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.

Background: Health counseling before marriage can be a most worthwhile and satisfying aspect of preventive medicine. It is important in genetic diagnosis and the prevention of hereditary, sexually transmitted and other infectious diseases. Objectives: To determine the acceptance of the concept of Premarital Health Counseling (PMHC), and to identify some factors, which may efect this acceptance among Saudis who attend Primary Health Care Center in Riyadh, Kingdom of Saudi Arabia (KSA), 1417H. Methods: The present study is a cross-sectional one with a selected sample of Saudis who attended the Primary Health Care Centers in Riyadh during the year 1417H. A multistage sampling and equal allocation stratified sampling within was used to select 484 persons comprising an equal number of males and females, married and single above the age of 18 years. A pre-designed pre-tested questionnaire sheet was used to collect the required data, which were then tabulated and statistically analyzed. Results: The study indicated that 364 (75.2%) of the study population accepted the concept of Premarital Health Counseling. PMHC was positively affected by the advancing age, experience of marriage, educational level and well-understood Islamic-health related issues. Out f those who accepted the concept, 273 (75%) agreed on the exchange of PMHC certificates between couples to be married and 152 (42%) agreed on the implementation of legislation on PMHC. Also, 298 (82%) of them wanted PMHC to be confidential and 168 (46%) agreed to the concept despite its cost. As regards the location of PMHC, most of participants who agreed to PMHC would prefer it to be given at governmental establishments. Recommendations: The study recommended the implementation of PMHC in Saudi Arabia, since it was accepted by the study population. However, further studies should be carried out to determine the details to be incorporated in the PMHC, their implementation and legislation on demographic basis of the Saudi community. Also, a community health education program for PMHC has to be devised in collaboration with Islamic leaders.

Objectives: (1) To determine the incidence rate of non-fatal occupational injuries requiring admission into private hospitals in Al-Khobar city during a 12-month period among workers insured by the General Organization for Social Insurance (GOSI). (2) To describe the pattern, characteristics and outcome of these injuries. (3) To estimate their subsequent direct medical costs. Methods: This is a cohort study design. The cohort consisted of workers at workplaces where insurance cover ensured admission into two private hospitals selected randomly in Al-Khobar city. A data-collecting sheet was used to collect the necessary data from both the patient and his medical file on admission into hospital. Results: The injury incidence rate was 7.1 per 1,000 full-time workers. All injured workers were males. Grouped by nationality, 1.5% were Saudis, 74.8% from the Indian subcontinent and 13.2% Filipinos. Main injury sites included hands and fingers (32.1%) multiple parts (20.7%), lower limbs (20.5%), eyes, head and neck (11.5%) and back (9.5%). Falls were the main cause of injury (33.4%), followed by tools-related injuries (23.9%), falling objects (14.5%) and car accidents (12.0%). The majority of admissions (77.8%) were for periods less than 1 week with only 7.1% for more than 3 weeks. Absence from work was more than 3 weeks and less than 1 week in 35.5% and 24.9% of the admissions, respectively. The majority of the cases (65.0%) visited clinics 2-7 times. Direct medical cost per admission was less than SR 2,000 in 63.9% of the cases in one hospital (1 USD = SR 3.75). Conclusions: The incidence rate was lower than, but comparable to those rates estimated in more detailed surveys from other countries. Occupational injuries requiring admission into hospitals contributed to 18.3% of the total cases of injuries among insured people during year 1995 and were responsible for significant medical charges, human suffering and loss of productivity. Based on the results of this study, it is recommended that GOSI should study the reasons behind the current situation and find appropriate solutions.

Objective: The aim of this study is to assess the perception and satisfaction of primary health care (PHC) trainees regarding their hospital training in Internal Medicine and Pediatrics. Methodology: A cross-sectional study was conducted by means of a self-administered questionnaire distributed to the trainees who had finished Medicine and/or Pediatrics rotation in 4 PHC training centers in Riyadh, Al-Khobar, Jeddah and Al-Medina during January 1996. Results: Trainees were more satisfied with the Pediatric rotation than the Internal Medicine rotation. Significant relationship (p<0.05) was found between trainee satisfaction in Internal Medicine rotation and both the quality of training and the relevance of training to the needs of PHC trainees. On the other hand, in Pediatrics, the only variable which was related significantly to the trainees' satisfaction was the duration of the rotation, which was found to be sufficient (p<0.05). Trainees' dissatisfaction with the rotation was due to many factors, such as the imbalance between service work and educational sessions and the lack of awareness of other specialists about PHC as a career. Conclusion: Attention and effort should be directed towards the improvement of hospital training through a close collaboration between the decision-makers for PHC training and the hospital consultants. Also the needs of trainees should be taken into account during planning of hospital training.

Background: This is a study of psychiatric presentations to an Accident and Emer-gency (A & E) Department of a Saudi general teaching hospital. Patients and Methods: Consecutive series of psychiatric presentations over 6 months to the A & E Department of a general teaching hospital at Al-Khobar, East-ern Saudi Arabia, were prospectively investigated. Diagnoses were made according to ICD-10 Classification of Mental and Behavioral Disorders. Results: There were 273 visits, accounted for by 182 index subjects and 37 subjects who made 91 repeat visits (33.3%). The age range of the index group was 5 to 82 years, with 75% below 38 years of age. The majority of the index group (78%) and repeaters (97.3%) were Saudi. Most index subjects (52.7%) were married, but only 40.5% of repeaters were so. Family was the predominant source of referral of both index (53.8%) and repeat visits (60%). Mood disorders were the commonest diagno-ses at both index (31.7%) and repeat visits (39.6%). Most index subjects (57.7%) and repeated visits (56%) were managed at the A &E Department and given psychiatric outpatient appointment. Just over one-fifth (22%) of the index subjects and a little over a quarter (25.3%) of repeated visits were admitted to the psychiatric ward, Mood Disorders being predominant among both. Conclusion: Adequate psychiatric training of primary health care physicians and the establishment of crisis intervention community psychiatric services are advocated.

Background: Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine. Objectives: To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings. Methods: A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives. Results: Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them. Conclusion: The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.

Worldwide malignant melanoma is the commonest tumor of the skin, though it occurs in many other organs. It is a serious disease, the prognosis of which is poor if not detected and treated early. The disease is on the increase in many countries e.g. USA, ^[1] England and Wales, ^[2] Australia, ^[3] and many parts of the world. ^[4],[5],[6] Saudi Arabia is a vast country which is undergoing rapid development with a changing social and economic environment. To the best of our knowledge, not many studies or reports of malignant melanoma have issued from the Eastern Region. It is therefore, important to report this case and review the incidence of the disease.