Factors Associated with Choice of Career in Family Medicine Among Junior Doctors in Oman

Objectives: The number of family physicians in Oman is far below that recommended by the World Health Organization. This study aimed to determine factors influencing junior doctors’ choice of a career in family medicine. Methods: This cross-sectional study was conducted between March and June 2018 and targeted applicants to Oman Medical Specialty Board residency programmes during the 2018–2019 academic year. Applicants were grouped according to their choice of either family medicine (n = 64) or other specialities (n = 81). A self-administered questionnaire was utilised to compare the applicants’ sociodemographic characteristics, factors influencing their choice of career and their Myers-Briggs Type Indicator® (MBTI) personality traits. Results: A total of 52 family medicine and 43 other residency applicants participated in the study (response rates: 81.3% and 53.1%, respectively). Most family medicine applicants were female (86.5%), married (65.4%) and resided in rural areas (73.1%); moreover, 19.2% were ≥30 years of age. Overall, emphasis on continuity of care, opportunity to deal with a variety of medical problems, the ability to use a wide range of skills and knowledge, early exposure to the discipline, opportunity to teach and perform research and the influence of family or friends were important factors in determining choice of a career in family medicine. Moreover, the MBTI analysis revealed that family medicine applicants were commonly extroverted-sensing-thinking-judging personality types. Conclusion: Knowledge of the factors influencing career choice among junior doctors may be useful in determining future admission policies in order to increase the number of family physicians in Oman.Keywords: Career Choice; Internship and Residency; Medical Specialty; Family Practice; Family Physicians; Myers-Briggs Type Indicator; Oman

The Psychological Impact of Referral for Mammography Screening for Breast Cancer Among Women in Muscat Governorate: A cross-sectional study

Objectives: Breast cancer constitutes the majority of diagnosed cancers in Oman’s females, accounting for 19.2%, which prompted the introduction of a breast cancer screening programme into the Omani healthcare system. There are rising international concerns about the effectiveness of mammography as a screening tool and its psychological impact. The current study aimed to determine the social, emotional and physical dysfunction caused by the waiting time from the day of scheduling the appointment until the day of screening and explore associated risk factors. Methods: This cross-sectional study was conducted between March and December 2017 at Khoula Hospital, Muscat, Oman, using a two-part self-administered questionnaire. Part one of the questionnaire collected clinical and demographic data. Part two consisted of the Psychological Consequences Questionnaire (PCQ) and focused on psychological consequences, measuring the effect of mammographic screening on emotional, physical and social functions. Results: A total of 300 women aged ≥40 years old participated in this study (response rate: 100%). Results revealed that there was a minimal negative psychological impact from screening using mammograms. All PCQ domains were significantly impacted for participants who reported a family history of cancer (P = 0.007). The social score was significantly higher among women between 40–50 years old (P = 0.008). Scores of emotional and social functions were significantly affected by participants’ employment status; employed women were more affected than those who were not (P = 0.043 and 0.012, respectively). However, women’s levels of literacy did not affect any of the domains. Conclusion: The psychosocial impact of the waiting period between scheduling and undergoing mammography screening was minimal in the current sample. Future research should evaluate the psychosocial impact on patients at different recall times.Keywords: Breast Cancer; Mammography; Psychological Factors; Depression; Anxiety; Oman

Sharing Unpleasant Health Information with Patients: A baseline study exploring physician attitudes, practices and adherence to the SPIKES protocol at a tertiary hospital in Muscat, Oman

Objectives: This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments. Results: A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information (‘bad news’), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients’ family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6–85.4%, 12.4–34.8% and 1.1–11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels

Epidemiology of Celiac Disease

Celiac disease (CD) is a chronic autoimmune disorder of the small bowel that is triggered by exposure to dietary gluten. In paediatric, CD commonly presents with intestinal manifestations, while in adults, many present with more subtle symptoms and extraintestinal manifestations, such as anaemia, fatigue, dermatitis, and headaches. The main scope of this chapter is to explore and present the prevalence of CD worldwide as well as trends in diagnosis over recent years. The prevalence of CD is approximately 0.5–1% in different regions of the world. However, exact prevalence rates may vary substantially in specific populations. Although CD was formerly believed to affect solely individuals of European ancestry, more recent studies indicate that the disease may have been either under-reported or undiagnosed in other populations. Moreover, it is possible that the increasing popularity of Western dietary practices may have an impact on the recent trend of increased rates of CD in non-Western populations. Certain population groups are also at high risk of developing CD, including first- or second-degree relatives of individuals with CD and those with diabetes or autoimmune disorders. Serological screening and HLA typing are therefore highly recommended for asymptomatic children in whom such risk factors are present

Modern Birth Control Methods

This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects

Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman

Objectives: This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women. Methods: A cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist. Results: A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each). Conclusion: The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections. Keywords: Cervical Cancer; Screening; Pap Smear; Human Papillomavirus; Oman

Evaluating Trauma Care Capabilities using the Essential Trauma Care Guidelines of the World Health Organization: Cross-sectional study of primary health centres in Muscat, Oman

Objectives: This study aimed to evaluate trauma care capabilities at the primary care level in Muscat, Oman, using World Health Organization guidelines. Methods: This descriptive cross-sectional study was conducted between January and March 2015 at eight primary health centres in Seeb. An English-language questionnaire was distributed to the medical officer or nurse in-charge at each centre to determine the number of staff, total population being served, number of emergency trauma cases and availability of ambulances. Subsequently, 10 doctors from each health centre were randomly selected to assess the availability of physical resources as well as their trauma skills and knowledge. Results: There were limited physical and human resources for the management of trauma and a complete absence of trauma administrative functions, such as local trauma registries or quality improvement activities. Conclusion: This study highlighted the need to introduce national guidelines and improve the delivery of trauma services in Oman. Keywords: Primary Healthcare; Trauma; Emergency Medicine; Capacity Building; Health Resources; Delivery of Health Care; Oman.

Inflammatory Markers as a Predictor of Postmenopausal Osteoporosis: A cross-sectional study from the Sultan Qaboos University Hospital

Objectives: Postmenopausal osteoporosis is a progressive metabolic bone disease resulting from estrogen deficiency. However, due to the silent nature of the disease, there is an urgent need for a simple, early predictive marker. This study, conducted between January 2017 to December 2019, aimed to assess the potential of three factors—specifically, the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR)—as inflammatory markers of bone mineral density (BMD) loss. Methods: A retrospective cross-sectional study was conducted among 450 postmenopausal Omani women undergoing dual-energy X-ray absorptiometry at the Sultan Qaboos University Hospital, Muscat, Oman. Participants were allocated into groups based on lumbar spine BMD t-score values. A receiver-operating characteristic curve was used to find the area under the curve (AUC). Multivariate logistic regression was performed to identify independent predictors of low BMD. Results: A total of 65 (14.4%), 164 (36.4%), and 221 (49.1%) women were allocated to the control, osteopenia, and osteoporosis groups, respectively. No significant differences in PLR, MLR, and NLR values were observed based on group allocation. BMD t-score values were reversely correlated with age (P = 0.007) and PLR (P = 0.004), and positively correlated with body mass index (BMI) (P <0.001). The AUC was 0.59. However, the only independent predictors of low BMD were age (>65 years) and BMI (<25 kg/m2). Conclusion: None of the three inflammatory biomarkers studied were found to be useful prognostic indicators of bone loss. Further research is recommended to reject or support theories regarding the role of inflammatory status in the pathogenesis. Keywords: inflammatory markers, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Bone mineral density, osteoporosi

Types of Primary Healthcare Emergencies in Muscat, Oman: A retrospective cross-sectional study of five primary care centres

Objectives: Emergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman. Methods: This retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care. Results: The proportion of emergency cases was <2.5% (range: 1–2.5%). The most common type of emergency was musculoskeletal issues/trauma (34.3%) followed by gastroenterological (15.1%) and genitourinary (10.0%) emergencies. Most patients were either 21–39 or 5–12 years old (35.0% and 21.6%, respectively). The majority (59.6%) were treated directly at the health centre, while the remaining patients (40.4%) were referred to tertiary care. At referral, only 12.1% were transported by ambulance and the rest via private transport. Conclusion: Musculoskeletal issues/trauma was the most common type of emergency seen at the selected PHC centres in Muscat. Further research is needed to determine whether PHC centres have the capability and resources necessary to appropriately manage emergency cases. Keywords: Emergencies; Primary Healthcare; Public Health; Emergency Medicine; Oman

Prevalence of Celiac Disease in Omani Adults with Iron Deficiency Anemia of Unknown Cause: A case-finding study

Objectives: This study aimed to estimate the serological prevalence of celiac disease in patients with IDA of unknown cause at primary health care facility. Methods: This is a prospective case finding study that was conducted at the primary care clinics in the Sultan Qaboos University Hospital (SQUH) from September 2018 to June 2020. A total of 104 patients aged 18 to 55 years old, with a hemoglobin (Hb) level less than 11.5 g/dl for males and less than 11.0 g/dl for females and a ferritin level less than 30 ng/mL for males and less than 13 ng/mL for females participated in the study. Blood samples were obtained for an initial serological screen using serum IgA level and then those with normal level of IgA, had IgA- Anti-tissue transglutaminase antibody (tTG) and IgA- anti-deamidated gliadin peptide (DGP). Positive IgA-tTG test was confirmed using IgA-endomysial antibodies. Patients with low IgA level were tested using IgG-tTG and IgG-DGP. Results: Eight patients out of the 104 (7.7%) found to have positive serological screening for celiac disease. Three patients out of the eight (37.5%) had a positive IgA tTG. Two of those three (66.7%) had a positive IgA-endomysial antibody as well. The IgA-DGP was positive in seven patients out of the 104 (6.7 %). Out of those seven patients, two also had a positive IgA tTG. Conclusion: Celiac disease is not a rare disorder. There is a need to increase awareness among healthcare professionals about celiac disease and its non-classical manifestations such as IDA.Keywords: cervical smears, conventional slides, ThinPrep slides, cervical organisms