Prevalence and Risk of Polypharmacy among Community-Dwelling, Elderly Kuwaiti Patients.

OBJECTIVES: To estimate the prevalence of polypharmacy in community-dwelling, older Kuwaiti patients, describe the number and types of drugs used, and identify risk factors associated with polypharmacy. SUBJECTS AND METHODS: This was a descriptive cross-sectional questionnaire-based survey in which we interviewed 500 community-dwelling Kuwaiti adults over 65 years of age. The data collection occurred during a 4-month period from March to July 2017. RESULTS: Fifty-two percent (n = 260) of the patients were males, with a mean age of 71.73 ± 5.32 years. The prevalence of polypharmacy (5-8 drugs) and excessive polypharmacy (>8 drugs) was 58.4% (n = 292) and 10.2% (n = 51), respectively. The risk factors associated with an increased number of medicines used were: female gender (p = 0.019), a lower level of education (p = 0.003), a high number of hospital admissions (p = 0.000), clinics visited by the patient (p =0.000), and number of comorbidities (p = 0.000). The most commonly used medications (82.6% of the study population) were blood glucose-lowering agents, excluding insulin. Other commonly used medications were antihypertensive drugs and lipid-modifying agents. CONCLUSION: A significant sector of the older Kuwaiti patient population has a high prevalence of polypharmacy and is thus exposed to its potential hazards. The current study highlights the need to revise the drug-dispensing policy among community-dwelling, older Kuwaiti people, as well as to initiate educational programs among healthcare practitioners concerning prescribing issues in older individuals.

Symptoms and health complaints and their association with perceived stress at university: survey of students at eleven faculties in Egypt.

AIMS: This study examined the relationships between perceived stress and a range of self reported symptoms and health complaints in a representative sample of students at one university in Egypt. METHODS: The data (3,271 students) was collected during the academic year 2009-2010 at eleven faculties at the university of Assiut city, Egypt. A self-administered questionnaire measured health complaints (22 symptoms) and Cohen's Perceived Stress Scale. Socio-demographic and lifestyle data were also collected. Factor analysis generated four groups of health complaints: psychological, circulatory/breathing, gastrointestinal, and pains/aches, and the internal consistency of each group of symptoms was computed using reliability analyses (Cronbach's alpha). Perceived stress was categorized into four levels based on quartiles. Multiple binomial or multinomial logistic regression analyses analysed the relationship between each of the four groups of symptoms and other students' general characteristics adjusted for the effect of all other groups of symptoms. RESULTS: The symptoms most often reported as having occurred sometimes/very often in the last 12 months were fatigue (85.3%), difficulties to concentrate (78.1%), headache (77.9%), and mood swings (74.5%), while nervousness/anxiety (63.2%) and sleep disorder (63.7%) affected many students. Multinominal logistic regression revealed a clear association and a linear trend between increasing level of stress and a higher frequency of psychological symptoms that remained significant after adjustment for other groups of symptoms. There were no associations between perceived stress and circulatory/breathing symptoms, gastrointestinal symptoms, or for pains/aches. Poor health was consistently associated with higher frequency of symptoms across all symptom groups except for gastrointestinal symptoms. Higher health awareness was associated with lower frequency of psychological and circulatory/breathing symptoms but not for the other two symptom groups. Better quality of life was associated with lower frequency of psychological and partly for circulatory/breathing symptoms, but not for the other two symptom groups. There were differences in levels of psychological symptoms and of perceived stress between faculties, where students of Physical Education showed the lowest risk profile regarding both psychological symptoms and perceived stress, while students of Veterinary Medicine showed the highest risk profile. Across all four symptom groups, females had higher ratings of complaints than males. CONCLUSIONS: The high prevalence of health complaints especially of psychological and pains/aches type of symptoms raise concern and calls for preventive actions at universities. Comprehensive programmes would be recommended that take the co-occurence of perceived stress and health complaints into account.

Family support for women's health-seeking behavior: a qualitative study in rural southern Egypt (Upper Egypt).

This qualitative study investigated the influence of family support on women's health-seeking behavior in rural southern Egypt (Upper Egypt). We carried out separate focus group discussions (FGDs) with 3 groups (6 women with children under 5 years old, 6 men, and 4 elderly women, respectively) in a village in Assiut Governorate, an underprivileged region in Upper Egypt. The FGDs aimed to identify how different types of family support affected women's health-seeking behavior in areas including maternal health and common illnesses of women and children. Our results showed that maternal health issues were often discussed by husbands and wives, while mothers-in-law had little apparent influence. We also found that women could access support resources more easily than expected through their extended families. Our study showed that husbands had an important role in encouraging women's health in the family, while the effect of mothers-in-law on women's health-seeking behavior was not substantial. The study indicated that women received considerable support from co-resident family members, their natal family, and their neighbors, which helped women in seeking health services.

Body image concern and its correlates among male and female undergraduate students at Assuit University in Egypt.

INTRODUCTION: This cross-sectional study examined variables associated with body image concern (BIC) and whether these associations differed between female and male students in Egypt. During the period 2009-2010, 3271 undergraduate students (1663 females, 1504 males) at Assuit University in Egypt completed a self-administered questionnaire that assessed BIC and other socio-demographic and health related variables. METHODS: Based on Cooper et al.'s Body Shape Questionnaire the authors categorized BIC into 'no BIC'; 'mild BIC'; and 'moderate/marked BIC'. Multifactorial linear regression analysis examined the association between BIC and BMI, body image perception, lifestyle (physical activity, nutrition, smoking) and mental well-being variables (quality of life, finances-related stress, perceived stress, perceived health, depressive symptoms). RESULTS: About 40% of the female students and 25.6% of male students reported having mild to marked BIC. The correlates of BIC did not exhibit striking differences between male and female students. For both genders, BIC was positively associated with BMI, body image perception as being too fat and with depressive symptoms. Self-rated health was inversely associated with BIC. CONCLUSION: These findings suggest that health promoting strategies should address the co-occurrence of depressive symptoms and BIC, and should furthermore pay due attention to higher prevalence of BIC among female students.

Physical and Psychological Well-being of University Students: Survey of Eleven Faculties in Egypt.

BACKGROUND: We examined perceived health status and physical and psychological well-being of 3,271 undergraduate students attending eleven faculties in a university in Egypt. METHODS: During 2009-2010, participants completed a self-administered questionnaire that gathered socio-demographic, physical and psychological health data. Body mass index (BMI) was calculated from students' measured height and weight. Differences across these variables were computed by gender and participating faculties. RESULTS: Whilst more females watched and rated their health favorably, they were more likely to feel psychosomatic/physical health problems, to have seen a medical practitioner or been ill that they had to stay in bed. Females were consistently more likely to feel burdened overall, and across several aspects apart from financial problems. Less females had 'normal' BMI, were satisfied with current weight, perceived their body image as 'just right', or were not worried about their shape. More males rated their quality of life favorably. About 25% of males and 32% of females were either overweight/obese. Exams, presentations, and the lack of time for studies were the frequently-reported burdens. Comparisons of health/well-being indicators across the participating faculties suggested some evidence of 'clustering': Favorable indicators would cluster at some faculties; and conversely, less favorable variables would cluster at other faculties. CONCLUSIONS: Generally, the levels of some health complaints and psychological problems/burdens are higher than in other countries. Increased vigilance of university administrators and leaders to monitoring the health and well-being of their students, as well as their health needs is required if policy makers are to operate from a valid evidence base platform. Given cultural factors prevalent in the Eastern Mediterranean region generally, female students might require particular attention. The clustering effects suggest the need for local (faculty-specific) health and well-being profiles as basis and guidance for relevant health promotion programs in faculty/university settings.

Barriers to the use of basic health services among women in rural southern Egypt (Upper Egypt).

This cross-sectional study examined potential demand-side barriers to women's use of basic health services in rural southern Egypt (Upper Egypt). Face-to-face interviews with a structured questionnaire were carried out on 205 currently-married women, inquiring about their use of health facilities: regular antenatal care (ANC) during the last pregnancy and medical treatment services when they suffered from common illness. Questions about their perceptions of barriers to the use of health services were categorized into three primary dimensions: structural, financial, and personal/cultural barriers. Distance and transportation to health facilities (structural barriers) prevented about 30 % of the women from seeing a doctor. Forty-two percent of them felt the difficulty paying for health services (financial barriers). Approximately a quarter of women answered that gaining family permission, allocating time to go to health facilities, or concern about lack of female physicians (personal/cultural barriers) was a big problem for them. After controlling for potential confounding factors, structural barriers showed an inverse association with the use of health services. Financial barriers indicated a strong association (OR=0.18, P<0.001) with the use of curative services (medical treatment), but not with the use of preventive services (regular ANC). Contrary to our expectation, personal/cultural barriers had no statistical significance with women's use of health services. Although the Egyptian government had successfully extended basic health service delivery networks throughout the country, women in rural Upper Egypt were still facing various barriers to the use of the services, especially structural and financial barriers.

Correlates of smoking, quit attempts and attitudes towards total smoking bans at university: findings from eleven faculties in Egypt.

OBJECTIVES: Smoking among university students represents a formidable and global public health challenge. We assessed the associations between socio-demographic, health and wellbeing variables as independent variables, with daily smoking, attempts to quit smoking, and agreement with smoking ban as dependent variables. METHODS: A sample of 3258 undergraduate students from eleven faculties at Assiut University, Assiut, Egypt, completed a general health questionnaire. RESULTS: Overall daily or occasional smoking in last three months prior to the survey was about 9% (8% occasional and 1% daily smokers), and smoking was generally more prevalent among males (male=17%, female=0.6%, P < 0.001). After adjustment for confounders, not having normal BMI and having a mother who completed at least bachelor's degree education was positively associated with daily smoking, and conversely, no history of illicit drug use was a protective factor. About 76% of smokers had attempted to quit smoking within the last 12 months prior to the survey. Although a large proportion of students agreed/ strongly agreed with the banning of smoking at university altogether (87%), such agreement was less likely among smokers. CONCLUSION: There is need for implementation of non-smoking policies on university premises, as well as regular up-to-date information on, and the periodic/yearly monitoring of tobacco use by university students employing standardised data collection instruments and reference periods. In addition, it would be valuable to develop campus-based educational/ awareness campaigns designed to counteract tobacco advertisement directed towards young people in Middle East countries. Otherwise, the danger could be that the current relatively low smoking prevalence among university students may escalate in the future.

Factors associated with wife beating in Egypt: analysis of two surveys (1995 and 2005).

BACKGROUND: Wife beating is an important public health problem in many developing countries. We assessed the rates of wife beating and examined factors associated with wife beating in 1995 and 2005 in Egypt. METHODS: We used data from two Demographic and Health Surveys (DHS) conducted in Egypt in 1995 and 2005 using multistage household sampling. Data related to wife beating included information from 7122 women in 1995 and 5612 women in 2005. Logistic regression was used to analyze factors independently associated with wife beating. Special weights were used to obtain nationally representative estimates. RESULTS: In 1995 17.5% of married women in Egypt experienced wife beating in the last 12 months, in 2005--18.9% or 16.0%, using different measures. The association between socio-demographic differentials and wife beating was weaker in the newer survey. The 12-month prevalence of wife beating was lower only when both partners were educated, but the differences across education levels were less pronounced in 2005. Based on the information available in the 2005 survey, more educated women experienced less severe forms of wife beating than less educated women. CONCLUSION: Different measures used in both surveys make a direct comparison difficult. The observed patterns indicate that the changes in prevalence may be masked by two opposite processes occurring in the society: a decrease in (severe forms of) wife beating and an increase in reporting of wife beating. Improving the access to education for women and raising education levels in the whole society may help reducing wife beating.