Prevalence and determinants of unconscious stereotyping among primary care physicians. An analytical cross-section study.

OBJECTIVES: To explore implicit stereotyping among primary healthcare (PHC) physicians and to identify determinants of physicians' stereotyping of patients based on the patients' characteristics and appearance. METHODS: This study followed an analytical cross-sectional design conducted between October 2019 and December 2019, and included 250 primary healthcare (PHC) physicians in Aseer Region, Kingdom of Saudi Arabia. Data was collected using a self-administered questionnaire, which included items concerning physicians' sociodemographic characteristics, and their attitudes toward patient characteristics and patient appearance. RESULTS: Prevalence of stereotyping among PHC physicians was 63.6% with respect to patient characteristics and 57.6% with respect to patient appearance. Stereotyping based on patient characteristics was higher among younger participants, females, those with bachelor's degrees, those in general practitioner positions, and those with less experience in PHC. CONCLUSION: Most PHC physicians in Aseer Region, Kingdom of Saudi Arabia, are liable to implicit stereotyping based on patient characteristics (namely, gender and educational level) and patient appearance (namely, clothing). Therefore, it is recommended to train PHC physicians in cultural competency to reduce unintentional acts of discrimination toward their patients.

Zellweger syndrome - a lethal peroxisome biogenesis disorder.

Zellweger syndrome (ZS) is the severest variety of peroxisomal biogenesis disorder (PBD). This is a fatal hereditary, autosomal recessive disorder. It is characterized by the absence of peroxisomes in the cells which are essential for many metabolic functions especially beta oxidation of very long chain fatty acids (VLCFAs). We report the case of a female Saudi toddler. She presented with dysmorphism, profound hypotonia, psychomotor retardation, seizures, and loss of hearing and vision with findings of optic atrophy. Biochemical study revealed significantly elevated level of VLCFAs, cerotic acid and phytanic acid. She also had periventricular leukomalacia and abnormal electroencephalography results and a PEX 1 gene mutation. The clinical data and investigations were consistent with ZS. As it is fatal in early life, genetic counseling and prenatal diagnosis are thus crucial.

Adherence of primary health care physicians to hypertension management guidelines in the Aseer region of Saudi Arabia.

Although there has been significant progress in the management of hypertension, rates for control of this chronic disease in the Kingdom of Saudi Arabia (KSA) has been shown to be very low. This study was aimed to assess the knowledge of primary health care (PHC) physicians and the extent of their adherence to the recommendations of clinical practice guidelines concerning care of hypertensive patients. The assessment was made in the Aseer region of KSA using a modified version of the World Health Organization "Physician Inquiry Questionnaire." Only 5.6% of the participants measured blood pressure (BP) with the patient in sitting and other postures. Variable sphygmomanometer cuff sizes for different patients were used by 56.5% of the participants, while 74.8% correctly recorded the diastolic BP at Koratkoff sound, phase- 5. Among non- diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 76.7% and 81.4% respectively, of the PHC physicians. Among diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 36% and 17.1% of the PHC physicians, respectively. Most physicians inquired about cardiovascular risk factors. Several important items of patients' clinical examination were not completely covered by physicians, e.g., fundus examination (75.2%). PHC physicians missed a few investigations and laboratory tests, e.g., ECG (87.9%), serum creatinine (88.2%) and lipid profile (89.8%). Less than one- fifth of the physicians correctly chose the thiazide diuretics as the preferred initial anti- hypertensive agent (19.9%). Almost two- thirds of the physicians (65.2%) emphasized the importance of BP self- measurement, 89.8% encouraged patients to use a reminder system while 96.3% motivated patients for BP control. Measures for lifestyle modification included weight reduction (98.8%), sodium restriction (97.5%), physical exercise (96.3%) and behavioral improvement (87.6%). Our study suggests that continuing medical education and training courses on guidelines for hypertension management should be arranged for PHC physicians in Aseer.

A potential protective effect of alpha-tocopherol on vascular complication in spinal cord reperfusion injury in rats.

BACKGROUND: Paraplegia remains a potential complication of spinal cord ischemic reperfusion injury (IRI) in which oxidative stress induced cyclooxygenase activities may contribute to ischemic neuronal damage. Prolonged administration of vitamin E (alpha-TOL), as a potent biological antioxidant, may have a protective role in this oxidative inflammatory ischemic cascade to reduce the incidence of paraplegia. The present study was designed to evaluate the preventive value of alpha-TOL in IRI of spinal cord. METHODS: For this study, 50 male Sprague-Dawley rats were used and divided into five experimental groups (n = 10): Control group (C); alpha-TOL control group (CE) which received intramuscular (i.m.) alpha-TOL injections (600 mg/kg); Sham operated group (S), IRI rats were subjected to laparotomy and clamping of the aorta just above the bifurcation for 45 min, then the clamp was released for 48 hrs for reperfusion; and IRIE rats group, received 600 mg/kg of alpha-TOL i.m. twice weekly for 6 weeks, followed by induction of IRI similar to the IRI group. At the end of the experimental protocol; motor, sensory and placing/stepping reflex evaluation was done. Plasma nitrite/nitrate (NOx) was measured. Then animals' spinal cord lumbar segments were harvested and homogenized for measurement of the levels of prostaglandin E2 (PGE2), malondialdehyde (MDA) and advanced oxidation products (AOPP), while superoxide dismutase (SOD) and catalase (CAT) activity were evaluated. RESULTS: Induction of IRI in rats resulted in significant increases in plasma levels of nitrite/nitrate (p < 0.001) and spinal cord homogenate levels of PGE2, MDA, advanced oxidation protein products AOPP and SOD with significant reduction (p < 0.001) in CAT homogenate levels. Significant impairment of motor, sensory functions and placing/stepping reflex was observed with IRI induction in the spinal cord (p < 0.001). alpha-TOL administration in IRIE group significantly improved all the previously measured parameters compared with IRI group. CONCLUSIONS: alpha-TOL administration significantly prevents the damage caused by spinal cord IRI in rats with subsequent recovery of both motor and sensory functions. Alpha-tocopherol improves the oxidative stress level with subsequent reduction of the incidence of neurological deficits due to spinal cord IRI conditions.

Prevalence of Depression, Anxiety and Stress as Measured by the Depression, Anxiety, and Stress Scale (DASS-42) among Secondary School Girls in Abha, Saudi Arabia.

OBJECTIVES: To determine the prevalence of symptoms of depression, anxiety and stress among secondary school girls. METHODS: A cross- sectional study was carried out on secondary school girls in Abha city, Aseer Region, Saudi Arabia, using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-42). RESULTS: Of 545 female students recruited in this study, 73.4% had the symptoms of at least one of the three studied disorders; 50.1% had at least two disorders. The prevalence of symptoms of depression, anxiety and stress was 41.5 %, 66.2% and 52.5% respectively. The majority of symptoms were mild to moderate in severity. The scores for depression, anxiety, and stress were positively and significantly correlated. No significant association was found between the girls' sociodemographic characteristics and the scores of the three studied disorders. CONCLUSION: One of the most important aspects of a primary care physician's care of females is to screen for and treat common mental disorders.

Barriers against application of evidence-based medicine in general hospitals in aseer region, kingdom of saudi arabia.

OBJECTIVE: To explore the attitudes of doctors in the general hospitals and their application of evidence-based medicine (EBM) and to identify the barriers that hinder its use. SUBJECTS AND METHODS: This study included 346 doctors in the general hospitals of Aseer. A questionnaire was designed to assess their awareness as well as the barriers that hinder their practice of EBM. A visual analogue scale was used to assess their attitude. RESULTS: The attitudes of doctors toward aspects of EBM were generally positive. However, their use of EBM sources and application were generally poor. The main reasons for retrieving evidence were to keep them up-to-date (72.8%) and to help make clinical decisions (70.2%). The least mentioned reason for evidence retrieval was research (41.9%). Review of textbooks was the main method of evidence retrieval (71.1%), while a database search was the method least used (22.8%). The main barriers to the practice of EBM practice were "lack of facilities" followed by "lack of time", while the barrier least mentioned was the "lack of interest". CONCLUSIONS: Although doctors have positive attitudes toward EBM, their knowledge and application of EBM need much improvement. The main barriers to their application of EBM are the lack of facilities and the lack of time. RECOMMENDATIONS: The necessary infrastructure for the application of EBM should be made available for all medical staff. There is a need for special courses and hands-on workshops in general hospitals to address the necessary knowledge and skills of EBM are essential.

Standards of growth and obesity for Saudi children (aged 3 -18 years) living at high altitudes.

AIM OF STUDY: To standardize the growth parameters for Saudi children aged 3-18 years living at high altitude and to investigate the appropriateness of using the National Center for Ilealth Statistics (NC(IIS) growth standards for the assessment of children's growth at this high attitude area. SUBJECTS AND METHODS: The present study follows a cross-sectional study design. A total of 13,580 native Saudi children (7,193 boys and 6,387 girls) aged 3-18 years living in Abha City (Elevation: 3,100 meters above sea level) constituted the study's sample. All chronically and acutely ill children were excluded. The data regarding the children were obtained from the well-baby clinics at primary health care centers and nurseries, as well as primary, intermediate and secondary schools. The percentiles for the weight and height and the body mass index (BMI) were calculated separately for the boys and the girls using one-year intervals. BMI values above the 95th and below the 5th percentiles were considered as diagnostic for obesity and underweight, respectively. RESULTS: Median values of weight and height for Saudi's children (both boys and girls) were lower than their corresponding values for children in the USA. Median values of the BMI for the Saudi's boys were almost identical to those of the USA's NCHS median values through all ages that were studied. On the other hand, the median values for the BMI were almost identical for the Saudi's and USA's girls aged 3-9 years. However, after the age of 9 years the differences in the median values for the BMI were increased progressively due to the higher values for the Saudi's girls. CONCLUSIONS: The use of the NCHS growth standards is not appropriate for the assessment of growth of children that live in the high altitude area of Abha and further studies are needed to determine the exact impact of high altitude on the growth patterns in children.