Journal of General Practice

Saudi Arabia is the largest state in Middle East and is a major force in the Arab world due to its oil wealth. The prevalence of disability is growing rapidly in the kingdom of Saudi Arabia. The government has taken number of reforms to improve health care system. As a consequence health care services improved significantly in recent decades. There is still greater requirement for rehabilitation services due to reasons such as growing population, change in life style leading to greater incidence of diabetes mellitus, cardiovascular diseases, increased road traffic accidents leading to head injury, stroke, spinal cord injury etc. This paper focuses on the current structure and future challenges of tertiary care in the capital city of Saudi Arabia, Riyadh.

The article aims to evaluate the current state of sexual and reproductive health policy regarding sexual and reproductive health service and reproductive rights for most at risk adolescent/youth. The training of trainers and local trainings present the nature of major challenges in service provision and the quality of services in the light of findings from international trainings conducted in Turkey and Tajikistan. The process of course development and feedback from participants was in focus of attention. The major findings of the study show that the past 10 years have seen unprecedented commitments to global health and development became known as the Millennium Development Goals with their corresponding set of time-bound targets. Greater attention to adolescence Sexual and Reproductive Health and Rights is needed if global health targets are to be met. However, for specific target group as most-at-risk adolescents and young people the access to the quality comprehensive package of reproductive health services is not reality yet. In this article we present the most-at-risk adolescent/young people trends, health service needs and in service trainings on providing comprehensive sexual and reproductive health and rights in the Eastern European and Central Asia countries based on official bodies statements, researchers evidences and acquired experience. The main conclusion is that healthcare providers and services providers, those who work with most-at-risk populations, vulnerable groups of young people, have to be trained to be able to meet the specific needs of most-at-risk adolescents and young people, to respond to their needs and to ensure sexual and reproductive health services and rights. These special trainings are definitely relevant to target populations, especially most at risk adolescents and young people in the Eastern European and Central Asia Region.

Objective: Alzheimer’s disease (AD) is a neurodegenerative disease of aging with unknown causative factors. Accumulating evidence suggests that inflammation and neurovascular dysfunction play important roles in AD. The postprandial period following a moderately high-fat meal is associated with vascular inflammation in young, healthy individuals; however, this relationship has not been investigated in Alzheimer’s patients despite their exaggerated inflammatory state. Methods: Patients with AD and age-matched control subjects were recruited through the UC Davis Alzheimer’s Disease Center. All subjects consumed a moderately high-fat breakfast meal. Fasting and postprandial blood samples were collected for lipid, lipoprotein, and oxylipin analyses, as well as assays for cytokine levels and monocyte activation. Results: The plasma lipid analyses revealed similar levels of triglycerides and esterified oxylipins between groups, but there was an interaction between postprandial non-esterified fatty acid (NEFA) levels and body mass index in the AD group compared to the control subjects. The AD group also had increased behenic acid and decreased linoleic and oleic acids in the postprandial period; however, these were not significantly different. Inflammatory assays revealed elevated fasting levels of interleukin (IL)-10 and IL-12 p70, but no change in monocyte activation in the AD group. Conclusion: The postprandial period following a moderately high-fat meal is not associated with an exaggerated inflammatory state in Alzheimer’s patients, and basal esterified oxylipin profiles do not indicate elevated oxidative stress. However, the baseline inflammatory state during fasting in AD patients includes elevated levels of plasma IL-10 and IL-12 p70, which may indicate a balance between immune responses mediated by these interleukins.

The high worldwide incidence of both acute and chronic pain leads to widespread consequences for both the healthcare system and the economy. First-line pain treatment options are typically oral pain medications; however, concerns regarding side effects, prescription drug abuse, risk of overdose, patient non-adherence to treatment regimens, and lack of efficacy in certain conditions provide a number of challenges for both healthcare providers and patients. As a result, healthcare providers have become increasingly interested in new ways to manage pain and develop customized treatment plans for their patients. Compounded transdermal pain medication may offer benefits such as customizable dosages and formulations, the ability to combine multiple drugs with various mechanisms of action, the likelihood of lower systemic absorption with minimization of side effects, more convenience and consequent improved adherence to treatment regimens, and minimization of risk of abuse and addiction. This review offers an overview of examples to provide evidence of the benefits of transdermal compounded pain medication in the treatment of a number of pain-related conditions, including neuropathic, musculoskeletal, arthritis-related, and postoperative pain, among other conditions.

The presented review is based on the survey of various computational tools that are being used to design novel compounds commonly referred as drugs. These drugs are commonly used in general practice by licensed professionals including physicians, chemists, pharmacists, doctors, etc. These drugs include drugs for depression, stress, fever, etc.

The use of medicinal plants among pregnant women and lactating is a common practice in diverse countries. However, many medicinal plants are contraindicated during pregnancy and lactating, due to various adverse effects, such as teratogenic, embryotoxic and abortive effects, exposing these women, their fetus and babies to health unknown risks. Thus, the purpose of this commentary, was to analyze the perception about the use of medicinal plants by pregnant women and lactating registered in the "baby on board" NGO, Araraquara, São Paulo state, Brazil, between 2010 at 2013. The group was constituted by 48 women, between the first and last trimester of pregnancy or whilst breastfeeding. Information was collected during group meetings by oral interview, using a questionnaire, as script. The nature of the study was a qualitative analysis. The results were based on reports about the use of medicinal plants by pregnant women during group meetings: use, indication of use, knowledge about risks. All participants received written and oral information about the study and they gave a written informed consent. The use of medicinal plants is a reality among pregnant and lactating women of the "baby on board" NGO. They reported that they feel that "natural" products are not harmful for their health. The primary information sources for the majority of women about medicinal plants during pregnancy are family, neighbors and herbalists. The plants most cited (in popular name in Brazil) were: senna, chamomile, boldo, lemon balm, lemon grass. They were used mainly for: nausea, heartburn, indigestion, flatulence, intestinal and abdominal pain, anxiety, intestinal constipation and low milk production. The pregnant and lactating women lacked knowledge about the health risks of the use of medicinal plants and herbal medicines in pregnancy and lactation. They also reported difficulties in clarifying some questions about the use of medicinal plants with their doctors. The results of the present study showed that educative actions about the rational use of medicinal plants in pregnancy and breastfeeding could be part of the operating protocols to promote the maternal and child health programs in Araraquara. Thus, our results also suggest the importance of creating institutionalized places, to the implementation of continued education programs about rational use of medicinal plants in pregnancy and lactation. These targeted programs are not only for health professionals, but also for community members, pregnant women and breastfeeding. Our results pointed out the importance of guidance of doctors and healthcare professionals on the scientific studies about medicinal plants and herbal medicines and the risk/benefit of using herbs during pregnancy. Finally, it is noted the importance of the health professionals to inform women of childbearing on risks to their health, as well as on possibilities of utilization of herbs during fertile period, giving special attention to the potential risk of self-medication.

The overbearing financial burden imposed by the U.S. healthcare system is a complex problem which must be addressed soon. Diabetes, with its multiple cardiovascular sequelae, is currently one of the largest contributors and threatens to worsen as the obesity epidemic blossoms. The implications of atherosclerosis and hypertension related to diabetes may take years to become evident, making the overall disease process a particularly insidious one. Similarities between the biochemical mechanisms of vascular damage in diabetes may someday be the key to preventing its significant morbidity. Until we are able to capitalize on the similarities in the development of complications of hyperglycemia, preventative medicine should be the focus. Lessons should be learned from the widespread success of anti-tobacco legislation and educational programs in decreasing the prevalence of smoking and subsequent pulmonary disease. New York has already passed legislation limiting the size of sugary drinks that can be sold in the city. Efforts should be made to redirect care from the end stages of this particular disease to preventing it in the lower socioeconomic class, where poor diet may be more of an issue.