In this issue we have a number of interesting reviews, case reports, and research from the Region of relevance to family medicine and general practitioners.

Alduwaisan, et al., looked into Mental Health program integration into Primary Health Care: Results of a Project Implemented at Yarmouk Health Care Center & Capital Health Primary Care Center, Kuwait. World Health Organization (WHO) identified a gap in meeting mental health care needs in the health services. To bridge this gap, at Yarmouk Primary Health Care Center and Capital Health District area in Kuwait, it was decided to implement a best practice model, for integrating mental health services into primary health care services in Kuwait. The program was initiated in 12 primary mental health care clinics in the Capital Health District area in Kuwait, 200 Family Physicians and General Practitioners, were trained in psychiatric integration within the primary health care system. Regular evaluation of the performance of physicians working in primary mental health clinics in the program was ensured. Periodic evaluation of psychiatric patient visits in the Primary mental health clinics was conducted for quality improvement. Mental health awareness days and educational sessions were organized. The authors concluded that with increasing psychiatric illnesses and a lack of adequate specialized mental health services, addressing this issue at the primary care level offers an attractive cost-effective option to deal with the crisis.

Alduwaisan, et al., looked at Electronic Incidence reporting impact on Quality and Patient Safety. Health care delivery was explored and paper-based incident reporting was found to compromise patient safety and quality. Induction of electronic reporting of incidents was started and its favorable outcome demonstrated. Electronic Incidence reporting was started in January 2022. A substantial increase (16 in paper-based versus 53 in electronic reporting) in Incidence reporting, following introduction of electronic reporting at Yarmouk PHCC was demonstrated. A reduction of time consumption from 35 minutes in paper-based Incidence reporting to 10 minutes in electronic reporting was demonstrated. An improvement in accuracy while using electronic Incidence report (94%) in comparison to that while using Paper based Incidence reporting (85%) was documented. Due to advancement of technology today, it is imperative and strongly recommended to use principles of quality improvement process to improve patient safety and quality of care. Electronic Incidence reporting is found to improve quality and patient safety. Further studies into impact of better utilization of electronic Incidence reporting on health care outcomes is strongly recommended.

Mohamed1, et al., did a cross-sectional study was conducted among 279 diabetic patients attending the diabetic center in a specialized hospital in Aljouf Region, Saudi Arabia. A structured anonymous questionnaire was distributed to the targeted population during a direct interview. The present study showed that HbA1c was ?7% among 86% of the participants. Regarding lipid profile, abnormal HDL, LDL, triglycerides, and cholesterol levels were detected among 39.4%, 41.2%, 68.5%, and 50.2% of the participants, respectively. Severe depression and severe family dysfunction were detected among 22% and 6% of the participants, respectively. Increasing age was associated with higher LDL levels and diabetes duration was associated with higher HbA1c levels in patients with diabetes. The study concluded that family function and depression do not directly affect diabetic patients' diabetes metabolic control and the study showed a high prevalence of uncontrolled HbA1c levels and dyslipidemia among the study participants. Further investigation into the variables underlying the control of diabetes is required to further enhance patient outcomes because many people are still failing to meet the metabolic control objectives.

Alrashidi et al., did a systematic review aims to evaluate the effectiveness of different interventions in improving medication adherence. A comprehensive search was conducted to identify relevant studies. The review included a total of 14 studies. Interventions involving tailored phone calls or educational materials did not yield significant improvements in medication adherence. The authors concluded that the findings from this systematic review suggest that interventions tailored to individual patient characteristics and involving personalized support and education show promise in improving medication adherence. However, interventions relying solely on tailored phone calls, educational materials, nurse-led care, pharmacist-led consultations, stroke physician specialist assessments, behavioral feedback, medication reviews, or motivational interviewing may not consistently improve adherence.

Alkahmous et al., did a cross sectional study to assess Vaccination Rates and Barriers in Family Medicine Practices. This study examined the demographic factors, vaccination rates, and barriers to vaccination among 385 participants. The study found that 80% of participants expressed their willingness to take the COVID-19 vaccine. The study highlights the importance of vaccination and provides valuable insights into the demographic factors, vaccination rates, and barriers to vaccination. The findings emphasize the need for targeted interventions to address specific concerns and improve accessibility to vaccines. By addressing these barriers, public health authorities can enhance vaccine acceptance and achieve widespread vaccination coverage, thereby mitigating the impact of infectious diseases on public health.
Mohamad et al., in a systematic review address the various aspects of Autism in children Including clinical symptoms, evaluation, diagnosis and widely used medication or care.
Autism Spectrum Disorders (ASDs) describe a category of neurodevelopmental disorders in which individuals experience difficulties of social interaction and age-appropriate play and struggle to establish healthy peer interactions at their stage of development. The search strategy involved utilizing two primary sources for obtaining relevant literature: Google Scholar and PubMed. While children with autism spectrum disorders share many characteristics with children that have other developmental disorders and can benefit from many of the same educational strategies, they pose specific challenges for families, teachers, and others who collaborate with them. The lack of traditional friendships and peer relationships influences child motivation structures and the sense of experience. Adequate social experiences can be some of the most challenging and valuable lessons a child can learn with autism spectrum disorders.

Alotaibi et al., report on a case of neonatal tetanus in Saudi Arabia, studying the different factors lead to infection, role and protocols used in hospital in diagnosis and management of the case. A newborn 7-day old girl with poor socioeconomical status and poor a-septic delivery had been admitted to hospital with symptoms of jerky repetitive movement and history of decrees feeding and poor sucking for one day. Laboratory tests, cranial computed tomography (CT) and lumbar puncture were performed, all of them with normal results. She was hospitalized at 12 November, 2019 in environment free of sensorial stimuli In Pediatric Intensive Care Unit (PICU), with assisted ventilation. The patient was treated with metronidazole 30mg/kg/day, ampicillin 150 mg/kg/day, and cefotaxime 150mg/kg/day.
this case indicates that non-sterile delivery by non-practical attendants are the most cause of neonatal tetanus besides, un-immunized mother against tetanus. However, in the rarest of incidence of neonatal tetanus, physicians should be prepared to suspect, diagnosis and treatment of neonatal tetanus and ensure clear and clean delivery of newborns. A combination of antibiotics and muscular relaxants are used to manage neonatal tetanus.

Alzahrani et al., followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To determine the prevalence of pregnancy-related anxiety and its associated factors among pregnant women. A structured literature review was carried out using the component of the PICO framework. A total of 69 articles were identified through the searches, while 13 articles met the inclusion criteria. Anxiety disorders are common during pregnancy. There is wide variability in its measurement, with a subsequently wide range in reported prevalence rates. Several risk factors are associated with pregnancy-related anxiety, such as younger age, low income, past history of stillbirth, unwanted pregnancy, current comorbidity, or mental illness.

Mohamed; looked at the Effect of screen time on Children's Behaviour. As more of their leisure time is spent with screens such as iPhones, tablets, computer games, and televisions, parents, health experts, and educators are concerned about the impact of screen time on children's well-being. Excessive screen usage has a negative impact on the verbal, emotional, and physical growth of children. Because children and teenagers are naturally drawn to screens, the idea is to teach them how to use them responsibly. Screens may help promote self-esteem and give numerous chances for learning and growth when used with good screen objectives and abilities. Children, especially those above the age of three, respond to interaction programming that is entertaining, suited to them, and stimulates imitation or participation. Dynamic video games may encourage light-to-moderate or acceptable physical exercise in the near future. Families and child care providers may include more physical activity into daily routines by using fun, age-appropriate exercise (e.g., yoga or dance) and fitness apps or videogames. As a result of these concerns, parents are being advised to limit their children's screen time on a daily basis, with particular time constraint for children and a general guideline to minimize screen time in teenagers.