Gamal Makboul

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

Abstract Background Breast cancer is by far the most frequent cancer of women. However the preventive measures for such problem are probably less than expected. Objectives 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. Methods 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. Results 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. Conclusions 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 patients attending primary care centers toward vitamin D in Kuwait

Abstract Background Extracellular calcium is vital for the functioning of many metabolic processes and neuromuscular activities. Awareness and practice of patients with vitamin D deficiency are very important. Objective To explore knowledge, attitude and practice of patients receiving vitamin D supplement and attending primary health care (PHC) in Kuwait. Subjects and methods The study design is a simple descriptive cross-sectional one that was carried out in two PHC centers. Two hundred patients were selected randomly from a list of all registered patients in the selected centers. Criteria for inclusion included adult age ⩾18 years, diagnosis with hypovitaminosis D within a year, and under vitamin D supplement. Results Only 28.5% of participants were aware about their condition, 53.5% related pain to vitamin D deficiency, 33.5% knew the presence of relation between vitamin D deficiency and joint pain. One third of the participants received the loading dose of vitamin D, and, 17.5% had the maintenance dose. Only 21.0% believed that they feel better regarding musculoskeletal symptoms after taking treatment doses and 12.5% of the participants knew that the level of vitamin D dropped again after stopping medication. Only 29.5% knew the relation between vitamin D and other diseases. The majority of patients (85.5%) agreed about the importance of sunshine as a source of vitamin D and 60.0% thought that they can get vitamin D from the nutrients. Regarding the main sources of knowledge about vitamin D, 40.5 % of patients got knowledge from doctors, 12.5% from the media, 29.0% from relatives and friends, 8.5% from background information and 9.5% from journals and magazines. Conclusions The majority of the study participants had limited knowledge, poor practices, and negative attitude toward vitamin D problems. Planning health education interventions for this group of patients are essential.

Practicing breast self-examination among women attending primary health care in Kuwait

Abstract Background Despite the benefits associated with breast self-examination (BSE), few women perform it and many do not even know how to perform it. Objectives The purpose of this study was to identify the proportion of women practicing BSE, factors that could affect its performance and explore women’s awareness about its practice steps. Methods The study design can be differentiated into two components. The first was a cross-sectional survey to determine the prevalence of BSE. Recruitment efforts resulted in 510 women. BSE was practiced by 109. The second component of the study was a case-control study to identify factors associated with BSE, whereas practicing subjects (control) were compared with a randomly selected similar number of non-practicing females (cases). Results The prevalence of BSE was 21%. Most of the socio-demographic variables have no significant effect on the practice of BSE. Practicing women had sufficient level of knowledge about BSE, clinical breast examination, and mammography. They believed significantly that bloody discharge from the nipple, presence of masses in the breasts, abnormal arm swelling, nipple retraction and discoloration of the breast were signs and symptoms of breast cancer. About 35% of practicing women in the current study performed correctly ⩽6 steps out of 12 steps. Conclusion Only 21% of women attending PHC had ever practiced BSE. Even a high proportion of them were not aware of the correct steps of the procedure. Health education programs are essential to encourage and improve women’s practice of BSE.

Weight status and perceived body size image in overweight and obese children 8–12 years old

Abstract Background Young peoples perception of their weight status attracted much interest. With a better understanding of childhood body image problems, investigating prevention programs within schools is an important next step. Objective The aim of the study was to investigate body size perception in school children using verbal descriptor and BMI-calibrated visual-matching methods to examine associations between perceived and actual body size. Methods The subjects of this study were 106 school students (8–12 years old) from Khaldia region in Kuwait. Cross-sectional data on height, weight, and body image were collected in the classroom. Only overweight and obese children were assigned to participant with BMI percentile values for age and sex of >85 to <95 and BMI >95, respectively. Students selected a figure to represent their current images. Body image was measured using a body image tool with a sequence of seven body silhouettes progressing from very thin to overweight. Results The results revealed that both verbal and visual scales overestimate overweight and underestimate obese ones. There is a predominance of underestimation rather than overestimation, especially in girls. Visual-matching could be considered a more precise measure of body size perception than verbal, which could explain the greater sensitivity to sex differences. Parents in general and of girls specific underestimate the size of their children than boys parents. The perception of friends of body size was underestimated. The majority of obese and overweight attributed their conditions to eating more foods. Those trying to lose weight did this through both reduction of amount of food. Conclusions These results indicated that children can estimate their body size with visual-matching and verbal-rating methods, but the degree of precision was more accurate by visual one. The verbal scale showed a tendency for children of all sizes to perceive themselves as normal or overweight.

Knowledge, attitude and behavior of health care workers regarding hepatitis B infection in primary health care, Kuwait.

Background: Health care workers are a high-risk group for acquiring hepatitis B virus infection and for transmission to their patients and close contacts Objective: The aim of the present study is to study health care workers’ knowledge, attitudes and behavior towards hepatitis B virus transmission and protection in Kuwait. Methods: This study was a cross-sectional survey that was conducted in all primary health center located in two randomly selected heath regions in Kuwait. An anonymous self-administered questionnaire was distributed to all currently working health care workers in the selected centers. Results: Within 534 participants, 76.2% were aware that Hepatitis B can be acquired from patient to health workers, 57.7% knew that Hepatitis B can be transmitted from health workers to patients, 81.5% were aware about vaccination, 65.0% knew the complete vaccination schedule, 44.4% knew the intervals between doses. Also, 74.7% have ever been vaccinated. Among them, 84.0% received the complete doses. Lastly, 73.8% declared that they need more information regarding hepatitis B. Conclusions: Health care workers in primary health care showed high to partial levels of knowledge and attitudes, regarding hepatitis B virus infection and vaccination with important gaps which need to be strengthened especially among non-vaccinated group

Knowledge and attitude of the physicians and nurses regarding blood borne infections in primary health care, Kuwait

Background: Physicians and nurses are a high-risk group of acquiring health care-associated infections and for transmission to their patients and close contacts Objective: The aim of the present study was to evaluate the level of knowledge and attitude of physicians and nurses in the field of blood borne infections (BBIs), and to identify factors associated with their level of knowledge. Methods: This study was a comparative one that was conducted in all primary health centers located in two randomly selected health regions in Kuwait. An anonymous self-administered questionnaire was distributed to all currently working physicians and nurses in the selected centers. Results: Recruitment effort resulted in participation of 277 nurses (64.6%) and 152 physicians (35.4%). The majority of nurses (83.0%, 74.4%, 73.6%) compared to 69.7%, 71.7% and 61.2% of the physicians recognized the possibility of transmission of the three BBIs (HBV, HCV and HIV) from patients to health care workers (HCWs). Lower proportions of participants recognized that HBV, HCV and HIV can be transmitted from HCWs to patients. A significant higher proportion of physicians than nurses were aware that blood and its products and improper usage of needles and sharps are the roots of transmissions (90.6% vs. 96.1% and 89.9% vs. 96.1% respectively). Faeco-oral and contaminated water were answered incorrectly as routes of transmission among nurses than physicians significantly (32.%1 vs. 19.7% and 21.7% vs. 10.5% respectively). Positive attitude was encountered in a significant higher proportion among physicians than nurses in certain beliefs regarding the risk of and vaccination against BBIs. On the other hand, higher proportions of nurses had positive attitude than physicians in practical aspects of BBIs control. Conclusions: Generally, the knowledge level was acceptable in the current study. Physicians were more knowledgeable than nurses. Positive attitudes were encountered in a significant higher proportion amongnurses than physicians regarding the practical aspects. Older age was an important determinant of lower level of knowledge.

Knowledge, attitude and behavior of primary health care workers regarding health care-associated infections in Kuwait.

Background: Health care workers (HCWs) are at high-risk for acquiring health care-associated infections (HAIs) and transmission to their patients and close contacts. Objective: The aim of the present study is to study primary health care (PHC) workers’ knowledge, attitudes and behavior towards HAIs in Kuwait. Methods: This study was a cross-sectional survey that was conducted in all primary health centers located in two randomly selected health regions in Kuwait. An anonymous self-administered questionnaire was distributed to all currently working physician and nurses in the selected centers. Results: The majority of the participants were aware that a HCW can acquire HAIs from a patient, but less than 60.0% knew that a HCW can transmit these infections to a patient. physicians and nurses’ beliefs regarding various control measures of HAIs were more or less positive as 59.4% to 85.1% of them believed in these various measures. It is observed that proportions of physicians and nurses practicing infection control measurements were less than that reported when describing their positive attitude towards HAIs. Conclusions: HCWs in primary health care showed good knowledge and positive attitude, but poor practice regarding control measures against HAIs. They need health education campaigns to enhance understanding the importance of practicing control measure that they believed in

Knowledge and attitude of primary care doctors towards management of postmenopausal symptoms

Abstract Background According to the current recommendations, women with post-menopausal symptoms should be managed. Knowledge and perception of primary care physicians towards management of postmenopausal symptoms are deficient. Aim The aim of the present study was to explore knowledge and attitude of primary care doctors towards management of postmenopausal symptoms. Methods This study is a cross-sectional survey that was conducted from October to December 2010 in the five health regions in Kuwait. Two centers were selected randomly from each health region. All physicians who were currently working in the selected centers were asked to participate in the study. Out of 209 physicians, 142 agreed to participate and completed a self-administered questionnaire. Results The study revealed that 82.4% of physicians had moderate knowledge about treatment options for postmenopausal symptoms, 88.0% discussed postmenopausal symptoms with their patients, and 45.1% of them either described or referred their patients for hormonal replacement therapy (HRT). The correct answers regarding 10 statements related to the Women Health Initiative finding were ranging from 2.8% to 78.9% which indicated low level of knowledge. Regarding the effectiveness of hormonal replacement therapy in postmenopausal women, the majority of the physicians agreed correctly that HRT is effective in prevention of osteoporosis (87.3%), treatment of vasomotor symptoms (83.7%), and treatment of vulvo-vaginal symptoms (82.4%). There was a variation among physicians opinion about the effectiveness of certain treatment options for managing hot flushes in postmenopausal women. Conclusion The results suggest that there is a lack of primary care physicians knowledge and confidence in recognizing signs and symptoms of menopause and in identifying and prescribing appropriate management.

Factors affecting the referral of primary health care doctors toward bariatric surgery in morbid obesity

Abstract Background Few eligible candidates are referred from primary care for bariatric surgery in spite of improvement in its safety and efficacy. Objective The aim of this study was to identify factors affecting primary care physicians’ (PCPs) referral to bariatric surgery in morbid obesity. Methods This study is a cross-sectional survey that was conducted at three randomly selected health regions in Kuwait. Primary care physicians were classified according to whether they refer patients to bariatric surgery or not into cases (non-referring) and controls (referring). The participating physicians were family practice physicians (FPs) or general practitioners (GPs). Self-administered questionnaires were distributed to all PCPs currently working in 50 centers in the selected regions. The questionnaire included data on their personal characteristics, their perception and knowledge about the use of bariatric surgery in morbid obesity. Univariate analyses were used followed by multiple logistic analysis to determine factors associated with non-referral to bariatric surgery. Results The results revealed that the referring physicians were more liable to be females and FPs (OR = 0.5, 95% CI: 0.3–0.9 and OR = 0.5, 95% CI: 0.3–0.8, respectively). Overweight and obese physicians were more liable to be non-referring than those with normal BMI (OR = 1.6, 95% CI: 1.2–3.3 and OR = 1.2, 95% CI: 1.1–2.8, respectively). Physicians who could not define correctly bariatric surgery for morbid obesity that requires surgery in a patient without or with co-morbidities were more liable to be non-referring (OR = 1.3, 95% CI: 1.2–2.4, OR = 1.4, 95% CI: 1.1–2.9 and OR = 1.8, 95% CI: 1.2–3.6, respectively). Also, non-referring physician didn’t know the average percentage of the excess weight that is lost in 5 years after bariatric surgery (OR = 1.4, 95% CI: 1.2–2.4). Conclusion Training in the referral process should ensure that PCPs obtain the skills necessary to expand their scope of practice, when appropriate and determine when and why a patient should be referred.

Knowledge, Attitudes and Self-Reported Behavior of Primary Health Care Workers for Hepatitis B and C Virus and other Health Care Associated Infection

Background: Health care workers are a high-risk group for acquiring Health care-associated infections and for transmission to their patients and close contacts. Objective: The aims of this study were to evaluate the level of knowledge, attitude and self-reported behavior of HCWs in relation to HBV, HCV and other HAIs and to identify factors that determine them in primary health care, Kuwait. Methods: This study was a cross-sectional survey that was conducted in all primary health center located in two randomly selected heath regions in Kuwait. An anonymous self-administered questionnaire was distributed to all currently working health care workers in the selected centers. Results: Out of 48 questions, the mean percentage of correct answer was 57.7% with a mean knowledge score = 28.3 ± 7.1. Out of 14 attitude statements, mean percentage of positive attitude was 10.2 ± 2.7. Out of 23 behavior statements, 82.8% reported satisfactory practice with a mean behavior score = 12.4±5.8. Multivariate logistic regression revealed that the pharmacists were at five times risk of giving low knowledge level compared to the nurses and non-Arab nationalities and those earning monthly income ≥1500 KD were more knowledgeable. Female gender and lower knowledge score were associated with negative attitude. Females, laboratory technicians and participants with negative attitude were more liable to practice unsatisfactory behavior. Conclusions: Health care workers in primary health care showed fair level of knowledge and positive attitude, but poor practice. This clearly indicated the urgency to implement initiatives for improving healthcare policies regarding HAIs.