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   Table of Contents - Current issue
Coverpage
May-August 2021
Volume 28 | Issue 2
Page Nos. 77-150

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ORIGINAL ARTICLES  

Perception and barriers to the use of cognitive-behavioral therapy in the treatment of depression in primary healthcare centers and family medicine clinics in Saudi Arabia p. 77
Ahmad N AlHadi, Hesham H AlGhofili, Nasser A Almujaiwel, Helmi M Alsweirky, Mohammed F Albeshr, Gassan T Almogbel
DOI:10.4103/jfcm.JFCM_494_20  
BACKGROUND: General practitioners (GPs) and family medicine physicians (FMPs) have a vital role to play in co-ordinating the care for mental disorders. The objective of this study was to determine the perception of GPs and FMPs on the use of cognitive-behavioral therapy (CBT) for depression in Saudi Arabia, and the barriers against the implementation of CBT in such settings. MATERIALS AND METHODS: All physicians working in Primary Healthcare Centers and Family Medicine Clinics in Saudi Arabia were targeted and invited to participate in this cross-sectional study. A self-administered online questionnaire was sent via E-mail through the Saudi Commission for Health Specialties and the Saudi Society of Family and Community Medicine. Data was collected using an existing validated questionnaire and was modified to fit the objectives of current study. RESULTS: A total of 469 FMPs and GPs completed the survey; the mean age of respondents was 38 years. More than half of the FMPs' and GPs' (53%) showed a positive perception of the use of CBT in primary healthcare settings. Most participants (91.9%) were willing to use CBT if they had adequate education and training. More than half of the participants (59.5%) thought it was time-consuming, while 39% thought that CBT training was a very time-intensive process. CONCLUSION: We conclude that more than half of the physicians clearly had a good perception of the effectiveness of CBT administration in primary healthcare settings. Younger physicians were more perceptive. The most agreed-on barrier to CBT implementation was the lack of training and education.
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Effect of direct monitoring by family members and counseling by health professionals on iron-folic acid supplementation: A cross-sectional study among pregnant women in Puducherry, India p. 85
Dhanusree Palivela, Syed I Shehnaz, Latha Chaturvedula
DOI:10.4103/jfcm.JFCM_445_20  
BACKGROUND: The prevalence of iron-deficiency anemia in pregnant Indian women is reportedly quite high. Despite the sustained efforts of the current national control program and undisputed efficacy of iron-folic acid supplementation (IFAS), the onslaught of anemia has not been curtailed, probably as a result of noncompliance to IFAS. The objective of this study was to assess the effect of direct monitoring of pregnant women by family members, counseling by health professionals, and other variables on adherence to IFAS in Puducherry, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 250 pregnant women visiting Outpatient Clinic, Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. Missing ≥2 doses of IFAS in the preceding 7 days was considered as nonadherence. The Pearson Chi-square test was applied to identify the association between the different variables. Bivariate and multivariate logistic regressions revealed variables affecting adherence. RESULTS: Around 34.4% of respondents reported nonadherence to IFAS. Direct monitoring by family members (Adjusted Odds Ratio [aOR] = 7.04; P < 0.001), counseling by health professionals (aOR = 2.97; P = 0.002), and improvement in hemoglobin (Hb) levels (aOR = 2.4; P = 0.01) were associated with better adherence. Vomiting, abdominal pain, and diarrhea were common ADRs. The distance to hospital, improvement in Hb levels, counseling by health professionals, and direct monitoring by family members significantly reduced the odds of ADRs. CONCLUSION: Direct monitoring of intake by family members and counseling by health professionals improved adherence to IFAS. Further in-depth formative research studies are recommended for strategies to improve adherence to IFAS in the vulnerable pregnant population of Puducherry and streamline the implementation of anemia national control program in a specific context.
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Prevalence and associated factors of eating disorders in patrons of sport centers in Saudi Arabia p. 94
Anfal A Al-Jumayan, Najeebah A Al-Eid, Nouf A AlShamlan, Reem S AlOmar
DOI:10.4103/jfcm.jfcm_113_21  
BACKGROUND: In recent times, mental health problems have been on the increase worldwide. Among these are eating disorders. The current study aim was to assess the prevalence of the symptoms of eating disorders in patrons of sport centers in the Eastern Province of Saudi Arabia, and its association with patrons' sociodemographic, and exercise characteristics, as well as social media use. MATERIALS AND METHODS: This cross-sectional study was conducted among 560 sport center clients. The Eating Attitude Test (EAT-26), as well as questions on sociodemographic, exercise, and the use of the social media was collected through self-administered questionnaires. Descriptive statistics, Chi-squared test, and Fischer's exact tests were performed. RESULTS: The prevalence of the symptoms of eating disorders was found to be 36.6% according to the results of the EAT-26. There were no significant differences in the rates of eating disorders between genders. Frequencies of eating disorder symptoms increased with an increase in the body mass index of the participants. In addition, more than half of the participants who were pressured by social media to be slim and perceived that social media influencers motivated them to go to the gym had eating disorders' symptoms. CONCLUSION: The prevalence of eating disorders symptoms was high among the sport center patrons examined. The findings from this study might help family physicians, mental health professionals, and sport medicine specialists wishing to understand this issue in Arab populations. Developing strategies regarding mental health in sport center patrons are suggested. In addition, a screening program is recommended for this population to identify those who need further evaluation and management.
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Water and sanitation risk exposure in children under-five in Pakistan p. 103
Fowad Murtaza, Mahvish Muzaffar, Tajammal Mustafa, Javaria Anwer
DOI:10.4103/jfcm.jfcm_149_21  
BACKGROUND: Children under-five constitute 11.9% (n = 20,447,628) of the total population of Pakistan. Poor water and sanitation in Pakistan cause 97,900 deaths annually, 54,000 of whom are children under-five. MATERIALS AND METHODS: This study calculates an index for water and sanitation risk for children under-5 in Pakistan to give a detailed understanding and insight into the prevalent risks. Data from Pakistan Integrated Household Survey 2011–12 are used. Stata 15.0 was used for data analysis. A risk index was created by integrating hazard and vulnerability factors including toilet facilities, water source, mother's education, and the number of children in the household. Children were ranked according to their risk score in three categories: low risk, medium risk, and high risk. For each level of risk, profiles of children are created at the national, regional (urban, rural), and provincial levels. RESULTS: Out of 20.5 million children under-five in Pakistan, 71.6% live in rural areas. About 24.9% of children benefit from pipe-borne drinking water; 15.5% of children have toilets connected to the public sewerage system; 62.6% of the children have mothers who had no education; and 50.5% of children live in households with three or more children. It appeared that 57.5% of children are at high risk of poor water and sanitation as compared to merely 1.3% of children at low risk. Around 69.9% of children living in rural areas are at high risk compared to 24.6% of children in urban areas. In Balochistan, 77.9% of children are at high risk, the highest of all provinces. CONCLUSION: The majority of children under-five in Pakistan are at high risk owing to poor water and sanitation. A comprehensive public health program is needed to address the key indicators related to child health risk identified in this research such as safe drinking water, improved sanitation, education and mothers' awareness, and population growth.
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Hearing impairment in military personnel in Eastern Saudi Arabia p. 110
Fahad A Alsaab, Abdulaziz K Alaraifi, Wafa A Alhomaydan, Ahmed Z Ahmed, Ahmed G Elzubair
DOI:10.4103/jfcm.JFCM_501_20  
BACKGROUND: Noise exposure is one of the most common occupational hazards worldwide. Studies have shown that the prevalence of hearing loss and tinnitus is higher in military personnel than in other occupations. This study aimed to estimate the prevalence of hearing impairment in military personnel in Eastern Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted among 409 military personnel. A self-administered questionnaire collected data on level of awareness, hearing impairment, and protection of hearing. Pure-tone audiometry (PTA) was conducted on 141 participants to determine the prevalence and pattern of hearing impairment. Multivariate analysis was used to determine the predictors of hearing loss in military personnel. RESULTS: More than half of the participants (54.3%) were unaware of the consequences of noise exposure and none used proper hearing protection. A small percentage (5.9%) complied with the annual hearing examination, and only 23% had had a previous hearing evaluation. More than half of the participants (58.4%) had one or more abnormal hearing-related symptoms, with tinnitus as the most common symptom (43.8%). PTA showed hearing impairment in 71.6% of the participants. Multivariate analysis showed older age as only significant factor associated with hearing impairment in military personnel. CONCLUSION: Noise-induced hearing loss and tinnitus are common occupational disabilities in military personnel. Hearing conservation programs have to be initiated to ensure the application of hearing protection measures and control the effects of exposure to noise.
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Parents' perception of cyberbullying of their children in Saudi Arabia p. 117
Sulhi A Alfakeh, Abdulrahman A Alghamdi, Khalid A Kouzaba, Mohammed I Altaifi, Sultan D Abu-Alamah, Malik M Salamah
DOI:10.4103/jfcm.JFCM_516_20  
BACKGROUND: The effect of cyberbullying varies from the small levels of discomfort to serious psychological and social issues. Studies on parents' perception of cyberbullying in Saudi Arabia are scarce. The aim of this study was to determine parents' awareness and perception of cyberbullying of their children in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was done on 1249 parents in Saudi Arabia using a standardized validated questionnaire. The questions were on cyberbullying and its association with the school, the difference between cyberbullying and traditional bullying, the importance of parents' attention and their knowledge of cyberbullying, and the platform on which they think cyberbullying occurs. Data were analyzed using SPSS version 24. Qualitative data were presented as frequencies and percentages while mean and standard deviation were computed for quantitative data. Student's t-test or Mann–Whitney and Kruskal–Wallis tests, as appropriate, were applied to test for statistical significance. RESULTS: About 43% parents strongly agreed that cyberbullying was more harmful than bullying in the schoolyard. Parents reported that video games were the most common social platform for cyberbullying. About 64% parents strongly believed that cyberbullying caused psychological harm, and 78% parents responded that it was important to monitor the child's use of the Internet. Seventy-eight percent of parents strongly believed that schools should be proactive in addressing cyberbullying. As for the parents' role, 72.8% strongly believed that parents should be more proactive in addressing cyberbullying, whereas 27.9% thought that parents' involvement would reduce it. Most participants (75.1%) said that more laws should be passed to prevent or punish cyberbullying. CONCLUSION: There is a need to raise the awareness of the Saudi community about the effects and consequences of cyberbullying.
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CASE SERIES Top

Outcome of early short-course corticosteroids in hospitalized patients with coronavirus disease-2019 (COVID-19): A report from a Saudi Arabian hospital p. 125
Salma Y Al-Bahrani, Amal S Al-Shammari, Maha J Al-Otaibi, Zubair R Ahmed
DOI:10.4103/jfcm.jfcm_69_21  
BACKGROUND: The efficacy of corticosteroid use in patients with acute respiratory illness due to coronavirus disease-2019 (COVID-19) is unclear. In this study, we describe the clinical course of COVID-19 patients who received early course of corticosteroid treatment in patients with severe respiratory distress secondary to COVID-19. MATERIALS AND METHODS: The clinical course of 30 COVID-19 patients admitted to King Fahad Military Medical Complex in Dhahran from the period of late March 2020 till June 2020 was assessed and described. All the 30 patients received steroids. Data on demographics, medical history, laboratory findings, chest radiology, medication use, and clinical outcomes were extracted from patients' records. Data was entered and analyzed with SPSS software. RESULTS: A total of 30 patients admitted with COVID-19 were included. The mean age 52.53 years (SD=16.31) with a range from 22-98 years; 73.3% were males. About two-thirds of the patients at least had comorbidities; most common were diabetes (46.7%) and hypertension (46.7%), and chronic heart disease (16.7%). About 57% patients had fever, cough, and shortness of breath. The median C-reactive protein (CRP) level was 87.5 mg/dL (IQR 45.0 – 165.65); 46.7% had CRP levels >120 mg/dL. The median white blood cell, lymphocytes, and platelet counts were 4.39, 1.05, and 212 K/μL, respectively. All the patients received corticosteroids; 17 (56.7%) patients were given IV methylprednisolone and 13 (43.3%) received dexamethasone tablets. Of the total patients, 13 (43.3%) patients developed acute respiratory distress syndrome (ARDS); 17 (56.7%) required oxygen, 10 (33.3%) were admitted to Intensive Care Unit (ICU), and 7 (23.3%) required mechanical ventilation. All the patients improved and were discharged home well. CONCLUSION: Early use of oral corticosteroids in patients with higher CRP levels may lead to better outcomes and may lower risk of transfer to ICU and use of mechanical ventilation.
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CASE REPORTS Top

A case of Kartagener's syndrome with combined aplasia of frontal and sphenoid sinuses and hypoplasia of maxillary and ethmoid sinuses p. 129
Sonica Sharma, Bhamidipaty K Durgaprasad, Payala Vijayalakshmi
DOI:10.4103/jfcm.JFCM_304_20  
Kartagener's syndrome (KS), characterized by a triad of bronchiectasis, chronic sinusitis, and situs inversus, is a subset of an autosomal recessive hereditary disorder of primary ciliary dyskinesia. We report the case of a 35-year-old male who presented with a history of intermittent episodes of productive cough, breathlessness, and cold since childhood. High resolution computed tomography of chest revealed bronchiectatic changes, dextrocardia, and right-sided aortic arch. Computed tomography (CT) scan of the abdomen revealed situs inversus. CT of the paranasal sinuses revealed combined aplasia of bilateral frontal and sphenoid sinus with sinusitis. Based on these findings, a diagnosis of KS was made. There was no complaint of infertility, which usually accompanies KS, even though an analysis of his seminal fluid revealed reduced count and reduced motility of sperms. The uniqueness of our case is that our patient was a male aged 35 years; besides, the third decade is an unusual age for presentation of combined aplasia/agenesis of bilateral frontal and sphenoid sinuses with hypoplasia of maxillary and ethmoid sinuses. Even though these findings have been reported in children and young adults, there are very few case reports of such a presentation in adults in literature.
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Gender dysphoria in Saudi Arabia p. 133
Hatem A Alqahtani, Sameerah M Motabgani
DOI:10.4103/jfcm.JFCM_512_20  
Gender dysphoria is defined as a multisystemic medical condition where a person has marked discordance between their biological sex and the gender they identify with. Here we report a case of 44-year-old male who presented to the family medicine clinic as a known case of gender dysphoria. Patient was severely distressed about his life and was actively seeking a solution to his problem. The patient requested that the treating physician addresses him as a female and uses feminine proverbs while speaking with him. On examination of genitalia, testicles were smaller than normal for his age and sex. Several abnormalities were found including low levels of testosterone, luteinizing hormone, and follicle-stimulating hormone, and elevated prolactin levels. Abdominal and pelvic ultrasound showed that the internal organs were all normal size and consistency. No uterus, ovaries or rudimentary female reproductive organs were found. Testicular ultrasound revealed atrophy of both testicles and weak peripheral testicular vascularity were noted. CT scan with contrast revealed severe hepatic steatosis as well as bilateral gynecomastia. Primary care physicians need to be aware of gender-related disorders as well as the importance of early recognition of these emerging disorders. A multidisciplinary approach is needed to manage these disorders.
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LETTERS TO EDITOR Top

Patient satisfaction with virtual clinics during the coronavirus disease-19 pandemic in primary healthcare, Riyadh, Saudi Arabia p. 137
Shweta Rajpal
DOI:10.4103/jfcm.jfcm_19_21  
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Author's reply p. 138
Khalid G Alharbi, Mohammed N Aldosari, Abdulrahman M Alhassan, Khalid A Alshallal, Abdullah M Altamimi, Bader A Altulaihi
DOI:10.4103/2230-8229.315724  
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Kano and other quality improvement models to enhance patient satisfaction in healthcare settings p. 139
Peter Anto Johnson, John Christy Johnson
DOI:10.4103/jfcm.jfcm_577_20  
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Author's reply p. 141
Abdulaziz A Howsawi, Mamdouh F Althageel, Noorulzaman K Mohaideen, Mohammad S Khan, Abdulaziz S Alzahrani, Mohamed A Alkhadir, Sulaiman M Alaqeel, Moath A Alkathiri, Rayan A Hawsawi
DOI:10.4103/2230-8229.315732  
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ABSTRACTS Top

Arabic Abstracts p. 142

DOI:10.4103/2230-8229.315735  
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010