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140430P - FORMULATION OF THE RESEARCH QUESTION / HYPOTHESIS

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Presented at the Writing workshop organized by the KFMA Research Center on April 30, 2014 by Professor Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard)


Sources of Information... 1
§  Existing data is from census, medical facilities, government, and private sector, health surveys, and vital statistics.
§  Experimental studies, natural or true experiments, involve deliberate human action or intervention whose outcome is then observed. They have the advantage of controlled conditions but have ethical problems of experimenting on humans.

Sources of Information... 2
§  Observational studies allow nature to take its course and just record the occurrences of disease and describe the what, where, when, and why of a disease.
§  Their advantage is low cost and fewer ethical issues. They suffer from 3 disadvantages: disease aetiology is not studied directly because the investigator does not manipulate the exposures, unavailability of information, and confounding.

Statistical Measures of Descriptive Studies
§  Prevalence = describe the status of disease at a point in time: proportion, percentage
§  Incidence = describe change in status of disease with time: incidence rate, cumulative incidence
§  The cardinal questions: who, where, when, how.

Statistical Measures of Analytic Study
§  Study of association eg t test, chi square
§  Study of effect eg odds ratio, rate ratio, logistic regression coefficient
§  Eliminating counfounders (inclusion and exclusion)

Study Designs of Experimental / Interventional Studies
§  Randomized clinical trial
§  Randomized community trial.
§  Experimental / interventional studies are always analytic

Study Designs of Observational Studies
§  Observational cross sectional (disease and causes studied at a point in time). Can be descriptive or analytic
§  Observational follow up (identify a cause and follow up to see disease occurrence. May be prospective, retrospective, or ambispective. May be descriptive or analytic
§  Observational case control: compare cases and no cases of disease at a point in time regarding potential causes. Is always analytic

Stages Of Dealing With A Problem
§  Stating the substantive problem
§  Formulating the substantive problem as a hypothesis / statistical problem
§  Testing the hypothesis using data and reaching a statistical conclusion
§  Reaching a substantial conclusion based on data interpretation

Stages Of Dealing With A Problem: As a diagram
Cycle: substantive problem… to… statistical problem …to… statistical conclusion … substantive conclusion

Where Do We Get The Research Question/Hypothesis?
§  Facing a real problem in life eg high rate of wound infection on the ward
§  Literature search and finding a gap in knowledge
§  Repeating/validating /challenging previous research
§  Pure intellectual curiosity

Hypotheses and the Scientific Method
§  The scientific method consists of hypothesis formulation, experimentation to test the hypothesis, and drawing conclusions.
§  Hypotheses are statements of prior belief. They are modified by results of experiments to give rise to new hypotheses. The new hypotheses then in turn become the basis for new experiments.

Null Hypothesis (H0)
§  The null or research hypothesis, H0, states that there is no difference between two comparison groups and that the apparent difference seen is due to sampling error.
§  A hypothesis can be rejected but cannot be proved. A hypothesis cannot be proved in a conclusive way but an objective measure of the probability of its truth can be given in the form of a p-value.
§  P value is the probability of rejecting a true hypothesis by error

Exercises
Working in groups, read each abstract and identify the following (if applicable):
1.      The substantive question (research question, general objective, ordinary  language )
2.      The study hypothesis (specific objective(s)
3.      The statistical question
4.      The type of study
5.      The statistical conclusion
6.      The substantive conclusion

ABSTRACT #1:
El-Sharkawy MF, Noweir ME.Indoor air quality levels in a University Hospital in the Eastern Province of Saudi Arabia.J Family Community Med. 2014 Jan;21(1):39-47. AIM OF THE STUDY: The complex hospital environment requires special attention to ensure a healthy indoor air quality (IAQ) to protect patients and healthcare workers against hospital-acquired infections and occupational diseases. Poor hospital IAQ may cause outbreaks of building-related illness such as headaches, fatigue, eye, and skin irritations, and other symptoms. The general objective for this study was to assess IAQ inside a large University hospital at Al-Khobar City in the Eastern Province of Saudi Arabia. MATERIALS AND METHODS:  Different locations representing areas where most activities and tasks are performed were selected as sampling points for air pollutants in the selected hospital. In addition, several factors were studied to determine those that were most likely to affect the IAQ levels. The temperature and relative percent humidity of different air pollutants were measured simultaneously at each location. RESULTS: The outdoor levels of all air pollutant levels, except volatile organic compounds (VOCs), were higher than the indoor levels which meant that the IAQ inside healthcare facilities (HCFs) were greatly affected by outdoor sources, particularly traffic. The highest levels of total suspended particulates (TSPs) and those less than 10 microns (PM10) inside the selected hospital were found at locations that are characterized with m4ore human activity. CONCLUSIONS:  Levels of particulate matter (both PM10 and TSP) were higher than the Air Quality Guidelines (AQGs). The highest concentrations of the fungal species recorded were Cladosporium and Penicillium. Education of occupants of HCF on IAQ is critical. They must be informed about the sources and effects of contaminants and the proper operation of the ventilation system.

ABSTRACT #2
Ahmed M, Zama SY, Nagarajarao V, Khan MA.Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India. J Family Community Med. 2014 Jan;21(1):48-52. INTRODUCTION: Iodine is an essential component of the hormones produced by the thyroid gland that are essential for mammalian life. Although goiter is the most visible sequelae of iodine deficiency, the major impact of hypothyroidism as a result of iodine deficiency is impaired neurodevelopment, particularly early in life. According to the World Health Organization, it is the single most preventable cause of mental retardation and brain damage. The simplest, most effective and inexpensive preventive method is the consumption of iodized salt. OBJECTIVES: The objective of the following study is to estimate the prevalence of goiter in children in the rural areas of Mysore and Coorg districts in India and estimate iodine levels in salt samples. MATERIALS AND METHODS: A cross-sectional study in the age group of 6-12 years, using population proportionate to size systematic sampling method. The total sample size was 10,082: out of which 5337 was from Mysore and the rest from Coorg district. Clinical examination of the thyroid gland was done and salt samples collected for the estimation of Iodine. RESULTS: The total prevalence of goiter was 19.01% in children of 6-12 years in Coorg district and 8.77% in Mysore district and it was more in females than in males. CONCLUSIONS: It was observed that iodine deficiency disorders is endemic in both districts, with a prevalence of 19.01% in children aged 6-12 years in Coorg district and 8.77% in Mysore district. Analysis of salt samples suggested that most of the samples were inadequately iodised (73.92% in Coorg and 45.92% in Mysore).

ABSTRACT #3
Bhattathiry MM, Ethirajan N. Unmet need for family planning among married women of reproductive age group in urban Tamil Nadu.J Family Community Med. 2014 Jan;21(1):53-7.  CONTEXT: Unmet need for family planning (FP), which refers to the condition in which there is the desire to avoid or post-pone child bearing, without the use of any means of contraception, has been a core concept in the field of international population for more than three decades. OBJECTIVES: The very objective of this study is to determine the prevalence of "unmet need for FP" and its socio-demographic determinants among married reproductive age group women in Chidambaram. MATERIALS AND METHODS: The study was a community-based cross-sectional study of married women of the reproductive age group, between 15 and 49 years. The sample size required was 700. The cluster sampling method was adopted. Unmarried, separated, divorced and widows were excluded. RESULTS: The prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as 27%. The major reason for unmet need for FP among the married group was 18%, for low perceived risk of pregnancy, 9%, feared the side effects of contraception 5% lacked information on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons. Higher education, late marriage, more than the desired family size, poor knowledge of FP, poor informed choice in FP and poor male participation were found to be associated with high unmet need for FP. CONCLUSION: Unmet need for younger women was spacing of births, whereas for older women, it was a limitation of births. Efforts should be made to identify the issues in a case by case approach. Male participation in reproductive issues should be addressed.

ABSTRACT #4
Kutty NA, Sreeramareddy CT.A cross-sectional online survey of compulsive internet use and mental health of young adults in Malaysia.J Family Community Med. 2014 Jan;21(1):23-8. BACKGROUND:  The last decade has seen the emergence of the internet as the prime communication medium changing the way people live and interact. Studies from various countries have reported on internet addiction and its association with mental health, but none have come from Malaysia. OBJECTIVES: We aimed at assessing the frequency of the use of various internet applications and exploring the association of compulsive internet use with mental health and socio-demographic factors. MATERIALS AND METHODS:A cross-sectional online survey was carried out among participants registered for the monthly opinion poll survey of University Tunku Abdul Rahman, Malaysia. The questionnaire contained socio-demographic information, the use of various internet applications on a five-point Likert scale, compulsive internet use scale (CIUS) and 12 item general health questionnaire (GHQ-12). Correlations and linear regression analyzes were carried out. RESULTS: Of the 330 respondents, 182 were females and 148 were males. The mean age was 23.17 (SD = 3.84). Mean CIUS score was 19.85 (SD = 10.57) and mean GHQ score was 15.47 (SD = 6.29). Correlation coefficients of CIUS score with age, years of use and daily hours of internet use were -0.118 (P = 0.03), -0.014 (P = 0.81) and 0.242 (P < 0.001) respectively. Multiple linear regression analysis showed that age (β = -0.111, P = 0.033) and marital status (β = -0.124, P = 0.018) were negatively associated with CIUS scores whereas daily hours of internet use (β = 0.269, P = 0.001) and GHQ score (β = 0.259, P = 0.001) were positively associated with the CIUS score. CONCLUSIONS: Compulsive internet use was correlated with GHQ score. More research is needed to confirm our results. Psychologists may consider assessing internet addiction when evaluating young psychiatric patients.

ABSTRACT #5
Al-Shaikh GK, Alzeidan RA, Mandil AM, Fayed AA, Marwa B, Wahabi HA. Awareness of an obstetric population about environmental tobacco smoking. J Family Community Med. 2014 Jan;21(1):17-22. BACKGROUND AND OBJECTIVES: The reported rate of women's smoking is typically low. However, many pregnant women are exposed to environmental tobacco smoke (ETS), which could affect their own health and the health of their growing fetus. The aim of this study was to estimate the magnitude of the problem of exposure to ETS and assess the awareness of postpartum women to ETS and its possible effects. DESIGNS AND SETTINGS:  This was a cross-sectional study conducted on 1182 postpartum women at a university hospital in Riyadh, Saudi Arabia, between 1(st) January and 30(th) June, 2012. MATERIALS AND METHODS: A structured questionnaire was used for data collection. Factors associated with the level of understanding of the possible effects of ETS exposure were analyzed. RESULTS: The majority of the participating women knew that exposure to ETS had adverse effects on maternal and fetal health (>80%), but their knowledge of the specific effects on fetal health was limited. The level of mothers' education was found to be associated with better knowledge of effects on mother and fetal health (P < 0.01).CONCLUSION: This study revealed that pregnant women in our sample had limited knowledge of the specific effects of ETS on fetal health. This shortcoming in knowledge needs to be addressed by improving health.

ABSTRACT #6
Alenizi DA. Consanguinity pattern and heritability of Vitiligo in Arar, Saudi Arabia. J Family Community Med. 2014 Jan;21(1):CONTEXT: Epidemiological studies have shown that vitiligo is a complex trait, involving combinations of pathogenic effects of multiple susceptibility genes as well as environmental risk factors. AIM: To observe whether consanguinity increased the incidence of vitiligo in Saudi patients from Arar. PATIENTS AND METHODS: This study included 69 Saudi patients with vitiligo and their families. These patients, selected from the experience specialist dermatology center in Arar, from April 2011 to 2012, were interviewed by a dermatologist to confirm the diagnosis and complete a questionnaire. RESULTS: A total of 69 patients, 40 males and 29 females were selected. Their mean age was 34.5 ± 11.8 years with the median age of 23 years. The mean age at onset of disease was 27.9 ± 12.9 years. The mean duration of the disease was 9.7 ± 5.3 years. The frequency of focal, vulgaris, universal, and acrofacial subtypes was 22 (31.9%), 21 (30.4%), 8 (11.6%), and 18 (26.1%), respectively. A positive family history of vitiligo was obtained in 45 (65.2%) cases. A comparison of the frequency of vitiligo among siblings in relation to the general population was more in accord with the multifactorial model. CONCLUSION: Consanguinity in marriage increases the incidence of the disease. Therefore, genetic counseling and premarital examination would be important contributions to lower the prevalence of vitiligo.

ABSTRACT #7
Lawan UM, Amole GT, Jahum MG2, Sani A. Age-appropriate feeding practices and nutritional status of infants attending child welfare clinic at a Teaching Hospital in Nigeria. BACKGROUND: Appropriate infant feeding is the key to optimum infant and child development and survival. This study investigates age-appropriate infant feeding practices and nutritional status of infants attending the immunization and child welfare clinic at Aminu Kano Teaching Hospital. MATERIALS AND METHODS:  Using a cross-sectional descriptive design, a sample of 300 sets of infants (age ≤12 months) and caregivers was systematically selected and studied. The data were analyzed using the MINITAB(®) 12.21 (USA) statistical software. RESULTS: All the infants studied were still on breast milk. Most of the mothers demonstrated correct body positioning (89.9) and attachment (78.7%) during breastfeeding, and effective suckling was demonstrated in 77.0%. Interestingly, none of the infants was either exclusively breastfed for 6 months or currently on exclusive breastfeeding. Furthermore, only 64 (58.2%) of the 110 infants that were more than 6 months of age had appropriately been started on complementary feeding from 6 months of age. Overall, most caregivers (88.7%) had "fair" to "good" infant feeding practices. The practices were significantly associated with their level of education, and their relationship with the infants. Up to 40.0% and 73.7% of the infants had varying degrees of wasting and stunting respectively. Infant feeding practices and the age of the infants emerged as the only factors significantly associated with stunting, while both the caregivers' practices and age of the infants emerged as significant predictors of wasting in the infants. CONCLUSION AND RECOMMENDATIONS:  Barely 3 years to the 2015 target of the millennium development goals (MDGs), infant feeding and nutritional status still poses a serious threat to the dream of realizing the MDG-4. The Ministry of Health and relevant developing partners in this region should as a matter of urgency, formulate and implement a strong community-based public health intervention program to improve the knowledge and practices of mothers on infant feeding.

ABSTRACT #8
Jabbari H, Bakhshian F, Velayati A, Mehrabi E, Allahverdizadeh S, Alikhah H, Maleki A, Ahadi HR, Ghorbaniyan M, Naghavi-Behzad M. Effectiveness of presence of physician and midwife in quantity and quality of family planning services in health care centers. J Family Community Med. 2014 Jan;21(1):1-5.  BACKGROUND AND AIM:  Iran's health sector has been engaging the services of physicians and midwives in healthcare centers since 2005, with the hope of improving the quantity and quality of family planning services. The aim of this study was to assess the effect of serving physicians and midwives on the quantity and quality of family planning services in the healthcare centers of Iran. MATERIALS AND METHODS: The present cross-sectional study (Jan 2010 until Sep 2011) was carried out on 600 eligible families who were clients of healthcare centers of Tabriz, Azarshahr and Osku, cities of Northwest Iran from 2006 until 2011, in two groups (before and after). Some of the characteristics of the participants and the data on the quality and quantity of family planning services provided were grouped in a checklist of 16 variables by comparing the patients' past medical histories. RESULTS: In comparison with 3 years prior to engaging physician and midwife services in health care centers, the Couple Year Protection (CYP) and the quantity of family planning service indexes significantly increased among eligible families. The family size of participants declined significantly after family physicians and midwives became available in the healthcare centers (P < 0.005).CONCLUSION: Our findings showed some improvement in the quantity of services without any noticeable changes in the quality of services provided as a consequence of this huge intervention. Therefore, it is suggested that there should be proper oversight of the duties of the health team in order to keep a close watch on primary healthcare, design of proper mechanisms for collecting and maintaining performance reports and statistics, and continuously monitor and control the quality of services.

ABSTRACT #9
Al Maghraby MA, Alshami AM. J Family Community Med. 2013 Sep;20(3):192-7. Learning style and teaching method preferences of Saudi students of physical therapy. CONTEXT: To the researchers' knowledge, there are no published studies that have investigated the learning styles and preferred teaching methods of physical therapy students in Saudi Arabia.AIM: The study was conducted to determine the learning styles and preferred teaching methods of Saudi physical therapy students. SETTINGS AND DESIGN:  A cross-sectional study design. MATERIALS AND METHODS: Fifty-three Saudis studying physical therapy (21 males and 32 females) participated in the study. The principal researcher gave an introductory lecture to explain the different learning styles and common teaching methods. Upon completion of the lecture, questionnaires were distributed, and were collected on completion. STATISTICAL ANALYSIS USED: Percentages were calculated for the learning styles and teaching methods. Pearson's correlations were performed to investigate the relationship between them. RESULTS: More than 45 (85%) of the students rated hands-on training as the most preferred teaching method. Approximately 30 (57%) students rated the following teaching methods as the most preferred methods: "Advanced organizers," "demonstrations," and "multimedia activities." Although 31 (59%) students rated the concrete-sequential learning style the most preferred, these students demonstrated mixed styles on the other style dimensions: Abstract-sequential, abstract-random, and concrete-random. CONCLUSIONS: The predominant concrete-sequential learning style is consistent with the most preferred teaching method (hands-on training). The high percentage of physical therapy students whose responses were indicative of mixed learning styles suggests that they can accommodate multiple teaching methods. It is recommended that educators consider the diverse learning styles of the students and utilize a variety of teaching methods in order to promote an optimal learning environment for the students.

ABSTRACT #10
Patil S, Yadav N, Patil P, Kaswan S. Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population. J Family Community Med. 2013 Sep;20(3):187-91. AIM: The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population. MATERIALS AND METHODS:  The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate's correction and ANOVA tests. RESULTS:  A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by lineaalba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (P < 0.05) was established between tobacco and melanin pigmentation, frictional keratosis, traumatic ulcerations and leukoplakia. In those who wore dentures a statistically significant relation (P < 0.05) was found between candidiasis, traumatic ulceration and frictional keratosis. CONCLUSION: The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.

ABSTRACT #11
Al Hayek AA, Khader YS, Jafal S, Khawaja N, Robert AA, Ajlouni K. Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study. J Family Community Med. 2013 Sep;20(3):179-86. BACKGROUND:  A high prevalence of low serum testosterone (LST) in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes. MATERIALS AND METHODS: This was a cross-sectional study, conducted among 1,089 men (aged 30-70 years) with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patients' demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male (ADAM) questionnaire. Venous blood sample was collected to test for total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), serum lipids, and glycosylated hemoglobin (HbA1c). LST was defined as TT <3 ng/ml. RESULTS: Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism (HG), and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index (BMI), smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST. CONCLUSIONS: The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST.

ABSTRACT #12
Shaker HA, Farooq MU. Computer literacy of physicians among the hospitals of Makkah region. J Family Community Med. 2013 Sep;20(3):173-8.BACKGROUND AND OBJECTIVES: A confidential inquiry by the Directorate General of Health Affairs, Makkah region, Saudi Arabia, found physicians in different hospitals were reluctant to enter patients' related information in electronic medical record systems. One of the major issues raised was that they didn't have the required computer literacy. Our aim, therefore, was to conduct a survey to highlight the computer literacy among the physicians of Makkah region. MATERIALS AND METHODS:  This cross-sectional survey was performed from May to July 2009. A structured questionnaire of four A4 size paper was distributed among the physicians of the Makkah region working in seven different hospitals. The questionnaire contained questions on background knowledge of computers, i.e., (a) basic computer vocabulary knowledge (BCVK) (10 questions), (b) basic computer skills (BCS) (22 questions), (c) basic communication and internet skills (BCIS) (12 questions). RESULTS:  Response rate of 368, i.e., 81.6% of sample size (n = 451) was attained. The maximum response came from King Abdul Aziz Hospital (Taif), i.e., 79%. Overall BCVK, BCS and BCIS were the highest among the physicians of Alnoor Specialist Hospital, i.e., 71.3%, 91.4%, 87.7%, respectively. All the hospitals had a satisfactory level of BCVK, but levels of BCS and BCIS were above satisfactory except King Abdul Aziz Hospital (Jeddah) that showed a satisfactory level in BCIS. CONCLUSION:  Majority of the physicians had a good or an excellent level of computer background knowledge that gave a prediction toward the issues of their non-promising attitude and beliefs about electronic data entry.

ABSTRACT #13
Fida HR, Abdelmoneim I. Prevalence of smoking among male secondary school students in Jeddah, Saudi Arabia.J Family Community Med. 2013 Sep;20(3):168-72. OBJECTIVES:  This study was conducted to examine the prevalence of smoking and habits of smoking among male secondary school students in Jeddah, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes toward it. MATERIALS AND METHODS:  A cross-sectional study was conducted in Jeddah, using a two-stage cluster sampling, randomly selecting 4 out of 85 government male secondary schools. Data were obtained through a self-administered questionnaire eliciting responses to questions on personal background, smoking behavior, knowledge, behavior, and attitude toward smoking. A total of 695 students responded to the questionnaires with 87.4% response rate. RESULTS:  Of the studied group, 258 (37%) currently smoked, and of these, 83.7% had started smoking at the age of 14 years or less. The most common reason for smoking was the influence of family, especially the presence of someone at home who smoked (65, 9%) and friends who smoked (42.5%). Many of the students search for information on the risks of smoking (66.3%), and only (45.3%) knew about the bad effects of passive smoking on others. Two-third of the students who smoked wanted to quit smoking (63.2%), especially if suitable help was offered, whereas (60.9%) had tried to quit. While 50% of students smoked for recreation and entertainment, and (33.6%) had difficulty avoiding smoking in no smoking areas. CONCLUSION:  A well-planned integrated antismoking campaign is urgently required, especially among students and teachers. The study revealed that the prevalence of smoking was high. This will contribute to an increase in smoking-related health problems in the future if proper preventive measures are not taken.

ABSTRACT #14
Salih SB, Yousuf M, Durihim H, Almodaimegh H, Tamim H.Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center. J Family Community Med. 2013 Sep;20(3):162-7.OBJECTIVE:The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients. MATERIALS AND METHODS:  A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients' age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18. RESULTS: Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. CONCLUSION: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.

ABSTRACT #15
Alqahtani JM. The prevalence of pterygium in Alkhobar: A hospital-based study.J Family Community Med. 2013 Sep;20(3):159-61. OBJECTIVE:  To analyze the epidemiology of pterygium in a hospital-based population in Alkhobar, which is located in the eastern province of Saudi Arabia. MATERIALS AND METHODS:  This was a retrospective, non-randomized, and consecutive case study. Out of 88,666 patients who were seen in the ophthalmology clinic between January 1995 through the end of December 2010, 116 patients were diagnosed with advanced pterygium. The medical records of these patients were evaluated. RESULTS: The overall prevalence of pterygium was found to be 0.074%. There was no significant difference by either gender, side, or by laterality (P > 0.05). A significant increase was noticed in the prevalence of pterygium with increasing age and nasal location (P < 0.05).CONCLUSION: The overall prevalence rate of pterygium in Alkhobar is low when compared with results reported from other areas of the world.

ABSTRACT #16
Al-KhaldiYM.Attitude of primary care physicians toward patient safety in Aseer region, Saudi Arabia.J Family Community Med. 2013 Sep;20(3):153-8.OBJECTIVE:The objective of this study was to assess the attitude of physicians at primary health-care centers (PHCC) in Aseer region toward patient safety. MATERIALS AND METHODS: This study was conducted among working primary health-care physicians in Aseer region, Saudi Arabia, in August 2011. A self-administered questionnaire consisting of three parts was used; the first part was on the socio-demographic, academic and about the work profile of the participants. The attitude consisting of 26 questions was assessed on a Likert scale of 7 points using attitude to patients safety questionnaire-III items and the last part concerned training on "patient safety", definition and factors that contribute to medical errors. Data of the questionnaire were entered and analyzed by Statistical Package for the Social Sciences (SPSS) version 15.RESULTS: The total number of participants was 228 doctors who represent about 65% of the physicians at PHCC, one-third of whom had attended a course on patient safety and only 52% of whom defined medical error correctly. The best score was given for the reduction of medical errors (6.2 points), followed by role of training and learning on patient safety (6 and 5.9 points), but undergraduate training on patient safety was given the least score. Confidence to report medical errors scored 4.6 points as did reporting the errors of other people and 5.6 points for being open with the supervisor about an error made. Participants agreed that "even the most experienced and competent doctors make errors" (5.9 points), on the other hand, they disagreed that most medical errors resulted from nurses' carelessness (3.9 points) or doctors' carelessness (4 points).CONCLUSION: This study showed that PHCC physicians in Aseer region had a positive attitude toward patient safety. Most of them need training on patient safety. Undergraduate education on patient safety which was considered a priority for making future doctors' work effective was inadequate.