This is the fifth issue this year with a variety of papers from the Region of great interest to primary care and family medicine.

Goweda, et al., did a cross sectional to screen for somatic symptom disorder among medical students. A self administered questionnaire was used to collect the data including two sections; socio-demographic information and Somatic Symptom Scale-8 (SSS-8) questions. Out of 374 students, 206 (55.1%) were males, 292 (78.1%) were from the clinical years (Years 4-6), 353(94.4%) were singles, 71(19.0%) were smokers, 83(22.2%) had social stressors and 88(23.5%) had educational problems. On considering only the high SSS-8 total risk scores, the prevalence of SSD is estimated to be 39% (20.3% had very high and 18.7% had high risk). Feeling tired or having low energy was the most prevalent symptom. Female students and students having social stressors and educational problems more vulnerable to have SSD. The authors concluded that there is high prevalence of SSD among our medical students. Accordingly, health education programs and frequent mentoring of the students are highly recommended.

Alam et al., looked at unplanned pregnancies. They followed a cross sectional study. This study aims to ascertain the prevalence of unintended pregnancies among antenatal women attending antenatal clinics in Primary Care in Qatar and to establish any demographic differences among antenatal women around the choice of pregnancy. A validated questionnaire (the London Measure of Unplanned Pregnancy (LMUP)) was used to look at the prevalence and hence the size of the problem. Among 107 participants, scores on the LMUP ranged from 0-12 with a median of 10. Most pregnancies 79.4%, (n=85) were categorized as planned, 17.8% (n=19) as ambivalent, and 2.8% (n=3) as unplanned. The authors stressed that unplanned pregnancies in this population are rare among women attending antenatal clinics. Less planned pregnancies are tended to be more prevalent among Qatari women compared to expatriates. Unplanned pregnancy prevention services need to be included within pregnancy care services in primary care settings to offer preferred contraception on time to effectively maintain the low rate of unplanned pregnancies in the country.

Altamimi, et al., did a cross-sectional study using an online questionnaire has been developed locally in Cluster one in Riyadh, Saudi Arabia. The authors aims to assess the mother’s knowledge, reaction, and immediate action towered head trauma of children under five years in Riyadh city, 2020-2021.
The study included 390 mothers who had the inclusion criteria. In this study, we collected data from 390 mothers of children under five years old who responded to our distributed questionnaire. Most of the participants were between 31-40 years old (40 %), while 31.5 % were between 20-30 years old. The authors concluded that the level of knowledge among mothers in Al Riyadh region toward managing head trauma and preventing home injuries among children is sub adequate. Many factors affect this knowledge, including maternal education, monthly income and occupation, and attending first aid training.

Elmeshmeshy, et al., stressed that the current COVID 19 pandemic has led to abrupt changes in medical education with an imperative need to shift to e-learning for continuity of the education.
The study aimed to retrieve a hybrid e-learning experience and the participants’ early perception. This is an interventional study. A shortly planned hybrid e-learning was conducted in the family medicine department programs of MD and MSc. Then, the enrolled 30 postgraduates were invited to participate in a web-based anonymous survey to assess their perception of e-learning after a 2- month experience. Twenty-six participants were recruited in the survey. The most perceived e-learning advantages were feasibility, saving costs, and motivation to learn. While the perceived challenges were lack of technical skills and internet connection strength. The authors concluded that the implementation of hybrid e-learning is a significant step forwards and easy to be conducted, but it requires work to be improved.

Alzahrani, et al., conducted a cross-sectional study on of 168 PHC physicians in Jeddah to assess knowledge and practice of physicians towards medication prescription during pregnancy and to determine obstacles in prescribing medications. A questionnaire was distributed to physicians online including questions about their characters and knowledge about medication prescribing (categories), reading sources, and practice. 78.6% of PHC physicians faced obstacles on prescribing medication for pregnant women, where lack of time to read, limited information about patient and treatment and pregnant women education level were the most common obstacles found. Amoxicillin (86.9%), Levothyroxine (75.6%), Methyldopa (73.8%), Calcium carbonate (71.4%), Nasal fluticasone (57.1%), and Penicillin G were the most commonly reported medications as safe during pregnancy by participants (56.5%). The authors concluded that there is an insufficient awareness and practice of PHC physician regarding medication prescribing during pregnancy. It is necessary to raise their awareness about the FDA guidelines.

Mohamad, et al., reviewed the Evaluation and assessment of male infertility in Primary care. Infertility is a common condition seen in primary care practices. The World Health Organization estimates that 9% of couples worldwide struggle with fertility issues and that the malefactor contributes to 20-30% of all infertility cases. The diagnosis of infertility in men is primarily based on semen analysis. The main parameters of semen include concentration, appearance, and motility of sperm. Recently, the demand for infertility services has increased, and infertile couples are seen frequently by primary care physicians. A flexible, patient-centred approach is indicated. This article outlines the Family Physician`s evaluation of male infertility and indications for referral to a male infertility specialist.

Alobaidi et al., reported on a case of ectopic pregnancy. The authors stressed that Ectopic pregnancy is a condition where pregnancy occurs outside the uterine cavity. It is a life-threatening condition and needs to be acted on urgently when suspected. Ectopic pregnancy should be suspected in any woman in childbearing age presenting with irregular vaginal bleeding like this case presented in this issue.

Aljehani, et al., conducted a cross-sectional study to assess family medicine residents’ level of resilience coping self-efficacy during COVID-19 crisis. It was conducted among 208 family medicine residents in the Western region of Saudi Arabia. Resilience and coping self-efficacy were assessed using the Connor-Davidson Resilience Scale-25 items (CD-RISC-25) and coping self-efficacy scale (CSES), respectively. Professional stressors including work environment satisfaction (WES) was assessed. The mean (SD) CD-RISC-25 and CSEC score was 54.53 (19.69) out of 100 and 136.81 (63.67) out of 260, respectively. Suboptimal resilience was independently associated with shorter (<10 min.) consultation time (OR=3.83, p=0.023) and lower CSES score (OR=0.98, p<0.001), with 32.5% variance. The authors concluded that Family medicine residents are at high-risk for psychological distress during COVID-19 crisis, indicated by low resilience and coping self-efficacy levels. The model suggests high impact of WES and spiritual fulfillment in coping self-efficacy indicating relevance in resilience-promoting interventions.

Tawhari, et al., attempt to assess safety culture in “Abu Arish” General Hospital to provide a starting point from which action planning begins and patient safety changes emerge.The methodology of this study was based on the guidelines provided by the Agency for Healthcare Research and Quality (AHRQ). Data were collected using the Hospital Survey on Patient Safety Culture Form. Analysis of data was by Microsoft Excel and the Statistical Package for Social Sciences (SPSS) programs. A survey questionnaire was distributed in “Abu Arish” General Hospital to 207 health care providers, including nurses, technicians, managers and medical staff. The patient safety composites with the highest positive scores were teamwork within units (72%), organizational learning and continuous improvement (70%) and The composites with the lowest scores were non-punitive response to error (22%), staffing (32%), Handoffs & Transitions (38%), frequency of events reported (40%), communication openness (43%), hospital management support for patient safety (43%) and Teamwork Across Units (43%). This study provides an overall assessment of perceptions of safety among hospital staff in a general hospital. There are areas of strengths and weakness in the patient safety culture dimensions. There are several areas for improvement, including non-punitive response to errors, staffing, hospital handoffs & transitions and error reporting

Dr. Haidarah, evaluated the results of total hip replacement for patients with femoral neck fractures in Aden, Yemen. Patients were retrospectively sought who suffered a femoral neck fracture and were all operated on by the author and a senior surgeon in the period from January 2018 to April 2020. The study conducted at the department of orthopedic surgery, in Alnaqeeb private hospital in Almansoora, Aden, Yemen. The study patients were 70. All patients suffered of femoral neck fracture and operated for total hip replacement. They were (50%) females and (50%) males with a ratio female to male 1:1. The mean age of all patients was 68.9 ± 7.8 years (range, 60 to 87 years). The patients of the age group 60 – 70 were predominant with (72.9%). There was statistical significant difference between the age groups and sex of patients (p=0.05). Causes of fractures were fall down (50%) patients, degenerative (25.7%) patients, inflammatory 7 (10%), and road traffic accident in (10%) patients. Neck femur fractures with severe displacement were predominant with (60%). Intraoperative periprosthetic fracture found in 3 (4.3%) patients, post-operative periprosthetic fracture also found in 5 (7.1%) patients. Also, we found implant failure or breakage in (1.4%), dislocations in (12.9%) patients and wound infections in (5.7%). Lower limbs discrepancy found in (1.4%) patient. The author concluded that their study and previous published studies have shown that the complication rates are significantly lower.

Dr Abdulrazak Abyad
Chief Editor
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