Relationship Between Socio-Demographics, Study Skills and Distress Among Pakistani School Students: A Cross-Sectional Study in Riyadh, Saudi Arabia

Purpose

The increasing prevalence of distress among students is of global concern. Several factors such as school and family environment and ineffective study skills could influence mental health. The study explored the rate of distress symptoms among school students' and its relationship with their study skills, stressors and demographic factors.

Methods

In this cross-sectional analytical study, a sample of 215 students from a community school participated in the study. Three questionnaires, demographic questionnaire, Study Skills Inventory and the Kessler Psychological Distress Scale, were used for data collection. Data were analyzed using Student's t-test, ANOVA, Pearson's correlation coefficient and stepwise linear regression.

Results

Response rate was 70% (n = 150). A high proportion of respondents (75%) was distressed (mean 27.28  ±  8.77). Correlation analysis showed that distress (K10 score) was negatively related to study skills (SSI total score) (r = -0.247, p = 0.002). The rate of distress symptoms was higher among female students (79%) compared to their male counterparts (72%). The factors associated with distress included negative association of teachers' level of help to develop competencies (p = 0.000, β = -0.278, R² = 0.249), unfavorable school environment (p = 0.000, β = 0.285, R² = 0.123), inability to cope with studies (p = 0.005, β = 0.205, R² = 0.038), family problems (p = 0.014, β = 0.184, R² = 0.173) and lower study skills (p = 0.031, β = -0.164, R² = 0.270). The overall regression analysis explained 33.6% of the variance (corrected R² = 0.336).

Conclusion

Higher than expected levels of distress (75%) was found in immigrant school students. Poor study skills have a significant relationship with distress. Learning environment and related stress factors were associated with distress among students. Based on the findings, it is recommended that stakeholders in education address the hidden curriculum, as it is usually unacknowledged and might affect students' wellbeing, and move from student centered to an interpersonal relation-centered education.

ARE FAMILY MEDICINE RESIDENTS USING JOURNALS PERTINENT TO THEIR DISCIPLINE IN RIYADH, SAUDI ARABIA?

Background: Today's clinicians have to adapt to rapidly changing medical environment and information overload. It has also been observed that family medicine residents study articles from journals of other specialties for updating their clinical knowledge base. The objective of this study was to determine the family medicine resident’s journal selection preferences in Riyadh, Saudi Arabia. Materials & Methods: This descriptive study was conducted from Dec 2018-May 2019 at Department of Family & Community Medicine, King Saud University, Riyadh, Saudi Arabia. Our population included 265 family medicine residents, taken as sample. After pilot testing, a confidential but anonymous questionnaire was mailed to 265 residents. Sex, age groups, training site were demographic, while choice of family medicine journals, selection of articles, patterns of educational activities and reasons for choosing specific journal were research variables. All data was categorical and was described as count and percentage with 95%CI. Results: The questionnaire response rate was 45.28% (120/265). Out of 120, 51 (42.5%) were men and 69 (57.5%) women. 84% belonged to age group 25-30 years. Most residents 55 (46.2%) were from Ministry of Health Centers. American Family Physician journal was most frequently accessed (94.16%), whereas Annals of Family Medicine was least accessed (15.83%). Journals selection criteria were based on EBM (45.43%) in most cases, while it was based on Institute for Scientific Information in 0.83% cases. Most (76.66%) residents were utilizing case study, while minimum (18.33%) residents were using journal club as learning tool. Majority of residents were choosing journals based on suggestions by colleagues (54.16%), while minimum by medical representatives (22.50%). Conclusion: The awareness of family practice journals that can make a family medicine resident think as a family physician was very low. By reading the high-quality family medicine journals they can learn to develop a family physicians’ approach which they can apply to the person rather than the disease alone. Supportive mentorship and guidance from a devoted faculty mentors should ensure the maintenance of this approach and should be maintained throughout the residency years.

Prevalence of insomnia and related psychological factors with coping strategies among medical students in clinical years during the COVID-19 pandemic

We explored the prevalence of insomnia, confirm the associated psychological factors and current coping strategies among undergraduate medical during their clinical years. This cross-sectional, quantitative, descriptive study was conducted at the department of medical education, college of medicine, King Saud University (KSU), Riyadh, Saudi Arabia. The participants (n = 463) were the 3rd to 5th year, and intern medical clinical students. We collected responses about sleep, using the Insomnia Severity Index (ISI). We also used Kessler-10 (K10), Psychological Distress and the Patient Health Questionnaire (PHQ-9). Items related to Coping strategies were also used from our previously published study and COVID-19 issues were explored using a self-developed questionnaire. According to the ISI ranking, 162 (34.9 %) of the participants had insomnia, among them 57.4% of females and 42.6% were males. Age groups between 22 and 25 have more sleeping disorder (43.2%) as compared to other age groups. 3rd-year students have more insomnia 36.41% as compared to other years. Individuals with insomnia symptoms were more likely (1.67 times higher) to be female students (OR = 1.67; P = 0.005) as compared to male students. A significantly high prevalence (3.37 times high) of insomnia was noted for those students or interns who have attended their clinical training irregularly as compare to regularly attending participants (OR = 2.32; P = 0.12) during COVID-19. Transition time i.e. year 3 of medical program was more stressful for the students and female students perceived stress and insomnia more than their male counterparts. It is important to address identified disorder early in order to reduce psychological morbidity and its harmful implications for medical students and young physicians.

Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City

Background

Male partners have a considerable role in influencing women’s contraceptive decision making to reduce the chance of unintended pregnancy. Most studies are focused on women’s knowledge and barriers for emergency contraception (EC) use. There is limited research on this topic from the male perspective. This study aimed to gather baseline data on men’s knowledge, attitudes and barriers about EC.

Methods

Descriptive analytic cross-sectional study was conducted from Dec 2019 –May 2020 at the King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Data were collected using a structured pretested questionnaire and analyzed using SPSS version 23.0. Descriptive statistics and Chi square tests were used. Multivariate logistic regression analysis was used to find significant predictors for EC awareness and use. A p value < 0.05 was considered statistically significant.

Results

A total of 461 participants completed the questionnaire (response rate 86%). The majority (82%) of the participants were unaware of EC; with only 18% having some knowledge. Knowledgeable men had positive attitudes (73.5%) about EC as compared to non- knowledgeable ones (55.0%). Factors found to be associated with less knowledge of EC were cultural [0.46, 95%CI 0.22. 0.96] and religious unacceptability [OR 0.51, 95%CI 0.29, 0.89)]. Higher level of education [OR 1.83, 95%CI 0.94, 3.53] was associated with more knowledge regarding EC. The study showed that correct information about using contraceptives within 3 days of unprotected sex [OR 4.96, 95%CI 1.81, 13.60]; availability without prescription [OR 5.06, 95%CI 1.68, 15.30], EC advertisement [OR 4.84, 95%CI 0.96, 24.27] and receipt of information from family/friends [OR 18.50, 95%CI 5.19, 65.93] were factors that contributed to men using EC.

Conclusion

The current knowledge of EC among men is limited. Social determinants affect these levels of knowledge, as well as the usage of EC. Factors that were associated with the use of ECPs were correct knowledge, advertisement, availability and receipt of information from family/friends. The findings highlight the need to educate men on this important topic to avoid unintended pregnancy, keeping in view cultural and social values. Future qualitative studies are needed to understand the male perspective.

Becoming virtual: a preliminary experience of outpatient primary care during COVID-19 pandemic

The World Health Organization (WHO) has declared COVID-19 outbreak as a pandemic. This pandemic is transforming the world and has posed exceptional challenges to health care delivery. Saudi Arabia has exerted unprecedented efforts and measures to fight the pandemic. Appreciating the value of primary health care during this crisis the family and community medicine department reorganized the services. We discuss the problems faced, solutions and lessons learned in the hope others may find it helpful.

Co-prescription of ciprofloxacin and statins; a dangerous combination: Case Report

Drug interaction is a common clinical problem which is often underestimated by physicians. Statins are one of the commonly prescribed medicines worldwide that are generally well tolerated. Muscle-related symptoms have a varied clinical presentation which usually increases if a new medicine is co-prescribed. We report the case of a 65- year-old woman who presented with a 10-day history of extreme fatigue, slowly progressing muscle weakness and insomnia. Drug-induced myopathy was diagnosed with concomitant use of atorvastatin and ciprofloxacin. Muscle weakness improved after the medicines were withdrawn. Co-prescription of Ciprofloxacin and statin therapy appeared to have contributed to muscle weakness in this patient. Drug interaction should also be kept in mind, when managing patients on statins as it may be underappreciated as a cause of muscle weakness and its consequences can have potentially serious outcomes.

The learning environment of four undergraduate health professional schools: Lessons learned

Background and Objectives:

Learning is an interplay between cognition and environmental factors. Any learning environment, that fulfills the intrinsic and extrinsic needs of the students will probably lead to better and more promising learning outcomes. This study aimed to investigate the student perceptions of Learning Environment (LE) in four health schools of a large university and compare between schools, years of study, and gender.

Methods:

Dundee Ready Education Environment Measure (DREEM) questionnaire and a socio-demographic questionnaire were completed by 1185 undergraduate students enrolled in the school of Medicine, Dentistry, Nursing and Applied Medical Sciences (AMS) of a large university during the academic year 2012-2013. Chi-square test was used to compare categorical variables. Independent student t-test or ANOVA (with Tukey post-hoc test) was used for continuous variables at a significance level of p≤0.05.

Results:

The mean total DREEM score was 89.23±33.3. The total DREEM mean scores for Dentistry (120.54±23.45) and Medicine (110.72±19.33) were higher compared with AMS (63.48±21.36) and Nursing (57.48±22.80) (p=0.000) (Post hoc Tukey p=0.000). First year students gave significantly higher positive perceptions ratings than the rest of the years (p=0.000). Total scores were significantly higher for male (92.78±33.86) than female students (84.70±32.25) p=0.000.

Conclusion:

The LE significantly differed by year and gender. The students from non-integrated curricula (nursing and AMS) perceived the LE less positively than their integrated curriculum counterparts (medicine and dentistry). A qualitative study is needed to investigate the variation in the perception of LE among these groups.

Emergency contraception: Awareness, attitudes and barriers of Saudi Arabian Women

Objectives:

To assess knowledge, attitude, and barriers about emergency contraception (EC) among married women of child bearing age.

Methods:

A quantitative cross-sectional study was conducted over a 6-month period, commencing in March 2013 at Family Practice Clinics of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Data was collected using a structured pretested questionnaire and analyzed using SPSS version 21.0 statistical software.

Result:

A total of 242 women were enrolled in the study. Only 6.2% (15/242) had some knowledge of EC and of these only two had ever used it. Health care professionals were the least reported source of EC information (6.6%, n=1). Majority (73.3%) had negative attitude toward EC being available over-the-counter without a prescription. The most common barriers to using EC were concerns about possible health effects. Only two women (13.3%) considered religious belief as a major hindrance to its use.

Conclusion:

Awareness of emergency contraception is very low among women of Saudi Arabia. Health care professionals were the least reported source of information, which is a cause for concern. Our findings reveal an urgent need to educate women about EC, keeping in view the social norms and the Islamic values.

Views of Family Medicine Trainees of a Teaching Hospital in Riyadh regarding their Hospital Rotations: A Qualitative Study

Objective: To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program.

Methodology: This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees’ views.

Results: The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts.

Conclusion: Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn’t reflect the views of trainees regarding its relevance to their day to day practice.

Evaluation of Continuing Professional Development Program for Family Physicians

OBJECTIVES

To evaluate the King Saud University Continuing Professional Development (CPD) Program for Family Physicians in relation to the Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) criteria.

METHODOLOGY

A descriptive study was conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. The authors used the six strategies of Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) for evaluation. The program was independently analyzed by the three authors using CRISIS framework. The results were synthesized. The suggestions were discussed and agreed upon and documented.

RESULTS

The results indicate that KSU-CPD program meets the CRISIS criteria for effective continuing professional development and offers a useful approach to learning. The course content covers specific areas of practice, but some shortcomings were found that need to be improved like self assessment area and individual learning needs analysis.

CONCLUSION

This program is suitable for Family Physicians, as it is well planned and utilizes most of the principles of CRISIS, but there is still room for improvement. Designing a program for general practitioners using hybrid model that offers a blend of e-learning as well as face-to-face learning opportunities would be an ideal solution.

Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi

OBJECTIVES

To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan.

METHODS

A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teaching hospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception (EC) and attitudes towards its use, Ethical requirements of informed consent and confidentiality were ensured Data was entered into Epi data and analyzed in SPSS.

RESULTS

Eighty-eight percent of women were not aware of EC. 83% were housewives. Only a small number (11.5%) ever used EC to prevent pregnancy, out of those, the correct timing of effectiveness of post-coital pill was known to only 40% of women while none of these women were aware of the existence of Intra Uterine Contraceptive Device (IUCD) insertion as an option for EC About 50% of women identified general practitioners or family medicine clinics as their main sources of knowledge about EC. Increased advertising was considered desirable by 72% while 37% considered over the counter availability of EC pill desirable and only 36% of women were uncomfortable to use EC because of religious reasons.

CONCLUSION

EC has a potential to offer women an important option for fertility control. Lack of women's knowledge about EC use and availability may account in part for its limited use. There is a need to improve women's education about EC. The primary health care providers can play a major role in informing their patients about emergency contraception.

Asthma knowledge and approach among Pakistani family physicians and the impact of an educational programme

OBJECTIVES

To assess asthma knowledge and approach among Pakistani family physicians and the impact of an educational programme.

DESIGN

A total of 89 family physicians attending a continuing medical education programme were evaluated using a 17-item questionnaire before and after a lecture and seminar-based educational programme. Three scores -- total score (TSc), knowledge subscore (KSc) and approach subscore (ASc) -- were calculated before and after the course.

RESULTS

A total of 82 (92%) family physicians completed the questionnaire. A minimum TSc of > or =9 was achieved by 57% physicians before the course; this increased to 78% after the course. Physicians with < or =10 years since graduation achieved a higher baseline TSc than those who had graduated > or =20 years previously. The latter group showed a larger post-course improvement. Analysis of individual questions disclosed that 79% of family physicians were unable to assess the empirical risk of asthma in an unborn child, 61% were unable to correctly classify/treat Stage 2 asthma and a similar number peak expiratory flow rate (PEFR) (l/min) based acute asthma exacerbation. Reassuringly, 97% correctly identified clinical signs and 87% life-threatening features of asthma.

CONCLUSION

Of all family physicians who responded to the questionnaire, 57% achieved acceptable baseline standards. Deficiencies regarding areas such as genetic counselling and disease severity assessment were observed. Strengths in identifying clinical signs and life-threatening features were evident. Continuing medical education resulted in a significant improvement in the post-course assessment, regardless of the years since graduation.