Mental health research in the Kingdom of Saudi Arabia: A review of trend and visibility over four decades Mahdi S Abumadini Journal of Family and Community Medicine 2019 26(3):163-167 In the last few decades, there has been significant advancement in higher education and research in the Kingdom of Saudi Arabia (KSA) However, no research has quantified the studies on mental health in Saudi Arabia. The aim of this review was to review literature on mental health in KSA over the last four decades and compare it with studies done in other medical and surgical specialties. This narrative review is based on research published in the global scientific database of Web of Science, Scopus and Medline/PubMed. Mental Health Research of Saudi Arabia published since 1975 was retrieved. Publications related to other medical specialties such as surgery, internal medicine and pharmacology were also retrieved for comparison. A total of 159,796 studies related to medical and non-medical specialties were conducted in Saudi Arabia. A total of 52,699 related to medical specialties, 670 of which were on mental health and 52,029 on other medical specialties. At the beginning of the last decade there was a sharp increase in medical research (including mental health) publications from Saudi Arabia. Mental health research does not differ from research in other medical specialties in its output. In spite of the huge strides made in research in KSA, the provision of support for mental health research in the Kingdom is inadequate. Possible challenges and recommendations have been identified.

Factors affecting treatment compliance of patients on antihypertensive therapy at National Guard Health Affairs (NGHA) Dammam Primary Health Care Clinics (PHCC) Hala N Abdelhalim, Adel I Zahrani, Ahmed M Shuaibi Journal of Family and Community Medicine 2019 26(3):168-172 BACKGROUND: Hypertension, a noteworthy hazard for stroke and coronary illness, is one of the most significant preventable causes of premature morbidity and mortality in developed and developing nations. Adherence to antihypertensive medications and lifestyle alterations can greatly affect the control of hypertension. This study investigated factors that impact on treatment compliance of patients on antihypertensive therapy at the National Guard-Health Affairs (NGHA) Primary Health-Care Clinics (PHCC), Dammam, Saudi Arabia, taking into account the Health Belief Model (HBM). MATERIALS AND METHODS: A cross-sectional study was conducted in the NGHA PHCC, Dammam. A total of 402 individuals were included in the study through convenience sampling method. Data were gathered by structured self-administered questionnaire. Data were entered into the computer and analyzed using SPSS software. The data were summarized using frequencies and percentages. The Chi-square test was used to compare ratios, and a Pearson's correlation analysis of HBM variables was carried out; all tests were performed at 0.05 significance level. RESULTS: The proportion of treatment-compliant participants in this study was 39.6%, and the participants' 'mean age was 54.09 (SD±10.703) years. About 59% females were compliant to the treatment regimen as against 19.7% of males. A total of 33.5% of the married participants were compliant, as against 16.7% of the single participants who were compliant. Unemployed patients (72.3%) were more compliant than the employed participants. CONCLUSIONS AND RECOMMENDATIONS: The study showed that the compliance of most hypertensive patients with antihypertensive therapy was poor. Based on the HBM, all predictors including perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and cues to action were statistically significant (P < 0.05). Therefore, the provision of health education by health-care providers to patients could have a substantial positive impact on patient compliance.

Community's compliance with measures for the prevention of respiratory infections in Riyadh, Saudi Arabia Ali M Alhazmi, Sulaiman A Alshammari, Hanan A Alenazi, Shaffi A Shaik, Hala M AlZaid, Nouf S Almahmoud, Hotoon S Alshammari Journal of Family and Community Medicine 2019 26(3):173-180 BACKGROUND: Acute respiratory tract infections are the most common causes of both morbidity and mortality worldwid, and the management and prevention of acute respiratory infections is a global problem, especially in developing countries. This study sought to assess the community's compliance and practice of measures for the prevention of respiratory infections and discover their source of health information. MATERIALS AND METHODS: A cross-sectional study was carried out in the five biggest shopping malls in Riyadh city in July 2014. The required sample size was 980 persons aged 15 or older, with 196 from each of the five biggest shopping malls from each of the five geographic areas of Riyadh. Data was collected by face-to-face interview using standardised questionnaire, and analyzed using SPSS. RESULTS: Overall, 48.3% of the participants thought that they were susceptible to any of the respiratory infections of pandemic influenza; 59.7% always washed their hands with water and soap and 34.8% used antibacterial soap. About 29% reported avoiding touching their eyes, noses, and mouths directly with their hands; 63.5% covered their noses and mouths with tissue paper when sneezing or coughing. A substantial number said they “never” shared their personal stuff, including towels (70.5%) and utensils (49.0%) with others. Only 21.2% avoided crowded places or wore a mask (9.1%) in such a situation. A high proportion (62.8%) did not take the seasonal flu vaccine. The most common sources of health information included television/radio (47.9%), social media (29.4%), and friends/family (28.1%). CONCLUSIONS: Health authorities should seize every opportunity to prevent respiratory infections by adopting all evidence-based infection control measures to improve public awareness, attitude, and practice.

Prevalence and risk factors for hypertension among school children in Ilorin, Northcentral Nigeria Olayinka R Ibrahim, Joseph K Afolabi, Olanrewaju T Adedoyin, Ayodele I Ojuawo Journal of Family and Community Medicine 2019 26(3):181-186 BACKGROUND: The global prevalence of childhood hypertension has increased from 1% to 2% to 4%–5%, with a value as high as 9.8% reported in Nigeria. However, the various risk factors associated with childhood hypertension in Nigeria are less explored. The aim of this study was to determine the prevalence of hypertension and related risk factors (sociodemographic, family history of hypertension, history of snoring, birth order, and anthropometric indices) in primary school children in Nigeria. MATERIALS AND METHODS: A total of 1745 school children aged 6-12 years were selected using systematic random sampling method. Blood pressure (BP) was measured using the fourth report guideline. Those with BP higher than 90th percentile had repeated BP measurements on two more occasions (2 and 4 weeks after initial measurement). Relevant history was obtained, and anthropometric measurements were taken by the standard methods. Data were analyzed using SPSS version 20. RESULTS: Prevalence of systolic and or diastolic hypertension at the third visit was 3.0%. Prevalence of systolic hypertension (3rd visit) was more in females (3.3%) than males (1.3%), P = 0.004. Prevalence of diastolic hypertension (3rd visit) was higher in females (1.4%) than males (0.3%), P = 0.019. Hypertension showed no significant relationship with socioeconomic class, family history of hypertension, birth order, and history of snoring. Of the anthropometric indices (weight, height, body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, and waist-to-height ratio, and only obesity (BMI ≥ 95th centile) was related with hypertension (odd ratio 8.3, 95% confidence interval 1.7, 40.3). CONCLUSIONS: Prevalence of hypertension is low (3.0%), and only obesity (BMI ≥ 95th centile) is associated with hypertension.

Potentially inappropriate medications prescribed for older persons: A study from two teaching hospitals in Southern India Arun N Bhatt, Sherin S Paul, Smitha Krishnamoorthy, Basil T Baby, Anna Mathew, Balakrishnan R Nair Journal of Family and Community Medicine 2019 26(3):187-192 BACKGROUND: Potentially inappropriate medications (PIMs) are a major concern in geriatric care. The primary objective of our study was to assess the prevalence of PIMs prescribed for older persons attending outpatient setting of two teaching hospitals in Kerala state in South India, where the population is aging. MATERIALS AND METHODS: A cross-sectional study was carried out in two teaching hospitals in Kerala. Four hundred consecutive outpatient medical records of patients aged 65 years and above were selected. The current medications of the patients were analyzed to identify PIMs by the Beers criteria 2015. Polypharmacy and hyperpolypharmacy were defined as 5–9 medications and ≥10 medications, respectively. Chi-square test was done to identify demographic variables and the pattern of health-care facility use associated with PIM prescription. Binary logistic regression was performed to adjust for confounding associations. RESULTS: The prevalence of PIMs prescription was 34.0% (95% confidence interval: 29.4%–38.6%) and that of polypharmacy and hyperpolypharmacy was 45.8% and 13.5%, respectively. The common PIMs were proton-pump inhibitors, benzodiazepines, peripheral α-1 blockers, and first-generation antihistamines. Inpatient admission, visits to the emergency department, multiple diagnoses, polypharmacy, and hyperpolypharmacy were associated with PIM prescription (P < 0.05). Age, gender, number of outpatient visits, and specialist consultation were not associated with PIM prescription. Polypharmacy (adjusted odds ratio [aOR] =2.11) and hyperpolypharmacy (aOR = 5.55) had independent association with PIM prescription (P < 0.05). CONCLUSION: PIM prescription appears to be common in teaching hospitals in Kerala. Polypharmacy and hyperpolypharmacy in older people should trigger a review of medication to reduce the use of PIM.

High blood pressure in children attending pediatric clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia Ranya A Ghamri, Amal A Hegazy, Anan Z Azizkhan, Sultanah F Alsalmi, Noha A Alharbi, Rawan A Hemedy, Amani A Alharbi Journal of Family and Community Medicine 2019 26(3):193-198 BACKGROUND: High blood pressure (BP) is an important health issue on a global level. It is one of the major factors for mortality in Saudi Arabia. Furthermore, high BP is considered a significant risk for heart disease responsible for 30% of all deaths all over the world. The aim of this research was to determine the prevalence of hypertension in children attending the pediatric clinics and determine the common risk factors associated with high BP. MATERIALS AND METHODS: It was a cross-sectional study conducted among 6-15 year aged children attending the pediatric clinic at King Abdulaziz University Hospital in Jeddah; children were selected using sytematic random sampling technique. Data was collected by interviewing the parents using a structured questionnaire. SPSS was used for data entry and analysis. Computed frequency and percentages for categorical variables, and mean and standard deviations for continuous variables. Chi-square test and correlation used to determine associations, and logistic regression performed to determine factors associated with blood pressure >= 95th percentile. RESULTS: The prevalence of hypertension and prehypertension was 14.4% and 6.5%, respectively, in males, whereas, in females, it was 16.3% and 5.2%, respectively. A high prevalence observed for the 6–10 years age group as compared with the 11–15 year age group, and the difference was statistically significant (P = 0.001). A high prevalence of hypertension and prehypertension in overweight and obese group was noticed. A significant positive correlation between systolic BP and weight, height, and BMI was demonstrated. The common risk factors for hypertension in this study were the age range of 6–10 years, (odds ratio OR = 2.44), overweight and obese children (OR = 2.44), children with family history of hypertension (OR = 1.39), and children with low birth weight (OR = 1.05). CONCLUSION: These factors are considered risk factors for such a chronic disease as cardiovascular disease. Consequently, continuous BP monitoring and early identification of high BP in children are some of the greatest strategies for the prevention of chronic diseases in adulthood.

Patient-rated physicians' empathy and its determinants in Riyadh, Saudi Arabia Zainab M Alzayer, Rizwan S Abdulkader, Kathiresan Jeyashree, Ahmad Alselihem Journal of Family and Community Medicine 2019 26(3):199-205 BACKGROUND: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated with it. MATERIALS AND METHODS: This hospital-based cross-sectional study enrolled adult (≥18 years) patients attending the outpatient clinics of the departments of family medicine, internal medicine, and surgery. We measured patients' rating of their physician's empathy using the Jefferson Scale of Patient's Perception of Physician Empathy questionnaire. Data were analyzed using SPSS v 23.0; categorical variables were presented as frequencies and percentages, and all quantitative variables were presented as mean and SD. Associations were explored by Chi-square test and Student's t-test. Regression analysis was performed to identify factors significantly associated with the empathy score; P< 0.05 was considered statistically significant. RESULTS: Of a total of 390 patients with a mean (standard deviation [SD]) age of 40.5 (13.6) years, 189 (48.5%) were male. The mean (SD) total patient-rated physician empathy score was 26.6 (6.0). Multilevel linear regression modeling revealed that having a health professional in the family, suffering from an acute illness (as compared to chronic illness), consulting a physician recommended by relatives/friends, trusting the physicians' expertise, shorter (<10 min) waiting time, and perceived adequate consultation time were associated with higher empathy ratings. CONCLUSIONS: Patients' perception of physicians' empathy is indispensable for the success of a clinical consultation. It is influenced by patient-level social and clinical factors. On-the-job physician training in empathy, effective monitoring, and feedback mechanisms should be an integral component of the quality control of hospital services.

Dentists' awareness about the link between oral and systemic health Muhammad A Nazir, Faisal Izhar, Kamal Akhtar, Khalid Almas Journal of Family and Community Medicine 2019 26(3):206-212 BACKGROUND: Oral health is integral to systemic health. There is a growing body of evidence of an association between periodontal and systemic diseases. The aim of the study was to evaluate the awareness of dentists regarding link between oral and systemic health. MATERIALS AND METHODS: Data was collected using a self-administered pilot-tested questionnaire. Dentists awareness about link between oral and systemic link was assessed on five point likert scale. Data was entered and analysed using SPSS. RESULTS: Of the 588 dentists, 500 completed the questionnaire (response rate 85.03%). About 93% of the participants (mean age 25.82 ± 4.21 years) agreed that oral health was associated with systemic health. Most dentists were aware of a connection between periodontal disease and diabetes (84.4%) and heart disease (70.2%). Similarly, 85.6% believed in the negative impact of oral disease on the quality of life of patients. More female than male dentists were aware of the relationship between periodontal disease and adverse pregnancy outcomes, diabetes, and rheumatoid arthritis (P < 0.001). Most dentists (97%) believed that more patients would seek oral care if they were aware of the oral-systemic link. After adjustments, private dentists were 4.65 times more likely than public dentists to believe in improving access to oral care with increased patient awareness of the oral-systemic connection (P = 0.011). CONCLUSIONS: Most dentists were aware of the oral-systemic link. They believed that patients' access to oral care would improve if they were aware of a connection between oral and systemic health. Therefore, patients should be informed of the oral-systemic link to improve their oral health.

Correlates of Psychotropic Polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia Fares F Alharbi, Samar F Alharbi, Saleh Bin Salih, Khaled Al-Surimi Journal of Family and Community Medicine 2019 26(3):213-220 BACKGROUND: Polypharmacy is meaningful and clinically justified under certain circumstances. However, the prescription of multiple psychiatric medicines is mostly based on practical experience rather than evidence. The aim of this study was to assess the current practice of and factors associated with the use of polypharmacy among patients attending outpatient psychiatric clinics. MATERIALS AND METHODS: A cross-sectional study was conducted among patients attending outpatient psychiatric clinics in two tertiary care hospitals in the kingdom of Saudi Arabia (KSA). Patients aged 18 years and above and who were taking any prescription or nonprescription medications were included. Data were collected by face-to-face interviews, followed by a review of electronic medical charts to determine the drugs being taken by patients, and track their current computerized drug prescriptions. Data were analyzed using SPSS statistical software version 21 (Chicago, IL, USA), applying both descriptive and inferential statistical analysis as appropriate. RESULTS: Of the 401 study participants, 53.6% were aged 25 years or older, and 63.6% were married and > 50% were unemployed. The overall prevalence of polypharmacy was 46.9%. The prevalence of polypharmacy was 67.3% in psychosis, 37.7% in depression, 27.1% in anxiety, 74.1% in bipolar disorders, and 53.6% for patients with two or more disorders, and 42.1% for patients diagnosed with “other” disorders. Overall, there was a significant association between polypharmacy and gender, marital status, and diagnosis of disorder. CONCLUSIONS: Psychotropic polypharmacy is common in outpatient practice. Patients with psychosis and bipolar disorders, especially those aged 25–45 years are exposed to high psychotropic polypharmacy. The concomitant use of large numbers of drugs should be periodically reviewed to improve the quality and safety of psychiatric care.

Attitude of medical students at King Saud Bin Abdulaziz University for Health Sciences toward family medicine as a future specialty Saad K Alshammari, Bader A Altulaihi, Hazim S Alghamdi, Abdullah M Alanazi, Saad M Alhazzaa, Rayan K Alanazi Journal of Family and Community Medicine 2019 26(3):221-226 BACKGROUND: Owing to the rising population of the Kingdom of Saudi Arabia, the need for family physicians is growing. The number of family physicians who would be available in the health service in future is dependent on the attitudes of medical students because their choice of specialty is a major factor in satisfying this demand. The aim of the study was to evaluate the attitudes of medical students to family medicine as a future career. MATERIALS AND METHODS: This cross-sectional study was conducted at King Saud Bin Abdulaziz University for Health Sciences. A total of 308 students were randomly selected from problem-based learning groups. Data were collected using a 25-item validated questionnaire, and Excel and SPSS were used for data entry and analysis. Mean and standard deviation were used to describe numerical data and frequencies and percentages to describe categorical data. P < 0.05 was considered statistically significant. RESULTS: A total of 308 medical students, 201 (65.3%) of whom were male, completed the questionnaire. Majority of the students (229 [74.3%]) agreed that family physicians make important contributions to medicine although family medicine was one of the least preferred specialties of the students. CONCLUSIONS: Most students were aware of the importance of family medicine; however, only a few of them chose this specialty. Further studies should be conducted to identify the factors that influence medical students' decisions in their choice of family medicine as a future career.