Eiad A Al-Faris

Prevalence and pattern of alternative medicine use: the results of a household survey

BACKGROUND AND OBJECTIVES Alternative medicine (AM) encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. SUBJECTS AND METHODS A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. RESULTS Of 1408 individuals participating in the study, 39% were men. The mean (+/-SD) age for the study population was 35.5 (+/-13.9) years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM (50.3%), followed by honey (40.1%), black seed (39.2%) and myrrh (35.4%). The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. CONCLUSIONS AND RECOMMENDATIONS There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system.

Traditional Healers in Riyadh Region: Reasons and Health Problems for Seeking Their Advice. A Household Survey

OBJECTIVES The objectives were to study sociodemographic characteristics of complementary and alternative medicine (CAM) visitors, rate of their visits, health problems, and reasons for the visits. DESIGN This was a cross-sectional study. SETTING This study was conducted in Riyadh city and its suburbs. SUBJECTS The sample size was calculated to be 462 families, selected according to the World Health Organization multistage random cluster sampling technique and was divided into 40 clusters. The 40 clusters were distributed proportionally according to the size of population in the catchment area. INTERVENTION AND OUTCOME MEASURES A well-structured questionnaire that contains the items that fulfill the research objectives was used to collect the data by trained research assistants. RESULTS The study includes 1408 individuals; 61% were female. About 42% of the participants consulted traditional healers (TH) sometime before and 24% within the past 12 months. There were more visits to TH in elderly people (> or =60 years), females, married, divorced, or widows and illiterate people. Common types of traditional healing included reciting the Holy Quran (62.5%), herb practitioners (43.2%), cautery (12.4%), and cupping (4.4%). Cautery was used more in suburban areas than in the city. The nationalities of the TH were Saudis (86%), Sudanese (3%), Yemenis (1%), Indians (1%), and others (9%). The common medical problems for seeking TH help were abdominal pain, flatulence, low back pain, sadness, depression, and headache. The common reasons for visiting TH were belief of success of CAM (51%), preference of natural materials (29%), and nonresponse to medical treatment (25%). Factors independently associated with consultation of TH were dissatisfaction with physician diagnosis (odds ratio [OR] = 122), failure of medical treatment (OR = 80), success of TH (OR = 79), long waiting time for physicians (OR = 20) and knowledge that some herbs are harmful (OR = 1.4). CONCLUSIONS In this study, about half of the participants have visited TH. Abdominal pain was the most common presenting health problem. CAM is a reality and it deserves more investigation and appropriate legislation and control.

The prevalence and correlates of depressive symptoms from an Arabian setting: a wake up call.

It has been shown that medical students have a higher rate of depressive symptoms than the general population and age- and sex-matched peers. This study aimed to estimate the prevalence of depressive symptoms among the medical students of a large school following a traditional curriculum and its relation to personal background variables. A descriptive–analytic, cross-sectional study was conducted in a medical school in Riyadh, Saudi Arabia. The medical students of King Saud University in Riyadh, Saudi Arabia, were screened for depressive symptoms using the 21-item Beck Depression Inventory. A high prevalence of depressive symptoms (48.2%) was found, it was either mild (21%), moderate (17%), or severe (11%). The presence and severity of depressive symptoms had a statistically significant association with early academic years (p < 0.000) and female gender (p < 0.002). The high prevalence of depressive symptoms is an alarming sign and calls for remedial action, particularly for the junior and female students.

Prevalence of sleep problems and habits in a sample of Saudi primary school children

BACKGROUND Sleep problems in children vary not only with age, but also with ethnic and sociocultural background. No research has been conducted to assess sleep problems in Saudi elementary school children. This study surveyed parents (or guardians) about their elementary school children’s sleep to assess the prevalence of certain sleep problems. METHODS The study population comprised boys and girls attending regular public elementary schools in all grades and was conducted during springtime of the year 1999. A questionnaire inquiring about demographic data, specific sleep problems and habits and home environment was distributed and completed by the parents or guardians. RESULTS A total of 1012 complete questionnaires were included in the analysis. The sample comprised 511 boys (50.5%) and 501 girls (49.5%). The mean age was 9.5±1.9 years, ranging from 5 to 13 years. Daytime fatigue was the most prevalent sleep problem (37.5%) followed by bedtime resistance (26.2%), difficulty rising in the morning during weekdays (20.7%), and sleep-onset delay (11.8%). Cosleeping with parents was reported in 12.4% of children. The study revealed some differences between boys and girls. Napping during the daytime was reported in 40.8% of children. CONCLUSION The study showed that sleep problems are prevalent among Saudi elementary school children. Moreover, the study shed some light on sleep habits and practices in this age group in Saudi Arabia, like the high prevalence of daytime napping.

Towards evidence-based medical education in Saudi medical schools.

Evidence-based medical education (BEME) is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the ‘science’ of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students (the consumers), but also has a wider impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal (secondary publication) that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use.

Correlates of emotional intelligence: Results from a multi-institutional study among undergraduate medical students

Abstract Background: Emotional Intelligence (EI) is the ability to deal with your own and others emotions. Medical students are inducted into medical schools on the basis of their academic achievement. Professionally, however, their success rate is variable and may depend on their interpersonal relationships. EI is thought to be significant in achieving good interpersonal relationships and success in life and career. Therefore, it is important to measure EI and understand its correlates in an undergraduate medical student population. Aim: The objective of study was to investigate the relationship between the EI of medical students and their academic achievement (based on cumulative grade point average [CGPA]), age, gender and year of study. Methods: A cross-sectional survey design was used. The SSREIS and demographic survey were administered in the three medical schools in Saudi Arabia from April to May 2012. Results: The response rate was 30%. For the Optimism subscale, the mean score was M = 3.79, SD ± 0.54 (α = 0.82), for Awareness-of-emotion subscale M = 3.94, SD ± 0.57 (α = 0.72) and for Use-of-emotion subscale M = 3.92, SD ± 0.54 (α = 0.63). Multiple regression showed a significant positive correlation between CGPA and the EI of medical students (r = 0.246, p = 0.000) on the Optimism subscale. No correlation was seen between CGPA and Awareness of Emotions and Use of Emotions subscales. No relationship was seen for the other independent variables. Conclusion: The current study demonstrates that CGPA is the only significant predictor, indicating that Optimism tends to be higher for students with a higher CPGA. None of the other independent variables (age, year of study, gender) showed a significant relationship.

Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students

BackgroundAny curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students’ perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study.MethodsA cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test.ResultsThe mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for the male students.ConclusionThe current study adds to the advantages of the SBC indicating not only healthier EE for both genders but also healthier emotional well-being for female students only.

A practical discussion to avoid common pitfalls when constructing multiple choice questions items

This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions (MCQs) used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types (i) related to testwiseness, (ii) related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations.

A history of childhood maltreatment among spouses predicts violence against women.

BACKGROUND AND OBJECTIVES Violence against women (VAW) is a worldwide problem that adversely affects women physically, psychologically, sexually, and financially. The aim of this study was to investigate (1) the rate of self-reported physical violence from husbands among women who presented to outpatient clinics of a major teaching hospital (2) the variables associated with VAW and (3) the pattern and the consequences of abuse on the victims’ health DESIGN AND SETTINGS This cross-sectional study was conducted over a 6-month period, commencing in December 2009 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. METHODS Women attending outpatient clinics regularly at KKUH, Riyadh, Saudi Arabia, were eligible for the study. The WHO VAW Instrument was used with some modifications to accommodate for the local culture. RESULTS A total of 222 Saudi women whose age ranged from 15 to 70 years were enrolled in the study. The rate of physical violence in the current study was 12.2%. Statistically significant associations were found between the self-reporting of VAW and the physical abuse of their husbands during childhood (odds ratio [OR]=8, 95% confidence interval [CI]: 2.2, 28.5, P=.002). Similarly living in rented houses resulted in higher likelihood of the wife being abused (OR=4.23, CI: 1.706, 10.49, P=.002). The likelihood increased if there was a history of wives being abused as a child (OR=3.563, CI: 1.438, 8.824, P=.008) and if their husbands were unemployed (OR=5.29, CI: 1.6, 17.57, P=.012). Furthermore, women who described family life as bad or disastrous were found more likely to be physically abused (OR=5.8, CI: 2.3, 14.5, P=.001). CONCLUSION VAW is a significant social and public health problem in the Saudi society. Health professionals may need to consider the diagnosis, when the risk factors identified in the current study are found.

The prevalence of abnormal results of annual investigations among diabetic patients with different risk factors.

BACKGROUND The basic theme of this study was to promote the use of risk approach and encourage selectivity in requesting laboratory investigations. The objective was to estimate the proportion of abnormal results obtained from routinely requested annual investigations among the whole study population, and the odds ratios of abnormal test results among patients with certain risk factors. PATIENTS AND METHODS A total of 459 diabetic patients aged 12 years and over, attending the primary care clinics of a university hospital in Riyadh, Saudi Arabia, were included in the study. In this cross-sectional study, analysis of the association between patients demographic characteristics and clinical findings (independent variables), and the results of the annual investigations were conducted. A multiple logistic regression analysis was carried out to identify certain independent variables associated with abnormal investigations. RESULTS The proportion of patients who had abnormal electrocardiogram (ECG) was 23%, chest x-ray (CXR) 26%, and liver function test (LFT) 9%. High systolic blood pressure (BP) and age were found to be important determinants of abnormal ECG and CXR. Patients who had high systolic BP (>140 mm Hg) were found to be 2.39 times more likely to have abnormal ECG (OR=2.39), and their odds ratio of abnormal CXR was 2.33. Furthermore, for each 10-year increment in age, there was a 43% increased likelihood of abnormal ECG and 29% increase of abnormal CXR. Smokers were nine times more likely to have abnormal LFT (OR=9.26, 95% CI=2.29 to 37.5). The disease duration and obesity were not found to have an independent association with the possibility of having abnormal results. CONCLUSION The study results led to some tentative suggestions on guidelines for clinicians in their decision either to request annual investigations for all diabetic patients, or to restrict some investigations to certain groups of patients. This was discussed and compared with the findings from the literature and other authorities recommendations.