BACKGROUND AND OBJECTIVESThe current picture of the Saudis’ use of complementary and alternative medicine (CAM) has not yet been developed. The aim of this study was to assess the feasibility of using the international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q) in Saudi Arabia to evaluate the use of and out-of-pocket spending on CAM.DESIGN AND SETTINGSIt was a cross-sectional study, conducted in 2011, in primary health care centers in Qassim.METHODSIn a multistage sampling technique, 12 primary health care centers were selected randomly in the Al-Qassim province in Saudi Arabia. From each center, 100 attendants were interviewed for a total of 1160 completed questionnaires.RESULTSA total of 74% of subjects had visited CAM providers in 12 months before the survey. This percentage decreased to 47.6% when spiritual healers were excluded. The specific CAM providers who were visited were spiritual healers (26.7%), herbalists (23.2%), providers of honeybee products (14.9%), and hijama (wet cupping; 13%). Chronic illnesses were the main reason for the visits. A total of 50% of subjects were satisfied with their visit. Physicians were the providers of CAM for 11.3% of the participants. More than 75% of the subjects used herbs in the previous 12 months for medical and health reasons, while only 25% used vitamins or minerals. Self-help was used in 26% of the participants. Relaxation (10.3%) was the most common self-CAM practice followed by meditation (6.7%). The subjects spent 350 000 (US$) on CAM visits and 300 000 (US$) purchasing CAM products.CONCLUSIONSI-CAM-Q can be used in different populations and cultures in the East including Saudi Arabia after customization to overcome its limitations, as the questionnaire was developed in Western societies.

Introduction: During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies. Design and settings: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated. Results: From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale >4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p,0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005). Conclusion: Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards.

Objective: To compare the injury risk between rear-facing (RFCS) and forward-facing (FFCS) car seats for children less than 2 years of age in the USA. Methods: Data were extracted from a US National Highway Traffic Safety Administration vehicle crash database for the years 1988-2003. Children 0-23 months of age restrained in an RFCS or FFCS when riding in passenger cars, sport utility vehicles, or light trucks were included in the study. Logistic regression models and restraint effectiveness calculations were used to compare the risk of injury between children restrained in RFCSs and FFCSs. Results: Children in FFCSs were significantly more likely to be seriously injured than children restrained in RFCSs in all crash types (OR = 1.76, 95% CI 1.40 to 2.20). When considering frontal crashes alone, children in FFCSs were more likely to be seriously injured (OR = 1.23), although this finding was not statistically significant (95% CI 0.95 to 1.59). In side crashes, however, children in FFCSs were much more likely to be injured (OR = 5.53, 95% CI 3.74 to 8.18). When 1 year olds were analyzed separately, these children were also more likely to be seriously injured when restrained in FFCSs (OR = 5.32, 95% CI 3.43 to 8.24). Effectiveness estimates for RFCSs (93%) were found to be 15% higher than those for FFCSs (78%). Conclusions: RFCSs are more effective than FFCSs in protecting restrained children aged 0-23 months. The same findings apply when 1 year olds are analyzed separately. Use of an RFCS, in accordance with restraint recommendations for child size and weight, is an excellent choice for optimum protection up to a child's second birthday.I n the USA, the rate of vehicle occupant deaths for children 1-3 years old has decreased by over 50% in the last 30 years 1 largely due to increased use of child restraint systems. Despite these impressive declines, however, motor vehicle crashes remain the leading cause of death for children 1-4 years of age. 2Although current child restraint systems have been shown to be effective, further reductions in child passenger injuries may be achieved by improving car seat features and designs. In particular, the orientation of car seats (rear facing or forward facing) probably plays a significant role in car seat effectiveness. By supporting the entire posterior torso, neck, head, and pelvis, a rear-facing car seat (RFCS) distributes crash forces over the entire body rather than focusing them only at belt contact points. In contrast with a forward-facing car seat (FFCS), an RFCS supports the child's head, preventing the relatively large head from loading the proportionately smaller neck with relatively weak neck musculature. 3 The primary question regarding car seat orientation is at what age children should make the transition to an FFCS, given that both biomechanical and practical considerations have to be taken into account.In the USA, the American Academy of Pediatrics and the National Highway Traffic Safety Administration (NHTSA) have developed guidelines stating that a child sho...

The adjusted age-dependent risks indicated by the current study should be considered when calculating or projecting pedestrian morbidity and mortality. Adjustment in statistical models is essential to achieve precise risk estimates and in turn to appropriately allocate public health rescores.

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Research in primary health care (PHC) is underdeveloped and scarce, especially in developing countries. It is important to understand the attitudes and aspirations of PHC physicians for the promotion of research. The aim of this study was to determine the attitudes of PHC physician managers toward research in Qassim province and to identify barriers that impede performing research in the PHC system. The study was based on social cognitive theory framework, and was pre-experimental with a 'one-group pre-test-post-test' design. The study participants were physician managers in PHC administration, Qassim. The participants' attitudes were measured by adapting statements from the Attitude Towards Research scale. The intervention was the 1-day training program 'Introduction to Research in Primary Health Care'. A total of 23 PHC physicians participated in the study. The mean age of the participants was 45.4 (±1.6) years, and the mean years of work experience was 16.2 (±2.2) years. Only one participant had an article published in a peer-reviewed journal. The results of the study showed that PHC physicians had a baseline positive attitude toward research that was further enhanced after participating in an introductory research-training program. During the pre-test, out of the total score of 63, the mean score on attitude toward research was 48.35 (±6.8) while the mean total attitude score in the post-test was 49.7 (±6.6). However, the difference was not statistically significant at P<0.05. The item with the highest score regarded the role of research in the improvement of health care services, while the lowest-scoring item was about support from administration to conduct research. The participants recognised lack of skills, lack of training and inadequate resources as major barriers in conducting research. Our study results suggest that the PHC physicians' positive attitudes toward research can be further improved through in-service training. To promote research in PHC in Qassim, regular research-training programs and incentives for conducting research should be provided to the PHC physicians.

The manuscript 'Car safety seats for children: rear facing for best protection' was published in Injury Prevention in 2007, after peer review. The paper used US data from the National Automotive Sampling System Crashworthiness Data System to conclude that children 0-23 months were less likely to be severely injured when using a rear-facing car seat than a front-facing car seat. This result, along with similar data from Swedish experience and biomechanical studies, has been used as the basis for public education and policy recommendations that favor a rearfacing position for children under age two in car seats. In 2016, the journal was contacted by a biostatistician employed as an expert witness in a court case involving a car seat manufacturer. She indicated that she was unable to replicate the results of the analysis reported in the Henary et al paper. The same letter was also forwarded to authors of the 2007 study. A subset of that authorship group attempted to replicate the analysis reported in the original published manuscript but were unable to do so. Specifically, they believe that survey weights were improperly handled in the initial analysis, which caused the apparent sample size to be larger than the actual sample size. This resulted in estimates of effect size that appeared to be statistically significant but were not. It is important to stress-per the authors-there is no evidence that current recommendations are harmful. However, these field data alone are inadequate to statistically support the safety benefit of rear facing seats. Indeed, given the relatively small number of injured passengers in the age range of interest, it is unsurprising that the estimates have wide confidence intervals. Decades of experience might be required to prove a benefit in rear facing position using this data set alone. Because of serious concerns regarding the magnitude, significance and replicability of the findings reported in this paper, the journal made the decision to retract it. A revised, peer-reviewed analysis of the same data, and an extended analysis of data through 2015, was published in Injury Prevention in November 2017. McMurry TL, Arbogast KB, Sherwood CP, et al. Rear-facing versus forward-facing child restraints: an updated assessment. Injury Prev.