General practitioners behavior, attitudes, and knowledge in relation to heart failure, Kuwait

To evaluate the knowledge of primary care physicians on the diagnosis and treatment of heart failure. A cross-sectional study was conducted during March 2009. An English form self-administered questionnaire was used. Out of 458 questionnaires distributed to all physicians working in primary health care in Kuwait during the study period 320 questionnaires were complete. The questionnaire consists of 22 questions to gather primary care physicians. Socio-demographic characteristics, type of practice and primary care physicians' knowledge of heart failure [including etiology, symptom and sign, diagnostic procedures and treatment. The response rate of completed questionnaires was 69.9%. Male subjects constituted 65.5% of all participants. More than two-thirds of the subjects were of 30-49 years of age [72.5%] over three-quarters of primary care physicians were general practitioners and 69.4% of primary care physicians, were working in general practitioner clinic. 59.4% of primary care physicians were having a disease register than would enable them to identify heart failure patients and 63.1% were participating in audit of prescribing for heart failure. Most participants thought that early diagnosis and management of heart failure improve quality of life and mortality [99.1%] and [96.9%] respectively. Majority of primary care physicians diagnosed heart failure on symptoms and signs alone [63.4%] without formal investigation or referral. Primary care physicians described the most frequent signs or symptoms of heart failure is oedema or breathlessness. Many primary care physicians arrange a chest X-ray [96.6%] and electrocardiography [91.6%] to establish the diagnosis and some arrange an echocardiogram [30.6%]. Only 28.5% described that the best diagnostic test of heart failure is echocardiography. 83.4% of participants claimed to prescribe for most of their patients with heart failure loop diuretics followed by Angiotensin converting enzyme inhibitor [76.2%] and cardiac glycosides [57.5%]. The vast majority of primary care physicians believed that there was strong evidence of reduced mortality in heart failure patients when using Angiotensin converting enzyme inhibitors. About two third of primary care physicians consider that beta blocker carry side effects in heart failure and should be cautiously use in heart failure. Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many primary care physicians in Kuwait treat people with suspected heart failure on the basic of symptoms and sings alone. Echocardigraphy is underused which may hamper the accuracy of heart failure. Angiotensin converting enzyme inhibitors and beta-blockers are also underused. These findings demonstrate that knowledge about diagnosis and treatment of heart failure is insufficient among primary care physicians and indicate the need for educational and systematic changes, including a wider access to echocardiography

Smoking among health care workers of the capital governorate health region, kuwait: prevalence and attitudes

To determine the prevalence of smoking among health care workers in the Capital Health Region and associate it to socio-demographic characteristics, and to study attitudes and behavior of smoking and quitting. A cross-sectional study was conducted during August and September 2002. All health care workers at Ministry of Health facilities, Capital Region, including Al-Amiri Hospital and the health centers propagated through the Capital Region were invited to participate using a self-administered questionnaire. The survey collected information on socio-demographic characteristics and on behavior and attitudes toward smoking and quitting. Out of a total of 1,625 participants in the study, 604 were male and 1021 were female; 76.4% were married, 47.7% were nurses and 41.1% had received a diploma. The overall prevalence of smoking among participants was 16.8%. The prevalence of smoking was 37.3% among males and 4.4% among females. It was observed that the prevalence of smoking was high among clerks [30.5%] and among those who had primary level of education [45.5%]. The majority of males [78.7%] started smoking before the age of 20 years while the highest percentage of females [60.5%] started after. The majority of male smokers [74%] attempted to stop smoking while only 50% of females attempted to quit. 8.8% of participants were classified as ex-smokers; they were obviously used to smoking fewer cigarettes daily. Health Care Workers have to set a good example to others by playing a vital role at various levels of smoking cessation. Hence, comprehensive tobacco control laws including bans on tobacco advertising and smoke-free public places, large clear health warnings and health education campaigns are needed

Prevalence of depression among Kuwait patients attending the Sawaber Health center

To determine the prevalence of depression among Kuwaiti patients attending a primary health care clinic. Subjects and A c ross-sectional study of consecutive Kuwaiti patients who attended the Sawaber clinic for physical medical problems, aged between 21 and 64 years during November and December 2002. One hundred and twenty-five patients were interviewed in detail about their socio-demographic characteristics, and the mental status examination was done by using the items of the American Diagnostic and Statistical Manual for Mental Disorders [DSM-IV criteria] to elicit symptoms of depression. Diagnosis of depression was based on DSM-IV criteria. Result: The study group consisted of 45 [36%] males and 80 [64%] females; 46.4% were clerks, 83.2% were married and 76% belonged to the medium socio-economic level. Based on the clinical interview, 29.6% of subjects fulfilled DSM-IV criteria for depression. Out of these, 78.4% were females, 70.3% were married and 64.9% were of intermediate socioeconomic level. Significantly, more female patients had depression. Depression was significantly commoner among patients who were married and from the low socioeconomic group. None of the subjects had suicidal thoughts. It is recommended that doctors in primary care settings should be aware of psychiatric morbidity in general, and depression in particular, with a view to