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 and perception of domestic violence among primary care physicians and nurses: a comparative study

Domestic violence [DV] has a deteriorating influence on society by affecting victims, their children, families, and friends, as well as social and financial relationships. Primary care providers, including physicians and nurses, frequently are the first in the community to encounter the battered women. The aim of this work was to compare the knowledge and perception of primary care physicians and nurses about DV. This study was carried out in all primary health care centers in Kuwait. All physicians and nurses 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 four 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. The response rate was 62.8% for physicians and 61.1% for nurses. The study revealed that the overall knowledge score was higher in physicians than nurses. Also, the scores for the individual domains were significantly higher for physicians than nurses except for psychological one. Overall, primary care physicians and nurses had poor knowledge and many had negative perception regarding DV. Although physicians are somewhat more knowledgeable about DV, many more educational activities are needed

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

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

Peak expiratory flow meter [PEFM] may reduce diagnostic delay and improve decision-making in asthma by providing an objective assessment of their flow. Knowledge of nurses and physicians in primary health care can play an essential role to enhance the response of patients about the measurements of peak expiratory flow [PEF]. The aim of the study was to reveal the extent and pattern of knowledge and perception of physicians and nurses about PEFM. Out of the total primary health care centers in Kuwait; only 50% were randomly selected. A total of 895 physicians and nurses were interviewed out of 1324 individuals currently working in the selected centers for this study with an overall response rate of 74.4%. The questionnaire contained a knowledge section consisted of seven domains with a total of 41 questions. The results of this study showed that physicians had a relatively higher total knowledge score percent than nurses [66.2 +/- 10.5% compared with 64.7 +/- 7.3%, P =0.004]. Physicians tended to have higher knowledge score for steps of use, defining normal values, and concepts of measurements domains of knowledge, while nurses had significantly higher score values for benefits of use, indicators of use, general concepts, and instructions for learning patients' knowledge domains of PEFM. Due to different patterns of knowledge and practice of nurses and physicians, training programs should be specifically tailored for each group to bridge the gap of knowledge and improve deficient practices

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

Epidemiological, clinical, and biochemical profile of type 2 diabetes in Kuwait

Type 2 diabetes mellitus is considered as one of the major public health problems in Kuwait. Many factors affect the standard of health care and achieving preset specific targets particularly patients' practice and utilization of health care facilities. The current study was formulated to describe the epidemiological features of type 2 diabetics and to reveal the common complications of type 2 diabetics as well as the extent of achieving the intended medical care targets. The study design is a cross sectional descriptive one whereas 64] type 2 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 54.3 +/- 10.4 years, with almost equal proportions for males and females [49.9% and 50.1%]. Only 31.3% could achieve the targeted fasting blood glucose level while just 19% could achieve the targeted Hb[A1c]. level. Also, 14% could demonstrate a "good" body mass index. The majority were adherent to regular use of drugs [85.5%] and regularly visiting the diabetes center [80%]. Only 17.3% were practicing moderate physical activity while 6.2% were self monitoring their blood glucose and 29.3% were testing blood for glucose at home. Those suffering from cardiovascular complications constituted 31.2% of the sample while 11.5% were suffered from nephropathy and 32.4% from peripheral neuropathy. Retinopathy was detected among 32.1% while vascular lower limb complications were revealed among 43.6%. 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

Prevalence of voice health problems among school teachers in Kuwait

Voice health problems are considered one of the important occupational hazards affecting school teachers. These problems can negatively affect health and performance of teachers. This study aimed at revealing the nature and prevalence of vocal symptoms and voice disorders among school teachers in Kuwait, and identifying risk factors that contribute to voice disorders and their impact on teachers. A cross sectional study was conducted. The stratified random sampling method was adopted to select 1077 teachers from 36 schools covering primary, middle and secondary school stages. A self administered questionnaire was utilized to collect data. It was found that 17.5% of studied teachers suffered from vocal disorders during one scholastic year. Female teachers were more likely affected than male teachers [26.1% compared with 5.9%]. Teachers in primary schools tended to have higher prevalence of vocal disorders than those in the middle or in the secondary schools [24.4% compared with 12.8% and 14.2% respectively]. Easy tiredness and hoarseness of voice were the most prevalent vocal symptoms [39.2% and 37.1%] among teachers. Out of the total studied teachers, 17.5% consulted a physician, 12.4% had voice related sickness absence while only 0.7% were hospitalized because of voice health problem. Those regularly using soothing agents for the throat constituted 7.6% of the total teachers. A high prevalence of voice health problems exists among school teachers in Kuwait. Female gender, noisy classes, positive history of past smoking, being Kuwaiti and free of chronic diseases in addition to practicing external activities using voice and teaching in a school with male gender proved to be significant risk predictors of vocal cord disorders among teachers

Impact of patient satisfaction with health care on glycaemic control among diabetic patients

Patient satisfaction with medical care is an important factor affecting treatment outcome in a chronic disease like diabetes mellitus. This study was formulated to detect the impact of patient satisfaction on glycaemic control among diabetic patients. The cross-sectional design was selected. A sample size of 526 diabetic patients was selected from a diabetes clinic to reveal the impact of patient satisfaction on fasting blood glucose and glycated haemoglobin A1c. The structured interview technique was adopted to collect both socio-demographic and clinical data of diabetic patients in addition to a fasting blood sample. The overall satisfaction and communication domains have the highest satisfaction mean scores [14.27 +/- 1.878 and 13.65 +/- 1.476], while accessibility and waiting time domains have the lowest satisfaction scores [8.97 +/- 2.059 and 8.99 +/- 1.387]. Diabetics with higher total satisfaction score were practicing regular periodic check up [82.37 +/- 7.027 compared with 78.63 +/- 7.538, P < 0.001], diet control [82.55 +/- 6.632 compared with 80.88 +/- 7.596, P = 0.0113] and were adherent to treatment regimen [81.96 +/- 7.072 compared with 77.92 +/- 8.068, P < 0.001]. Diabetic patients achieving the targeted level of either fasting blood glucose [83.35 +/- 6.777 compared with 80.72 +/- 7.418, P <0.001] or HbA1c [85.66 +/- 5.211 compared with 80.48 +/- 7.415, P < 0.001] had a significantly higher total satisfaction score than those not achieving the targeted levels. Satisfied diabetics with administered health services were more adherent to healthy practices and had a better control on HbA1c the long term component of glycaemic control

Effects of occupational exposure to lead and noise on hearing

Noise induced hearing loss is one of the most common and expensive sources of compensated work related health problems in modern industrialized countries. This study was conducted to detect the combined effect of occupational exposure to noise and lead on hearing. An observational analytic comparative approach was selected for this study. The inference population comprised 208 production workers from the Egyptian Copper Works Company in Alexandria, of these workers 51 were exposed to both noise and lead, 54 workers were exposed to noise, 53 workers were exposed to lead, and the rest, 50 workers were not exposed to neither noise or lead. All workers were subjected to a detailed interview, physical examination, otological examination, and auditory evaluation through a pure-tone audiometry, speech audiometry [Speech Reception Threshold [SRT] and Speech Discrimination Score [SDS]%], tympanometry, and auditory brain-stem response audiometry. Moreover, the blood lead level of workers, and workplace noise intensity were measured. Clinical evaluation of workers revealed a significant increase in mean systolic blood pressure among lead exposed and noise exposed workers. Neurological manifestations [tremors, tingling/numbness, reduced visual acuity and headache], urinary troubles, and oral manifestations gingivitis and bleeding gum], were significantly more encountered among lead exposed workers and workers with combined exposure. On assessing the workers' mean hearing threshold of the right ear, it was evident that at low frequencies [250 Hz and 500 Hz] the maximum significant drop was recorded among the workers with combined exposure [30.2 +/- 9.8 dB, 30.2 +/- 9.74 dB respectively], compared to lead exposed workers [29.15 +/- 8.42 dB, 28.49 +/- 6.97 dB respectively], and noise exposed workers [27.68 +/- 6.98 dB, 28.43 +/- 7.57 dB]. On the contrary, at higher frequencies [1 KHz - 8 KHz] the maximum drop was recorded by noise exposed worker. Regarding the left ear, the maximum impairment at low frequencies was observed among lead exposed workers [28.3 +/- 8.08 dB, 28.49 +/- 9.38 dB respectively], but at the higher frequencies a similar pattern to that observed at the right ear was obtained. Noise exposed workers had the most impaired mean SRT [31.48 +/- 8.22 dB], while workers with combined exposure recorded the worst mean SDS% [91.67 +/- 6.06%]. No significant delay was observed in the Auditory Brainstem Response [ABR] audiometry recorded at the latencies I, III, and V and inter-peak latencies; I-III, I-V, and III-V for the studied workers. On calculating the total hearing impairment percent, noise exposure imposed the worst effect on hearing, where both noise exposed workers and workers with combined exposure had the highest mean hearing impairment percent [15.25 +/- 13.61%, 13.22 +/- 13,49% respectively]. Among noise exposed workers, the significant predictors of hearing impairment were the duration of employment and smoking. While, blood lead level and aging were the significant predictors for hearing impairment among workers with combined exposure. Cochlear affection is the main site of lesion in noise and/or lead exposed workers, and the risk of combined exposure to noise and lead imposed on the auditory system sensitivity at the studied levels of exposure is nearly similar to that encountered by noise exposure alone

Effectiveness of self monitoring of blood glucose on glycaemic control among diabetic patients

Self monitoring of blood glucose [SMBG] is becoming of great importance for self management of diabetes mellitus. This study was formulated to detect the impact of decreased SMBG on glycaemic control among diabetic patients. The design of this study was a cross-sectional one. A sample size of 526 diabetic patients was selected from a diabetes clinic to reveal the impact of SMBG on fasting blood glucose and glycated haemoglobin A1c. The structured interview technique was adopted to collect both socio-demographic and clinical data of diabetic patients in addition to a fasting blood sample. Out of the total sample, 59.7% were performing SMBG, while only 18.6% were monitoring using this technique according to the recommended standard. Users of SMBG were more likely to have controlled fasting blood glucose [29.9% compared with 20.8%, P = 0.09] and controlled HbA1c [25.5% compared with 6.6%, P < 0.001] than non users. This impact was also evident after adjusting for the confounding factors. A decreasing trend in FBG was demonstrated with increased frequency of SMBG. Older age, higher level of education and positive family history proved to be significant predictors for using SMBG. SMBG can help diabetic patients to achieve a better glycaemic control especially if it is used in the recommended frequency. SMBG should be encouraged among all diabetic patients

Personal factors and working conditions as predictors of work injuries among industrial workers

The purpose of this study was to determine the personal factors and working conditions that predict work injuries among industrial workers. To fulfill this aim, a case control study was conducted including 2003 industrial workers who sustained a work injury and an equal number of controls. All were subjected to an interview questionnaire to collect relevant information. Moreover, records were reviewed to obtain the medical history of enrolled workers. Data revealed that workers in the index and control groups are comparable in respect to their sociodemographic characteristics. The multivariate logistic regression analysis pointed out that safety training significantly reduces the risk of work accidents among industrial workers. On the other hand, work accidents are more likely to occur in the main working shift. Moreover, workers who suffer from chronic health problems calling for surgical treatment, as well as those who reported family problems, are more likely to experience work accidents. These workers should receive considerable attention to reduce the extent of work injuries. More importantly, safety-training programs are mandatory for accident prevention in industrial settings

Are new textile machines more safe?

The aim of this study was to assess the effect of machine replacement on accident pattern in textile industry. Accident's records were reviewed for a period of 2 years before the intervention and another 2 years, thereafter. In all mills, improved design of new machines could explain the significant reduction of machines as accident's agency of caught in or between objects type of accidents, and of accidents with hazardous condition due to lack of protection. Insignificant changes were observed in the frequency of injuries among production workers and foremen, as well as unsafe acts following replacement which could be attributed to insufficient or inefficient training. Increased frequency of boxes as agency of accidents could be due to their bad design and handling. Defective ground caused insignificant reduction of ground surface as agency of accidents. It was concluded that, in the studied factory, the new textile machines contributed to the reduction of work accidents as reflected by the injury index. Moreover, great potential for further reduction could be achieved through efficient training of workers, and improvement of methods of transportation between mills, as well as good housekeeping of the workplace

Effects of heavy metals exposure on hand function performance

The neuromuscular system is one of the most important systems of the body affected by heavy metals exposure. In order to assess its dysfunction, hand function performance using hand grip and pinch test were carried out to two groups of workers exposed to inorganic lead and inorganic mercury separately. It was found that both heavy metals exposed workers showed a weak hand grip and pinch test results when compared to their controls. Also a negative significant association was found between the level of lead in blood or mercury in urine with the power of small muscles of the hand and long flexor muscles. The duration of employment was found to play an important role in the weakness of the muscles of the hand specially if it exceeds 15 years. We recommend the use of this simple non invasive technique periodically to assess the integrity of the neuromuscular system in such exposed workers

Epidemiological features of virus hepatitis in Saudi Arabia

This study included all cases of Hepatitis A [n=202] and Hepatitis B [n=77] notified during the year 1987 to the Centre for prevention and Control of Communicable Diseases in the Eastern province of Saudi Arabia. Cases of Hepatitis A were more likely to be female patients aged one to less than 20 years, residing in Dammam and Khafgi with higher prevalence during summer. The source of infection was local in 91.58% of cases with almost no spread of the disease to others in 99.01% and about half of cases were isolated and treated at home. On the other hand, cases of Hepatitis B were more encountered among adult males aged 20 to less than 40 years and residing in Khobar. The source of infection was exotic in 14.29% of cases. With spread of the disease in 72.73% and almost three quarter of cases were isolated in Hospitals

Mother's opinions of when to attend health centres for antenatal care

A case control study was carried out in 3 health centres in Dammam City during the period from may to august 1989. a number of 500 women matched age groups of late and early attenders for antenatal care was interviewed

Seasonal variation in spontaneous abortion

Spotaneous abortion can be defined as the termination of previable conception through natural causes. The aim of this work was to estimate the spontaneous abortion rate as well as to find out if there is any seasonal variation in this estimate, untilizing data of the child health care in primary health care centers in dammam, saudi arabia in the years 1986, 1987 and 1988. The study showed significant periodic changes of the average monthly spontaneous abortion rate, with peak to low ratio 2.6399 and expected between May and June. This finding maybe due to increase in recreational activities during this period of the year. Further researches are highly recommended to reveal the possible real cause leading to this high rate of spontaneous abortion in this period of the year.