Medhat K. El-Shazly

Risk Factors for Lower Limb Complications in Diabetic Patients

Diabetic lower extremity complications may be influenced by a number of factors, including those related to the interaction between patients and the health-care system. Our objective is to identify risk factors for the development of lower limb complications, by looking for classical clinical variables and those related to quality of care. A case-control study was carried out between December 1993 and June 1994 by interviewing 348 patients with lower-limb diabetic complications and 1050 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioners offices in Italy. Among sociodemographic characteristics associated with increased risk of lower limb complications were male gender [odds ratio (OR) = 2.5, confidence interval (CI) 1.6-3.9], age between 50 and 70 years as opposed to younger than 50 (OR = 3.6, CI 2.1-6.3) and being single as opposed to married (OR = 1.4, CI 1.1-1.8). Among clinical variables, treatment with insulin for IDDM and NIDDM patients was an important predictor of lower extremity complications compared to NIDDM patients not being treated with insulin. Cardio-cerebrovascular disease and presence of diabetic neuropathy were associated with a higher risk of being a case (OR = 1.4, CI 1.2-1.8 and OR = 3.0, CI 2.1-4.2, respectively). Patients who needed help to reach the health facility before the onset of the complications and those who did not attend health facilities regularly were more liable to develop complications (OR = 1.5, CI 1.1-2.2 and OR = 2.0, CI 1.3-3.0, respectively). Patients who had never received educational intervention had a threefold risk of being a case as compared to those who received health information regularly. The study identifies factors most likely to be related to adverse outcome and permits to discriminate between avoidable and unavoidable factors.

Health care for diabetic patients in developing countries: a case from Egypt.

The aim of this was to evaluate the pattern of care for diabetic patients in Alexandria as a model from a developing country. It is a cross-sectional multi-centric. One thousand diabetic patients who had diabetes for no less than one year were randomly selected from 14 out-patient clinics and diabetic centres. Results showed that monitoring of the glycaemic state was based, almost entirely upon fasting blood glucose levels, with only a small minority (4%) having HbA measurements. During the previous 12 months, an electrocardiogram had not been performed in 26% of the subjects studies and the fundus was not examined in 38%. Twenty nine percent did not receive neurological examination, and feet were not inspected in 24%. Testing for albuminuria, serum creatinine, blood cholesterol, and triglycerides was performed only in 34%, 37%, 36% and 32% respectively. Patients habits in seeking care revealed that 78% regularly attended the medical centre for follow up, 64% followed dietetic instructions, and 89% were compliant with prescribed therapy. Only 8% did self examination of blood glucose and 26% checked glucose in urine by themselves. Generally, the pattern of care provided for health insured diabetic patients is better than that received by non-health-insured cases. It is concluded that in Egypt the quality of diabetes care differs in many aspects from the recommended standards and that structural as well as organisational improvements are urgently needed, particularly to guarantee adequate care to non-health insured patients.

Patterns of Care of an Italian Diabetic Population

We set out to describe patterns of care of an Italian diabetic population, with reference to the recommendations of the St Vincent Declaration. We investigated different aspects of care received by 2707 patients, of whom 2196 in the charge of 35 Diabetes Outpatient Clinics (DOCs) and 511 cared for by 49 General Practitioners (GPs). Data were collected by interviewing the patients, their physicians and by reviewing medical records. Our data show that diabetes care in Italy differs in many aspects from the recommendations of the St Vincent Declaration. Glycated haemoglobin measurement was lacking in 50 % of the patients in the charge of GPs and in 15 % of those attending DOCs. While the control of cardiovascular risk factors was satisfactory, information on albumin excretion was not available in one third of the patients. Overall, 79 % of the patients had had an eye examination in the previous 12 months. More than one‐third of the patients had not received adequate information on different aspects of care, with wide variations according to the setting of care. Forty‐two per cent of the patients attending DOCs and 14 % of those cared for by GPs practised blood glucose self‐monitoring; similarly, insulin therapy self‐management was performed by 50 % and 19 % of the patients attending DOCs and GPs, respectively. Our data call for vigorous efforts aimed at improving the awareness of the potential for reducing major diabetic complications. Therefore, it is essential to promote the incorporation of clearly defined clinical practice guidelines at each level of care.

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.

Burnout syndrome among physicians working in primary health care centers in Kuwait

Abstract Objective The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health care units in the selected regions agreed to participate in the study. A specifically designed questionnaire for this research was derived from Maslach Burnout Inventory (BMI). It included four domains, namely emotional exhaustion, depersonalization, personal accomplishment, and involvement. In addition, socio-demographic and work characteristics of physicians were studied and their association with burnout domains was illustrated. Results More than half the sample was females (56%), in the age group 30–49 (56.5%) and of non-Kuwait nationality (51%). Emotional exhaustion and depersonalization had lower percentage scores than the positive ones namely, personal accomplishment, and involvement. Physicians had a mean percent score of 37.1 + 29.0% on the emotional exhaustion domain, 21.0 + 22.9% on the depersonalization domain, 63.2 + 26.3% on the personal accomplishment domain, and 46.2 + 29.9% on the involvement domain. The four domains of MBI were associated only with some of the studied socio-demographic and job characteristics of the studied physicians. Nationality, place of work, job and income had a significant association with emotional exhaustion, depersonalization, and personal accomplishment domains. Conclusion Burnout syndrome is relatively common among Kuwaiti physicians working at the primary care level. The syndrome is more common among non-Kuwaiti physicians, general practitioners, and those with lower income. There is a need for training the physicians about how to cope with stress at work.

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

Abstract Introduction 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. Objective The aim of this work was to compare the knowledge and perception of primary care physicians and nurses about DV. Methods 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 participants answers for each item. Results 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. Conclusion 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.