A menopause-specific quality of life questionnaire: development and psychometric properties.

OBJECTIVE: To develop a condition-specific quality of life questionnaire for the menopause with documented psychometric properties, based on women's experience. SUBJECTS: Women 2-7 years post-menopause with a uterus and not currently on hormone replacement therapy. Questionnaire development: A list of 106 menopause symptoms was reduced using the importance score method. Replies to the item-reduction questionnaire from 88 women resulted in a 30-item questionnaire with four domains, vasomotor, physical, psychosocial and sexual, and a global quality of life question. Psychometric properties: A separate sample of 20 women was used to determine face validity, and a panel of experts was used to confirm content validity. Reliability, responsiveness and construct validity were determined within the context of a randomized controlled trial. Construct validation involved comparison with the Neugarten and Kraines' Somatic, Psychosomatic and Psychologic subscales, the reported intensity of hot flushes, the General Well-Being Schedule, Channon and Ballinger's Vaginal Symptoms Score and Libido Index, and the Life Satisfaction Index. RESULTS: The face validity score was 4.7 out of a possible 5. Content validity was confirmed. Test-retest reliability measures, using intraclass correlation coefficients were 0.81, 0.79, 0.70 and 0.55 for the physical, psychosocial, sexual domains and the quality of life question. The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change. Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain, 0.66 and 0.40 for the vasomotor domain, 0.65 and -0.71 for the psychosocial domain, 0.48 and 0.38 for the sexual domain, and 0.57 for the quality of life question. Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain, 0.28 for the vasomotor domain, 0.55 and - 0.54 for the psychosocial domain, 0.54 and 0.32 for the sexual domain, and 0.12 for the quality of life question. Responsiveness scores ranged from 0.78 to 1.34. CONCLUSIONS: The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life.

An update on the etiology and epidemiology of diabetes mellitus.

Diabetes mellitus is one of the most common endocrine disorders affecting almost 6% of the world's population. The number of diabetic patients will reach 300 million in 2025 (International Diabetes Federation, 2001). More than 97% of these patients will have type II diabetes. The projected increase in the number of diabetic patients will strain the capabilities of healthcare providers the world over. Thus it is of paramount importance to revisit the causes and epidemiology of diabetes mellitus. Diabetes mellitus is caused by both environmental and genetic factors. The environmental factors that may lead to the development of diabetes mellitus include physical inactivity, drugs and toxic agents, obesity, viral infection, and location. While type I diabetes is not a genetically predestined disease, an increased susceptibility can be inherited. Genetic susceptibility plays a crucial role in the etiology and manifestation of type II diabetes, with concordance in monozygotic twins approaching 100%. Genetic factors may have to be modified by environmental factors for diabetes mellitus to become overt. An individual with a susceptible gene may become diabetic if environmental factors modify the expression of these genes. Since there is an increase in the trend at which diabetes prevail, it is evident that environmental factors are playing a more increasing role in the cause of diabetes mellitus. The incidence of type I diabetes ranged from 1.9 to 7.0/100,000/yr in Africa, 0.13 to 10/100,000/yr in Asia, approximately 4.4/100,000/yr in Australasia, 3.4 to 36/100,000/yr in Europe, 2.62 to 20.18/100,000/yr in the Middle East, 7.61 to 25.7/100,000/yr in North America, and 1.27 to 18/100,000/yr in South America. The epidemiology of type II diabetes is equally bleak. The prevalence of type II diabetes ranged from 0.3 to 17.9% in Africa, 1.2 to 14.6% in Asia, 0.7 to 11.6% in Europe, 4.6 to 40% in the Middle East, 6.69 to 28.2% in North America, and 2.01 to 17.4% in South America.

A controlled before-after trial of structured diabetes care in primary health centres in a newly developed country.

OBJECTIVE: To evaluate the long-term impact of a structured approach to improving the quality of diabetes care in general practice in the United Arab Emirates. DESIGN: Controlled before-after trial within a health district with three primary health centres (PHCs) in the intervention group and the six remaining serving as controls. Outcomes and adherence to guidelines were measured over the year before the intervention began and for a second 1-year period at the end of the intervention period. Data were collected by chart abstraction. SETTING: The study was performed in PHCs in the United Arab Emirates, a newly developed country on the Arabian peninsula. STUDY PARTICIPANTS: Subjects continuously followed in nine PHCs for diabetes care for the period of the study (N = 738) were included in the study. INTERVENTION: Structured diabetes care, including the development of general practice diabetes clinics, a patient education program, a health care professional education program, and improved recording of clinical information, was provided for the 33-month time period. RESULTS: There was a statistically significant improvement in three of the process of care variables (ordering HbA1c, cholesterol, and documenting foot examinations) whereas the four remaining variables did not improve. There was limited impact on outcome variables. CONCLUSIONS: The intervention described in this study demonstrated an improvement in some process of care measures suggesting an impact of this type of delivery model in this environment.

Factors associated with iron depletion and iron deficiency anemia among Arabic preschool children of the United Arab Emirates.

OBJECTIVE: The purpose of this study was: 1. To estimate the prevalence of iron depletion and iron deficiency anemia in preschool Arabic children of the United Arab Emirates (UAE), and 2. To determine the risk factors associated with these conditions in this population of children. METHODS: From April through to October 2000 a questionnaire and capillary blood survey was carried out in one primary health care (PHC) centre of Al Ain, UAE. Children whose capillary hemoglobin (Hb) or mean cell volume (MCV) results fell below predetermined cutoffs were offered venous blood workup. An additional sample of children with capillary blood results above those cutoffs were offered the same workup. All blood sampling was completed by May 2001. RESULTS: Five hundred and eight parents were questionnaired and 496 children capillary blood tested. Of the 320 venous blood tested, 315 were analyzed, in relation to questionnaire responses, using univariate analysis and logistic regression. Anemia, iron depletion and iron deficiency anemia were found in an estimated 36.1%, 26%, and 9.9% of this population of children. Age was a significant independent predictor of both iron depletion and iron deficiency anemia. Mother's current pregnancy was an additional predictor of iron deficiency anemia. CONCLUSION: The prevalences of iron depletion and iron deficiency anemia in this population of children were consistent with other reports from the region. Child's age and mother's current pregnancy were predictors of iron deficiency anemia. These findings have important implications for antenatal and childcare both in hospital and primary health care clinics.

Assessment of obesity, lifestyle, and reproductive health needs of female citizens of Al Ain, United Arab Emirates.

This study was conducted to determine the reproductive and lifestyle characteristics in a representative sample (n = 535) of women in Al Ain, United Arab Emirates, to guide the development of health programmes for this population with rising affluence. A cross-sectional survey was carried out using the stratified two-stage sampling technique. Although most women were young, were pre-menopausal, did not smoke, reported good health status, and 84% (95% confidence interval [CI] 81-87%) reported being sufficiently active to meet expert recommendations, the prevalence of obesity (defined by body mass index > or = 30) was very high (35%; 95% CI 31-39%) and many (28%; 95% CI 24-32%) reported having a chronic disease. The prevalence of obesity was associated positively with age and negatively with education (p < 0.001 for both). Postmenopausal women had significantly more chronic diseases, reported poor health more often, were less physically active (p < 0.001 for all), and had a higher percentage of body fat (p = 0.002) compared to premenopausal women. Health services should emphasize the prevention and treatment of obesity and improving the general health status of postmenopausal women.

Educational interventions to improve practice of nonspecialty physicians who are identified in need by peer review.

This article reports on the peer review process of the College of Physicians and Surgeons of Ontario, the licensing and regulatory authority, and the effect of educational interventions on physicians identified to be in need. Since 1980, the college has assessed more than 175 random and targeted nonspecialist physicians each year. A structured remediation process has been employed for those in need. Extensive data files have been maintained by the college. A majority of physicians identified as needing improvement improved and maintained their improved performance. The simple structured interventions employed by the college demonstrate an educational intervention that produces practice improvement.

The health status of community based elderly in the United Arab Emirates.

Little is known about the elderly in the United Arab Emirates (UAE), a country with both developing country features (high fertility rate, few elderly, strong traditional culture) and developed country characteristics (high-income economy, urbanized population, high growth rate of people aged 65+ years). In this cross sectional survey of 184 randomly chosen community based people aged 65+ years, the mean age was 71.8 +/- 6.3, 52% were female, 76% were married, 11% were literate, 89% lived in multi-generational households, 85% lived in households with servants and 15% had a personal servant. Health status was largely independent of age. Compared with the ambulatory aged USA population, the rate of functional independence in activities of daily living (ADL) (83%) was similar and chronic medical problems were less frequent, with the notable exception of diabetes (37% UAE, 10-12% USA). Almost all (95%) participants in this study rated their health as satisfactory or higher, compared with 82% of US ambulatory elderly. There appeared to be a significant under-diagnosis of psychological problems. In the presence of a high regard for traditional values, close family ties, universal practice of religion and high economic resources, the elderly in the UAE have a high level of health, which they maintain into their later years. There may be a need to substantially increase health care resources for aged care in the near future due to the high prevalence of diabetes, amount of hidden psychological morbidity and known demographic trends. Encouraging families to continue to provide home based long-term care may minimize the need for government intervention in this area.

A hematological survey of preschool children of the United Arab Emirates.

OBJECTIVE: Anemia is common worldwide, particularly in developing countries including states of the Arabian Peninsular. The purpose of this study was to produce a hematological profile of preschool national children of the United Arab Emirates (UAE). METHODS: From April 2000 to October 2000, a cross-sectional community clinic-based capillary blood survey was carried out on a convenience sample of 1-5-year-old Emirati children attending a Primary Health Care Center in Al-Ain, UAE. Those children with capillary hemoglobin (Hb) and mean corpuscular volume (MCV) values below predetermined cutoffs were offered venous blood hematological workup. A random sample of children with values above those cutoffs were also offered the same workup. All venous blood sampling was completed by May 2001. RESULTS: Four hundred and ninety six children were surveyed. The mean Hb and adjusted MCV rose with increasing age but were not significantly different by gender. Two hundred and sixty-two children with Hb or MCV below the cutoffs and 50 children above the cutoffs were venous blood tested. The estimated abnormalities for this population of children were as follows: anemia 36.1%; iron deficiency anemia 9.9%; glucose-6-phosphate dehydrogenase (G6PD) deficiency 9.1%; sickle cell trait 4.6%; and beta thalassemia 8.7%. There was likely to be a high prevalence of alpha thalassemia. CONCLUSION: Rates of anemia and iron deficiency anemia in this population of children were consistent with other reports from the region, but higher than in developed countries. Hereditary red cell abnormalities were common, particularly G6PD deficiency. The gene frequency of alpha thalassemia is likely to be high but requires DNA studies.

Validation of additional domains in activities of daily living, culturally appropriate for Muslims.

BACKGROUND: Measurement of activities of daily living (ADL) is an integral part of geriatric care. Prayer is a central part of the life of practicing Muslims. OBJECTIVES: To validate additional domains of ADL based on the functional capacity of Muslims to perform prayer, a culturally appropriate measure for those practicing the Islamic faith. METHODS: Functional capacity was measured using 2 scales: an 8-domain scale (ADL-8) and a 3-component domain scale assessing the key components of Islamic prayer: washing for prayer, physical motion during prayer and the words spoken. A randomly selected sample of 132 community-based practicing Muslim people from Arabic-speaking countries, aged 65+ years were assessed. RESULTS: The mean age +/- standard deviation was 72.6 +/- 7.0 with a female to male ratio of 0.97. The correlation between the summation scores for the prayer ADL and the ADL-8 was r = 0.922 (p < 0.001), while correlation with prayer ADL and each of the 8 components in the ADL-8 ranged from r = 0.806 (p < 0.001) to r = 0.906 (p < 0.001). There was a high level of construct validity with the reliability coefficient for the 3 components of the prayer ADL being 0.933 with a standardized item alpha of 0.935, with a range of 0.746-0.896 for the subscales. CONCLUSION: The prayer ADL domains provide an additional valid, short, simple and culturally orientated functional assessment for those of the Islamic faith.

The determinants of breast cancer screening behavior: a focus group study of women in the United Arab Emirates.

PURPOSE/OBJECTIVES: To explore perceptions, knowledge, attitudes, and beliefs about breast cancer and its screening among Emirati national women in Al Ain, United Arab Emirates. DESIGN: A qualitative study using focus group methods. SETTING: Primary healthcare centers and a community-based women's association in the United Arab Emirates. SAMPLE: 41 women, aged 25-45 years. METHODS: Four 90-minute focus group discussions exploring perceptions, knowledge, attitudes, beliefs, and practices regarding breast cancer were audiotaped, transcribed, translated, and analyzed. MAIN RESEARCH VARIABLES: Social and cultural themes related to breast cancer and its screening. FINDINGS: Focus group methodology worked well in this setting. The women's perceptions, knowledge, attitudes, and beliefs regarding cancer and screening, together with aspects of the healthcare system and social milieu, appeared to strongly influence the women's preventive practices. Some of these factors had an encouraging effect on the women's practices, and others had a deterring effect. The encouraging factors included feelings of susceptibility, high levels of knowledge in some women, attitudes and beliefs about personal responsibility for health, and a supportive social milieu. Deterring factors included anxiety and fear leading to denial; lack of knowledge about cancer and the screening program; fear, embarrassment, and mistrust of health care; and belief in predestination. CONCLUSIONS: Health planners and healthcare providers must capitalize on encouraging factors and minimize deterring factors to optimize breast cancer screening practices among these women. IMPLICATIONS FOR NURSING: Identifying and accounting for the factors that encourage or deter women in their breast cancer screening practices will help to optimize screening programs.

Primary prevention drug therapy: can it meet patients' requirements for reduced risk?

The objective was to identify, in primary prevention, patients whose "required risk reduction" (ReqRR) is greater than the "achievable risk reduction" (ARR) that cholesterol-lowering or antihypertensive medication could provide. Individualized estimates of 10-year coronary heart disease or stroke risk were derived for 66 hypercholesterolemic (HC) and 64 hypertensive (HT) patients without symptomatic cardiovascular disease. These estimates were used in trade-off tasks identifying each individual's ReqRR. Then individual ARRs were estimated (in HC patients by assuming total cholesterol/high density lipoprotein ratio reductions to 5.0; in HT patients by assuming systolic blood pressure reductions to 120 mmHg). 12 (18%) HC and 12 (19%) HT subjects would refuse medication regardless of the risk reduction offered. Of the remaining patients, 15/54 (28%; 95% C.I.:16-40%) HC and 19/52 (37%; 95% C.I: 24-51%) HT subjects were "over-requirers," in that their ReqRR/ARR ratio was 1.5. There maybe a notable proportion of patients whose ReqRR is considerably greater than what is achievable, implying that decision aids may help individuals clarify preferences about accepting/refusing medication for the primary prevention of cardiovascular disease.

Glycemic index of 3 varieties of dates.

OBJECTIVE: Dates are consumed worldwide and are a dietary staple for many Arabic people. The prevalence of type-2 diabetes mellitus is high in many developing communities, including many Arabic communities. The consumption of low glycemic index diets has been shown to have benefits for glycemic and lipid control. The purpose of this study was to determine and compare the glycemic indexes of 3 varieties of commercially available dates. METHODS: The available carbohydrate content of the dates was determined by standard laboratory methods. Normal volunteer subjects were fed the commercially processed khalas, barhi, and bo ma'an dates. Glycemic indexes were calculated by standard methods. Results were calculated using means and standard deviations. Glycemic responses were compared by using paired t-tests. The study was performed at the Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates, between March 2000 and August 2001. RESULTS: The mean glycemic indexes of the dates were 35.5 for khalas, 49.7 for barhi and 30.5 for bo ma'an. There was a significant difference between the results for bo ma'an and for the other 2 varieties. CONCLUSION: Dates can be classified as low glycemic index food items. There appears to be significant and unexplained differences in glycemic index between some date varieties. Nonetheless, the consumption of the 3 varieties of dates tested in this study may be of benefit in glycemic and lipid control of diabetic patients.

Ethics and family practice: some modern dilemmas.

Ethical dilemmas in family practice have increased in frequency and complexity as both the potential benefit and the potential harm of medical treatments have increased. All physicians must be aware of moral issues relating to medicine. Family physicians commonly face ethical problems concerning the patient with diminished autonomy; the right to refuse treatment; allocation of resources; informed consent; surrogate consent (for children, for the incompetent, and for those with diminished autonomy); and the appropriate level of aggressiveness in treatment.