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   2015| May-August  | Volume 22 | Issue 2  
    Online since April 17, 2015

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Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city
Ameel F Al-Shawi, Riyadh K Lafta
May-August 2015, 22(2):78-84
DOI:10.4103/2230-8229.155374  PMID:25983602
Background: Studies have revealed a powerful relationship between adverse childhood experiences (ACEs) and physical and mental health in adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into organic disease later in life. Objective: The aim was to estimate the effect of childhood experiences on the physical health of adults in Baghdad city. Subjects and Methods: A cross-sectional study was conducted from January 2013 to January 2014. The study sample was drawn from Baghdad city. Multistage sampling techniques were used in choosing 13 primary health care centers and eight colleges of three universities in Baghdad. In addition, teachers of seven primary schools and two secondary schools were chosen by a convenient method. Childhood experiences were measured by applying a modified standardized ACEs-International Questionnaire form and with questions for bonding to family and parental monitoring. Physical health assessment was measured by a modified questionnaire derived from Health Appraisal Questionnaire of Centers for Disease Control and Prevention. The questionnaire includes questions on cerebrovascular diseases, diabetes mellitus, tumor, respiratory and gastrointestinal diseases. Results: Logistic regression model showed that a higher level of bonding to family (fourth quartile) is expected to reduce the risk of chronic physical diseases by almost the half (odds ratio = 0.57) and exposure to a high level of household dysfunction and abuse (fourth quartile) is expected to increase the risk of chronic physical diseases by 81%. Conclusion: Childhood experiences play a major role in the determination of health outcomes in adulthood, and early prevention of ACEs. Encouraging strong family bonding can promote physical health in later life.
  11 3,560 506
Nigella sativa: A potential natural protective agent against cardiac dysfunction in patients with type 2 diabetes mellitus
Abdullah Bamosa, Huda Kaatabi, Ahmed Badar, Akram Al-Khadra, Abdulmohsen Al Elq, Bodour Abou-Hozaifa, Fatma Lebda, Sameeh Al-Almaie
May-August 2015, 22(2):88-95
DOI:10.4103/2230-8229.155380  PMID:25983604
Objectives: To study the effect of Nigella sativa supplementation on cardiac functions in Type 2 diabetic patients treated with oral hypoglycemic agents. Background: Diabetes mellitus is associated with a high risk of cardiovascular morbidity and mortality. A number of reported beneficial effects of N. sativa on cardiovascular function were the inspiration for this study. Materials and Methods: Sixty patients with uncontrolled diabetes (hemoglobin A 1c [HbA 1c ] >7%) and with no known cardiovascular complications were recruited from the outpatient diabetes clinic. They were assigned, by convenience, to two groups; the control group received activated charcoal as placebo while the test group received 2 g/day of powdered N. sativa for 1-year. All patients continued with their standard oral hypoglycemic agents. Echocardiography was used to evaluate the diastolic function, systolic function, and left ventricular mass (LVM) before the intervention and after 6 and 12 months of the treatment. Results: HbA 1c decreased significantly in the N. sativa group but did not change in the control group. Echocardiographic assessment in the control group showed impairment in diastolic function after 12 months, but there were no significant changes in fractional shortening (FS) or ejection fraction (EF). Furthermore, left ventricular (LV) dimensions at diastole and systole, LVM, and LVM index were significantly increased. In N. sativa group, no significant changes were found in diastolic function or LVM. LV dimension at systole was decreased while FS and EF were significantly increased after 6 and 12 months. Conclusion: N. sativa supplementation may protect the hearts of type 2 diabetic patients from diastolic dysfunction while improving LV systolic function.
  11 3,082 440
Three years of antibacterial consumption in Indonesian Community Health Centers: The application of anatomical therapeutic chemical/defined daily doses and drug utilization 90% method to monitor antibacterial use
Ivan S Pradipta, Elis Ronasih, Arrum D Kartikawati, Hartanto Hartanto, Rizki Amelia, Ellin Febrina, Rizky Abdulah
May-August 2015, 22(2):101-105
DOI:10.4103/2230-8229.155385  PMID:25983606
Context: Irrational use of antibacterial drugs in Community Health-Care Centers (CHCs) may lead to increased resistance, morbidity, and mortality. Aims: The aim of this study was to determine patterns of antibacterial use at CHCs in a district of Indonesia and use this as data for an antibiotic policy. Settings and Design: The observational-descriptive study was conducted in a district of Indonesia to obtain antibacterial use from 2008 to 2010. Subjects and Methods: The data obtained from the report on the use of medicines were classified and processed using the anatomical therapeutic chemical (ATC) and defined daily doses (DDD) method, with DDD/1000 patients as a unit measurement. The number of patients was obtained from attending patients in that research period. The most abundant antibacterial drugs use segment was identified by the drug utilization 90% (DU90%) method. Statistical Analysis Used: Descriptive analysis were performed in this study. Results: Fourteen kinds of antibacterial drugs were used in 61 CHCs. The total of antibacterial drug use during the period 2008-2010 was 871.36 DDD/1000 patients/day. Declining antibacterial use was observed between 2008 and 2010. Six kinds of antibacterial drugs were the most commonly used. The data show that the average use per visit was as high as 24.41 DDD. Conclusions: Amoxicillin, sulfamethoxazole and trimethoprim are antibacterials that have to be reconsidered by physicians for use in the Bandung CHC. The high use of antibacterial drugs, as described in the study, can be used as reference to develop an antimicrobial stewardship program and increase awareness of resistance, adverse drug reaction and drug interaction of antibacterial drugs.
  9 3,321 445
Clinical presentation and causes of the delayed diagnosis of breast cancer in patients with pregnancy associated breast cancer
Ali M Al-Amri
May-August 2015, 22(2):96-100
DOI:10.4103/2230-8229.155383  PMID:25983605
Objective: The objective was to assess the clinical presentation, delay of diagnosis, and the causes of delay in the diagnosis of patients with pregnancy-associated breast cancer (PABC) and patients with non-PABC. Patients and Methods: This was a face-to-face interview with women who had histologically confirmed BC. All respondents were interviewed at our hospital. Results: We interviewed 56 patients, 36 with non-PABC and 20 with PABC. Of the 20 patients with PABC, BC was diagnosed in 12 (60%) during pregnancy and 8 (40%) during postpartum. 18 of the patients (90%) with PABC presented mainly with a mass 3 (15%) with pain and ulcer, 5 (25%) with skin redness and thickening, 6 (30%) with nipple retraction and 4 (20%) with discharge 12 (60%) patients with PABC had delayed diagnosis and 8 (40%) of this delay was due to physicians' reassurance, and 2 (10%) because of fear of cancer. Similarly, 35 (97%) patients with non-PABC presented with breast mass, 3 (8.3%) with infrequent pain 4 (11.11%) with inflammation 2 (5.55%) with ulcer 2 (5.55%) with nipple discharge and4 (11.11%) with thickening of the skin compared with PABC patients. Only 4 (11.11%) in non-PABC had delayed diagnosis, and for half of them the delay was due to the fear of cancer. Two patients with PABC and non-PABC were afraid of cancer 16.66% and 5.55%, respectively. However, 8 (60%) of patients with PABC had delayed diagnosis compared to 0% of patients with non-PABC. Conclusion: In this study, the majority of patients with PABC or non-PABC presented with a breast lump. Other symptoms were more common in patients with PABC than in patients with non-PABC. An increased awareness of clinicians may help reduce delay in the diagnosis of patients with PABC.
  8 3,049 436
Why medical students do not like to join rural health service? An exploratory study in India
Srinivas Nallala, Subhashisa Swain, Sanju Das, Shravan K Kasam, Sanghamitra Pati
May-August 2015, 22(2):111-117
DOI:10.4103/2230-8229.155390  PMID:25983608
Introduction: Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. Odisha, a state in India faces a major shortage of doctors particularly in rural and remote areas. In order to address this challenge, it is essential to understand medical students' career plans, specialization preferences, choices of job location and sector, and views on working in rural and remote areas. This study explored the immediate and long-term career plans of final year medical students, their intended practice locations and underlying reasons for the choices. Methodology: A cross-sectional survey was conducted in all the medical colleges (three government and three private) in the state of Odisha. Through the systematic sampling method, data were gathered from 390 final year students. A semi-structured questionnaire was administered to the students and data were analyzed using SPSS version 20. Results: Of the 390 students, 290 (74.35%) were from a government college. The most preferred immediate career goal was postgraduation studies (45.9% of students in government medical schools and 54% in private). About 17% of government students and 9% of private students showed willingness to work in rural areas, in the long run. Nearly 44.5% mentioned opportunities for career growth, followed by the possibilities for higher education (26.8%) as major the factors for preferring an urban posting. Similarly, higher pay scales, better working conditions were major factors for preferring the private sector. Most of the students maintained that good housing, better salaries, and adequate facilities at the workplace would attract more students toward rural service. Conclusion: Since public funded medical students are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue. Approaches such as extended clinical apprenticeship in rural health facilities, long-term community engagement during medical studentship could be considered.
  5 3,064 376
Prevention of occupational Back Pain
Sultan T Al-Otaibi
May-August 2015, 22(2):73-77
DOI:10.4103/2230-8229.155370  PMID:25983601
This paper reviews scientific research on occupational back pain and focuses on prevention of this problem. It discusses some of the challenges of translating the evidence of this multi-factorial condition into policy. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but which affects the individual's capacity to work. Back pain affects the vast majority of people at some point in their lives and is very costly to both the health care system and the industry. Evidence suggests that heavy lifting, driving, and vibration of the whole body are linked to occupational back pain. Once the risk factors for occupational back pain are identified, an otherwise chronic and disabling condition can be prevented in the majority of patients. As explained in this article, three levels of prevention for occupational back pain have been reported as effective. Failure to implement preventive measures may lead to a high incidence of occupational back pain.
  2 4,282 705
Medical grand rounds in Riyadh, Saudi Arabia: Current attitudes and barriers
Mohammad Alqahtani, Nora Al Balawy, Salih A Bin Salih, Abdullah Al Sayyari, Hanan Al Shammari, Mohammed AlGhobain, Naji Aljohani
May-August 2015, 22(2):118-123
DOI:10.4103/2230-8229.155396  PMID:25983609
Background: Medical grand rounds (MGRs) are considered key educational tools in most academic medical institutions. In this multi-center cross-sectional survey, we tried to determine the current attitudes of local medical practitioners to MGRs, as well as perceived barriers. Methodology: A total of 120 physicians from the National Guard Hospital, King Fahad Medical City, King Khalid University Hospital and King Faisal Specialist Hospital participated in the survey. The questionnaire consisted of statements on attitudes and perceived barriers against participating in MGRs, as well as participants' levels of agreement. Results: Most participants attend MGRs regularly (94.2%), claiming that it is mandatory (88%). Participants also agreed that MGRs were important tools for continuing medical education (89.2%) and that they provided an opportunity to both present materials and interact with their colleagues in other divisions (86.7% and 81.6%, respectively). The vast majority of respondents agreed that "topic review/update" and "inviting guest speakers" were the two most preferred suggestions for improving MGRs (94.2% and 92.5%, respectively). Major barriers included constraints of time (43.3%) and topics that were not patient-related (40.8%). Conclusion: MGRs in the major Tertiary Hospitals in Riyadh are well attended, and the majority of the local practitioners believe in the positive effect of MGRs in delivering quality and up to date medical knowledge. Time and physician-specific issues were identified as major barriers that needed to be addressed in order to maximize participation of medical staff.
  1 2,246 264
Family medicine training in Saudi Arabia: Are there any variations among different regions?
Ammar R Abu Zuhairah, Kasim M Al-Dawood, Amar H Khamis
May-August 2015, 22(2):106-110
DOI:10.4103/2230-8229.155387  PMID:25983607
Aims: The aim was to compare Eastern, Makkah, and Asir regions in term of residents' perception of the achievement of training objectives, and to assess various rotations based on residents' perception. Settings and Design: This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions. Methodology: A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents. Statistical Analysis Used: Cronbach's alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6%) residents completed the questionnaire. There were 51 (47.7%), 27 (25.2%), and 29 (27.1%) residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2%) were married, and more than half (54.2%) of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine. Conclusions: Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as perceived by the family medicine residents were psychiatry and otolaryngology while lowest were orthopedics and ophthalmology. Sharing of experience and further studies are needed to improve the program rotations.
  1 2,769 256
Is it reliable to measure the forearm blood pressure in children?
Amar M Taksande, Aishwarya Jadhav, Jyoti Nair
May-August 2015, 22(2):85-87
DOI:10.4103/2230-8229.155376  PMID:25983603
Background: When the upper arm (UA) is inaccessible or a standard-sized blood pressure (BP) cuff is unavailable, some healthcare workers use the forearm (FA) to measure BP with a mercury sphygmomanometer. Objective: The objective was to determine the accuracy of BP measurement in the arm and FA. Design: Prospective, randomized study. Setting: Department of Pediatrics, JNMC, Sawangi (Meghe) Participants: A total of 72 children aged 5-15 years. Measurements: Mercury and Automatic (OMRON Tokyo, 108-0075 Japan) BP measurements were recorded from the arm and FA at 2 min intervals. Results: In our study, 72 children of both sexes were enrolled. The mean age of the children was 10.13 ± 2.82 years, and 48% were females. Pearson's correlation coefficient between FA and UA systolic BP (SBP) measured by mercury was 0.782, and for diastolic BP (DBP) it was 0.824. Similarly, Pearson's correlation coefficient between FA and UA SBP measured with an automated device (OMRON) was 0.843, and for DBP it was 0.846. The average readings for the SBP and DBP were higher in the FA than in the UA by approximately 3 mmHg. There was a statistically significant difference in both SBP and DBP. Conclusions: The FA is an acceptable method of BP monitoring when the UA cannot be accessed. The pressure from FA is probably higher than it would be from UA.
  1 2,764 331
Brief Arabic tobacco craving questionnaire: An investigation into craving and heavy smoking in Saudi Arabian males: Erratum

May-August 2015, 22(2):126-126
DOI:10.4103/2230-8229.155399  PMID:25983611
  - 1,451 156
Can the diagnostic delay of oral cancer by healthcare practitioners be prevented? Who should bear the blame of delay?
Gaurav Sharma, Archna Nagpal
May-August 2015, 22(2):124-125
DOI:10.4103/2230-8229.155398  PMID:25983610
  - 2,460 217


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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010