Mechanism linking diabetes mellitus and obesity.

Body mass index has a strong relationship to diabetes and insulin resistance. In obese individuals, the amount of nonesterified fatty acids, glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance, is increased. The pathogenesis in the development of diabetes is based on the fact that the ß-islet cells of the pancreas are impaired, causing a lack of control of blood glucose. The development of diabetes becomes more inevitable if the failure of ß-islet cells of the pancreas is accompanied by insulin resistance. Weight gain and body mass are central to the formation and rising incidence of type 1 and type 2 diabetes. This literature review will demonstrate the facts that link obesity with insulin resistance and pancreatic ß-cell dysfunction. In conclusion, new approaches in managing and preventing diabetes in obese individuals must be studied and investigated based on the facts.

Audit of well-baby care in primary health care centers in Buraidah, Saudi Arabia.

OBJECTIVE: To evaluate the quality of utilization and documentation of the required process of well-baby care (WBC) visits and immunizations in primary health care centers (PHCCs). METHODS: Ten PHCCs were randomly selected. Of the average annual 7000 registered births, 350 children who had completed their fifth birthday were selected. All registered children who were born during 2 randomly selected months were included. Data were collected in Buraidah city, Kingdom of Saudi Arabia's PHCCs by the investigators from March to December 2005. Data were extracted from children's files, and well-baby and annual vaccination registers using a pre-designed form based on the Quality Assurance and Maternal and Child Health Care Manual of the Saudi Ministry of Health. RESULTS: Half of children were males, and most were Saudis. Pregnancy and delivery history were available in >90%, while that of neonatal history was available in 74.3%. Nutritional status was available in 96.3% of the files, but only 37.8% of them had the duration of breast feeding recorded. Number of children's visit to WBC clinics lessens as they grow older, >90% for infants, and less than one third for toddlers. Growth charts were completed in more than 90% of the files. All children completed the first year Expanded Program on Immunization schedule (up to date), and more than 75% of them were age-appropriately-immunized. CONCLUSION: The utilization level of WBC visits is lower than recommended. Careful well organized continuous field training of staff and parents' education programs are needed.

Quality of primary care referral letters and feedback reports in buraidah, qassim region, saudi arabia.

OBJECTIVE: To evaluate the quality of referral letters and feedback reports written according to the standards of Quality Assurance Manual of Ministry of Health from primary health care centers (PHCC's) in Buraidah. METHODOLOGY: This study was conducted during October and November 2004. A total of 330 referral letters and feedback reports were randomly selected from six PHCCs (20% from PHCCs in Buraidah City). About 55 referral and feedback letters were selected from each PHCC by systematic sampling method. The referral letters and feedback reports were reviewed thoroughly for the main items required in ideal referral letters and feedback reports according to the standard of Quality Assurance Manual of Ministry of Health, and a scoring system was used RESULT: Many of the referral letters lacked such important information as the history in 36%, vital signs in 30%, results of clinical examination in 45%, results of basic investigations in 52%, provisional diagnosis in 50%, and treatment given in PHCCs in 47%. The legibility of referral letters and feedback reports was good in 75%, and 63% respectively, and the quality of referral letters and feedback reports was good in 63% and 39% respectively. The rate of feedback reports received by PHCCs was 30% of total number of referrals to the hospitals. The referral rate was (4%) from total number of patients seen in PHCCs. The most frequent reasons for referrals were for general treatment 36.7%, for general diagnostic evaluation 28%, and for laboratory investigation 18.8%. CONCLUSION: The referral rate from PHCCs in Buraidah fell within the standard set in Quality Assurance Manual. However, the quality of referral letters and feedback reports was poor in 17.6% and 29.7% respectively. The quality of both referral letters and feedback reports should improve to guarantee the quality of patient care..

Cigarette smoking behavior among male secondary school students in the Central region of Saudi Arabia.

OBJECTIVE: This study was conducted to examine the smoking habits among male secondary school students in Al-Qassim, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes towards smoking. METHODS: This cross-sectional study was conducted in Al-Qassim region, KSA during March 2003. Randomly selected was 14 out of 110 government male secondary schools. In the sample section, care was taken to represent urban and rural communities. In urban areas, 8 schools with the largest number of students were selected. This is in addition to 3 schools, which were the only schools with special education on Islamic, Commercial and Technical programs. In the rural areas the 3 most distant schools were included in the sample. Data were obtained through self-administered questionnaires that contained questions on personal background, smoking behavior, knowledge and attitude towards cigarette smoking. A total of 2203 students responded to the questionnaires with 83% response rate. RESULTS: Of the studied group, 606 (29.8%) were current smokers and among these 83.7% started smoking at the age of 15 years or less. Technical and commercial secondary school students had higher prevalence of the habit of smoking than those in general and Islamic secondary schools. It was found that the more pocket money received by the students, the higher was the prevalence of smoking. The most common reason given for cigarette smoking behavior (CSB) was the influence of friends (63.5%). Family factor, especially the brother's smoking habit (24.8%) was also important. Most of the students knew that smoking is harmful to their own health (89.3%), and to others (73.9%). The association between smoking and lung cancer was 84.3%, 80.9% for chest disease and 78.2% for heart disease, while the relation to other diseases was less known. CONCLUSION: We conclude that onset of smoking in the young is alarming. This is of immense importance in formulating health education strategies, which should be directed towards pupils, teachers and parents. The religious aspect should also be an integral part of such programs.

Hypertension care in Al asyah primary health care center, Al qassim, saudi arabia: an audit of structure, process, and outcome.

OBJECTIVES: The objective of this study is to assess the quality of hypertension care in Al-Asyah primary health cares (PHC) center, Al Qassim Region, Saudi Arabia through an auditing of structure, process, and outcome. SUBJECTS AND METHODS: All files of registered hypertensive patients in the PHC center were reviewed as recommended by WHO, National Quality Assurance protocol, protocol of management of hypertension and criteria in the Sixth report of Joint National Committee on detection, evaluation and treatment of high blood pressure (JNCVI), to evaluate the structure, process, and outcome of hypertension care. RESULT: All hypertensive patients registered in Al Asyah PHC center ( 201 patients ) were included in this study. The prevalence of HTN among adults (≥15 years) was7.4% and increased with age. Patients were mostly Saudi (94.5%) with a mean age of 58.6 ± 13.9 years. Most of the patients were diagnosed as essential HTN (98.5%) at Al Asyah PHC center (87.1%). The mean duration of the HTN was 7.7 years, and 48.8% had a family history of HTN and 35.3% had diabetes mellitus. Most patients were obese or overweight (53.7% and 31.3% respectively), blood pressure of 79.6% of the patients was well controlled, and 45.3% of these patients had at least one complication. Ischemic heart disease, left ventricular hypertrophy, stroke, and myocardial infarction were the most common recorded complications. CONCLUSION: This study proves that all essential resources needed for hypertension care are available, but the results of process and outcome indicators show the need for the improvement of the referral system as well as good continuous constant health education programs to encourage the patients, their families and the community to observe more healthy lifestyles.