Effect of the Trauma Evaluation and Management module on the knowledge of senior medical students: a prospective cohort study

Background: Despite the high incidence of motor vehicle collisions and associated mortality rates in Saudi Arabia, formal trauma training and management for undergraduate medical students is not optimal. The aim of our study was to assess the effect of the Trauma Evaluation and Management (TEAM) module on trauma knowledge among senior medical students. Methods: Final-year medical students were recruited between September 2016 and May 2017 at King Abdulaziz University, Jeddah. They were allocated to 1 of 2 groups: 1 group was exposed to the TEAM module, and the other was not (control group). We employed a widely used 20-item multiple-choice standardized questionnaire to assess trauma-related knowledge of both groups. Results: Our study included 136 participants, 68 in the TEAM module group and 68 in the control group. The mean scores for trauma-related knowledge were 68.4% (standard deviation [SD] 15.63%) and 45.4% (SD 19.52%), respectively. Linear regression analysis showed that the TEAM module participants scored 23% higher on the test than the control participants (ß = 22.94%, 95% confidence interval 16.94%­28.94%). Conclusion: Mean test scores were significantly higher for those who completed the TEAM module than for those who did not. We highly recommend incorporating the TEAM module into the formal medical curriculum at all Saudi universities.

Contexte: Malgré la forte incidence des accidents de la route et la mortalité qui y est associée en Arabie saoudite, la formation formelle au traitement et à la prise en charge en traumatologie chez les étudiants en médecine de premier cycle laisse à désirer. Notre étude avait pour but d'évaluer l'effet du module TEAM (Trauma Evaluation and Management) sur les connaissances en matière de traumatologie acquises par les étudiants en médecine de niveau avancé. Méthodes: Durant leur dernière année de formation, des étudiants en médecine ont été recrutés entre septembre 2016 et mai 2017 à l'Université du roi Abdulaziz, à Djeddah. On les a assignés à 1 de 2 groupes : un groupe a été exposé au module TEAM, et l'autre non (groupe témoin). Nous avons utilisé un questionnaire à choix multiples standardisé en 20 points pour évaluer les connaissances des 2 groupes en matière de traumatologie. Résultats: Notre étude a regroupé 136 participants, 68 dans le groupe exposé au module TEAM et 68 dans le groupe témoin. Les scores moyens en ce qui concerne les connaissances en traumatologie ont été de 68,4 % (écart-type [É.-T.] 15,63 %) et de 45,4 % (É.-T. 19,52 %), respectivement. L'analyse de régression linéaire a révélé que les participants exposés au module TEAM ont obtenu des résultats de 23 % supérieurs aux participants du groupe témoin (ß = 22,94 %, intervalle de confiance à 95 % 16,94 %­28,94 %). Conclusion: Les scores moyens aux tests ont été significativement plus élevés chez les participants ayant complété le module TEAM que chez les autres. Nous recommandons fortement d'intégrer le module TEAM au programme de formation médicale dans toutes les universités de l'Arabie saoudite.

The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families. METHODS: A translated version of the "Impact of Pediatric Epilepsy Scale" (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child. RESULTS: The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child's QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child's QoL as low. IPES score was significantly associated with cause of seizure (ß=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child's QoL was significantly associated with frequency of seizure (ß=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child's nationality (ß=-0.270; 95%-CI -0.252, -0.013; p= 0.031). CONCLUSIONS: Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.

Factors associated with antenatal and delivery care in Sudan: analysis of the 2010 Sudan household survey.

BACKGROUND: Every day, globally approximately a thousand women and girls needlessly die as a result of complications during pregnancy, childbirth or the 6 weeks following delivery. The majority of maternal deaths are avoidable and could be prevented with proven interventions to prevent or manage complications during pregnancy and child birth. The aim of this study was to examine factors associated with underutilization of maternal health services in Sudan. METHODS: Data was obtained from the Sudan Household Health Survey 2010(SHHS). The SHHS collected data from 5730 women, aged 15-49 years and who were pregnant in the last 2 years preceding the survey. The selection of the respondents was through a multi-stage cluster sampling technique. Interviews were conducted with respondents to collect data about their demographic characteristics, reproductive history, pregnancy and child delivery. Univariate analysis and logistic regression were used to analyze the data. RESULTS: The factors associated with receiving antenatal care were, higher educational level (odds ratio (OR) = 3.428, 95% CI 2.473-4.751 - p value 0.001), higher household wealth (OR 1.656, 95% CI: 1.484-1.855 - p value 0.001) and low parity (OR =1.214, 95% CI: 1.035-1.423 - p value 0.017). The factors associated with institutional delivery were higher educational level (OR = 1.929, 95% CI: 1.380-2.697 - p value 0.001), high household wealth (OR = 2.293, 95% CI: 1.988-2.644 p value 0.001), urban residence (OR = 1.364, 95% CI: 1.081-1.721 p value 0.009), low parity (OR = 2.222, 95% CI: 1/786-2.765 p value 0.001), receiving ANC (OR = 3.342, 95% CI: 2.306-4.844 p value 0.001) and complications during pregnancy (OR = 1.606, 95% CI: 1.319-1.957 p value 0.001). CONCLUSIONS: The factors associated with both antenatal care use and institutional delivery are similar and interventions to target these include expanding female education and improving coverage and affordability of health services.

Delirium and correlates of delirium among newly admitted elderly patients: a cross-sectional study in a Saudi general hospital.

BACKGROUND: Delirium is a common, often undiagnosed disorder in elderly patients, but no studies have been conducted in Saudi Arabia. OBJECTIVES: To determine the prevalence of delirium among elderly patients on admission and to identify associated factors. DESIGN: A cross-sectional study. SETTING: Tertiary care hospital, Saudi Arabia. PATIENTS AND METHODS: Elderly patients were evaluated for delirium within 24 hours of admission using the Confusion Assessment Method (CAM). The medical records were also reviewed to identify associated factors and whether the diagnosis of delirium was documented by the admitting physician. MAIN OUTCOME MEASURES: Prevalence of delirium. RESULTS: Of 147 patients aged 60 or over screened for delirium within 24 hours of admission, 32 (21.8%) patients were identified with delirium. Seven (21.9%) of the 32 patients with delirium had documentation of their diagnosis in the patient chart by the attending physician. Univariate logistic regression identified greater age (OR=2.70, 95%-CI: 1.21-6.02), higher unemployment rate (OR=3.30, 95%-CI: 1.43-7.61), more often had 3-5 co-morbidities (OR=2.69, 95%-CI: 1.14-6.33), and more cognitive impairment (OR=38.90, 95%-CI: 8.78-172.34) as risk factors for delirium on admission. Multivariate logistic regression analysis identified greater age (OR=2.53, 95%-CI: 1.08-5.88), higher unemployment rate (OR=3.73, 95%-CI: 1.52-9.13) and 3-5 co-morbidities (OR=3.31, 95%-CI: 1.30-8.46) as risk factors for delirium. CONCLUSIONS: Delirium was common and frequently not recognized in elderly patients admitted to the hospital. Administration of the CAM was very helpful in identifying delirium at admission. LIMITATIONS: The main limitation of our study was the relatively small number of patients which might have limited the power to detect some associations.

Association between type 2 diabetes mellitus and hypothyroidism: a case-control study.

OBJECTIVES: Type 2 diabetes mellitus (DM-II) is highly prevalent in Saudi Arabia and only few studies have assessed it as a risk factor for hypothyroidism. This study aimed to examine the association between DM-II and hypothyroidism. SUBJECTS AND METHODS: We conducted a hospital-based case-control study. As cases, we included all adults admitted to King Abdulaziz University Hospital (KAUH) with laboratory-confirmed hypothyroidism. As controls, we drew a random sample of patients admitted to the orthopedic clinic at KAUH with laboratory-confirmed absence of hypothyroidism. We extracted data from the medical records regarding age, sex, presence of DM-II, HbA1c, comorbidities, treatment, and complications. We used multivariate logistic regression to identify factors associated with hypothyroidism. RESULTS: We included 121 cases and 121 controls. In comparison to controls, cases were older (P=0.005), had higher prevalence of DM-II (P<0.001), had higher levels of HbA1c (P=0.03), used insulin (P<0.001) and oral hypoglycemic drugs (P<0.001) more often, and suffered more often from hypertension (P<0.001), coronary artery disease (CAD) (P<0.001), stroke (P=0.04), diabetic foot (P<0.001), and nephropathy (P<0.001). According to multivariate regression, the risk of hypothyroidism was significantly increased among patients with DM-II (OR=4.14; 95% CI=20.20-7.80; P<0.001) and CAD (OR=14.15; 95% CI=1.80-111.43; P=0.01). CONCLUSION: Patients with DM-II were at increased risk of developing hypothyroidism. Adequate management and control of DM-II might reduce the risk of developing hypothyroidism. Further research using a prospective cohort study design is needed to confirm these findings. KEY MESSAGES: Patients with DM-II had an increased risk of developing hypothyroidism.

Parental perceptions of dental health and need for treatment in children with epilepsy: a multicenter cross-sectional study.

BACKGROUND: Epilepsy is a common neurological disorder in childhood. However, there have been limited studies on its impact on the oral health of affected children. Our study aimed to assess the oral health of children with epilepsy in the city of Jeddah, Saudi Arabia, as perceived by their mothers. METHODS: We conducted a cross-sectional study in three hospitals. We included children 2-18 years old with physician-confirmed epilepsy diagnosis. We assessed parental perception of dental status and need for dental care using a standardized questionnaire that was completed by the mothers. To adjust for potential confounding variables, we used univariate and multivariate logistic regression. RESULTS: We included 96 children with epilepsy in our study. Their mean age was 6.4±3.4 years. In 55.2% (n=53), dental status was rated as bad, and in 84.4% (n=81) a need for dental care was expressed. Cerebral palsy (OR 5.06, 95% CI 1.28-19.99; P=0.021), motor disability (OR 6.41, 95% CI 1.12-36.73; P=0.037), referral from a pediatric neurology clinic to a dentist (OR 10.755, 95% CI 3.290-35.151; P<0.001), and irregular brushing of teeth (OR 5.397, 95% CI 1.536-18.961; P=0.009) were significantly associated with increased risk of perceived bad dental status. Perception of the child as being overweight (OR 0.117, 95% CI 0.034-0.400; P=0.001) was significantly associated with decreased risk of perceived bad dental status. Motor disability (OR 5.73, 95% CI 1.64-20.04; P=0.006) was significantly associated with increased parental expression of need for dental care. CONCLUSION: In most children with epilepsy, perceived dental status was bad and there was a high expressed need for dental care. Interventions to improve the dental health of children with epilepsy should focus on those with cerebral palsy and motor disability.

Prevalence of Vitamin D Deficiency and Calcium Homeostasis in Saudi Children.

OBJECTIVE: Vitamin D deficiency (VDD) and vitamin D insufficiency (VDI) are significant health problems all over the world. The aim of this study was to determine the prevalence of VDD and VDI in children and adolescents residing in 8 provinces in the Kingdom of Saudi Arabia and to also investigate calcium homeostasis in these subjects. METHODS: A cross-sectional study was conducted in 2110 participants aged between 6 and 15 years. Information on socio-demographic status, anthropometric measurements, knowledge about vitamin D, color of the skin, dietary intake, sun exposure experience, smoking, and physical activity were collected through a questionnaire given to the parents of all subjects. The subjects were divided into three groups as vitamin D deficient, vitamin D insufficient, and vitamin sufficient according to their blood level of vitamin D [VDD ≤25 nmol/L (25 hydroxy vitamin D), VDI >25-50 nmol/L, and VDS >50 nmol/L]. RESULTS: VDD was highly prevalent in this group of children. 95.3 of the subjects had either VDD (45.5%) or VDI (49.9%). The prevalence rate of VDD combined with VDI was higher in females (97.8%) compared to males (92.8%) (p<0.001). Only 1.6% had significant hypocalcaemia. Children with dark skin had lower concentrations of vitamin D and higher concentrations of parathormone. A positive correlation was observed between 25 hydroxy vitamin D level and serum calcium, inorganic phosphate, and alkaline phosphatase concentrations. onclusion: The results showed a high prevalence of VDD and VDI in Saudi children with significantly higher prevalence in girls. These findings necessitate the set-up of a national program for vitamin D supplementation and health education for this vulnerable group.