Patients’ Perceptions of Communication and Clinical Skills of Primary Healthcare Physicians in Oman

ABSTRACT: Objectives: As a large proportion of patients are seen in primary healthcare (PHC) centres, it is important to explore patients’ perceptions of communication and clinical skills of PHC physicians. In Oman, PHC is provided by both trained family physicians (FPs) and general practitioners (GPs). Methods: This crosssectional study was conducted at 12 PHC centres in Muscat Governorate, Oman between November 2014 and August 2015. Adult Omani patients’ perceptions of Omani and other Arabic-speaking doctors were examined using an Arabic translation of a validated self-administered questionnaire. Results: A total of 626 patients completed the questionnaire (response rate: 100%). The patients’ responses were significantly more positive towards FPs compared to GPs on whether the doctor provided reassurance (P = 0.03), took a complete medical history (P = 0.03) and gave the patient the opportunity of a follow-up with the same doctor (P = 0.01). Conclusion: Certain skills in communication and clinical aspects of FPs were favourably viewed by patients compared to GPs.Keywords: Patient Satisfaction; Physicians, Primary Health Care; Communication; Clinical Competence; Quality of Health Care; Oman

Urinary Incontinence Among Omani Women: Prevalence, risk factors and impact on quality of life

Objectives: Urinary incontinence (UI) in women is a common health problem which can have a negative impact on quality of life (QOL). This study aimed to determine the prevalence, risk factors and impact of UI on the QOL of Omani women attending primary healthcare centres in Muscat, Oman. Methods: This crosssectional study was conducted at three primary healthcare centres in Muscat from April to August 2018. Women who were 20–50 years of age, not pregnant, not in the six-month postnatal period, not seriously ill and not diagnosed with pelvic organ prolapse were included. A self-administered questionnaire using the International Consultation Incontinence Questionnaire-Short Form was used to evaluate the frequency, severity and impact of UI on QOL. Results: A total of 1,070 women were included in this study (response rate = 92.5%). The mean age was 31.39 ± 7.64 years. UI was reported by 369 (34.5%) women, of whom 182 (49.3%) had stress UI, 97 (26.3%) had urgency UI, 88 (23.8%) had mixed UI and two (0.5%) had other UI. Age, body mass index (BMI), having been married or employed, hypertension, cough, constipation and vaginal or assisted vaginal delivery during the previous birth were significant risk factors for UI. Only 41 (11.1%) out of the 369 women with UI had ever sought medical advice despite the fact that more than two thirds of the women with UI reported negative effects on their QOL. Conclusion: UI is a common medical problem in Oman. Several risk factors, including age and BMI, were identified. Despite its negative consequences for QOL, women were found to be reluctant to seek medical attention for the condition.Keywords: Urinary Incontinence; Prevalence; Risk Factors; Quality of Life; Oman

Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman

Objectives: This study aimed to determine the prevalence of vitamin B12 deficiency amongst diabetic patients on metformin therapy. Methods: This cross-sectional study was conducted at general clinics at the University Health Center and diabetes outpatient clinics at Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2017. All Omani adults who were diagnosed with type 2 diabetes mellitus and took metformin were invited to participate in the study. The variables included in this study were age, gender, duration of diabetes, dose and duration of metformin therapy, haemoglobin and glycosylated haemoglobin level. Results: A total of 248 subjects were included (response rate = 95.4%) of which 26 (10.5%) were vitamin B12 deficient and 53 (21.4%) were borderline deficient. The mean daily dose of metformin was highest among vitamin B12 deficient group (1,981 ± 222 mg; P = 0.004). Conclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Further research is needed to confirm the need for routine screening and monitoring.Keywords: Type 2 Diabetes Mellitus; Prevalence; Metformin; Vitamin B12 Deficiency; Oman

Daytime Sleepiness Among Young Adult Omani Car Drivers

Objectives: Sleepiness and fatigue play significant roles in exacerbating the occurrence of car crashes. However, there is a dearth of studies examining the prevalence of sleepiness while driving among Omanis. This study aimed to determine the proportion of young Omani adults who confess to daytime sleepiness while driving and to investigate associations between gender, daytime sleepiness and risk of obstructive sleep apnoea syndrome (OSAS). Methods: This cross-sectional study took place at the Sultan Qaboos University Hospital, Muscat, Oman, between May and July 2014 and included 600 young adult Omani non-commercial drivers. The Berlin Questionnaire and Epworth Sleepiness Scale (ESS) were distributed among the participants, along with additional questions about their sleeping habits. Associations between daytime sleepiness while driving and nocturnal sleep duration, risk of OSAS and gender were determined. Results: A total of 492 private vehicle drivers took part in the study (response rate: 82%), of which 50.4% were male. Overall, 124 Omanis (25.2%) reported experiencing daytime sleepiness while driving at least once per month. There was a significant association between nocturnal sleep duration of 10 on the ESS, indicating a greater propensity for daytime sleepiness (P = 0.006). However, male drivers were significantly more likely to report sleepiness while driving (P = 0.001). Conclusion: Sleepiness while driving was common among young male drivers in Oman and might be due to nocturnal sleep deprivation. Further studies are needed so that preventative measures can be developed. Keywords: Motor Vehicles; Traffic Accidents; Sleep; Fatigue; Obstructive Sleep Apnea Syndrome; Oman

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Objectives: This study aimed to evaluate cognitive and behavioural changes among 9–14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT). Methods: This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards. Results: A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; P <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; P <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; P <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores (P <0.01 each). Conclusion: These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure. Keywords: Adenoidectomy; Obstructive Sleep Apnea; Cognitive Function; Behavior; Attention Deficit Hyperactivity Disorders; Children; Oman

Methylphenidate improves executive functions in patients with traumatic brain injuries : a feasibility trial via the idiographic approach

Background: Road traffic accidents are known to be the main cause of traumatic brain injury (TBI). TBI is also a leading cause of death and disability. This study, by means of the idiographic approach (single-case experimental designs using multiple-baseline designs), has examined whether methylphenidate (MPH - trade name Ritalin) had a differential effect on cognitive measures among patients with TBI with the sequel of acute and chronic post-concussion syndromes. The effect on gender was also explored. Methods: In comparison with healthy controls, patients with TBI (acute and chronic) and accompanying mild cognitive impairment (MCI) were screened for their integrity of executive functioning. Twenty-four patients exhibiting executive dysfunction (ED) were then instituted with the pharmacological intervention methylphenidate (MPH). The methylphenidate was administered using an uncontrolled, open label design. Results: The administration of methylphenidate impacted ED in the TBI group but had no effect on mood. Attenuation of ED was more apparent in the chronic phases of TBI. The effect on gender was not statistically significant with regard to the observed changes. Conclusions: To our knowledge, this is the first feasibility trial from the Arabian Gulf to report the performance of a TBI population with mild cognitive impairment according to the IQCODE Arabic version. This investigation confirms anecdotal observations of methylphenidate having the potential to attenuate cognitive impairment; particularly those functions that are critically involved in the integrity of executive functioning. The present feasibility trial should be followed by nomothetic studies such as those that adhere to the protocol of the randomized controlled trial. This evidence-based research is the foundation for intervention and future resource allocation by policy- or public health decision-makers

Microsatellite Genotyping of Plasmodium vivax Isolates from Pregnant Women in Four Malaria Endemic Countries

Plasmodium vivax is the most widely distributed human parasite and the main cause of human malaria outside the African continent. However, the knowledge about the genetic variability of P. vivax is limited when compared to the information available for P. falciparum. We present the results of a study aimed at characterizing the genetic structure of P. vivax populations obtained from pregnant women from different malaria endemic settings. Between June 2008 and October 2011 nearly 2000 pregnant women were recruited during routine antenatal care at each site and followed up until delivery. A capillary blood sample from the study participants was collected for genotyping at different time points. Seven P. vivax microsatellite markers were used for genotypic characterization on a total of 229 P. vivax isolates obtained from Brazil, Colombia, India and Papua New Guinea. In each population, the number of alleles per locus, the expected heterozygosity and the levels of multilocus linkage disequilibrium were assessed. The extent of genetic differentiation among populations was also estimated. Six microsatellite loci on 137 P. falciparum isolates from three countries were screened for comparison. The mean value of expected heterozygosity per country ranged from 0.839 to 0.874 for P. vivax and from 0.578 to 0.758 for P. falciparum. P. vivax populations were more diverse than those of P. falciparum. In some of the studied countries, the diversity of P. vivax population was very high compared to the respective level of endemicity. The level of inter-population differentiation was moderate to high in all P. vivax and P. falciparum populations studied

Prevalence and age-of-onset distributions of DSM IV mental disorders and their severity among school going Omani adolescents and youths: WMH-CIDI findings

<p>Abstract</p> <p>Background</p> <p>There is a dearth of studies exploring the magnitude of mental disorders amongst adolescents and youths in the Arab world. To our knowledge, this phase 2 survey in Oman is the first nationally representative school-based study to determine the prevalence of DSM-IV mental disorders (lifetime and over the preceding 12 months), their age-of-onset distributions and determine their severity over the past 12 months using the World Mental Health-Composite International Diagnostic Interview, the WMH-CIDI, used for international comparison.</p> <p>Methods</p> <p>A total of 1,682 (91.61%) students out of 1836 students who formed the phase 2 random sub-sample of a multi-stage, stratified, random sampling design (phase 1), participated in the face-to-face structured interview using the Arabic-version of WMH-CIDI 3.0.</p> <p>Results</p> <p>The phase 1 results using the General Health Questionnaire (GHQ-12) and Child Depression Inventory (CDI) showed depressive symptoms to be 17% prevalent in the larger sample of 5409 adolescents and youths. Amongst the phase 2 respondents from this sample, 13.9% had at least one DSM IV diagnostic label. The lifetime prevalence of Major Depressive Disorder (MDD) was 3.0%; Bipolar Mood Disorder (BMD) was 1%, Specific phobia 5.8% and Social phobia 1.6%. The female gender was a strong predictor of a lifetime risk of MDD (OR 3.3, 95% CI 1.7-6.3, <it>p </it>= 0.000); Any Mood Disorders (OR 2.5, 95% CI 1.4-4.3, p = 0.002) and Specific Phobia (OR 1.5, 95% CI 1.0-2.4, p = 0.047). The severity of illness for cases diagnosed with 12 month DSM IV disorders was found to be 80% lower in females (OR 0.2, 95%CI 0.0-0.8). The estimates over the previous 12 month period when compared with the lifetime prevalence showed a 25% to 40% lower prevalence for MDD, Specific phobia, Social phobia, Any Anxiety Disorders (AAD) and Any Mood disorders (AMD) while the rate was 80% lower for Separation Anxiety Disorder/Adult Separation Anxiety (SAD/ASA). Mood disorders were significantly lower in the 14-16 age groups (70% lower) in comparison to the older age groups and AMD showed a linear increase in prevalence across increasing age groups (<it>p </it>= 0.035).</p> <p>Conclusion</p> <p>The implications of the present findings are not clear cut, however this study endorses the adult CIDI studies findings that mental disorders do begin earlier in life. The relatively lower prevalence of DSM IV depressive disorders cautions against any conclusive interpretation of the inflated results based on the exclusive study of the depressive symptoms alone in the same sample in the same time period. The female gender proved to be a strong predictor of lifetime risk of MDD, any mood disorder and specific phobia. Under-reporting by males or some other gender-specific factors may have contributed to such a discrepancy. The odds of the severity of illness for cases with 12 month DSM IV disorders were significantly lower in females.</p

COST OF QUALITY MANAGEMENT IN INDIAN INDUSTRIES: A PRACTICAL INSIGHT

In India, quality cost management system is becoming an important area within the purview of quality engineering; where in upper management can get true reflection of status of quality department in monetary terms for all types of organizations. Cost of Quality (COQ) practices; have well defined standards and lot of research backing, still lacks in large scale adoption at industry level practically. Reason could be, the sustainability and usefulness of these practices has normally not been elaborated or tracked once primary research objective is over. At the same time, it is observed that COQ initiatives taken by industry people are not published. This work intends to study the COQ practices followed by reputed and successful industries of different types. Eight industries shortlisted are classified into two groups and detailed analysis of COQ practices adopted was done for each industry. The analysis provides useful input for design of quality cost management system (QCMS) for the industries where COQ practices are not implemented

Depression in Urban Omani Adults with Type 2 Diabetes: A cross-sectional study

Objectives: This study aimed to identify the prevalence of clinically significant depression among adult Omani patients with type 2 diabetes mellitus (T2DM) and explore potential associations with sociodemographic and clinical variables in this population. Methods: This descriptive cross-sectional study was conducted between August 2018 and September 2019 and included 427 Omani T2DM patients from 12 randomly selected government health centres in Muscat, Oman. An Arabic version of the validated Patient Health Questionnaire-9 was administered to the participants via face-to-face interviews to determine the prevalence of depression. Results: A total of 111 T2DM patients (response rate: 100%) had depression (26%). The presence of a personal history of depression was the only variable significantly associated with depression (P &lt;0.001). Other sociodemographic and clinical factors including age, gender, duration of diabetes, glycated haemoglobin level, mode of diabetes treatment or the presence of diabetes-related complications such as cardiac complications, renal impairment, retinopathy, neuropathy and erectile dysfunction, were not associated with depression, (P &gt;0.050 each). Conclusion: This study revealed a high prevalence of depression among urban Omani adults with T2DM and a personal history of depression, which was found to be significantly associated with depression. Therefore, early screening for depressive symptoms is necessary to improve the quality of life of diabetic patients in this region. Keywords: Depression; Type 2 Diabetes Mellitus; Prevalence; Public Health; Primary Healthcare; Oman