Characteristics of Breast Masses of Female Patients Referred for Diagnostic Breast Ultrasound from a Saudi Primary Health Care Setting.

BACKGROUND: Breast masses are common among females presenting to primary health care (PHC) facilities. The family physician's role is crucial in detecting breast disease. Utilization of breast ultrasonography has been increasing recently as a diagnostic tool. OBJECTIVE: This study aims to determine the characteristics of masses detected on breast ultrasound, their associations with characteristics of females attending the PHC setting and explore the management of these cases by family physicians. METHODS: This registered based, cross-sectional study included 321 females who were referred for diagnostic breast ultrasound in the PHC center of the University hospital, Eastern province, Saudi Arabia (2017-2019). t-test, Chi-squared and Fisher's Exact tests were performed to assess associations between the presence of breast masses in the ultrasound and patients' characteristics. Moreover, to compare the breast masses in two groups of patients (< 40 years and ≥ 40 years) regarding their characteristics, ultrasound findings, and further management performed. P < 0.05 was considered statistically significant. RESULTS: Approximately 24% patients had a breast mass and 70.92% of cases were detected among females ≥ 40 years old. The odds of having a breast mass were highest among overweight, females complaining from a breast lump, and who had early menarche. Grand multiparous had lower odds of a breast mass. Females < 40 years old had higher rates of breastfeeding, increasing parity, and obesity than older females. Sonographic examined masses were larger in young females, and posterior enhancement of the mass was more reported in older. BI-RADs of the masses were not associated with the patient's age. CONCLUSION: Breast masses were prevalent among females who underwent breast ultrasound. The results support referral for investigation when a female complains of a breast lump. Family physicians have a vital role in encouraging protective behaviors from developing breast masses such as maintaining normal weight and breastfeeding.

Anxiety and Its Association with Preparation for Future Specialty: A Cross-Sectional Study Among Medical Students, Saudi Arabia.

BACKGROUND: Anxiety disorders are a significant global health concern with destructive morbidity and mortality. Medical school is a stressful environment worldwide. This study measures the prevalence of anxiety symptoms among clinical-year medical students in Saudi Arabia. As well as to explore its association with students' sociodemographic factors, academic performance, issues experienced by them during the study of medicine, and their perceived readiness for their future specialties. METHODS: The generalized anxiety disorder (GAD-7) tool along with a sociodemographic questionnaire was distributed to 523 clinical-year medical students (fourth, fifth and sixth years) from the Imam Abdulrahman Bin Faisal University, Saudi Arabia, in this cross-sectional study. Data analysis was performed with SPSS version 23 and it included the Chi-Square or Fisher's exact tests for bivariate analysis, and the multivariable logistic regression to account for confounders. RESULTS: The prevalence of anxiety symptoms as measured by the GAD-7 was found to be 31.7%. Of these, 14.3% had severe symptoms. Only 4.4% students went to a healthcare professional and were diagnosed with psychiatric problems. Logistic regression analysis revealed that the odds of anxiety was higher among females and students who had perceived psychological problems. However, students' grade point average (GPA) and perceived readiness for their future specialty were not statistically significant with anxiety symptoms. CONCLUSION: Anxiety was highly prevalent among clinical-year medical students included in this study. This urges periodic mental health screening, proper diagnosis of high-risk individuals in medical schools, and early interventions through confidential access to mental health services.

Prevalence of depression and its associated factors among clinical-year medical students in Eastern Province, Saudi Arabia.

BACKGROUND: To assess the prevalence of depression among medical students in their clinical years (fourth, fifth, and sixth years) in a government university in Eastern Province, Saudi Arabia, and its association with the students' sociodemographic characteristics, academic factors, perceived health problems and their perceived readiness to their future specialties. METHODS: A cross-sectional study was conducted among 527 clinical-year medical students. The Patient Health Questionnaire (PHQ-9) and questionnaire designed by the researchers to collect data on sociodemographic and academic variables were used as research instruments. Statistical analyses were conducted using Stata Statistical Software V.15. Descriptive statistics, the χ test, and both an ordered logistic regression and a binary logistic regression analysis were performed. RESULTS: The prevalence of depression was found to be 39.27%, according to the results of the PHQ-9. Both the ordered logistic regression and the binary logistic regression analyses revealed that the odds of severe depression were high among women, and students who perceived that they were not yet ready for their future specialties. The more senior the medical students were, the less likely it is that they have severe depression. A similar association was found for students who perceived that they did not have psychological problems. However, students' grade point average was not statistically significantly associated with depression. CONCLUSIONS: The prevalence of depression was high among the medical students examined. Policy makers should establish screening programmes, provide counselling for students who need it and deliver early interventions in detected cases.

Evaluation of Multifaceted Assessment of the Fifth-Year Medical Students in Family Medicine Clerkship, Saudi Arabia Experience.

BACKGROUND: There are few data on assessment methods in the field of family medicine in Arab countries. Imam Abdulrahman Bin Faisal University (IAU) in 2017 established the family medicine clerkship rotation for the fifth-year medical students. The objective of the study is to evaluate the multifaceted assessment of family medicine clerkship and their correlation to each other among fifth-year medical students in IAU. METHODS: We examined the performance of 455 fifth-year medical students from two batches (2018 and 2019) in the continuous course assessment, Objective Structured Clinical Examinations (OSCE), extended matching questions (EMQ), and multiple-choice questions exams (MCQ). RESULTS: The students' total mark range was 55.16 to 95.64. Batch 2018 and females had significantly higher marks (p=0.000). On the other hand, no significant associations were seen between the total marks and the semester in which the clerkship was taken or the order of group in each semester (p= 0.464 and 0.980 respectively). Significant positive correlations were seen between all forms of assessment during the family medicine clerkship (p=0.000). CONCLUSION: This study demonstrates that different assessment methods used to evaluate medical students during the family medicine clerkship were correlated. The performances of the female and the first batch were superior. This finding is the basis for introducing a platform for developing modern learning and the improvement of the assessment standards in family medicine clerkship rotation.

Association between air pollutants and anthropometric measurements of boys in primary schools in Dammam, Eastern Saudi Arabia.

BACKGROUND: The combined action of biological, physical, and chemical agents in the environment impacts on children's health resulting in illness and disability. Body measurements provide the optimum method of evaluating the health status of children. This study was done to measure the main air pollutants that affect the physical growth of primary schoolboys and compare the growth patterns of these young boys in three different areas in the city of Dammam in the Eastern Province of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was conducted in three different environmental areas (residential, commercial, and industrial). The total number of boys in the study was 851. Data were collected using a self-administered questionnaire with three main parts: sociodemographic, anthropometric measurements, and air pollutant measurements. RESULTS: Less than half the children (45%) residing in the residential area belonged to Classes 4 and 5 socioeconomic groups. In addition, 56.6% of the children residing in the commercial area and 26.5% of children in the industrial area belonged to the same socioeconomic class. There was a statistically significant difference between the mean age (P < 0.01), nationality, and the number of rooms and bedrooms (P < 0.001) in the boys' homes. Furthermore, there were statistically significant differences in weight (P < 0.05), height (P < 0.001), and height for age according to international standards (P < 0.01). Moreover, arm anthropometry of boys living in the residential area was higher than in the other two studied areas. Low values of all anthropometric measurements of the studied boys were significantly associated with exposure to high levels of nitrogen dioxide (NO2) >0.35 parts per million (ppm) or carbon monoxide >35 ppm (Saudi standard) outdoors, irrespective of socioeconomic conditions. CONCLUSIONS: The most significant factors that affected anthropometric values were total suspended particulate concentration in the outdoor air of the studied areas, parental education, and/or occupation. It is recommended that steps be taken to reduce indoor and outdoor air pollution.

Primary care physicians' knowledge and perceived barriers in the management of overweight and obesity.

OBJECTIVES: To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia. SETTING: Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia. DESIGN: A cross-sectional study. MATERIALS AND METHODS: One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese. RESULTS: One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity. CONCLUSION: Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.

Coronary heart disease risk factors: prevalence and behavior among male university students in Dammam City, Saudi Arabia.

Smoking, hypertension, and diabetes mellitus are the common risk factors among patients with coronary heart disease (CHD). High dietary fat intake, smoking, and lack of physical exercise have all been documented as independent risk factors for the development of CHD. The aim of the present study was to determine the prevalence of CHD risk factors among King Faisal University (KFU) male students in Dammam city, Saudi Arabia. A sample size of 10% of the target population (2054 male students of KFU colleges) was selected comprising 205 students. The study sample was selected by a multistage stratified random sampling technique with proportional allocation from all class levels. The response rate was 77.6%, where a total of 159 students were included in the study. Data was collected using an interviewer-administered questionnaire, which included sociodemographic variables and risk factors for CHD. The following measurements were performed: weight, height, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and random capillary blood glucose. It was found that 28.9% of the university students do not practice any type of physical exercise. About 19% of the students were current smokers. A high proportion of university students were consuming fast foods, saturated fats, and soft drinks. Overweight (24.5%), obesity (11.9%), severe obesity (10.7%) as measured by BMI, as well as unacceptable WHR (10.7%) as an indicator of obesity were evident. Family history of obesity and unacceptable WHR were found to be statistically associated with increased obesity. Therefore, intervention programs to raise the health awareness of adolescents about CHD risk factors and encourage them to adopt a healthy dietary behavior, promote physical exercise and smoking cessation should be initiated.

Apoptosis role of FAS/FAS ligand system in the regulation of myelopoiesis.

OBJECTIVES: CD34+ cells and colony forming unit-granulocyte and macrophage (CFU-GM) from human bone marrow were used to investigate the role of Fas/FasL system in the regulation of myelopoiesis. METHODS: Fas and FasL expression in CD34+ cells and in day 14 CFU-GM were measured by RT-PCR and immunofluorescence respectively. The functional assays for the CFU-GM were measured by a standard colony assay and the proliferative capacity of CFU-GM was measured by replating the primary colony and observing the secondary colony formation. Human marrow cells were treated with IETD (caspase-8 inhibitor) or anti-Fas CH-11 Mab. RESULTS: Treatment with the CFU-GM with IETD significantly increased, the proliferative capacity, while anti-Fas CH-11 Mab markedly reduced it. Fas and FasL expression were demonstrated using RT-PCR and immunofluorescence respectively. CONCLUSION: Fas, FasL, and caspase activation are likely to play an important role in the regulation of myelopoiesis.

New trends in medical education. The clinical skills laboratories.

A clinical skills laboratory or center is a facility in which students, physicians, nurses and other health care professionals learn clinical, communication and information technology skills to a specified level of competence prior to or coordinated with direct patient contact. The purpose of the clinical skill laboratory is to support the acquisition, maintenance and enhancement of the clinical skills of students in health care professions. Within this non-threatening environment, patient volunteers, simulated patients, mannequins and information technology are employed to provide hands-on learning experiences for the practice of the essential clinical skills. The skills laboratory helps to ensure that all students have necessary learning opportunities and appropriate assessment and feedback before approaching real patients. As more and more schools integrate skills laboratories into their curricula, it is important to review this new trend, to introduce the reader to its nature, factors that led to its development, advantages and problems related to its implementation. This review will also suggest some guidelines that may help in overcoming the implementation problems.

Occupational health in Saudi Arabia.

The Kingdom of Saudi Arabia is rapidly industrializing, and the economy is now less dependent on oil. The future of industrial growth is very bright. Two industrial complexes (at the Arabian Gulf and the Red Sea coasts) of eight provide the basis for the Kingdom s programs to develop hydrocarbon-based and energy-intensive industries. Expatriates form the driving workforce in industry. Today, more Saudis are being recruited and trained to man the factories. Occupation-related disorders in industry vary from minor irritations to injuries and cancers. However, the risk of massive releases of toxic chemicals is not great. The national Occupational Health Service directorate is based at the Ministry of Health. Together with the Ministry of Labor, it assumes the overall supervision of industrial health and safety. However, there are constraints the most important of which is the lack of enough qualified Saudis in this field.