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Nouf A AlShamlan,1 Reem S AlOmar,1 Omar Y Almukhadhib,2 Saad A Algarni,2 Askar K Alshaibani,2 Sara A Elmaki,3 Malak A Al Shammari,1 Abdulaziz M Sebiany1 1Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Radiology at Family and Community Medicine Center, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nouf A AlShamlanDepartment of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966504901406Email nashamlan@iau.edu.saBackground: Breast masses are common among females presenting to primary health care (PHC) facilities. The family physician’s role is crucial in detecting breast disease. Utilization of breast ultrasonography has been increasing recently as a diagnostic tool.Objective: This study aims to determine the characteristics of masses detected on breast ultrasound, their associations with characteristics of females attending the PHC setting and explore the management of these cases by family physicians.Methods: This registered based, cross-sectional study included 321 females who were referred for diagnostic breast ultrasound in the PHC center of the University hospital, Eastern province, Saudi Arabia (2017– 2019). t-test, Chi-squared and Fisher’s Exact tests were performed to assess associations between the presence of breast masses in the ultrasound and patients’ characteristics. Moreover, to compare the breast masses in two groups of patients (< 40 years and ≥ 40 years) regarding their characteristics, ultrasound findings, and further management performed. P < 0.05 was considered statistically significant.Results: Approximately 24% patients had a breast mass and 70.92% of cases were detected among females ≥ 40 years old. The odds of having a breast mass were highest among overweight, females complaining from a breast lump, and who had early menarche. Grand multiparous had lower odds of a breast mass. Females < 40 years old had higher rates of breastfeeding, increasing parity, and obesity than older females. Sonographic examined masses were larger in young females, and posterior enhancement of the mass was more reported in older. BI-RADs of the masses were not associated with the patient’s age.Conclusion: Breast masses were prevalent among females who underwent breast ultrasound. The results support referral for investigation when a female complains of a breast lump. Family physicians have a vital role in encouraging protective behaviors from developing breast masses such as maintaining normal weight and breastfeeding.Keywords: breast, mass, ultrasound, primary care, family physician

Background Anxiety disorders are a significant global health concern with destructive morbidity and mortality. Medical school is a stressful environment worldwide. This study measures the prevalence of anxiety symptoms among clinical-year medical students in Saudi Arabia. As well as to explore its association with students' sociodemographic factors, academic performance, issues experienced by them during the study of medicine, and their perceived readiness for their future specialties. Methods The generalized anxiety disorder (GAD-7) tool along with a sociodemographic questionnaire was distributed to 523 clinical-year medical students (fourth, fifth and sixth years) from the Imam Abdulrahman Bin Faisal University, Saudi Arabia, in this cross-sectional study. Data analysis was performed with SPSS version 23 and it included the Chi-Square or Fisher's exact tests for bivariate analysis, and the multivariable logistic regression to account for confounders. Results The prevalence of anxiety symptoms as measured by the GAD-7 was found to be 31.7%. Of these, 14.3% had severe symptoms. Only 4.4% students went to a healthcare professional and were diagnosed with psychiatric problems. Logistic regression analysis revealed that the odds of anxiety was higher among females and students who had perceived psychological problems. However, students' grade point average (GPA) and perceived readiness for their future specialty were not statistically significant with anxiety symptoms. Conclusion Anxiety was highly prevalent among clinical-year medical students included in this study. This urges periodic mental health screening, proper diagnosis of high-risk individuals in medical schools, and early interventions through confidential access to mental health services.

Background There are few data on assessment methods in the field of family medicine in Arab countries. Imam Abdulrahman Bin Faisal University (IAU) in 2017 established the family medicine clerkship rotation for the fifth-year medical students. The objective of the study is to evaluate the multifaceted assessment of family medicine clerkship and their correlation to each other among fifth-year medical students in IAU. Methods We examined the performance of 455 fifth-year medical students from two batches (2018 and 2019) in the continuous course assessment, Objective Structured Clinical Examinations (OSCE), extended matching questions (EMQ), and multiple-choice questions exams (MCQ). Results The students' total mark range was 55.16 to 95.64. Batch 2018 and females had significantly higher marks (p=0.000). On the other hand, no significant associations were seen between the total marks and the semester in which the clerkship was taken or the order of group in each semester (p= 0.464 and 0.980 respectively). Significant positive correlations were seen between all forms of assessment during the family medicine clerkship (p=0.000). Conclusion This study demonstrates that different assessment methods used to evaluate medical students during the family medicine clerkship were correlated. The performances of the female and the first batch were superior. This finding is the basis for introducing a platform for developing modern learning and the improvement of the assessment standards in family medicine clerkship rotation.

BACKGROUND Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer. CASE REPORT A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain. CONCLUSIONS The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.

Background To assess the prevalence of depression among medical students in their clinical years (fourth, fifth, and sixth years) in a government university in Eastern Province, Saudi Arabia, and its association with the students’ sociodemographic characteristics, academic factors, perceived health problems and their perceived readiness to their future specialties. Methods A cross-sectional study was conducted among 527 clinical-year medical students. The Patient Health Questionnaire (PHQ-9) and questionnaire designed by the researchers to collect data on sociodemographic and academic variables were used as research instruments. Statistical analyses were conducted using Stata Statistical Software V.15. Descriptive statistics, the χ test, and both an ordered logistic regression and a binary logistic regression analysis were performed. Results The prevalence of depression was found to be 39.27%, according to the results of the PHQ-9. Both the ordered logistic regression and the binary logistic regression analyses revealed that the odds of severe depression were high among women, and students who perceived that they were not yet ready for their future specialties. The more senior the medical students were, the less likely it is that they have severe depression. A similar association was found for students who perceived that they did not have psychological problems. However, students’ grade point average was not statistically significantly associated with depression. Conclusions The prevalence of depression was high among the medical students examined. Policy makers should establish screening programmes, provide counselling for students who need it and deliver early interventions in detected cases.

Context: Campuses of the University of Dammam (UOD) have several sources of air pollution that can adversely affect human health, welfare and the overall efficiency of the educational process. Aims: This study was aiming to assess the role of environmental protection procedures in UOD and evaluate their impact on improving the air quality inside its campuses. Settings and Design: In both the new and old campuses, three different sites were selected to assess air quality level. Methods: Five air pollutants, in addition to environmental noise, were measured at all selected sites. These pollutants included particulate matter less than 10 microns (PM10), carbon monoxide (CO), sulfur dioxide (SO2), volatile organic compounds (VOCs) and nitrogen dioxide (NO2). The data were compared to pollutant levels, in the same locations, that were measured during a previous 6-year period, starting from 2008. Statistical Analysis Used: Results of this research were statistically analyzed by the Statistical Package for the Social Sciences (Version 16, SPSS Inc., Chicago, USA). Results: The highest mean ± standard deviation of PM10 (124.5 ± 25.0 μ g/m3), CO (1.9 ± 0.7 ppm), VOCs (0.12 ± 0.09 ppm), NO2 (0.039 ± 0.022 ppm), SO2 (0.036 ± 0.047 ppm) and environmental noise (71.8 ± 4.1 dB) were found in the old UOD campus. Levels of all pollutants, except environmental noise, during the morning period were higher than those in the afternoon period. In addition, the level of the five air pollutants gradually reduced from 2008 to 2013, and reached to lower than their air quality guidelines. Conclusions: The administrative policies and management procedures of UOD had a positive effect on the level of ambient air quality and reflect the presence of a healthy and safe educational environment inside its campus.

BACKGROUND & OBJECTIVE: Working long shifts are associated with fatigue, medical errors and poor outcomes of care. However, there is a lack of guide that can provide policy-makers the optimal duty length in the Malaysian hospitals. The study aims to investigate the impact of nursing duty hours’ length on the quality and safety of care delivered in the “Medical-Surgical Wards” in Malaysia.METHOD: Cross-sectional study was carried out on 12 private hospitals. Data was collected, through questionnaires, from 652 nurses (61.8 % response rate). Stratified random sampling was used in the study. Regression analyses were conducted to explore the impact of the nursing duty hours’ length on the care quality and safety.FINDINGS: The length of nurses’ duty hours is not significantly affecting care quality (F = 1.27 and P value = 0.28) and patient safety (F = 1.81 and P value = 0.13), at p

This article was migrated. The article was marked as recommended. Objectives: This study aimed to collect information on the personal health status of health sciences students in Imam Abdulrahman Bin Faisal University. It also aimed to investigate the relationships between levels of physical activity and other behaviours as well as specific health indicators in students attending college. Methods: A convenience sample of 147 college students, ages 18 to 24 years, participated in this research study at Imam Abdulrahman Bin Faisal University. The data were obtained through interview questionnaire and trained investigators collected weight, height, blood pressure and blood sugar measurements. Results: Forty-five percent of the students were either overweight or obese (21.8% and 23.1%) while 17.0% of the students were current smokers and 7.5% of them were ex-smokers. The majority of the students (91.8%) had fast food (hamburger, French fries, and soft drink) and out of these 62.9% had it three times or more weekly. Furthermore, 35% or more of the students did not have breakfast or drink milk or have vegetables on a daily basis. Also, 22.4% of the students were inactive. Ten percent of the participants were hypertensive while 1.4% had impaired random blood sugar with increased risk for diabetes mellitus. All of these students were unaware that they had hypertension or high random blood sugar. There was a significant statistical relationship between living in-campus at university and frequency of consumption of fast food (p = 0.003). Conclusion: This study shows that there were high rates of risky lifestyles, namely, obesity, smoking, unhealthy diet, and inactivity among health sciences students, while some have health issues such as hypertension and high risk of diabetes.

Background Medical science is perceived as a stressful educational career, and medical students experience monstrous stress during their undergraduate studies, internship, and residency training, which affects their cognitive function, practical life, and patient care. In the present study, an assessment of the prevalence of self-perceived stress among new medical graduates during their internship training has been performed, and correlations of self-perceived stress with sex, marital status, and clinical rotations have been evaluated. Patients and methods Interns of the King Khalid, King Abdulaziz, and King Fahd University hospitals in Saudi Arabia were invited to complete a stress inventory known as the Kessler 10, which is used for stress measurement. Apart from stress evaluation, the questionnaire collected personal data, such as age, sex, and marital status, in addition to information relevant to hospital training, assigned duties, and clinical training rotations. Results Our results showed that nearly 73.0% of interns were under stressed conditions. Most of the interns were affected by a severe level of stress (34.9%), followed by mild (19.3%) and moderate (18.8%) levels of stress. The stress level was significantly higher (84.0%) among female interns in comparison with male interns (66.5%) (odds ratio =2.64; confidence interval =1.59–4.39; P, Video abstract

Background: Depression is the most common mental health problem among the elderly, causing considerable morbidity worldwide, as well as increased healthcare costs. The purpose of this study was to determine the severity of depression among Saudi elderly women attending Quran Memorization Centers in the Kingdom of Saudi Arabia. Methods: We recruited 340 participants aged 65 years and older from 11 Quran Memorization Centers in the cities of Dammam, Khobar and Dhahran in the Eastern Province of Saudi Arabia. We used a structured interview questionnaire composed of socio-demographic characteristics and the Activity of Daily Living instrument to assess participants’ physical, social, and health-status conditions. In addition, we used the English version of the Geriatric Depression Scale and the Arabic version of Montreal Cognitive Assessment as the main screening instruments for depression and cognitive impairment respectively. Results: Severity of depression among all participants was 42.1%. Low monthly income, the absence of a caregiver, diabetes, disability, and sleep disturbance were identified as common factors associated with depression. Conclusion: The present study showed that depression in elderly females attending these centers was high and associated with multiple medical and socioeconomic characteristics, which is a cause of concern.

Objectives: To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia. Setting: Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia. Design: A cross-sectional study. Materials and Methods: One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese. Results: One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity. Conclusion: Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.