Rate and factors for scabies recurrence in children in Saudi Arabia: a retrospective study.

BACKGROUND: Despite the fact that several scabies outbreaks emerged in schools in Saudi Arabia in 2018, no study has investigated the risk of scabies recurrence among children in Saudi Arabia. This study aimed to estimate the rate of scabies recurrence and identify factors that were associated with an increased risk of recurrence among children. METHODS: This is a multi-center retrospective study of children (age < 14 years) who were diagnosed between May 20, 2015 and September 12, 2018 with one or multiple recurrent scabies at the Ministry of National Guard Health Affairs (MNGHA) hospitals and clinics in Saudi Arabia. Data were obtained from an electronic health system, BestCare database. RESULTS: A sample of 264 children analyzed (mean age of 6.7 years) resulted in a cumulative number of 316 scabies diagnoses in which 86 (27.2%) experienced scabies recurrence (at least once). Independent factors associated with a high risk of scabies recurrence: older children (adjusted hazard ratio [aHR], 1.036; 95% CI, 1.002-1.072; P = 0.039), female gender (aHR, 1.734; 95% CI, 1.329-2.262; P = 0.001), Western region of Saudi Arabia (aHR, 1.548; 95% CI, 1.115-2.151; P = 0.009), and 2nd tertile season [May to August] (aHR, 2.368; 95% CI, 1.706-3.288; P = 0.001). CONCLUSIONS: The study demonstrated that the recurrence rate of scabies among children is high. Older children, the female gender, the Western region of Saudi Arabia, and the seasonality were independently associated with an increased risk of scabies recurrence. High temperature and low humidity should be explored as leading factors for scabies infestations in Saudi Arabia. Findings derived from this study may be useful for clinicians and governments in optimizing clinical management of scabies cases and contacts.

A lesson learned from Middle East respiratory syndrome (MERS) in Saudi Arabia.

Middle East respiratory syndrome (MERS) caused by novel Corona virus hit Kingdom of Saudi Arabia (KSA) and resulted in hundreds of mortality and morbidity, fears and psychosocial stress among population, economic loss and major political change at Ministry of Health (MoH). Although MERS discovered two years ago, confusion still exists about its origin, nature, and consequences. In 2003, similar virus (SARS) hit Canada and resulted in a reform of Canada's public health system and creation of a Canadian Agency for Public Health, similar to the US Centers for Disease Control (CDC). The idea of Saudi CDC is attractive and even "sexy" but it is not the best option. Experience and literature indicate that the best option for KSA is to revitalize national public health systems on the basis of comprehensive, continuing, and integrated primary health care (PHC) and public health (PH). This article proposes three initial, but essential, steps for such revitalization to take place: political will and support, integration of PHC and PH, and on-job professional programs for the workforce. In addition, current academic and training programs for PHC and PH should be revisited in the light of national vision and strategy that aim for high quality products that protect and promote healthy nation. Scientific associations, medical education research chair, and relevant academic bodies should be involved in the revitalization to ensure quality of process and outcomes.

Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

Problem-based learning in undergraduate medical education in Saudi Arabia: time has come to reflect on the experience.

BACKGROUND: Problem-based learning (PBL) is being increasingly used in many undergraduate medical schools worldwide due to its recognized advantages. OBJECTIVES: To explore views of medical students in the Kingdom of Saudi Arabia (KSA) about the appropriateness of the PBL concepts and process. Differences in students' views were examined as well. METHODS: This is a cross-sectional, questionnaire-based study conducted in two medical colleges in Riyadh, Saudi Arabia, during the period from April to June 2012. RESULTS: One hundred seventy four undergraduate medical students participated in the study. Majority of the participants supported the concept of PBL and thought it is a beneficial learning strategy. However, only about half of them consider the problems used in tutorials are relevant for the local setting. Significant differences have been identified between the gender, schools, and study level of participants and their views on the process of PBL tutorials. About 35% of participants either undecided or will not recommend medical schools that adopt PBL curriculums for their friends. CONCLUSIONS: The majority of participants were satisfied with PBL approach and valued its importance in their learning process. Specific concerns have been expressed about relevance of some aspects of PBL. Underlying factors should be further explored in order to improve the outcomes of PBL curriculum in the local Saudi setting.

Systematic review of the epidemiology of attention deficit hyperactivity disorder in Arab countries.

OBJECTIVE: To assess the epidemiology of attention deficit hyperactivity disorder (ADHD) in Arab countries, and identify gaps for future research. METHODS: We searched PubMed from July 1978 to July 2014 and reviewed local journals with cross-referencing. The keywords we used were ADHD, diagnosis, prevalence, incidence, factor, diagnosis, rate, risk, and each of the names of the 22 Arab countries (Jordan, Egypt, Lebanon, Saudi Arabia, and so on). Studies were eligible for inclusion if they investigated the epidemiology of ADHD in any Arab country, and were published in English. The search was conducted from 2nd to 5th August 2014 in King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. RESULTS: A total of 22 articles were included in the review. Twenty studies were cross-sectional and found the prevalence of ADHD ranged between 1.3-16%, prevalence of hyperactive type ADHD between 1.4-7.8%, and the prevalence of inattention type between 2.1-2.7%. Only 2 case-control studies investigated potential risk factors. Evidence extracted from these studies shows a significant association between ADHD and male gender, previous psychiatric illness in the family, vitamin D deficiency, poor school performance, sleep problems, and nocturnal enuresis. CONCLUSION: The prevalence of ADHD in Arab countries is comparable to reports in North America, Africa, and other countries of the Middle East. Longitudinal studies are needed to investigate the prognosis and determinants of this condition in the Arab world.

Accreditation and culture of quality in medical schools in Saudi Arabia.

Saudi Arabia (SA), the largest country in the Gulf Region, has witnessed unprecedented expansion in undergraduate medical education (UME) with more than 200% increase in medical schools over the last five years. Such rapid expansion creates major challenges in relation to quality of outcomes to the extent that some authors argue that SA needs reform similar to Abraham Flexner. This may explain the strong movement towards accreditation of UME in SA but it is important to reflect on purpose of accreditation and learn from the experience of developed countries. In USA, more than 100 years ago Flexner used a predetermined gold standard to judge all medical schools and resulted in closing more than 50% of the medical schools at that time. For accreditation to fulfill its promises in ensuring quality of UME, it has to reassure stakeholders of its contribution to their culture of quality rather than an external judge of their quality. Recently, the World Federation for Medical Education recognizes that the presence of accreditation systems "does not provide a guarantee that the system is working and resulting in trustworthy decisions on the quality of programs in medical education". However, there must be a way of introducing quality management that maintain recent needed quantity development of UME in SA while ensuring the quality of products of medical schools. This paper describes accreditation development in SA and suggests a strategy for creating a culture of quality in medical schools in preparation for meaningful accreditation systems that ensure proper participation of all stakeholders in quality management on basis of evidence.

Recurrence rate of scabies in patients 14 years or older in Saudi Arabia.

OBJECTIVES: To estimate the rate of scabies diagnostic recurrence and identify factors associated with the high likelihood of frequent scabies recurrences among adults in Saudi Arabia.  Methods: This multi-center retrospective study was conducted in adult patients who were diagnosed with one or multiple recurrent infestations of scabies between January 2016 and September 2018 at the Ministry of National Guard-Health Affairs hospitals and clinics, Saudi Arabia. The number of scabies recurrences during the study period was recorded and modeled using a Poisson model. Results: A total of 468 adult patients (39.8±17.8, range: 14.2-105.7 years) were included in the study, resulting in 645 scabies diagnoses in which 302 (46.8%) were recurrences. The multivariate Poisson model revealed that male gender (adjusted rate ratios [aRR]: 1.465; 95% CI: 1.064 - 2.017; p=0.019), first tertile (January to April) (aRR: 3.021; 95% CI: 1.484 - 6.149; p=0.002), and high humidity (aRR: 1.066; 95% CI: 1.002 - 1.133; p=0.043) had a higher likelihood of frequent scabies recurrences. Conclusion: The rate of scabies recurrence among adult patients in Saudi Arabia was high, and is comparable with previous report in Japan. The study suggests that male gender, first tertile, and high humidity were independently associated with the high rate of scabies recurrences among adults. An interventional program to lower the rate of scabies recurrences and prevent outbreak should be undertaken.

Is there a need to involve doctors in management of health care in Saudi Arabia.

Recently, the role of doctors and managers in health care management has become a hot topic in the newspapers and public magazine in the Kingdom of Saudi Arabia. The aim of this paper is to contribute constructively and scientifically to this topical issue by emphasizing that commonality and interaction between medicine and management dictate more involvement of doctors in management. Although one may argue that doctors are usually not well trained in resources management, scientific evidence supports the need for more involvement of doctors in managing health care system. In addition, government needs to make a strategic shift towards high quality primary and preventive care to enable doctors in management role to maintain essential services and contain cost.

E-learning in Saudi Arabia: 'To E or not to E, that is the question'.

BACKGROUND: The Kingdom of Saudi Arabia (KSA) has witnessed unprecedented growth in higher education and E-learning in recent times. In the last five years, one university and five colleges have been commissioned every month; 800 scholarships have been awarded every month for overseas study; a national center for E-learning has been established; and E-units or departments have been set-up in almost every university. E-learning has become important for discussion to quote Shakespeare 'To E or not to E that is the question.' OBJECTIVES: To examine current and future developments and challenges of E-learning in KSA. MATERIALS AND METHODS: A qualitative approach was used to explore views of 30 senior academicians involved in E-learning during their attendance at a two-week course on the subject. RESULTS: All participants considered themselves as decision makers on E-learning in their units or departments. They felt that E-learning had come to stay, but acknowledged challenges in respect of resources, organization, management, and information technology. CONCLUSION: The fast development of E-learning poses many challenges. Clear vision and strategic planning with prospective E-learners in mind are essential to make E-learning programs cost effective.

Medical students' evaluation of their exposure to the teaching of ethics.

BACKGROUND: The subject of Biomedical Ethics has become recognized as an essential integral component in the undergraduate curriculum of medical students. OBJECTIVES: (1) To review the current Biomedical Ethics Course offered at the College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS). (2) To explore the perception of medical students on the different components of the course. MATERIALS AND METHODS: The medical students were requested to participate in the study at the end of the course by filling in a pre-designed questionnaire. A qualitative approach was used also to examine their perceptions about certain components of the course. RESULTS: Forty-one medical students participated in this study. All students expressed their strong agreement on the importance of their learning biomedical ethics. Their views about the role of Biomedical Ethics were also considered. These include professional development, assessment of ethical competencies, and the timing of the teaching of ethics. CONCLUSION: The students provided valuable comments that were supported by the literature reviews. Medical Students' views of the teaching of the various components of biomedical ethics are important and should be sought in the planning of a curriculum.

Perceptions of primary health care (phc) doctors on the prevention of coronary heart disease (chd) in riyadh, saudi arabia.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death throughout the world. PHC doctors are in a unique position to prevent CHD and promote health in the population. However, the perception of PHC doctors on CHD prevention has not been well documented. OBJECTIVES: To explore and examine the perception of PHC doctors on the prevention of CHD. SUBJECT AND METHOD: A questionnaire survey of all PHC doctors attending a continuing medical education (CME) activity in Riyadh city. The questionnaire was designed and piloted with local PHC doctors before being used in this survey. RESULTS: All the 77 PHC doctors responded (100%) and almost all the them (97.4%) agreed that the primary prevention of CHD was an essential task. Fifty-two participants (67.53%) confirmed that little attention had been paid to the primary prevention of CHD. While the majority of respondents (71.43%) felt that the primary prevention of CHD was an easy task, a significant minority (23.37%) disagreed. Interestingly, 70 (90.91%) respondents were not aware of any local literature on how to achieve primary prevention of CHD and would like to have the literature made available to them. Finally, participants indicated that the percentage prevalence of CHD risk factors among their patients was high. CONCLUSION: the findings of this survey confirm a general feeling that the primary prevention of CHD is not being given enough attention. Participants accepted that the primary prevention of CHD was an essential part of their work, but the lack of local literature and research on this vital area was a major concern.

Appointment system in primary care: opinion of consumers and providers.

BACKGROUND: The appointment system in primary care is widely used in developed countries, but there seems to be a problem with its use in Saudi Arabia. OBJECTIVES: (1) To explore opinions and satisfaction of consumers and providers of care in Primary Health Care regarding walk-in and the introduction of the appointment system. (2) To examine factors which may affect commitment to an appointment system in PHC. SUBJECT AND METHOD: Two hundred sixty (260) consumers above the age of 15 years as well as seventy (70) members of staff were randomly selected from 10 Primary Health Care Clinics in the National Guard Housing Area, Riyadh and asked to complete a structured questionnaire designed to meet the study's objectives. RESULTS: The majority of consumers and providers of care were in favour of introducing appointments despite their satisfaction with the existing walk-in sysem. Respondents saw many advantages in the appointment system in PHC such as time saving, reduction of crowds in the clinics and guarantee of a time slot. The main perceived disadvantage was the limitation of accessibility to patients especially with acute conditions. The main organizational advantages and disadvantages perceived by providers were related to follow-ups of chronic patients, no shows and late arrivals. The majority of the patients preferred appointments in the afternoon and the possibility of obtaining an appointment over the telephone. CONCLUSION: In this study, both consumers and providers supportted the idea of introducing the appointment mixed system in primary care, but further study is required.

Learning objectives of medical students: What is the message.

Full text is available as a scanned copy of the original print version.

Patterns of referral from health centres to hospitals in Riyadh region

Patterns of attendance and referrals in hospitals and health centres in Riyadh region, Saudi Arabia, studied before and after implementing a referral system showed a 40.6% total decrease in patients attending hospital outpatient clinics; an 11.9% increase in patients attending primary health centres; a 19.2% increase in referrals; a 33.2% increase in patients attending emergency departments; and a 17.3% increase in inpatients. It is clear that the referral system has, and will have, an impact on primary and secondary health care services. In order to optimize positive and minimize negative aspects of this impact, communication between primary health centres and hospitals should be of high standard. Regular reviews and studies of referral systems are recommended