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   2012| May-August  | Volume 19 | Issue 2  
    Online since July 10, 2012

 
 
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REVIEW ARTICLES
The attitude of health care professionals towards accreditation: A systematic review of the literature
Abdullah Alkhenizan, Charles Shaw
May-August 2012, 19(2):74-80
DOI:10.4103/2230-8229.98281  PMID:22870409
Accreditation is usually a voluntary program, in which authorized external peer reviewers evaluate the compliance of a health care organization with pre-established performance standards. The aim of this study was to systematically review the literature of the attitude of health care professionals towards professional accreditation. A systematic search of four databases including Medline, Embase, Healthstar, and Cinhal presented seventeen studies that had evaluated the attitudes of health care professionals towards accreditation. Health care professionals had a skeptical attitude towards accreditation. Owners of hospitals indicated that accreditation had the potential of being used as a marketing tool. Health care professionals viewed accreditation programs as bureaucratic and demanding. There was consistent concern, especially in developing countries, about the cost of accreditation programs and their impact on the quality of health care services.
  7,864 1,287 30
ORIGINAL ARTICLES
Infant feeding practices in the rural population of north India
Syed E Mahmood, Anurag Srivastava, Ved P Shrotriya, Payal Mishra
May-August 2012, 19(2):130-135
DOI:10.4103/2230-8229.98305  PMID:22870418
Background : Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding practices vary among different regions and communities. Objectives: To assess the pattern of infant feeding and its relation to certain practices of maternity and newborn care, and to assess the knowledge of mothers on the advantages of exclusive breastfeeding. Materials and Methods: The cross-sectional study was carried out in randomly selected villages of the Bhojipura Block of Bareilly district, Uttar Pradesh. A total of 123 women who had delivered within the last year were interviewed in a house-to-house survey. A study instrument was used to collect data. Chi- square test and regression analysis were used to analyze the data. Results: Most of the mothers were aged less than 30 years (78.04%) and were Hindus (73.9%). Most were illiterate (69.9%) and belonged to the lower socioeconomic class (97.5%). The majority were housewives (99.1%) and multiparous (68.2%). Most had initiated breastfeeding (78.8%) within 24 hours of delivery. About 15.4% of the infants did not receive colostrum and 22.8% of the infants were not exclusively breastfed. Ghutti (water mixed with honey and herbs), boiled water, tea, and animal milk were commonly used pre-lacteal feeds. About 47.2% of the respondents were not aware of the benefits of exclusive breastfeeding. About one quarter of the mothers started complementary feeding before the child was six months old. About half the deliveries had taken place at home and only a quarter of the females had had three or more antenatal visits during pregnancy. The birth weight of the majority (78%) of newborns was not measured. A majority (69.9%) of the mothers did not receive advice on child feeding. Multivariate logistic regression analysis showed that maternity and newborn care variables had no significant association with exclusive breastfeeding. Conclusions: Despite higher rates of early initiation of breastfeeding and exclusive breastfeeding, awareness of the benefits of exclusive breastfeeding was low. This indicates the need to promote awareness of the correct method of infant feeding and care of the newborn. Creating an awareness of the advantages of exclusive breastfeeding will further strengthen and support this common practice in rural communities and avoid an early introduction to complementary foods for sociocultural reasons.
  7,030 950 18
Pattern of self-medication with analgesics among Iranian University students in central Iran
Shadi Sarahroodi, Ali Maleki-Jamshid, Ansam F Sawalha, Peyman Mikaili, Leila Safaeian
May-August 2012, 19(2):125-129
DOI:10.4103/2230-8229.98302  PMID:22870417
Background: Self-medication is defined as the use of drugs for the treatment of self-diagnosed disorders. It is influenced by factors such as education, family, society, law, availability of drugs and exposure to advertisements. This study was performed to evaluate self-medication with analgesics and its pattern among different groups of Iranian University Students. Materials and Methods: A randomized, cross-sectional, multicenter study was conducted from December 2009 to February 2010. The target population of this study was 564 students out of 10,000 students attending four medical and non-medical science universities in Qom state. Data was analyzed using SPSS version 16, and analysis was conducted with descriptive analysis procedures. Results: 76.6% of the students had used analgesics in self-medication in the previous 3 months. The frequency of analgesic use in the study period was once in 19.2% of the participants, twice in 22.2%, three times in 16.3% and more than three times in 35.5% of the participants, although 6.8% of them were not sure when they were used. Of all the respondents, 49.8% reported headache as the problem. This was the most common problem, after which came Dysmenorrhea,headache and stomach ache. Bone and joint pains were other problems that led to the use of analgesics. The most commonly used source of information for self-medication with analgesics was advice from friends and family (54.7%), previously prescribed medications (30.1%), their medical knowledge (13.3%) and recommendation of a pharmacist (1.9%). Conclusion: Self-medication with analgesics is very high among Iranian students in Qom city. This could be an index for other parts of the Iranian community. Because the source of information about analgesics is inappropriate, we would recommend education courses about analgesics and self-medication on the radio and television for the entire population.
  6,475 871 22
Knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward complementary and alternative medicine
Abdullah M AlBedah, Ahmed T El-Olemy, Mohammed K. M. Khalil
May-August 2012, 19(2):93-99
DOI:10.4103/2230-8229.98290  PMID:22870412
Background: Complementary and alternative medicine (CAM) is a popular treatment option for many populations. The present work is aimed at studying the knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward CAM. Material and Methods: In this cross-sectional survey, a multistage random sample was taken from health professionals working in hospitals in Riyadh city and surrounding governorates. Data were collected through a self-administered questionnaire, from 306 health professionals working in 19 hospitals, on socio-demographic data, knowledge about CAM and their sources, and attitudes toward CAM practices. Results: Of the participants, 88.9% had some knowledge about CAM. Respondents with a doctorate degree (94.74%) and 92.53% of those with a bachelor's degree had significantly higher knowledge of CAM than subjects with a diploma, a fellowship, or a master's degree (68.75%, 76.67%, and 85.41%, respectively, P = 0.004). Mass media represented 60.1% of sources of the knowledge of CAM followed by family, relatives, and friends (29.08%) and health educational organizations (14.71%). Participants estimated that prophetic medicine including prayer, honey and bee products, medical herbs, Hijama, nutrition and nutritional supplements, cauterization, and camel milk and urine were the most commonly used CAM practices (90.5%, 85%, 76.9%, 70.6%, 61.4%, 55.9%, and 52.5%, respectively) in addition to medical massage (61.8%) and acupuncture (55%). One hundred and fifteen (80%) physicians were ready to talk with their patients on CAM. Conclusion: The willingness to improve knowledge and create a positive attitude in health professionals toward CAM has increased. Religious practices, especially those related to prophetic medicine, are more common in the region. Health educational organizations have to play a greater role by being the source of evidence-based knowledge of CAM. Talking on CAM with patients should be improved by rooting them on evidence-based practices.
  5,400 775 16
REVIEW ARTICLES
Clinical effect of metformin in children and adolescents with type 2 diabetes mellitus: A systematic review and meta-analysis
Mohammed A Al-Shareef, Abdoulie F. N. S. Sanneh, Abdullah S Aljoudi
May-August 2012, 19(2):68-73
DOI:10.4103/2230-8229.98279  PMID:22870408
To assess the clinical value and of metformin as mono-therapy versus other treatments for type 2 diabetes mellitus in children and adolescents. Major electronic databases, the reference lists of relevant articles and databases of ongoing trials were searched. Authors of reviews and metformin manufacturers were contacted in order to obtain more references and reports of unpublished trials. The methodological quality of these reports, included randomised controlled trials (RCTs) was assessed using the National Health System Centre for Reviews and Dissemination (NHS CRD) checklist. The search identified 1,825 studies. Three RCTs met the inclusion criteria. Two RCTs had been completed and one was still ongoing. In the metformin group there were significant reductions of mean change of HBA1c from baseline. It reduced by -0.71% (P = 0.0002) and in the other trial the result was reduced by -1.10 (95% CI: -1.19 to -1.01). In addition, more patients (48.1%) in the metformin group achieved good glycaemic control (<7%) at week 24. The mean changes in FPG from baseline were significantly (P < 0.05) different in the metformin group (-16.6%, for week 18 and week 24 20.6%. In the second trial there was a significant (P < 0.001) reduction in the adjusted mean of FPG from baseline in the metformin group, while there was an increase in the placebo group ( -42.9 mg/dl vs. +21.4mg/dl) with mean difference of -64.80 in favour of the metformin group. For BMI, significant (P < 0.001) differences were seen at week 12 and week 24 (0.07 and 0.55 kg 2 ) for metformin and glimepiride respectively. There was no significant difference between the placebo and metformin in the other trials. For lipid value there was a significant decrease in LDL levels in the metformin group. No significant changes were found in the other lipid parameters after adjusting. There were more adverse events in the metformin group but they were not statistically significant. There was a limited but not convincing evidence to suggest that metformin can improve the glycaemic control in children and adolescent with type 2 diabetes compared with other interventions. This is may be the result of the limited number, poor quality and short duration of the included trials.
  4,816 781 3
ORIGINAL ARTICLES
Pre-hypertension and hypertension in college students in Kuwait: A neglected issue
Hana T Al-Majed, Ali A Sadek
May-August 2012, 19(2):105-112
DOI:10.4103/2230-8229.98296  PMID:22870414
Objective: To determine the proportion of pre-hypertension and hypertension in college students in Kuwait and their related risk factors. Materials and Methods: A total of 803, randomly selected students aged 17 to 23 years (346 male, 457 female) from different colleges in Kuwait, were included in the study between 2009 and 2010. Systolic and diastolic blood pressure measurements were taken by trained personnel. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg. Risk factor measurements that were determined, included smoking, body mass index (BMI), and family history of hypertension. Blood samples were collected and impaired glucose tolerance (IGT) and lipid profile levels were determined. Results: There were no hypotensive students. Normotensives constituted 53.5% (n = 430), pre-hypertensives formed 39.5% (n = 317), and hypertensive students comprised of 7% (n = 56). The overall proportions of hypertension and pre-hypertension were higher among male students (85.7 and 64.4%) than female students (14.3 and 35.6%), respectively. Hypertensive and pre-hypertensive students versus normotensive students had significantly higher levels of BMI-based obesity, smoking, glycated hemoglobin (HbA1c), and IGT. Also, hypertensive and pre-hypertensive, compared to normotensive students, had significantly higher proportions (21.4, 18.3, and 4.0%, respectively) of risky high-density lipoprotein (HDL) level (< 1 mg / dL), cholesterol (7.1, 3.8, and 1.4%, respectively), and triglycerides (TG) (17.9, 9.1, and 7.9%, respectively) where p was< 0.001, 0.016, and 0.051, respectively. Conclusion: Hypertensive and pre-hypertensive students showed elevated levels of lipids and BMI-based obesity more than normotensive students. TG, HDL, HbA1c, and cholesterol appeared to influence pre-hypertension.
  4,116 569 17
The status of Vitamin D in medical students in the preclerkship years of a Saudi medical school
Abdulmohsen H Al-Elq
May-August 2012, 19(2):100-104
DOI:10.4103/2230-8229.98293  PMID:22870413
Background : The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community. The objective of this study was to evaluate the prevalence of low levels of vitamin D in healthy Saudi medical students. Materials and Methods: A cross-sectional study was carried out in November 2009 on male and female students in the preclerkship years of medical school at the King Faisal University, Dammam. Data on age, consumption of dairy products and seafood, and exposure to sunlight were collected. The body mass index was calculated. Approximately, 15 ml of blood was extracted for the measurement of serum calcium, serum albumin, serum phosphorus, alkaline phosphatase, fasting parathyroid hormone, and vitamin D levels. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D < 50 nmol/l. Comparison between groups was done for statistical significance using an unpaired t-test. Significance was set at P < 0.05 using 95% CI for all comparisons. Results: The data from 95 male and 103 female students were analyzed. The mean age for all students was 19.54 years. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% (92.64% in males and 99.03% in females), while the remaining 4% had vitamin D insufficiency. The mean 25-hydroxy vitamin D level was 26.83 ± 12.60 nmol/l in males and 16.03 ± 8.28 nmol/l in females (P-value = 0.0001). Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun. Conclusion: Vitamin D deficiency was highly prevalent among medical students included in this study. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in the young, otherwise healthy populations.
  4,123 490 13
Effectiveness of physical activity promotion in blood pressure and blood sugar reduction: A community-based intervention study in rural south India
Subitha Lakshminarayanan, Soudarssanane M Bala, Murugesan Ramanujam, G Kannan
May-August 2012, 19(2):81-87
DOI:10.4103/2230-8229.98284  PMID:22870410
Context: Physical activity of moderate intensity for 30 minutes a day, on most days substantially reduces the risk of many chronic diseases. Aim: To assess the effect of regular physical activity on blood pressure and blood sugar levels in a rural Indian community Settings and Design: This community-based study was carried out in Periakattupalayam and Rangareddipalayam in south India, with 485 subjects, aged 20 to 49 years. Materials and Methods: The study was done in five phases: Awareness campaign, baseline assessment of participants, intervention phase (10 weeks), interim, and final assessment. Physical activity of moderate intensity (brisk walking for 30 minutes on four days / week) was promoted by forming 30 small walking groups, in a home-based setting, with professional supervision. Village leaders and Self-Help Group members were the resource people for the promotion of physical activity. Statistical Analysis: Analysis was done by using paired 't' test; the 'Intention-to-Treat' approach was utilized for the interpretation of the findings of the study. Results: Of the 485 subjects, 265 (54.6%) complied with walking on more than four days / week, while 156 (32.2%) walked on one to four days / week, and 64 (13.2%) dropped out during the intervention period. This study has shown that a 10-week intervention to promote physical activity was effective in significantly decreasing the population's BP by 1.56 / 0.74 mm Hg, fasting blood sugar levels by 2.82 mg%, body weight by 0.17 kg, and BMI by 0.06 kg / m 2 . Conclusions: This study has proved the functional feasibility of enabling people to undertake physical activity in a rural Indian community, and the effectiveness of using physical activity, to significantly reduce the population's mean BP and blood sugar levels.
  3,982 630 2
Predictors of pulmonary involvement in patients with extra-pulmonary tuberculosis
Malak M El-Hazmi, Fawzia E Al-Otaibi
May-August 2012, 19(2):88-92
DOI:10.4103/2230-8229.98287  PMID:22870411
Objectives: The aim of this study is to assess the value of chest radiographs (CXRs) and sputum examinations in detecting pulmonary involvement of tuberculosis (TB) in patients with extra-pulmonary tuberculosis (EPTB). Materials and Methods: A retrospective analysis was performed among 248 EPTB patients with culture-proven diagnosis of tuberculosis seen between January 2001 and December 2007 at a tertiary teaching hospital, Riyadh, Saudi Arabia. Demographics, clinical, laboratory and radiological findings were reviewed and assessed. This study was approved by the hospital ethics and research committee. Results: One hundred twenty five of 233 EPTB patients (53.6%) had abnormal CXR findings. There was a significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings (30/57) and those with normal CXR findings (4/17) (P = 0.04). Of 17 HIV-negative/unknown HIV-status EPTB patients with normal CXR results, 4 patients (23.5%) had positive sputum culture results. Intrathoracic lymphadenopathy (P < 0.001), pleural TB (P < 0. 001) and disseminated TB (P = 0.004) were associated with an increased risk of abnormal CXR findings. Patients with cough (52.9%), weight loss (41.2%) and night sweats (26.5%) are more likely to have positive sputum culture results. Conclusion: CXR findings are predictive of positive sputum culture results. However, the rate of normal CXR among EPTB patients with positive sputum culture results was relatively high. Therefore, respiratory specimen cultures should be obtained in TB suspects with a normal CXR to identify potentially infectious cases of TB.
  3,988 486 2
MEDICAL EDUCATION
Integration of evidence based medicine into the clinical years of a medical curriculum
Mazen Ferwana, Ibrahim Al Alwan, Mohamed A Moamary, Mohi E Magzoub, Hani M Tamim
May-August 2012, 19(2):136-140
DOI:10.4103/2230-8229.98307  PMID:22870419
Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.
  3,293 415 5
ORIGINAL ARTICLES
Maternal antecedents of infants with abnormal head sizes in southwest Nigeria: A community-based study
Bolajoko O Olusanya
May-August 2012, 19(2):113-118
DOI:10.4103/2230-8229.98298  PMID:22870415
Objective: To identify the socio-demographic antecedents and pregnancy-related history of infants with abnormal head sizes in a developing country. Materials and Methods: An observational study of mother-infant pairs attending routine immunization clinics in an inner-city community in Lagos, Nigeria. Age and gender-specific head circumference was determined with the current Child Growth Standards of the World Health Organization (WHO). Factors independently associated with any abnormal head size (z-score < - 2SD or > 2SD), based on the adjusted odds ratio (OR) and 95% confidence interval (CI), were explored with multiple logistic regression analyses. Results: Of the 5731 mothers studied, 730 (12.7%) had an offspring with an abnormal head size. In the final regression model, teenage mothers (OR:1.86; CI:1.26 - 2.75), mothers with primary or no education (OR:1.65; P = 0.007), multiple pregnancies (OR:3.88; CI:2.53 - 5.95), and delivery in either private hospitals (OR:1.54; CI:1.22 - 1.95) or residential homes (OR:1.50; CI:1.05 - 2.14), compared to government hospitals, were significantly more likely to have offsprings with abnormal head sizes. Conclusions: Community-oriented public health education, targeting prospective mothers with multiple pregnancies, teenage girls, and women with little or no formal education on the potential risk of delivery outside public hospitals, may curtail the burden of abnormal head size of their offspring and reduce the pressure on the already overstretched rehabilitation services in resource-poor countries.
  3,364 298 2
EDITORIAL
A new era for the Journal of Family and Community Medicine
Sameeh M Al-Almaie
May-August 2012, 19(2):67-67
DOI:10.4103/2230-8229.98277  PMID:22870407
  3,092 488 -
ORIGINAL ARTICLES
Interpreting the psychometric properties of the components of primary care instrument in an elderly population
Cheryl B Aspy, Robert M Hamm, Kyle J Schauf, James W Mold, Susan Flocke
May-August 2012, 19(2):119-124
DOI:10.4103/2230-8229.98299  PMID:22870416
Objective: To determine the psychometric properties of the Components of Primary Care Instrument (CPCI) in a patient population aged 65 or older. Materials and Methods: 795 participants in the OKLAHOMA Studies, a longitudinal population-based study of predominantly Caucasian, elderly patients, completed the CPCI. Reliability analysis and confirmatory factor analysis were done to provide psychometric properties for this elderly sample. Models were constructed and tested to determine the best fit for the data including the addition of a method factor for negatively worded items. Results: Cronbach's alphas were comparable to values reported in prior studies. The confirmatory factor analysis with factor inter-correlations and a method factor each improved the fit of the factor model to the data. The combined model's fit approached the level conventionally recognized as adequate. Conclusion: CPCI appears to be a reliable tool for describing patient perceptions of the quality of primary care for patients over age 65.
  2,926 320 -
CASE REPORT
Hyercalcemia induced by interferon therapy in chronic hepatitis C
Waleed I Albaker
May-August 2012, 19(2):141-144
DOI:10.4103/2230-8229.98308  PMID:22870420
Interferon is being increasingly used in the treatment of chronic hepatitis C. Several case reports have suggested an association between interferon therapy and sarcoidosis with hypercalcemia. We report a case of severe hypercalcemic crisis with bilateral hilar lymphadenopathy in a male patient who was receiving interferon therapy for hepatitis C. Gastroenterologists should be aware of this unusual but clinically important complication of interferon therapy.
  2,476 294 2
LETTER TO EDITOR
How NICE do we have to be? Lessons learned from the NICE experience
Mohammed A Al-Shareef
May-August 2012, 19(2):145-146
DOI:10.4103/2230-8229.98309  PMID:22870421
  2,157 266 -
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010