The management of patients with low back pain (LBP) problems by primary care physicians or even spine specialists differ significantly and little is known about treatment strategy. This review is to present the clinical profile and to assess the most common treatment modalities of patients with low-back pain in order to improve the clinical judgment of the treating physician. Data were obtained from a midline literature search of articles in English. A manual revision of original articles was done and demonstrative figures from patients at our institute were added. LBP is an extremely common problem. It is characterized by attacks, remissions and exacerbations. It is best managed by a multidisciplinary team. Primary coordination of treatment may depend on the patient's need and the awareness of the treating physician of the importance of history and physical examinations. The following suggested protocol may help to identify red flags that denote more serious conditions.

Background: The admission rate for bronchial asthma has increased dramatically all over the world. Part of this increase in hospital admissions is due to patient readmission. Objective: To determine the risk factors associated with short-term hospital readmission of pediatric patients with asthma within two months of the last hospital admission. Methods and setting: A retrospective case-control study using the registration books of both admissions and discharges to identify patient groups. All hospital records of patients admitted from August 1998 through December 2002 at Aseer Central Hospital, southwestern Saudi Arabia were reviewed. Patients who were admitted during this period of study and readmitted to hospital within two months were used as the study group (n=28) and those patients admitted within the same period but not readmitted within two months constituted the control group (n=45). Demographic variables, route of admission, patient's previous medical history, clinical assessment, hospital treatment as well as discharge treatment were obtained and entered for analysis. Results: Twenty-eight patients were readmitted within two months of their discharge from hospital (17 boys and 11 girls). Seventy percent of these were less than four years of age. Significant predictors of readmission were: prior history of asthma admission (adjusted OR 2.21,95% CI 1.08-9.10), neonatal intensive care graduate (adjusted OR 4.44,95% CI 1.67-9.34), bronchopulmonary dysplasia (adjusted OR 3.06,95% CI 2.01-7.95), recurrent aspiration (adjusted OR 1.96,95% CI 1.08-4.27), duration of asthma symptoms more than five days (adjusted OR 0.15,95% CI 0.03-0.42), moderate to severe clinical assessment (adjusted OR 1.12,95% CI 1.01-2.94), positive X-ray findings (adjusted OR 0.04,95%CI 0.011-0.230), intensive care admission (adjusted OR 1.96,95%CI 1.08-4.63), mechanical ventilation (adjusted OR 0.010,95%CI 0.002-0.130), intravenous steroids (adjusted OR 0.104 ,95%CI 0.016-0.321). Conclusion: Prior neonatal intensive care unit admission, bronchopulmonary dysplasia, history of previous asthma admissions, recurrent aspirations, intensive care unit admission, intravenous steroids, positive X-ray findings and mechanical ventilation were significant predictors of asthma short-term hospital readmissions.

Objective: The aim of this study was to determine self-reported knowledge and practice of physical activity among male school students and their teachers in Al Khobar, Saudi Arabia. Methods: This was a cross-sectional study conducted in the Al Khobar area, Eastern Province of Saudi Arabia. The target population consisted of third grade intermediate and all three grades of male secondary school students. A multistage stratified self-weighting sampling design was adopted. All students, a total of 1240, in the selected classes as well as their teachers (142) in the selected schools were included in the sample. Two sets of self-administered questionnaires were used: one for male students and the other for teachers. The questionnaire contained demographic data and data on knowledge and practice of physical activity. Results: The majority of male students knew that physical activity was protective against diseases in general ((92.8%) and was helpful in the prevention of obesity (74.4%). Teachers had significantly better knowledge about the benefits of physical activity. Both students and teachers had poor knowledge about the role of physical activity in the prevention of diabetes mellitus and hypertension (36.6% and 28.8% for students vs. 43.0% and 46.5% for teachers respectively). The frequency and duration of practice of effective physical activity were significantly better than their teachers (45.6% and 71.3% for students vs. 23.1% and 36.6% for teachers respectively). Age and the knowledge that exercise protects from obesity were the main determinants of practice of physical activity among male students. Youthfulness was statistically significantly associated with practice of physical activity. Conclusions: Teachers had significantly better knowledge about the benefits of physical activity than their students. Both students and teachers had poor knowledge about the role of physical activity in the prevention of diabetes mellitus and hypertension. Health education should concentrate on clarifying this area. Students practiced effective physical activity significantly more than their teachers. Programs to increase regular physical activity were suggested .

Background: The lack of baseline information on the magnitude of health problems among school children is considered one of the factors of the unsatisfactory status of school health in Sudan. Availability of such data from schools will help in the health promotion of school children. Objective: To determine the proportions of the commoner diseases or health problems among Wad Medani basic school children (males and females) at the end of the school year 2000-2001. Method: This is a cross-sectional study conducted on 3862 basic school children (males and females).They were selected by multi-stage stratified proportional random sampling according to their sex and localities. A pre-designed pre-tested questionnaire was used to collect data which were then tabulated and statistically analyzed. Results: The study revealed that 77.9% of the study group had malaria, 33% of them had sore throat, 26.4% suffered from psychosocial problems that affected their school performance. Dental carries 24.5%, diarrhea attacks 17.5%, oxyuris worm 16.8%, pneumonia 11.5, measles infection 12.4%, asthma 9.2% and visual defects 8.9%. Some of these problems were related to the poor quality of school environment including sanitation and poor nutritional services. These findings should be considered in planning school health programmes. Appropriate interventions to reduce these problems through improving school environment and raising the awareness of the school community towards such problems is recommended.

Objective : To study the demographic characteristics of immunization providers in Riyadh City and their self-perception of competency. Methods : A cross-sectional study was conducted among immunization providers in Riyadh City from August 2003 to March 2004. This study covered 71 institutions: (25 primary health care centers, 30 private clinics and dispensaries, 8 government hospitals and 8 private hospitals). Immunization providers were selected by stratified random process. One hundred and one physicians participated in the study and the data were obtained by self-administered questionnaires, tabulated and analyzed using appropriate statistics. Results : The participating physicians were mostly pediatricians (50.5%) and general practitioners (38.6%). About 47% of them had had no training in immunization during the preceding 10 years. Self-evaluation revealed that 30.7% of them ranked themselves as excellent, 67.3% as average and 2.0% as poor immunization providers. Self-confidence was associated with specialty, qualification, place of work, years of experience and training on immunization (p<0.05). Most of participating doctors (83.7%) used books as their references. The doctors were least confident in vaccinating pregnant and lactating women and the vaccination of travelers to endemic areas. Conclusion : To improve immunization services, doctors should be trained before being involved in this practice. There should be frequent distribution of national and international protocols with the auditing of the practice to improve and sustain a highly effective service.

Objective: The objective of this study was to determine the general knowledge of diabetes among female diabetic school teachers in Al-Khobar, Eastern Province of Saudi Arabia. Methods : A total of 91 female diabetic school teachers were interviewed in the School Health Clinic in Al-Khobar using a structured questionnaire. Their weight and height were measured and BMI was calculated. Results : The results showed that understanding of diabetes was inadequate. Knowledge about symptoms of hypoglycemia was low. One-fourth (25%) of the sample of this study was using certain herbs for the treatment or management of diabetes mellitus. About three- fourths were overweight and obese. The results showed a deficiency of knowledge on the general aspects of diabetes mellitus. An appropriate educational material was prepared in the form leaflets, lectures and workshops. Conclusion : This paper concludes that awareness and education about diabetes are needed urgently among the studied sample.

Background: A medical record contains data on patients to support current and continuing patient care. Medical Records Department has the traditional role of keeping the patient's records safe. This is the first attempt in the Kingdom, to the best of our knowledge, to assess the feasibility of introducing electronic medical records. Objective: The aim of the study was to assess the views of physicians, patients and nurses of medical records services and physicians' views on the use of electronic medical records. Methods: The study was conducted with physicians, nurses and patients selected randomly from the Military hospital in Riyadh. The data was collected via a self- administered, pilot-tested, internally consistent questionnaire. Results: On the staff of medical records, the highest mean score was obtained for confidentiality (2.92), and the lowest for the training of medical staff (1.88). On medical record documents, the highest mean score was reported for "information is confidentially maintained" (2.70), and the lowest for the organization of files within file sections (2.28). On the Medical Records Department, the highest mean score was reported for overstaffing (2.89), and the lowest for receptiveness of receptionists (2.27). Physicians had low scores for computer literacy, ranging from 1% for prior computer experience to 27% for owning a computer. Physicians were not enthusiastic about the change to electronic medical records. Conclusions: Despite the observed shortcomings of the existing medical records system, it is not expected that medical records would be computerized in the near future since physicians have not accepted this technology wholeheartedly.

Since the burden of disease has shifted towards non-communicable diseases and public health management, there is a greater need to direct resources to address risk factors of the diseases rather than the diseases themselves. The downstream agenda focused on treatment services and is still an important problem at the level of national health management. Much has been accomplished in preventive programs for infectious diseases in Saudi Arabia but a great deal more is needed to combat non-communicable diseases. While a national non-communicable diseases program is being established in the Kingdom, more advanced pilot projects of NCD can be started in the regions. A model for cardiovascular diseases in Qassim will be presented.