, and their computerized records reviewed. Glycated hemoglobin levels (HbA1c), low-density lipoprotein (LDL), blood pressure (BP), and the albumin-creatinine ratio (ACR) were noted and the patients categorized accordingly. Demographic data (age and gender) were also documented. Inactive patients (not seen for more than 2 years) were excluded. Results: The overall prevalence of type 2 diabetes for all age groups in ISKAN population was 3.25%. About 56% of the diabetics were female and 70% were aged between 18 and 59 years. The rate of uncontrolled diabetes was 59.3%. Males were more likely to have uncontrolled diabetes (odds ratio: 1.44, CI: 1.17-1.76, P = 0.0004). Forty percent of the diabetics had an LDL above target (≥2.6 mmol/l) while 25.9% had uncontrolled hypertension (BP ≥ 140/90 mmHg). Of those who had an ACR test done within the last year (59.3%), the rate of micro- and macro-albuminuria was 8.8% and 2.5%, respectively. Conclusions: The overall prevalence of type 2 diabetes in our community seems lower than the previously reported national figures. An alarming number of diabetics in our population have an uncontrolled disease. More stringent diabetes annual review and recall program is needed to control diabetes and reduce complications.
  2,487 425 3
Establishing rapport: Physicians' practice and attendees' satisfaction at a Primary Health Care Center, Dammam, Saudi Arabia, 2013
Ayat A Al Ali, Ahmed G Elzubair
January-April 2016, 23(1):12-17
DOI:10.4103/2230-8229.172224  
Background: Establishing rapport is an important step in physician-patient communication resulting in a positive effect on patient satisfaction and overall clinical outcomes. However, there is a dearth of studies on the condition of doctor-patient relations in Saudi Arabia. This study was performed to estimate the proportion of physicians who have a good rapport with patients in their practice and the proportion of satisfied attendees. Materials and Methods: A cross-sectional study was conducted at a Primary Health Care Center, Dammam, KSA. The data were collected through a structured self-administered questionnaire given to samples of attendees and physicians to estimate patient satisfaction and the practice of rapport by physicians. Results: A total of 374 attendees and 27 physicians participated in the study. The percentage of physicians who had good rapport was 51.9%. Factors that showed significant relationship with rapport practice were: Physician's age (p = 0.016), physician's experience (p = 0.043), and professional status (p = 0.031). The attendees satisfied with their physician's rapport with them were 50.5%. Factors that showed significant relationship with satisfaction were: Attendee's age (p < 0.0001), educational level (p < 0.0001), having a chronic illness (p < 0.0001), having appointment (p < 0.0001), physicians' professional status (p < 0.0001), and a nonsurgical specialty (p < 0.0001). Conclusion and Recommendation: Physicians' rapport with patients and patients' satisfaction with physicians' empathy is not high. Training is required to optimize physician-patient communication.
  2,283 315 3
CASE REPORT
Acute epiploic appendagitis: A rare cause of acute abdomen and a diagnostic dilemma
Afnan F Almuhanna, Zeead M Alghamdi, Eiman Alshammari
January-April 2016, 23(1):48-50
DOI:10.4103/2230-8229.172234  
Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.
  1,940 184 3
MEDICAL EDUCATION
Communication skills in pediatric training program: National-based survey of residents' perspectives in Saudi Arabia
Tariq Alofisan, Saleh Al-Alaiyan, Moath Al-Abdulsalam, Khawar Siddiqui, Ibrahim Bin Hussain, Mohammad H Al-Qahtani
January-April 2016, 23(1):43-47
DOI:10.4103/2230-8229.172233  
Background: Good communication skills and rapport building are considered the cardinal tools for developing a patient-doctor relationship. A positive, healthy competition among different health care organizations in Saudi Arabia underlines an ever increasing emphasis on effective patient-doctor relationship. Despite the numerous guidelines provided and programs available, there is a significant variation in the acceptance and approach to the use of this important tool among pediatric residents in this part of the world. Objective: To determine pediatric residents' attitude toward communication skills, their perception of important communication skills, and their confidence in the use of their communication skills in the performance of their primary duties. Materials and Methods: A cross-sectional study was conducted among all pediatrics trainee residents working in 13 different hospitals in Saudi Arabia. A standardized self-administered questionnaire developed by the Harvard Medical School was used. Results: A total of 297 residents out of all trainees in these centers participated in the data collection. The 283 (95%) residents considered learning communication skills a priority in establishing a good patient-doctor relationship. Thirty four percent reported being very confident with regard to their communication skills. Few residents had the skills, and the confidence to communicate with children with serious diseases, discuss end-of-life issues, and deal with difficult patients and parents. Conclusion: Pediatric residents perceive the importance of communication skills and competencies as crucial components in their training. A proper comprehensive communication skills training should be incorporated into the pediatric resident training curriculum.
  1,586 244 -
ORIGINAL ARTICLES
Determinants of nonimmunization of children under 5 years of age in Pakistan
Fowad Murtaza, Tajammal Mustafa, Rabia Awan
January-April 2016, 23(1):32-37
DOI:10.4103/2230-8229.172231  
Background: Child vaccination is perhaps the first line of defense to ensure a healthy society. Unfortunately, the coverage of child vaccination in Pakistan is poor resulting in unnecessary yet preventable deaths. This study investigated the determinants and reasons for not vaccinating children in Pakistan. Materials and Methods: The study used the Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002 data. Demographic, distance to health facility, poverty status, literacy and education, and location of residence were used as determinants of nonimmunization of children. Descriptive statistics including frequency distribution, proportions for categorical variables and mean for continuous variables, and logistic regression analysis were done using the Stata 11.0. Results: Almost 7.73% children in Pakistan were never immunized. More than 87.4% of these lived in the rural areas. Prevalence of nonimmunization was highest in Balochistan compared to other provinces. Large households appeared to have increased risk of a child not being vaccinated. Moreover, low literacy and education of the head of the household and the spouse was also associated with low vaccination coverage. Distance from the health facility was found to be another factor related to nonimmunization of children. Increase in per capita income significantly decreased the risk of missing vaccinations. Conclusions: Prevention and immunization programs should focus more on high-risk regions such as Balochistan and rural areas. Literacy, education, and economic status were among the other significant factors associated with low vaccination rates, which need a special focus in the public policy to achieve the target of a healthy society.
  1,442 231 6
LETTER TO EDITOR
Should family physicians perform frenotomy for neonatal ankyloglossia?
Joeseph Adragna, Morteza Khodaee
January-April 2016, 23(1):51-52
DOI:10.4103/2230-8229.172235  
  1,358 269 -
ORIGINAL ARTICLES
Budding adult hypertensives with modifiable risk factors: "Catch them young"
Aravind S.K. Ramanathan, Prabha Senguttuvan, Vel Prakash, Appasamy Vengadesan, Rajendiran Padmaraj
January-April 2016, 23(1):38-42
DOI:10.4103/2230-8229.172232  
Background: Since the data of primary hypertension (HT) in children is scanty in India, this study attempted to evaluate HT by a multidimensional investigation of the various risk factors in children and adolescents. Materials and Methods: A total of 3906 subjects were recruited, all of whom lived in Chennai, an urban area of Tamil Nadu. The children and adolescents aged from 10 to 17 years were selected by random sampling. The children/adolescents were randomized into one control and further divided into two groups. The National High Blood Pressure Education Program fourth report (2004) and anthropometric body mass index (BMI), food frequency questionnaire (PURE) were followed in the study. Results: Out of 3906 children, 2107 were girls and 1799 boys. On screening, we found 9.5% to be hypertensive with the prevalence rate of boys and girls 8% and 10.8%, respectively. Overall obesity was 2.7%, (boys 2%, girls 3.32%); hypertensives and normotensives were 8.4% and 2.1%, respectively. We found that overweight (odds ratio [OR]: 2.06 [1.40-3.01] 95% confidence interval [CI]), obese children (OR: 1.21 [2.72-6.48] 95% CI), and those with a family history of HT (OR: 1.66 [1.20-2.30] 95% CI) had increased risk of hypertension. Females were 1.39 times (OR: 1.39 [1.11-1.72] 95% CI) more at risk of getting HT. Multivariate analysis showed that obese children/adolescent were four times more likely to have HT than children with normal BMI (OR: 4.67 [3.00-7.26] 95% CI]. Conclusion: Family history of HT, obesity, and female gender are associated with a high risk of HT. The prevalence of HT was higher among obese adolescents than among slender subjects. This may be related to their sedentary lifestyle, faulty eating habits, high fat content in the diet and little physical activity.
  1,367 253 1
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010