Adherence of type-2 diabetic patients to treatment

To determine the percentage of non-adherent patients with type 2 diabetes [T2D] attending primary health care [PHC] settings and to assess related factors Cross sectional case-control study Five primary health care centers [one from each health region in Kuwait] Six hundred and ninety-three T2D patients Comparison between cases and control was conducted using univariate analysis followed by a logistic regression analysis. The collected data included sociodemographic, Clinical, and patients' practice data. Adherence to T2D treatment recommendations Among 693 participants in this study, 181 were diagnosed as non-adherent to treatment recommendations with an overall 26.1% rate. They were compared with 512 adherent patients. Within socio-demographic variables, only education and family income were proved to be significantly associated with adherence to treatment. Among Clinical variables, poor glycemic state [OR = 2.1, 95% CI: 1.2 - 4.7], hypertension [OR = 1.9, 95% CI: 1.2 - 3.2], co-morbid conditions [OR = 3.2, 95% CI: 1.3 - 6.2] were significant determinants of the outcome of interest. Regular follow- up visits, compliance with diet recommendations and mild physical activity were significant protective determinants related to patients' practice [OR = 0.4, 95% CI: 0.1 - 0.9], [OR = 0.3, 95% CI: 0.1- 0.6], [OR = 0.3, 95% CI: 0.2 - 0.8], and [OR 0.5, 95% CI: 0.2 - 0.9] respectively. Many amenable factors were associated with non-adherence. Health education to diabetic patients should be emphasied to improve patients' knowledge, attitude and practice to encourage their adherence. Further studies are needed regarding physicians' practice and their relation with patients

Domestic violence screening among primary health care workers in Kuwait

Screening for violence against women provides an important opportunity for early detection and proper management of affected women. Primary health care workers can play an important role to implement screening measures for women. Multiple factors such as knowledge, attitude as well as barriers and enabling factors available for medical staff can affect these programs. The aim of this study was to reveal the extent of screening for domestic violence among physicians and nurses in the primary health care unit, identify knowledge, attitude, and barriers toward violence screening, and reveal factors affecting screening. To achieve these objectives, an observational cross-sectional study was carried out in PHC centers located in two randomly selected health regions in Kuwait. The study involved all available physicians [210] and nurses [464] in the selected centers. The overall response rate was 54.3%. A self-administrative questionnaire was used for data collection. Less than two-thirds [62.5%] of the primary health care workers were aware about the topic while only about one-third [34.7%] regularly screened for violence among women. Of those regularly screening for violence, about two-thirds [66.1%] screened only less than 5% of women whom they examined, while 7.9% regularly screened more than 50% of their examinees. Physicians tended to screen for violence more than nurses as they constituted 51.2% of those screening compared with 26.4% of those not screening for violence, P < 0.001. Those screening for violence had a significantly higher mean percent overall knowledge score [73.8 +/- 9.5% compared with 70.9 +/- 11.2%, P =0.006] while they had a lower attitude score [65.5 +/- 16.5 compared with 70.1 +/- 18.6%, P =0.015]. Barriers related to the victim herself were the most common followed by those related to those related to women culture and administrative procedures. Primary health care workers admitted that they have low rates of screening for domestic violence against women. Physicians were more likely to screen for violence than nurses. Multiple barriers were revealed for screening including mainly those related to women whether their characteristics or culture in addition to administrative ones

Barriers for domestic violence screening in primary health care centers

Violence against women is an important public health problem that draws attention of a wide spectrum of clinicians. However, multiple barriers undermine the efforts of primary health care workers to screen battered women. Reveal barriers that might impede screening of women for domestic violence and compare the list of barriers of physicians and nurses. An observational cross-sectional study was carried out in primary health care centers located in two randomly selected health regions in Kuwait. The study involved all available physicians [210] and nurses [464] in the selected centers. The overall response rate was 54.3%. A self-administered questionnaire was used for data collection. Barriers related to the battered woman herself topped the list of ranks for both physicians [92.9 +/- 19.7%] and nurses [85.9 +/- 17.6%], P = 0.02, followed by women culture in general [89.5 +/- 17.2% for physician and 83.8 +20.8% for nurses, P = 0.38], then health administration barriers [78.7 +/- 22.4% for physician and 72.5 +/- 26.4% for nurses, P = 0.04]. Barriers related to the examiner appeared at the bottom of the list [67.8 +/- 26.9% for physician and 69.9 +/- 28.6% for nurses, P = 0.01]. Medical staff face major barriers in screening for domestic violence against women in the primary health care centers. Specifically tailored programs are required to enhance both knowledge and skills of the health care staff about the screening process. Infrastructure and physical environment needs modification to facilitate screening of women

Knowledge and attitude of primary health care staff screening and not screening for domestic violence against women

Violence against women is an important public health problem that draws attention of a wide spectrum of clinicians. Attitude and knowledge of the primary health care [PHC] staff can affect their ability and willingness to screen for and manage domestic violence [DV] against women. Reveal the impact of knowledge and attitude of workers to screen for DV against women. An observational cross-sectional study was carried out in PHC centers located in two randomly selected health regions in Kuwait. The study involved all available physicians [210] and nurses [464] in the selected centers. The overall response rate was 54.3%. Aself-administrative questionnaire was used for data collection. It included four main aspects relevant to knowledge and one attitude domain regarding DV. A 5-point, Likert-scale was used to assess participant's answers for each item. Male physicians were significantly more likely to screen for violence [36.2% compared with 18.8% for females, P < 0.001] and [51.2% compared with 26.4% for nurses, P < 0.001].Those screening for violence had a significantly higher mean percent overall knowledge score [73.8 +/- 9.5 compared with 70.9 +/- 11.2%, P= 0.006]. The only knowledge sub-domain showing significant difference was the psychological sub-domain [78.4 +/- 20.3 compared with 69.4 +/- 26.3%, P =0.004]. Although, no significant differences were detected for each of the questions of this domain yet, those not screening for violence had a significantly higher mean percent score than those screening for violence [70.1 +/- 18.6 compared with 65.5 +/- 16.5%, P = 0.015]. Physicians at the PHC centers screened for violence against women more than nurses. Although, the knowledge of those screening for violence was better than those for not screening, yet more positive attitude was demonstrated among those not screening. Task and skill based programs should be planned to enhance both knowledge and skills of the health care staff about the screening process. Other factors affecting the screening process such as infrastructure and physical environment need to be considered

Knowledge, awareness, and practices concerning breast cancer among Kuwaiti female school teachers

Breast cancer is by far the most frequent cancer of women. However the preventive measures for such problem are probably less than expected. The objectives of this study are to assess the breast cancer knowledge and awareness and factors associated with the practice of breast self examination [BSE] among female teachers. This study is a cross-sectional survey of teachers working in schools in Al-Jahra, governorate. A sample of twenty schools was selected randomly by the stratified sampling method from all schools of the selected governorate that included primary, intermediate and secondary schools. All ever married Kuwaiti female teachers working in the selected schools were asked to fill a self administered questionnaire to investigate their knowledge about the risk factors of breast cancer, their awareness and screening behaviors. Data were collected from 421 female teachers with 87.5% response rate. The results of the study showed that 67.5% of the participants declared that they had information about breast cancer and their sources of information were mainly health professionals/workers [98.2%], friends/neighbors [83.5%], TV/Radio [76.0%] and printed materials [60.2%]. Of the participants, 18.5% reported positive family history of breast cancer, 49.9% did not know how to practice BSE, 29.0% knew the procedure but never applied it. Moreover, 81.9% has no breast examination by health professionals and 85.7% did not know what the mammography is. The factors that may have an impact on acquiring satisfactory level of knowledge were, women older than 40 years, married, user of contraceptive pills, with a history of child death. The study points to the insufficient knowledge of female teachers about breast cancer and identified the negative influence of low knowledge on the practice of BSE

Knowledge, attitude and practice of nurses toward peak expiratory flow meter in primary health care centers in Kuwait

Peak expiratory flow meter [PEFM] is an easy to use, relatively cheap device that can be used for guiding management of bronchial asthma by the patients at home according to a preset plan by health care workers. The aim of the study is to reveal the extent of knowledge and perception of nurses about PEFM and factors affecting their knowledge. Out of the total primary health care centers in Kuwait, 50% were randomly selected. Out of 699 nurses currently working in the selected centers, 516 nurses were interviewed for this study with an overall response rate of 73.8%. The results of this study showed that nurses had a relatively low total knowledge score percent of 64.7 +/- 7.3%. The lowest individual mean percent score was that of procedures and steps of measuring peak expiratory flow rate [39.0 +/- 24.1%]. The highest percent knowledge score was that of benefits of use and content instructions for teaching patients [78.3 +/- 19.5% and 78.1 +/- 12.0%, respectively]. Sociodemographic factors did not affect the total knowledge score. Receiving training, availability of PRFM in the health center and being responsible about taking the measurements for patients proved to significantly affect the level of knowledge of nurses. Training nurses about use of PEFM and providing primary health care centers with the devices would plan an important role to improve knowledge of nurses and hence improve domestic health care of patients with obstructive lung diseases

Prevalence and factors associated with diabetic retinopathy, a multi-centric study in Kuwait

Diabetic retinopathy [DR] remains one of the major causes of vision loss and blindness in young adults despite the availability of effective treatment. To determine the prevalence of DR among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with DR. The current study is a part of a larger multi-centric one. The first phase of the study is a cross sectional one to determine the prevalence of DR among diabetic patients attending the selected primary health care centers. The second one was a nested case-control study, whereas all patients with DR [case group n = 216] were compared with all other diabetic patients without DR [control group n = 488] to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, in addition to health care characteristics and personal practice. Basic univariate analyses were followed by multiple logistic regression analysis. The prevalence of DR among adult diabetic patients attending primary health care centers was 43.6%. Of the personal factors examined, age was the only significant determinant of DR [OR = 2.2, 95% CI: 1.1 - 5.2] and [OR = 4.6, 95% CI: 2.0 - 11.0] for age groups 50 - 59 and > 60 as compared with those < 40 years respectively. Among clinical factors, patients with type 2 - insulin treated diabetes were more prone to have DR [OR = 8.0, 95% CI: 3.5 - 19.4]. Duration of diabetes was a significant predictor of DR [OR = 2.6, 95% CI: 1.61 - 4.2] and [OR = 2.8, 95% CI: 1.5 - 5.5] for a duration of 10 - 19 and > 20 years as compared with < 10 years respectively. Also, poor glycemic state and uncontrolled hypertension were associated factors [OR = 2.0, 95% CI: 1.2 - 2.8] and [OR = 3.1, 95% CI: 2.0 - 4.9] respectively. Cardiovascular complications, neuropathy, nephropathy and diabetic foot were significantly associated with DR. Within patients' practice, regular follow-up was proved to be a protective factor [OR = 0.5, 95% CI: 0.3 - 0.8] Regular follow-up is the strongest modifiable risk factor for DR. Old patients with longer duration of diabetes particularly those having other types of long term diabetic complications and on insulin therapy are more prone and should be regularly screened for DR

Factors associated with progression of diabetic retinopathy, a multi-centric study in Kuwait

Diabetic retinopathy [DR] is a progressive sight threatening diabetic complication. The prognosis seems to be related to largely modifiable risk factors. The aim of the study was to identify factors that could be associated with progression of DR. among adult diabetic patients attending primary health care centers in Kuwait. The current study is a part of a larger multi-centric one that included 704 diabetic patients. A nested case-control study was used whereas all patients with proliferative diabetic retinopathy [PDR] [case group, n = 33] were compared with all other diabetic patients with non-proliferative diabetic retinopathy [NPDR] [control group, n = 183] to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, laboratory investigations, in addition to health care characteristics and personal practice. Basically univariate analyses were followed by multiple logistic regression analysis. Out of 704 diabetic patients participated in the study 216 were diagnosed as having DR with an overall 30.7% prevalence rate. Among 216 patients with DR, 33 were diagnosed as PDR [4.7%] and 183 were diagnosed as NPDR [26.0%]. Of the personal factors examined, nationality was the only significant determinant of PDR [OR = 0.8, 95% CI: 0.71 - 0.9]. Among clinical factors, patients with type 2 - insulin treated diabetes were more prone to have PDR as compared to type 1 [OR = 1.2, 95% CI: 1.1 - 1.4]. Duration of diabetes > 20 years was a significant predictor of PDR [OR = 1.3, 95% CI: 1.1 - 1.5]. Also, poor hyperglycemia and hypertension were significantly modifiable risk factors [OR = 1.2, 95% CI: 1.1 - 1.3] and [OR = 1.2, 95% CI: 1.1 - 1.4] respectively. Ex-smoking was significantly associated with PDR [OR = 8.3, 95% CI: 3.3 - 23.8]. Hyperglycemia and hypertension are the strongest modifiable risk factor for PDR. Patients with longer duration of diabetes particularly those with type 2-insulin treated diabetes were more prone for PDR and should be regularly screened for DR

Prevalence and associated factors of thyroid dysfunction among type 2 diabetic patients, Kuwait

Diabetes mellitus is commonly associated with altered thyroid function. There is much less data about thyroid diseases in patients with type 2 diabetes. This study was conducted to examine the prevalence and associated factors of the most frequent thyroid dysfunction among type 2 diabetic patients. The study design can be differentiated into two components. The first was a cross-sectional survey to determine the prevalence of thyroid dysfunction among type 2 diabetic patients. Recruitment efforts resulted in 1580 patients. Thyroid dysfunctions were diagnosed in 204 patients. The second component of the study was a case-control study to identify factors associated with thyroid diseases, whereas patients with thyroid dysfunctions [cases] were compared with a randomly selected similar number of type 2 diabetic patients with euthyroid status. The prevalence rate of thyroid dysfunction in type 2 diabetic patients was 12.9%, the most common was subclinical hypothyroidism [45.1%]. The multivariate analysis revealed that female gender, Kuwaiti nationality, personal history of autoimmune disease and smoking were significant predictor variables. The prevalence of thyroid dysfunction among diabetic patients in Kuwait is common. Subclinical hypothyroidism is prevailing. All patients with type 2 diabetes should undergo bi-annual screening to detect asymptomatic thyroid dysfunction

Incidence and potential risk factors of low birth weight among full term deliveries

Low birth weight [less than 2500 grams] [LBW] is a reliable indicator in monitoring and evaluating the success of maternal and child health programs. Giving birth to a LBW infant is influenced by several factors. The aim of the study was to determine the incidence of LBW among live born full term deliveries in Al-Adan governmental hospital and to study the possible determinants of its occurrence. The first phase of the study was a descriptive one including all live born full term deliveries of women attended the hospital within the first 2 months of pregnancy and followed up till delivery. In the second phase LBW women [cases] were compared with a double number of women who gave birth to normal birth weight infants. Among 939 women eligible for the study, the incidence of LBW was 7.8%. Reproductive age lower than 25 years, gestational age lower than 40 weeks, history of previous abortion, primiparity, maternal underweight and anemia were detected as independent risk factors for LBW. On the other hand, obesity was a protective factor. Low birth weight occurs frequently in Kuwait, although its incidence is much lower than in many countries in the region. Prenatal management of modifiable factors and adequate antenatal care and screening for susceptible women should be a target for all obstetricians for reducing the incidence of LBW

Prevalence and factors associated with chronic diabetic complications among patients attending primary health care, a multi-centric study in Kuwait

A substantial proportion of patients with diabetes develop long-term macrovascular and microvascular complications. Many risk factors have identified for development and progression of these complications. The aim of the present study was to determine the prevalence of these complications among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with especially those factors that can be considered avoidable. This study was carried out in five primary health care centers representing the five health regions in Kuwait. The sample included 704 adult diabetic patients who had been diabetic for at least 2 years. The first phase of study was a cross sectional study to determine the prevalence of chronic diabetic complications. The second one was a case-control study, whereas all patients with chronic diabetic complications [case group, n = 434] were compared to diabetic patients free from chronic complications [control group, n = 270] to determine the associated factors with cases. Analysis was initially carried out based on a series of univariate comparisons followed by multiple logistic regression analysis. Out of 704 diabetic patients 61.6% n= had one or more chronic diabetic complications. Cardiovascular complications were diagnosed in 30.3%, nephropathy in 12.4%, neuropathy in 32.1%, lower limb complications in 21.9%, and retinopathy in 30.7% of patients. Logistic regression analysis revealed that age, nationality, type and duration of diabetes, glycemic control, hypertension, obesity, physical exercises, and compliance with diet recommendations were proved as significant predictors of these complications. The high economic burden raised by diabetes and its complications challenges the Kuwaiti health care system to prevent the development and progression of diabetic complications. The study identified a group of predictor factors as hypertension and hyperglycemia, enhancement of patient' compliance with regular follow-up visit, the role of health care providers in supplying patients with health information groups of patients who needed priorities of screening programs for development of complication

Knowledge and attitude of primary health care providers regarding domestic violence. a validation study

Violence against women is a worldwide problem with extensive repercussions. Primary care physicians frequently are the first in the community to encounter the battered woman. They must be equipped with the necessary knowledge, training and experience. We developed a questionnaire to obtain information from the physicians and nurses on various aspects of domestic violence [DV] The aim of this study was to test the reliability and validity of this questionnaire to evaluate knowledge and attitude of primary care providers towards DV. This study was carried out in 5 primary health care centers on 10 physicians and 10 nurses who were asked to complete a self-administered close-ended questionnaire that included 4 main aspects relevant to DV, namely knowledge, attitude, causes and topics that participants were interested in to be included in training workshops. Each domain consisted of a number questions [items]. Test-retest reliability was tested by Spearman's correlation coefficients. To evaluate for internal consistency, parity co-variances were used to estimate Cronbach' alpha. Discrimination between participant groups [physicians and nurses] was tested by Mann-Whitney test. Spearman's correlation was utilized to test the correlations between different domains to evaluate the convergent validity. Test re-test reliability of the questionnaire revealed that all scales were reliable, with an overall significant strong correlation [r=0.90]. Testing the internal consistency revealed that coefficients of Cronbach's a were>0.80 for all domains except for items of management of DV and relationship causes of DV. Overall, the scales of the questionnaire could discriminate between physicians and nurses [P=0.001]. Attitude scores were significantly higher in nurses, whereas knowledge and causes scores were higher in physicians. Within each studied aspect, the scores of different domains in the questionnaire were positively correlated with each other significantly. The questionnaire was reliable and valid for assessing knowledge, attitude and other aspects of DV among primary care providers

Knowledge of primary care physicians regarding domestic violence

Domestic violence [DV] is considered as one of the most frequent forms of gender-based violence. Since primary care physicians frequently are the first in the community to encounter the battered woman, they must be equipped with the necessary knowledge, training and experience. The aim of this work was to study the knowledge and perception of primary care physicians about DV. This study was carried out in all primary health care centers in Kuwait. All physicians who were currently working in these centers during the study period were asked to complete a self-administered close-ended questionnaire that included personal and working conditions information. It included also Knowledge about prevalence of DV, and 4 main aspects relevant to DV, namely deprivation, psychological, physical and sexual domains. A 5-point, Likert-scale was used to assess participant's answers for each item. For each participant, the scores were summed and categorized into high and low considering the median as the cutoff level. Out of 900 physicians currently working in primary care, 565 returned the filled questionnaire with a response rate of 62.8%. The study revealed that physicians' knowledge about the prevalence of DV were poor. A large group of physicians had negative perception to DV particularly regarding deprivation aspect. Nearly all physicians agreed about statements of physical and sexual domains. Psychological items scores came in between deprivation in one side and physical and sexual aspects in the other side. After adjustment for confounding, only female gender and family physicians [FPs]/specialists remained as significant factors associated high knowledge and perception score. Less than a third of the participating physicians received their knowledge and instructions about DV from scientific formal sources as medical schools, training courses and conferences. The majority of them [>80%] indicated that they were willing to receive training or guidelines instructions in the different topics for management of DV in the future. Overall, primary care physicians had poor knowledge regarding DV. Although female doctors and FPs are somewhat more knowledgeable about DV, many more educational activities are needed

Attitude of primary health care physicians in Kuwait towards domestic violence against women

Domestic violence against women is an important public health problem. The medical practitioner's personal value system and beliefs about domestic violence can play an important role to deal with problem and provide support to battered women. The current study was formulated to reveal attitude of physicians towards domestic violence against women and factors affecting this attitude. To achieve such aims, a sample of 565 physicians were interviewed out of 899 physicians selected for this study with an overall response rate of 62.8%. The target population for this study was all physicians in the primary health care centers in Kuwait. The results of the current study revealed that physicians tended to have a relatively low positive overall attitude score towards violence against women [60.75 +13.16%], with a mean percent score of 42.36 +15.37% for relationship between partners domain, 75.73 +21.80% for good reasons to hit wives domain, and 58.39 +17.11% for management of domestic violence domain. Female physicians tended to have a higher positive attitude score than males [62.9 +13.36% compared with 58.3 +12.52%, P<0.001] as well as for each attitude domain. Years spent at the current job negatively correlated with the total attitude score of physicians towards domestic violence against women. There is a great need to improve attitude of physicians about domestic violence, especially against women through properly planned training programs so that a better medical care and support of battered women can be achieved

Attitude of primary health care nurses in Kuwait towards domestic violence against women

Domestic violence against women is an important public health problem. Battered women attend primary health care centers seeking for both medical treatment and support. Nurses with a positive attitude play a key role to deal with victimized women. The current study was formulated to reveal attitude of nurses towards domestic violence against women and factors affecting this attitude. All 1617 nurses registered in primary health care centers in Kuwait were the target population for this study. A total of 988 nurses were interviewed with an overall response rate of 61.1%. The results of the current study revealed that nurses tended to have a relatively low positive overall attitude score towards violence against women [58.3 +13.82%], with a mean percent score of 42.9 +15.99% for relationship between partners domain, 69.7 +21.03% for good reasons to hit wives domain, and 58.7 +20.59% for management of domestic violence domain. Female Kuwaiti nurses tended to have higher positive attitude score than male non-Kuwaiti nurses. Years spent at the current job negatively correlated with the total attitude score of nurses towards domestic violence against women. Training nurses about domestic violence, especially against women can improve their attitude and hence a better medical care and support of battered women

Comparison of attitude of primary health care physicians and nurses towards domestic violence against women

Domestic violence [DV] against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. The current study was formulated to compare attitude of physicians and nurses towards DV against women. All physicians and nurses currently working in the primary health care centers in Kuwait [2516] were asked to answer a self-administered questionnaire. Out of them, 1553 completed the questionnaire with an overall response rate of 61.7%. Physicians tended to have a higher positive overall attitude score towards violence against women than nurses [60.75 +13.16% compared with 58.3 +13.82%, P<0.001], with a mean percent score of 75.73 +21.80% compared with 69.7 +21.3% for good reasons to hit women domain. No significant differences were revealed between the two groups for either the relationship between partners domain [42.36 +15.37% compared with 42.9 +15.99%, P=0.679] or the management domain [58.39 +17.11% compared with 58.7 +20.59%, P=0.104]. Relatively low positive attitude scores were recorded by primary care physicians and nurses Yet, physicians tended to have higher scores than nurses. There is a great need to improve attitude of health care workers, especially nurses, about DV against women through properly planned training programs

Clinical profile and medical care of type 1 diabetics in Kuwait

Although the mult[factorial nature of type 1 diabetes mellitus is still not resolved yet especially the interaction between the genetic and environmental roles yet, the complications of the disease is well established. The current study was formulated to describe the epidemiological features of type 1 diabetics and reveal the common complications of type I diabetics as well as reveal the extent of achieving the intended medical care targets for diabetics. The study design is a cross sectional descriptive one whereas 63 type I diabetics were randomly selected from 5 diabetes health centers that represent the five health regions of Kuwait. The results of the study showed that the mean age of the studied population was 30.27 +/- 10.45 years. The majority [63.5] were women. Only 35.4% could achieve the targeted fasting blood glucose level while just 18% could achieve the targeted HbA1c level. Also, 28.6% could demonstrate a "good" body mass index. The majority were adherent to regular use of drugs [82.5%] and regularly visiting the diabetes center [76.2%]. Only 17.3% were practicing moderate physical activity while 27% were self monitoring their blood glucose and 61.9% were testing blood for glucose at home. Those suffering from cardiovascular complications constituted 20.6% of the sample and the same percent suffered from nephropathy while 28.6% had peripheral polyneuropathy. Retinopathy was detected among 14.3% while vascular lower limb complications were revealed among 30.9%. In general, the available medical resources and facilities need to be more and properly utilized. More effort is needed to achieve the targeted health care levels

Are waist circumference and body mass index independently associated with severity of knee osteoarthritis in elderly Kuwaiti populations?

Osteoarthritis [OA] of the knee is one of the major causes of pain and physical disability. Obesity is perhaps the strongest modifiable risk factor for the progression of the disease. The study aimed at exploring the associations between the severity of knee osteoarthritis [OA], and body mass index [BMI], and waist circumference [WC] as two putative parameter of obesity. The study design is a cross sectional one, in which 110 patients with idiopathic symptomatic knee OA were classified using Health Assessment questionnaire [HAQ] score into row groups: mild/moderate [48 patients] and severe [62 cases]. A pre-designed questionnaire included personal data, anthropometric measurements and results of clinical and radiological examination. Basic univariate analyses were followed by multiple logistic regression analysis. Of the risk factors examined, obesity was the only significant determinant of progression of knee OA [OR = 48.8, 95% CI: 2.9-90.2], while female gender and presence of Heberden's nodes showed border line statistical significance [OR = 1.5, 95% CI: 1.0 - 2.2 and OR = 1.4, 95% CI: 1.0 - 1.9 respectively]. Weight, BMI and WC were significantly correlated with HAQ severity score of OA. Obesity is the strongest modifiable risk factor for the severity of osteoarthritis. Weight loss may reduce the risk of progression of OA of the knee, BMI and waist WC can be used as clinical measures and predictors of the severity of knee OA

Prevalence of diabetic nephropathy and associated factors in type 2 diabetes mellitus in primary health care in Kuwait

Diabetic nephropathy is the leading cause of chronic kidney disease in patients starting renal replacement therapy. Optimal reduction in the morbidity and mortality of diabetic nephropathy cases require early identification of at risk patients allowing application of appropriate management protocols. This study aimed at identifying the prevalence rate of nephropathy among patients with type 2 diabetes attending primary health care centers, and determining risk factors associated with diabetic nephropathy. The study was conducted in 3 primary health care centers in Kuwait. The design can be differentiated into two components. The first one was a cross sectional descriptive study to determine the prevalence of nephropathy. The second one was case-control study to define factors associated with nephropathy. The prevalence of nephropathy in type 2 diabetes in primary care was 22.1%. The prevalence of microalbuminuria alone was 11.1%. Patient age 50-60 years, duration of diabetes >/= 5 years, smoking, blood pressure, Hb[Alc], HDL cholesterol, triglycerides were independently associated with diabetic nephropathy. The prevalence of diabetic nephropathy in type 2 diabetes in primary care in Kuwait is relatively low as compared with other countries. Many factors are associated with nephropathy in type 2 diabetic patients. Therefore attention needs to be paid to all these factors especially those, which are amenable to improvement. This would require intervention at a community level starting screening programs for early detection of microalbuminuria, control of glycemic state and blood pressure, treatment of dyslipidemia, and health education regarding smoking and dietary habits

Accuracy of cause-of-death statements on death certificates; before and after a training program in Kuwait

Population-based mortality statistics are derived from the information recorded on death 1ertificates. Many physicians did not receive adequate training in completing death certulcates resulting in undermining the quality of the data derived from death certificates. A training program for all certifier physicians in Kuwait has been conducted. The objective of this study was to examine improving the accuracy of death certificates for coding and the results of an audit of death certificate accuracy before and after this training program. An educational intervention was designed and implemented to improve accuracy in death certificate completion. A total of 2020 death certificates [986 completed before and 1034 completed after the intervention] were audited for major and minor errors, and the proportion of errors before and after the intervention was compared. Major errors were identified in 69.1% of the death certificates completed before the intervention. Following the intervention the major error proportion decreased to 34.6% [P=0.001]. The reduction in the major error proportion was accounted for by significant reductions in the proportion of listing of mechanism of death whiteout a legitimate underlying cause of death [27.0% v. 18.4%, P=0.001] and the proportion of improper sequencing of death certificate information [41.8% v. 15.9% P=0.001]. No improvement in minor errors or demographic errors. Errors are common in the completion of death certificates in Kuwait. The accuracy of death certification can be improved with the implementation of a simple educational intervention