Non-steroidal Anti-inflammatory Drugs (NSAIDs) Use in Primary Health Care Centers in A’Seeb, Muscat: A Clinical Audit

Objective: We sought to assess the trend of non-steroidal anti-inflammatory drug (NSAID) use in primary health care institutions located in A’Seeb, a province in the capital city of Oman, Muscat. Additionally, we evaluated the relationship between a physician’s years of experience and the number of prescription issued, as well as the presence of risk factors and side effects in the patients who received these prescriptions. Method: A clinical audit was conducted in four primary health care centers in the Muscat region over a one-week period in April 2014. The target population included patients aged 18 years or over who attended one of the four health centers and were prescribed NSAIDs. Overall, 272 patients were recruited by systematic random sampling. The data were collected by two methods: direct face-to-face interviews and evaluations of the patient’s electronic medical file. The prescribing doctors were blind to the audit. The collected information included patients demographics, past and current medical history of related comorbidities, NSAID type, dose, duration and indications for use, concomitant warfarin or/and aspirin prescriptions, and co-prescription of gastroprotective agents. Results: In total, 15% of patients received an NSAID prescription: females were issued more prescriptions than males. The percentage of patients who received an NSAID prescription across the health centers ranged from 9% to 24%. The main reason for prescribing NSAIDs was musculoskeletal problems. The most frequently prescribed NSAID was ibuprofen. Sixteen percent of patients who received an NSAID prescription had a risk factor related to its use. The mean and median duration of the NSAID prescriptions of all types were 5.6 and 5.0 days, respectively. Physicians with a greater number of years experience prescribed more NSAIDs. Conclusion: Our study showed that the number of prescriptions of NSAIDs among various institutes varied, which could reflect the level of awareness concerning NSAID risks among the prescribing doctors. NSAIDs were prescribed for patients with comorbidities and patients with previously documented side effects without considering protective agents. Therefore, we suggest that the use of these medications is controlled, especially in high-risk populations

The Effect of Antepartum Depression on the Outcomes of Pregnancy and Development of Postpartum Depression: A prospective cohort study of Omani women

Objectives: This study aimed to identify the relationship between antenatal depression and pregnancy outcomes, including the risk of developing postpartum depression in Oman. Methods: This follow-up prospective longitudinal cohort study included pregnant women attending primary healthcare institutions in Muscat, Oman from January to November 2014. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal and postnatal depression. Pregnant Omani women with a gestational age ≥32 weeks attending 12 local health centres for antenatal care in Muscat were invited to participate. Recruited women were followed-up at 6–8 weeks after delivery. The following pregnancy outcomes were assessed: mode of delivery (normal or Caesarean section [CS]), gestational age at delivery (preterm or fullterm), baby’s birth weight and development of postnatal depression. Results: A total of 959 women participated in this study (response rate: 97.3%). In total, 233 women (24.4%) had antenatal depression with a score of ≥13 on the EPDS. Of the 592 participants (61.7%) who attended postnatal clinics at 6–8 weeks post-delivery, 126 (21.3%) were positive for postnatal depression. Logistic multivariate regression analysis showed that antenatal depression was associated with increased risk of CS (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.20–2.66) and postnatal depression (OR = 8.63; 95% CI: 5.56–13.39). Conclusion: Screening women for antenatal depression and providing appropriate management may reduce adverse pregnancy outcomes and the risk of developing postnatal depression.Keywords: Depression; Postnatal depression; Women Health Services; Maternal Health Services; Pregnancy; Primary Health Care; Oman

Comparison between Efficacy of Human Milk Fortification Using Human Milk Fortifier versus Preterm Formula: A Retrospective Single-institutional Experience

Objectives: This study sought to evaluate the relative efficacy of expressed breast milk (EBM) fortified using human milk fortifier (HMF) compared to commercial preterm formula (PF) on preterm and very low birth weight (VLBW) infants in a major tertiary healthcare center in Oman. Methods: This retrospective cohort study included two cohorts of preterm (< 32 weeks gestation) or VLBW infants (birth weight < 1500 g) treated in the neonatal intensive care unit (NICU). Cohort one included infants who were given PF-fortified EBM between January and December 2016, and cohort two were given newly-introduced HMF-fortified EBM between November 2018 and December 2019. Analysis was performed to compare the cohorts with respect to baseline characteristics, primary outcomes, and secondary outcomes. Results: A total of 103 neonates were included (cohort 1: n = 55, cohort 2: n = 48). There were no significant differences in the growth of the weekly length, the growth of the head circumference, or discharge growth parameters. Compared to PF, HMF was associated with significantly better weight gain velocity (g/kg/day) during the first week (p =0.009) and second week (p =0.050) after starting fortification, lower need for other adjunctive forms of fortification (p =0.035), and lower rates of necrotizing enterocolitis in premature infants or VLBW (p =0.018). Conclusions: This is likely to be the first study to analyze the relative efficacy of HMF and PF in the Middle East. The results of this study will be helpful in guiding standards of nutritional care in NICUs in Oman

Assessment of patient safety culture in primary health care in Muscat, Oman: a questionnaire -based survey

Abstract Background Patient safety is a universal issue which affects countries at all stages of health system development. Patient safety research in primary care reveals that globally millions of people suffer disabilities, injuries, or death due to unsafe medical practices. This study aims to explore the understanding of frontline primary health care professionals regarding patient safety culture in health care facilities in Oman. Methods A questionnaire–based survey was conducted using a validated Hospital Survey of Patient Safety Culture tool. Invitations were sent to all 198 health professionals from each occupational category from each primary care center in Muscat, Oman. Results The total number of respondents was 186 participants out of 198 (response rate: 94%). Overall, the staff had a strong sense of teamwork within the units (85%), they reported organization learning for continuous improvement (84%) and teamwork across the units (82%). However, the four dimensions which received the lowest scores were related to communication problems between the staff (23%), non-punitive response to errors (27%), frequency of event reporting (40%), and errors occurring when transferring patients to higher levels of health care during handoffs and transitions (46%). Conclusions Overall, the participants rated patient safety in the primary health care setting as excellent or very good and the perception of patient safety was moderately positive. The core areas of strength were teamwork within the units with positivity and organization learning and continuous improvement. The weaknesses were non-punitive response to errors, inadequate staffing and hand offs and transition. The results of this study will provide policy makers and health care professionals with a detailed understanding of the current patient safety culture in primary care in Muscat, Oman. The results will be used by the Ministry of Health to inform policy and strategies to strengthen patient safety within primary health care in Oman

Influence of Eysenckian Personality Traits in Choice of Specialization by Young Omani Doctors

Objectives:The role of personality in occupational specialty choices has been explored in many parts of the world. To our knowledge, there is a dearth of such studies in the Arab/Islamic population and Oman is no exception. This study aimed to explore the relationship between personality traits and specialty choice among residents of Oman Medical Specialty Board (OMSB). Methods: A cross-sectional study was carried out among Omani resident physicians working under OMSB. The Eysenck Personality Questionnaire–Revised was employed to quantify personality subtypes (e.g., psychoticism, extraversion, and neuroticism). Specialties were categorized as surgical, medical, and diagnostics as per standard of North American medical specialties. A total of 255 residents in 17 medical specialties participated in the study (m = 40.4%; f = 59.6%) of 300 eligible subjects giving a response rate of 85.0%. Results: Respondents who had chosen surgical specialties scored significantly higher on the psychoticism subscale than those who had opted for medical and diagnostic specialties. As for individual specialties, orthopedic respondents had statistically significant higher mean scores on psychoticism and neuroticism compared to radiologists and psychiatrists who scored the lowest in the two personality traits, respectively. Conclusions: This study found statistically significant associations between personality traits and choices of specialty by young Omani doctors. We recommend more detailed studies that examine further psychological and cultural variables that are likely to affect the choices of specializations by young Omani professionals in both medical and non-medical fields

Preoperative predictors of poor laryngoscope views in pediatric population undergoing cardiac catheterization

Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy

Parental Age and the Risk of Autism Spectrum Disorder in Oman: A case-control study

Objective: This study aimed at evaluating advanced parental age as a risk factor for Autism Spectrum Disorder (ASD) in an Omani cohort. Methods: Case-control study of 278 ASD cases compared with 722 sex-matched controls retrieved from the electronic records of the Developmental Paediatric Clinic, Sultan Qaboos University Hospital (SQUH) between January 2015 and June 2016. Results: ASD cases (76.6% male) were mostly diagnosed between 3-4 years of age, with more than 50% of them originating from Muscat and Batinah governorates. Compared to controls, mothers from the case group had significantly higher educational level (post-secondary education versus high school/no formal education (odds-ratio (OR)=1.62; 95% C.I. 1.20-2.19). In a multivariate logistic regression, the odds ratio of maternal age as a risk for ASD increased dramatically with advancing age category (using age&lt;25 as a reference, OR was 3.39, 6.12, 7.86 and 13.13 for age categories 25-29, 30-34, 35-39, and ≥40 years, respectively). The ORs of advancing paternal age as a risk for ASD were also statistically significant (using age&lt;30 as referent, OR was 2.20, 2.36, and 3.12 for age categories 30-34, 35-39 and 40-44 years); however, there was a drop in the effect with paternal age ≥ 45 years (OR=1.42; 95% C.I .64-3.15). Conclusion: Both maternal and paternal increased age were associated with a higher risk of ASD; however, the association was more pronounced and more consistent with advanced maternal age compared to paternal age. Keywords: Autism; parental age; case-control stud

Differential executive functioning in the topology of Spirit possession or dissociative disorders: an explorative cultural study

Background In Oman, anecdotal and impressionistic observation have helped parse and categorize various manifestations of spirit possession into two broad and distinct categories: intermittent dissociative phenomenon and transitory dissociative phenomenon. The primary aim of the present study was to compare the performance of participants on neuropsychological tests among different grades of possession. Other correlates were also sought. Methods Assessment criteria for the two groups included measures examining executive functioning: controlled oral word association test Verbal Fluency, Wisconsin Card Sorting Test (Perseverative error and the number of categories achieved), Trail Making Test and the Tower of London Test (number of correctly solved problems). Sociodemographic variables and the history of trauma were also sought. Result Among 84 participants, one third of them presented the intermittent possession type and two thirds, the transitory possession type. Their mean age was 34.17 ± 11.82 and 56% of them were female. Nearly 35% of them endorsed a history of a traumatic experience. Both the multivariate models showed statistical significance (F (5, 78) = 5.57, p  Conclusions This study suggests that typology of spirit possession found in Oman tends to differ on indices of executive function. Those with ‘diagnosis’ of intermittent possession showed impairment in many indices of executive functioning. Despite its wide prevalence, spirit possession has not been examined in terms of its neuropsychological functioning. We believe that this study will be instrumental in laying the groundwork for a more robust methodology.Other Information Published in: BMC Psychiatry License: http://creativecommons.org/licenses/by/4.0/See article on publisher's website: http://dx.doi.org/10.1186/s12888-019-2358-2</p

Prevalence and predictors of depressive symptoms among caregivers of children with attention-deficit/hyperactivity disorder attending a tertiary care facility: a cross-sectional analytical study from Muscat, Oman

A number of studies suggested that the rates of depression in Euro-American populations are higher among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) than typically developing children. There is a dearth of studies in this field among non-Western populations. This study attempts to explore the depressive symptoms’ prevalence and predictors among a systematic random sample of caregivers of children with a diagnosis of ADHD who sought consultation from a child and adolescent mental health services unit in Muscat. The prevalence and predictors of depressive symptoms were quantified using the Patient Health Questionnaire-9. Results showed that depressive symptoms are common among caregivers of children with ADHD in Oman. A binary regression analysis revealed that low income, being the only caregiver in the family and hyperactive/impulsive and combined types of ADHD were significant predictors of depression