Journal of Family & Community Medicine
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   Table of Contents - Current issue
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September-December 2021
Volume 28 | Issue 3
Page Nos. 155-219

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REVIEW ARTICLES  

Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps p. 155
Ashraf A Amir, Said A Khader, Ziad El Chami, Sami M Bahlas, Mahmoud Bakir, Shams Arifeen
DOI:10.4103/jfcm.jfcm_79_21  
We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%–65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%–80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%–65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%–62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.
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Journal of Family and Community Medicine: A scientometric analysis 1994–2020 p. 164
Shafiq Ur Rehman, Sameeh M Al-Almaie, Ikram Ul Haq, Shakil Ahmad, Shakil Ahmad, Malak A Al-Shammari, Magdy Darwish, Tajammal Mustafa
DOI:10.4103/jfcm.jfcm_289_21  
The Journal of Family and Community Medicine (JFCM) is a peer-reviewed open access journal published by the Saudi Society of Family and Community Medicine. This review is aimed to analyze the scientometric attributes of manuscripts published over 27 years from 1994 to 2020 using scientometric technique. The bibliographic records of manuscripts published from 1994 to 2020 were retrieved from the Web of Science and Medline-PubMed databases. The data were analyzed by using VOSviewer, CiteSpace, and Biblioshiny software. A total of 648 manuscripts were included; these were written by 1442 authors, with an average of 2.22 authors per manuscript and 24 manuscripts per year. All manuscripts gained 2,693 citations with a mean ratio of 4.15 citations per manuscript. All the top-20 contributing authors belonged to Saudi Arabia, and 48% of the manuscripts were in the single-author pattern; the multiauthored manuscripts received a higher ratio of citations. The review highlighted the most contributing institutions and countries.Bibliographic coupling of countries, institutions, keywords co-occurrence, and co-citation of journals were also presented. The JFCM is an important journal of Saudi Arabia that has provided a platform to family medicine researchers to share their scholarly and scientific communication for the past 27 years. Over the years, the frequency and number of publications in the journal have improved. Although the journal has received manuscripts from all over the world, most contributions were from Saudi Arabia.
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ORIGINAL ARTICLES Top

The effect of stress and acculturation on the self-rated health of Arab Americans p. 175
Abdul-Rahman M Suleiman, Arash Javanbakht, Keith E Whitfield
DOI:10.4103/jfcm.jfcm_150_21  
BACKGROUND: The self-rated health of Arab Americans has been found to be worse than non-Hispanic whites. Psychosocial factors such as stress and acculturation may explain this disparity. As a result, we designed this survey to better understand the effects of stress and acculturation on the self-rated health of the Arab-American community. MATERIALS AND METHODS: Using a convenience sample, we surveyed 142 self-identified Arab Americans regarding demographics, stress, acculturation, and self-rated health. Stress was measured using instruments assessing perceived stress, everyday discrimination, and acculturative stress. Acculturation was measured using a modified Vancouver Index of Acculturation. To measure self-rated health, participants were asked to rate their current health on a scale of 1 (very poor) to 5 (very good). RESULTS: A logistic regression model adjusted for age, sex, body mass index, and education did not find that stress significantly affected the odds of having poor self-rated health in Arab Americans. Heritage identity was associated with lower odds of having poor self-rated health (odds ratio = 0.37, 95% confidence interval [CI] 0.15, 0.94, P < 0.05). No association was found between acculturation and poor self-rated health. CONCLUSION: Greater levels of stress were not significantly associated with greater odds of poor self-rated health in Arab Americans. We also found that greater heritage identity significantly decreased the odds of poor self-rated health in Arab Americans. The effects of everyday discrimination, perceived stress, and acculturation on self-rated health in Arab Americans remain unclear and need to be examined further.
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Bridging the gap: Engagement of family and community physicians in digital networks for health issues p. 181
Amani M Alqarni, Maha A Almuraisel, Rasha H Alsheikh, Rana S Almansour, Moataza M Abdelwahab
DOI:10.4103/jfcm.jfcm_105_21  
BACKGROUND: The use of social media (SM) is unlocking infinite opportunities for healthcare disciplines and is fast becoming the preferred medium of communication. This underlines the importance of meeting the challenges of this new era. The aim of this study was to assess the readiness of Saudi family medicine physicians to the use of SM in health promotion and to explore their prospective attitudes toward its use professionally. MATERIALS AND METHODS: The two largest hospital-based primary care centers in the Eastern Province of Saudi Arabia were used for the quantitative analysis. All known physician bloggers in Saudi Arabia from seven different cities were invited to participate in the qualitative aspect of this study. The quantitative component of this study was conducted in the Eastern Province at two main hospitals. A 37-item questionnaire was distributed to all family physicians practising at these hospitals. The qualitative component of this study covered all of Saudi Arabia, and 11 in-depth interviews were held with family physician bloggers, followed by verbatim transcription, content analysis, and coding of the results. Chi-squared and independent t-tests were used. All physicians at the two largest hospitals in the Eastern Province were invited to participate in the quantitative aspect of the study. The response rate was 86.2% (n = 159). RESULTS: Study included 136 primary care physicians; majority were <50 years old (96.3%) with 58.8% females. About 60% were residents and 27.2 % consultants, and 76.5% were were family medicine physicians. Ninety-six percent physicians had SM accounts, the mean use of 3 h per day, 46.3% of the family physicians had good knowledge of SM ethics, and 69.9% used SM professionally for medical issues. Most of the responses showed a strong positive attitude; more than 60% of the participants responded as “agree” or “strongly agree” to the positive statements. CONCLUSION: Organizations urgently need to design their own bioethical guidelines and rules on the safe use of SM by healthcare professionals.
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Quality assessment of orthopedic surgery referral request letters from primary care consultation: Evaluation of a Spanish healthcare area p. 189
Carmen da Casa, Ángel V Suárez, Nuria Asensio, Juan F Blanco
DOI:10.4103/jfcm.jfcm_133_21  
BACKGROUND: One of the most requested referrals for specialist consultations from primary care (PC) is orthopedic surgery (OS). The purpose of this work was to analyze the number, characteristics, and quality of PC referral request letters in a Spanish healthcare area to their OS reference department. MATERIALS AND METHODS: The referral rates for 10 years were collected, and a total of 6,225 referral letters issued during the first half of 2019 were analyzed in detail. Gender, age, patient provenance, as well as priority and other process descriptors (type of pathology, suspected diagnosis, exploratory signs, imaging tests) were assessed. A scoring system was developed to evaluate the quality of the referral to an OS consultation: Quality evaluation in OS (QEOS) model. RESULTS: The rate of referral to OS is rising. The mean age of the referred patient was 53 years and 59.3% were women. Degenerative pathologies justified most referral requests (65.7%), most of which related to the spine (24.2%) or the knee (23.2%). In the QEOS analysis of the referral request letters, we noted that only 36.5% described some physical exploration, 32.9% image tool request, 25.8% indicated the pharmacological treatment, and 11.2% subsequent physiotherapy, resulting in a poor average quality of PC to OS patient referral. CONCLUSION: There is a growing demand for patient referral from PC to OS, however, the number, content, and quality of referral request letters varies greatly. The QEOS tool can be the germ of a simple evaluation system that would help in the improvement of the process of continuous care.
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Prevalence of color vision deficiency in medical students at a Saudi University p. 196
Naela B Alamoudi, Razan Z AlShammari, Reem S AlOmar, Nouf A AlShamlan, Abdullah A Alqahtani, Naheel A AlAmer
DOI:10.4103/jfcm.jfcm_235_21  
BACKGROUND: Color vision deficiency (CVD) affects approximately one in 12 men and one in 200 women in the world. It is considered a problem in the medical field since the color is often used as a sign in the practice of medicine, in observational assessment, diagnosis, and follow-up. These conditions make the appreciation of color essential in doctors' lives, thus we aimed at finding the prevalence and predictors of CVD in medical students. MATERIALS AND METHODS: This cross-sectional study included 1115 medical students. A pretested questionnaire consisting of personal data, history of vision problems, familial color vision defect, eye surgery, bad trauma on the head or eyes, drugs taken or chemicals exposed to, other health problems, and whether sufficient amount of Vitamin A is taken was used. This was followed by the screening of the participants for CVD using the Ishihara 15-plates test. RESULTS: A total of 1115 students participated in the study; 52.2% were females and the mean age of the participants was 21.7 years (±1.4). The prevalence of definitive CVD was found to be 2.1%; all of which comprised males. Eighty-seven percent of the affected participants were not aware of their color vision problem. A highly statistically significant association was found between history of vision problems and CVD status (P < 0.008). No association were found for nationality, marital status, family history of CVD, history of eye surgery, and eye trauma. CONCLUSION: The percentage of CVD in the present study is lower than that reported by previous studies done in other countries. Many medical students with CVD remain unaware of their condition. Therefore, we recommend early screening of all school-age children, and proper counseling of medical students with definite CVD to take care of their own health and wellbeing.
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Assessing knowledge of Saudi mothers with regard to parenting and child developmental milestones p. 202
Faisal O Alqurashi, Bassam H Awary, Basim F Khan, Sara A AlARhain, Ali I Alkhaleel, Batool A Albahrani, Amnah S Alali
DOI:10.4103/jfcm.jfcm_186_21  
BACKGROUND: Knowledge about childrearing and development of children greatly impacts on how parents can adequately and safely raise and interact with a child. This study aimed to assess Saudi mothers' level of knowledge of parenting and developmental milestones and describe the associated factors that affect their knowledge. MATERIALS AND METHODS: This cross-sectional study was conducted in the Eastern Province of Saudi Arabia from January to February 2020. Four hundred Saudi mothers with children up to 6 years of age were included in the study from 20 randomly selected primary healthcare centers. The Knowledge of Infant Developmental Inventory Tool (KIDI-P) was used. Relevant demographic data were collected. Data were analyzed using the Statistical Package for the Social Sciences software version 21 (SPSS). One-way ANOVA and t-test were used to detect any significant differences in mother's knowledge about developmental milestones related to the research variables. RESULTS: The majority of mothers (42.2%) were between 28 and 35 years of age. Knowledge about parentaging scored on the average 53.3%, health and safety scored 63.4%, general principles 55.9%, and developmental milestones 51.8%. Data showed a statistically significant relation between mothers' age and parenting subscale (mean = 0.54, standard deviation [SD] = 0.18, P = 0.001), and mothers' education and parenting (mean = 0.52, SD = 0.18, P = 0.015). Significant differences were found between planned pregnancy and parenting (mean = 0.53, SD = 0.178, P = 0.044) and between planned pregnancy and child developmental milestones (mean = 0.51, SD = 0.12, P = 0.042). CONCLUSION: Saudi mothers have limited overall knowledge of childrearing and developmental milestones of their children. Mothers' age, parental education, parity, and planned pregnancies had a positive effect on mother's knowledge of parenting and milestones parameters.
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Telemedicine monitoring of high-risk coronavirus disease 2019 (COVID-19) patients by Family Medicine service after discharge from the Emergency Department p. 210
Imran Khalid, Maryam Imran, Manahil Imran, Saifullah Khan, Muhammad A Akhtar, Khadijah Amanullah, Tabindeh J Khalid
DOI:10.4103/jfcm.jfcm_184_21  
BACKGROUND: Up to 25% of the total coronavirus disease 2019 (COVID-19) admissions comprise patients with comorbidities who present to the emergency department (ED) with only mild-to-moderate disease. It is unclear whether as an alternative to hospitalization, telemedicine can be used to monitor these “high-risk” comorbid patients. The aim of our study was to answer this question by comparing the outcome of such patients discharged under a family medicine service (FMS) telemonitoring program and those admitted to hospital. MATERIALS AND METHODS: Patients with three or more risk factors for progression to severe COVID-19 disease were designated as “high-risk” in our study. In the absence of acute indication for hospitalization, these high-risk patients with mild-to-moderate disease were discharged home under the supervision of FMS led telemonitoring between October 2020 and February 2021 and were labelled as “Telemedicine group.” They were compared to similar patients who were admitted to hospital between March-August 2020 before the implementation of telemedicine service (TMS) and were taken as “Control group.” Outcome measures included intubation, number of inpatient days, 28-day mortality and cost analysis for the two groups. RESULTS: Out of 572 COVID-19 patients who presented to the ED, 70 met the inclusion criteria for the “Telemedicine Group” and 35 were included in the “Control Group”. In the Telemedicine group, 21 (30.0%) patients were brought back to ED for re-evaluation and 16 (22.9%) were eventually admitted to the hospital. There was no difference in terms of oxygen requirements, intubation, and intensive care unit admission (P > 0.74) between the groups, and none of the study patients died. The Family Medicine-led TMS saved 77% inpatient admissions and on average 4.4 hospital days and $3400 per patient (P < . 0001). CONCLUSION: Family medicine-led telemonitoring of high-risk COVID-19 patients presenting to the ED with mild-to-moderate disease is a feasible and cost-effective alternative to hospitalization.
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CASE REPORT Top

An approach to café au lait macules in primary care setting p. 217
Seereen R Almuhaidib, Fajar A Aldulijan, Najlaa A Alkanaan, Abdulmohsin K Almulhim, Khalid S Alyami
DOI:10.4103/jfcm.jfcm_161_21  
Café au lait macules (CALMs), if solitary, are benign lesion with no clinical meaning, and are common in the general population. Multiple CALMs may be the hallmark of some disorders and need to be assessed by an interprofessional team. The diagnosis and evaluation of a patient with a suspected condition may include a team of pediatric neurologists, dermatologists, ophthalmologists, geneticists, and orthopedic surgeons. To evaluate the progression of the disease, an annual follow-up is required.
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ABSTRACTS Top

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DOI:10.4103/2230-8229.325652  
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010