Journal of Family and Community Medicine最新文献

Background: Depression is a major mental problem in the elderly, particularly those with disability. This study's aim was to identify variables that predict depression in the elderly with disabilities.

Materials and methods: This cross-sectional study was conducted in Gunungkidul Regency and Yogyakarta City from April to June 2021. The study participants were community-dwelling elderly aged 60 years and above with disabilities, who could communicate verbally without any apparent cognitive impairment. Data was collected by interviewing participants using structured questionnaire on following sections: Demographic characteristics, Mini-Mental State Examination (MMSE), Washington Group Short Set (WG-SS), Barthel Index of activities of daily living (ADL), Lawton Instrumental ADL (IADL) Scale, and Geriatric Depression Scale-30 (GDS-30). Multivariate linear regression analysis applied to identify variables significantly correlated with depression. Multinomial logistic regression analysis performed to obtain the odds ratio (OR).

Results: Study included 115 elderly persons with disabilities. Most of them had mobility impairment. Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001). The elderly who had greater independence with daily activities were less likely to have depression (OR = 0.639 for mild depression and OR = 0.589 for severe depression). Those who were not married were more likely to have mild depression (OR = 3.203) and severe depression (OR = 29.119). compared to the married elderly. Age at acquiring disability was associated with higher risk for mild depression (OR = 1.025) and severe depression (OR = 1.053). Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001).

Conclusion: Independence in the ADL, being married, and being disabled as a young adult are negative predictors of depression in the elderly with disability.

Despite the numerous reports of cutaneous manifestations associated with vaccines for coronavirus disease 2019 (COVID-19), the relationship between COVID-19 vaccines and cutaneous side effects remains unevaluated. In this review, we examine these manifestations and their management. Reported dermatoses included injection-site reaction (early and delayed), type I allergic reaction, morbilliform eruption, pityriasis rosea, Sweet syndrome, lichen planus, psoriasis, herpes zoster reactivation, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). The most common COVID-19 vaccination-related cutaneous manifestations are delayed local reactions, approximately 66% of which are associated with the Moderna vaccine, and 33% with the Pfizer vaccine. Aside from mild injection-site reactions, severe reactions include anaphylaxis and TEN. Most reactions, except for Stevens-Johnson syndrome and anaphylaxis, though unpredictable and unpreventable are mild and can be treated symptomatically. Findings from this review should allow primary care physicians and dermatologists to reach faster diagnosis and initiate prompt intervention.

Background: Carpal tunnel syndrome (CTS), the most common entrapment neuropathy in the upper extremity, is known to be a multi-factorial disease that raises medical and nonmedical risk factors. The aim of the current study was to determine the risk factors of CTS in patients attending the primary care center at a tertiary hospital.

Materials and methods: A case-control study was conducted by reviewing all medical records of patients above the age of 18 years old diagnosed with CTS from 2015 to 2021. The selected cases were evaluated by physical examination and confirmed by a nerve conduction study. Cases and controls were matched by age, gender, and nationality, with a case-to-control ratio of 1:2. Odds ratios were calculated for association between carpel tunnel syndrome and various factors and Chi-sqauare test determined statistical significance. Multiple logistic regression was performed to adjust for confounding.

Results: The study recruited 144 cases with a mean age of 53.38 ± 12.20 years and 288 controls with a mean age of 53.80 ± 12.27 years. The majority of subjects were female (84.7%) and of Saudi nationality (68.3%). There was a significant difference in body mass index, employment status, number of years of employment, occupation, mean systolic blood pressure, mean low-density lipoprotein cholesterol level, and mean blood urea level between cases and controls (P < 0.05). Laboratory tests that were found to be significantly associated with CTS in univariate analysis were thyroid-stimulating hormone (crude odds ratio [COR] = 0.828) and urea level (COR = 0.802). In fully adjusted analyses, obesity (adjusted odds ratio [AOR] =3.080), chronic kidney disease (AOR = 3.629), and the use of corticosteroid (AOR = 0.470) were also significantly associated with CTS.

Conclusion: Similar to the findings of other studies, this study identified several potential risk factors for CTS. More large-scale longitudinal studies are required to establish a precise causal association.

Background: Team-based care (TBC) is becoming the standard method of delivering primary care services in Saudi Arabia. Family medicine residents are considered the future leaders who will apply the Saudi Ministry of Health (MOH) strategic transformation plans in practice. The aim of this study was to assess the attitude of family medicine residents toward TBC and the factors associated with their current attitudes.

Materials and methods: A cross-sectional study was conducted between February and April 2022. The study targeted all Family Medicine residents rotating in primary healthcare centers of the Saudi MOH. A web-based survey was built using a modified version of the Attitudes Toward Health-Care Teams Scale. Data was analyzed using SPSS. Mann-Whitney U test and analysis of variance (ANOVA) were performed to compare mean attitude scores between various study variables.

Results: The overall mean attitude score was 2.71; the mean scores for attitudes toward team value, team efficiency, and physicians shared role were 3.94, 2.47, and 1.71, respectively. The residents who had received TBC training had significantly higher mean scores for attitudes toward team value subscale compared to those who had no training (4.09 vs. 3.87, P = 0.038). Similarly, the mean score for same attitude subscale was significantly higher among those who practice TBC compared to those who do not (4.08 vs. 3.85, P = 0.038).

Conclusion: The residents exhibited an overall positive attitude, especially toward team value; however, their understanding of physicians' shared role in the team should be improved by training and practice with role models.

Background: A health house (HH) is a basic health facility in rural Iraq. The function of a HH is to provide simple health services and treatments such as giving injections, dressing simple wounds, and monitoring mother and child health. The duties also include dispensing medications, measuring blood pressure, and the daily monitoring of chlorine levels in water. These HHs also provide awareness on different subjects. The main objectives of this study are to assess the availability of the basic features of the HHs and core components of the framework of the World Health Organization (WHO) building blocks.

Materials and methods: A multistage sampling technique was used to select 50 HHs out of 497 in Iraq. A questionnaire comprising closed-ended questions was developed to be completed using the researcher's observations and interviews with the healthcare workers in the HHs. The questionnaire covered the basic features of HHs as recommended by the Iraq Ministry of Health (MOH) and the six WHO health system building blocks.

Results: Fifty HHs were enrolled in the study. The availability score of basic features was 43.6% and the general service score was 55.1%. The service-specific score was 23.3%, the health workforce score was 29.6%, and the health information system score was 79.5%. The availability of essential medicines score was 21.2%, the health financing system score was 0.0%, and the leadership and governance score was 66.7%.

Conclusion: The HHs need to follow the standard criteria determined by the Iraq MOH to ensure the proper functioning of the health outlets.

Background: Obesity is a complex health problem characterized by abnormal and excessive body weight. Globally, the epidemic of obesity is escalating, and today, around one-third of the world's adult population is overweight or obese. Obesity is a risk factor and a predictor of poor outcomes of diabetes. This study aimed to determine the prevalence and characteristics of obesity in adults with type-2 diabetes mellitus.

Materials and methods: This study was conducted at five primary care centers in Bahrain. Obesity was assessed using body mass index, while glycemic control status was assessed using glycated hemoglobin (HbA1c). Informed consent was obtained from all participants. Means and standard deviation were computed for continuous variables, while categorical variables were presented as frequencies and percentages. Student's t-test and Mann-WhitneyU test, as appropriate, were performed to determine statistical significance between two continuous variables. Chi-square or Fisher's Exact test were used to test for statistical significance for categorical variables.

Results: A total of 732 participants were included; the mean age was 58.4 ± 11.3 years. Hypertension was the most prevalent comorbidity (63.5%), followed by hyperlipidemia (51.9%). Most participants (59.8%) had HbA1c levels of more than 7%, 20.9% had HbA1c levels between 7% and 8%, and 38.9% had HbA1c levels of more than 8%. Of the cohort, 47.5% were obese and 35.0% were overweight. Obesity was significantly higher in Bahraini patients and females (P < 0.001). Lower obesity rates were observed among patients who exercised regularly (P < 0.001) and patients who followed diet control measures (P = 0.039). In addition, we found higher obesity rates were found in patients with uncontrolled diabetes (P = 0.004), hypertension (P = 0.032), and hyperlipidemia (P = 0.048).

Conclusion: Obesity is prevalent among type-2 diabetic patients and is associated with poor glycemic outcomes. Thus, more efforts should be taken by physicians to address obesity in diabetic patients as it negatively impacts their glycemic control.

Background: Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students.

Materials and methods: A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables.

Results: The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS.

Conclusion: The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Background: Research in family medicine is important. The objectives of this study were to explore the contribution of family physicians, their attitudes and practice, and the barriers to research in family medicine in Saudi Arabia.

Materials and methods: This study was conducted on Saudi family physicians in 2021. A self-administered questionnaire was sent to family physicians through WhatsApp and email. Information sought included demographic data, scientific profile, number of publications, reasons for conducting research, barriers to the conduct of research, attitudes and skills for the conduct of research, and priority areas of research. Data were analyzed using SPSS version 15. Descriptive statistics included mean and standard deviation for continuous variables and frequencies and percentages for categorical variables. Student's t-test was used to compare the means of two groups of physicians. Chi-square test and logistic regression analysis were performed to determine the association between categorical variables.

Results: A total of 313 family physicians filled the questionnaire; majority were male (65%), were married (90%), and worked under the Ministry of Health (73%). The total number of publications since graduation was 1165 papers with an average of 3.8 papers per physician. More than 70% were interested in conducting research, and more than two-thirds considered research important to the advancement of family medicine. One-third of the family physicians were currently involved in conducting research, while 30% were supervising at least one research project. The top five areas of priority were chronic diseases, mental health, health promotion, quality of healthcare, and medical education/training; whereas the top five obstacles to the conduct of research were the lack of time, lack of research environment, lack of financial and technical support, and the absence of skills.

Conclusion: Saudi family physicians make a good contribution to research. The researchers and research bodies should focus on identifying the priority areas for research in family medicine in the next few years and provide support to achieve some of the objectives of the National Vision of 2030.

Background: Teaching is indeed a very stressful occupation. Owing to the novel coronavirus SARS-CoV-2, certain changes were made in education in Saudi Arabia. A switch to a 100% distant learning in some courses was implemented, thereby increasing the burden on teachers. The aim of this study was to assess the level of burnout and the impact of distant learning on burnout in primary school teachers during the pandemic.

Materials and methods: This cross-sectional study recruited 295 primary school teachers in Jeddah City, Saudi Arabia. Data were collected using self-administered questionnaire having two parts: the first part included questions on sociodemographic charecteristics and the second part included questions related to distant learning and the Arabic version of the Maslach Burnout Inventory. Chi-square test was used to assess association between burnout and various factors. For comparison of mean scores by various factors, analysis of variance (ANOVA) was performed.

Results: A high level of burnout was perceived by 48.4% of the teachers in the dimension of emotional exhaustion, 26.4% in the depersonalization dimension, and 60% in the reduced personal accomplishment dimension. Teachers in the public school showed a higher burnout score than teachers in the private schools. The teachers in 40-50 age group had higher scores than the teachers with other age groups. There were no significant differences in terms of gender and years of experience. A higher proportion of teachers working in private schools had higher personal accomplishment than teachers working in Government schools (P = 0.01). Regarding personal accomplishment and depersonalization subscales, there were differences between the different types of schools. The teachers who believed "distance/E-learning was difficult" had lower personal accomplishment score.

Conclusion: According to the study, primary teachers in Jeddah suffer from burnout. More programs should be implemented to deal with teacher burnout and more research focusing on these groups should be done.

[This corrects the article on p. 181 in vol. 29, PMID: 36389026.].