Context: The prevalence of bronchial asthma (BA) is increasing in the Kingdom of Saudi Arabia. Primary health care (PHC) centers follow the national protocol, which is based on the severity of the disease for the management of asthma. The Saudi initiative for asthma (SINA) management adopted from the global initiative for asthma guidelines, which was recommended by several recent studies, is based on the control level of asthma. Aims: To assess the knowledge of PHC physicians and family medicine (FM) residents in Al-Khobar, about the management of BA. Methodology: A cross-sectional study was conducted in all PHC centers and the university FM clinic in Al-Khobar. All PHC physicians and 3 ^rd and 4 ^th year FM residents were included in the study. A self-administered questionnaire developed according to SINA guidelines was used to assess theoretical knowledge of BA, and a predesigned checklist was used to assess the different inhaler techniques. Scoring was established and collected data were analyzed. Results: Only 8% of the sample had good theoretical knowledge of BA; 41% had poor knowledge. The knowledge of the residents was better than that of the PHC physicians. The mean knowledge score was significantly better among those using guidelines compared to the rest. About 23% had good knowledge of inhaler techniques. Knowledge of PHC physicians and FM residents about dry powder inhalers was deficient, and PHC physicians had little knowledge of metered dose inhalers with spacers. Conclusion: The knowledge of physicians about the management of BA was deficient. The national guidelines based on the level of control for asthma management should be updated and physicians given periodic training.

Background and Objectives: Research in the United States has shown that craving tobacco is associated with smoking, yet no investigation has been done into the relationship between craving and the use of tobacco in Saudi Arabian smokers. The aim of this cross-sectional study was to examine the craving of tobacco by Saudi males and its influence on daily smoking. Subjects were recruited under the auspices of the Tobacco Control Program in Jeddah City and Riyadh. Methods: The American English version of the tobacco craving questionnaire (TCQ-12) is a valid measure of four distinct aspects (factors) of tobacco craving. The TCQ-12 was translated into Arabic tobacco craving questionnaire (ATCQ-12) and administered to a sample of 322 male smokers. Predictive validity was determined by examining the relationship between the factors and the number of cigarettes smoked per day (CPD). Results: In a general linear multivariate analysis of variance model, CPD increased significantly as either ATCQ-12 Factor 1 (emotionality) or Factor 3 (compulsiveness) increased. A significant Factor 1 by Factor 3 interaction indicated that Factor 1 was a better predictor of heavy smoking, but only when Factor 3 was low. Factor 3 was a better predictor of heavy smoking, but only when Factor 1 was low. Conclusions: The ATCQ-12 is a rapid measure of craving and valid predictor of CPD and heavy smoking. Craving in anticipation of smoking as relief from a negative mood (emotionality) is an indicator of psychological withdrawal symptoms, while craving in anticipation of the inability to control tobacco use (compulsiveness) is an indicator of physical dependence.

Background and Aim: Violence against women during pregnancy is linked to poor outcome of pregnancy, which is reported to have widespread in Iran. The aim of this study was to determine the prevalence of physical violence against women by an intimate partner during pregnancy, and to assess the impact of this physical violence on pregnancy outcomes. Materials and Methods: A prospective cohort study was conducted on the characteristics of pregnant women in urban areas and related violence. The modified standard World Health Organization Domestic Violence Questionnaire was used to classify pregnant women and domestic violence. A total of 1461 pregnant women were selected using cluster sampling. The association between sociodemographic with intimate partner violence (IPV) and IPV with pregnancy outcomes was determined using logistic regression. Results: Of these, 206 (14.1%) (confidence interval = 12.3-15.9) reported physical IPV during pregnancy. The adjusted odds ratio for IPV in illiterate women or those with primary level of education (0.001), secondary level education (0.003), and in low income households (0.0001) were significantly higher than in those women with university level education and in higher income households. After adjusting for suspected confounding factors, the women with a history of violence by partners had 1.9 fold risk of premature rupture of membranes, and a 2.9 fold risk of low birth weight compared to women who did not experience any violence from their partners. Conclusion: The results of this research indicated that the prevalence of IPV was high among pregnant women. Therefore, it is necessary to emphasize the screening of pregnant women at Primary Health Centers to prevent physical abuse.

Aim of the Study: The aim was to investigate the bacteriological quality of drinking water, and explore the factors involved in the knowledge of the public about the quality of drinking water in Najran region, Saudi Arabia. Study Design: A cross-sectional descriptive study. Materials and Methods: A total of 160 water samples were collected. Total coliforms, fecal coliform, and fecal streptococci were counted using Most Probable Number method. The bacterial genes lacZ and uidA specific to total coliforms and Escherichia coli, respectively, were detected using multiplex polymerase chain reaction. An interview was conducted with 1200 residents using a questionnaire. Results: Total coliforms were detected in 8 (20%) of 40 samples from wells, 13 (32.5%) of 40 samples from tankers, and 55 (68.8%) of 80 samples from roof tanks. Twenty (25%) and 8 (10%) samples from roof tanks were positive for E. coli and Streptococcus faecalis, respectively. Of the 1200 residents participating in the study, 10%, 45.5%, and 44.5% claimed that they depended on municipal water, bottled water, and well water, respectively. The majority (95.5%) reported the use of roof water tanks as a source of water supply in their homes. Most people (80%) believed that drinking water transmitted diseases. However, only 25% of them participated in educational programs on the effect of polluted water on health. Conclusions: Our results could help health authorities consider a proper regular monitoring program and a sustainable continuous assessment of the quality of well water. In addition, this study highlights the importance of the awareness and educational programs for residents on the effect of polluted water on public health.

Background: Biomedical publications from a country mirror the standard of Medical Education and practice in that country. It is important that the performance of the health profession is occasionally documented. Aims: This study aimed to analyze the quantity and quality of biomedical publications from the Kingdom of Saudi Arabia (KSA) in international journals indexed in PubMed between 2008 and 2012. Materials and Methods: PubMed was searched for publications associated with KSA from 2008 to 2012. The search was limited to medical and biomedical subjects. Results were saved in a text file and later checked carefully to exclude false positive errors. The quality of the publication was assessed using Journal Citation Report 2012. Results: Biomedical research production in KSA in those 5 years showed a clear linear progression. Riyadh was the main hub of medical and biomedical research activity. Most of the publications (40.9%) originated from King Saud University (KSU). About half of the articles were published in journals with an Impact Factor (IF) of < 1, one-fourth in journals with no IF, and the remaining one-fourth in journals with a high IF (≥1). Conclusion: This study revealed that research activity in KSA is increasing. However, there is an increasing trend of publishing in local journals with a low IF. More effort is required to promote medical research in Saudi Arabia.

Objectives: A community-based intervention, the Crown Health Project (CHP), was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. Methods: A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics (e.g., age, gender, education, occupation, urban/rural residence) and CHP awareness (its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities). Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. Results: Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying "health education" as the main goal of the CHP (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1-5.5), "noncommunicable diseases" as the main diseases targeted (OR, 4.8; 95% CI, 3.6-6.4) and "attention to health" as the purpose (OR, 6.0; 95% CI, 4.0-8.9). Conclusion: The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf.

Background: The percentage of elderly is growing rapidly and malnutrition is not uncommon in the elderly. Objectives: The present study was carried out to assess the nutritional status of the elderly using the Mini Nutritional Assessment (MNA) tool, and to study the various epidemiological factors influencing their nutritional status. Materials and Methods: This cross-sectional study was done from July 2012 to August 2013 in Boko-Bongaon Block, Kamrup District, Assam, India. The elderly, those over 60 years of age, who met the inclusion criteria participated in the study. A total of 30 clusters were selected and 12 elderly from each cluster were taken to achieve the desired sample size of 360. Nutritional status was assessed by the MNA tool and a 24-h dietary recall method. Results: Out of the total of 360 elderly persons, 15% were found to be malnourished and 55% were at risk of malnutrition. The association between nutritional status and older age group, female gender, dependent functional status, dependent financial status and inadequate calorie intake was found to be significant. Conclusion: The present findings reveal that malnutrition is not an uncommon problem in the elderly, and further studies are needed in this regard.

Background and Aim: Medication Errors can result in drug-related problems (DRPs). Insight into the frequency, type, and severity of DRPs could help reduce their incidence. The aim of the present study was to estimate the prevalence of admissions as a result of DRPs at the Emergency Department (ED) of a university hospital in the Kingdom of Saudi Arabia. Materials and Methods: Files of suspected cases of DRPs reporting to ED in the year 2012 were scrutinized. Suspicion arose from the hospital record system based on Diagnosis Code Numbers (ICD-9-CM, Professional 2010) and from triggers, such as some drugs, laboratory tests, and signs and symptoms pointing to DRPs. Results: Of 5574 admissions, 253 (4.5%) were DRPs and were categorized as: Overdose toxicity and side effects of drugs 50 (19.8%), drug-interactions 29 (11.5%), accidental and suicidal drug ingestions 26 (10.3%), drug abuse 18 (7.1%), drug allergy 10 (4%), super-infections 8 (3.2%), and noncompliance to treatment 112 (44.3%). About 70% of DRPs were preventable; 67 (26.5%) required hospital admission for 7-102 days and 10 (4%) died. Conclusions: Noncompliance to treatment, overdose toxicity, drug interactions, and drug abuse are important causes of hospital admissions as a result of DRPs. Awareness of prescribers to the problem and their education would help to prevent them and improve patient care.

Objectives: The study was conducted to evaluate the educational environment (EE) in Family Medicine Training Programs. Materials and Methods: A cross-sectional survey, The Postgraduate Hospital Educational Environment Measure (PHEEM), was distributed to all residents at the four training centers in the central region. Cronbach's alpha was used to test the reliability. The mean and standard deviation (SD) for each item, the overall score and the three domains were calculated. A multiple linear regression model was developed with PHEEM scores as an outcome. The Mann-Whitney-Wilcoxon test was used to compare each item based on the selected factors. Results: The overall score was 67.1/160 (SD: 20.1). The PHEEM's domains scores: 24.2/56 (SD: 7.13) for perception of role autonomy; 25.3/60 (SD: 8.88), for perception of teaching; and 17/44 (SD: 5.6), for perception of social support. Training center and Level of training were the significant outcome predictors. Centre 1 (Joint Program) significantly had better scores than Centre 2. The instrument showed great reliability with a Cronbach's alpha of 0.92. Conclusions: There are many problems in the training program. Urgent actions are needed to improve the residents' learning experience particularly during rotations. Also, the curriculum should be restructured, and effective training methods introduced using the Best Evidence in Medical Education to meet the expectations and learning needs of family physicians.