Mohamed I. Kamel

Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome

To determine perioperative factors that may optimize the outcome after delayed perineal repair of a pelvic fracture urethral injury (PFUI).

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 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.

How to screen for domestic violence against women in primary health care centers

Abstract Background Violence against women is a major public health problem. Primary health care workers are involved in both detection and management of violence. Screening of women for violence is an important tool for early detection and prevention of violence through a valid and accepted screening tool. Objectives The purpose of this study was to identify the main elements and characteristics of a violence screening tool that can be used in primary health care centers. Methods 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-administrative questionnaire was used for data collection. Results Physicians favored an indirect question about violence (79.7%), while a question about feeling safe (83.6%) was suggested by nurses. The most frequently suggested method was searching for signs of violence. The majority of both nurses (82.4%) and physicians (82.0%) suggested physicians to carry out the screening process for domestic violence against women. The primary health care level was suggested to be in charge of screening for violence by 88.7% of nurses and 82.0% of physicians. Both nurses and physicians agreed that the examination should be carried out in complete privacy (95.0% and 91.4%), by an examiner of the same sex (89.1% and 89.8%), and not allowing a relative of the victim to attend the screening (85.3% and 78.9%). Opportunistic screening was preferred by both physicians (69.5%) and nurses (87.8%) when manifestations of violence are noticed. Conclusion A short tool containing a question about safety and looking for signs of violence administered by a physician on opportunistic basis in the primary health care centers in complete privacy was suggested for screening of women.

Burnout among family and general practitioners

Abstract Background Job burnout is an important syndrome that can deplete the emotional health aspects of physicians. Its impacts are reflected both on the physicians and their patients through undermining the performance of physicians and degrading the quality of the administered medical care leading to dissatisfaction of the patients about the medical service. Objectives This study is formulated to compare the prevalence of high burnout among family physicians and general practitioners and reveal the predictors of high grades of burnout among physicians. Subjects and methods A cross sectional study was carried out. Out of 378 physicians working in two health regions in Kuwait, 200 physicians returned a filled questionnaire, of these 105 were family physicians and the rest were primary health care physicians. Maslach Burnout Inventory–Human Service Survey tool was used to estimate high degree of burnout on three domains, namely emotional exhaustion, depersonalization and personal accomplishment. Results General practitioners were more likely to suffer from high grades of emotional exhaustion (63.2%) than family physicians (19.0%). They also suffered from high grade of depersonalization (65.3%) compared with family physicians (27.6%). Those suffering from high grades of personal accomplishment burnout (inverse score) constituted 61.1% of primary health care physicians and 33.3% of family physicians. Those suffering from grades for the three burnout domain constituted more than one third of primary health care physicians (36.8%) compared with only 5.7% of family physicians. Type of physician job and marital status proved to be significant predictors of high grades of burnout. Conclusion Burnout is more common among primary care than family physicians. Searching for and eliminating all sources of stress in the primary health care centers in addition to training of these physicians on coping strategies to deal with stress at work seems to be an important step.

Barriers for domestic violence screening in primary health care centers

Abstract Backgrounds 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. Objectives Reveal barriers that might impede screening of women for domestic violence and compare the list of barriers of physicians and nurses. Methods 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. Results 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). Conclusion 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

Abstract Background 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. Objectives Reveal the impact of knowledge and attitude of workers to screen for DV against women. Methods 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. It included four main aspects relevant to knowledge and one attitude domain regarding DV. A 5-point, Likert-scale was used to assess participants answers for each item. Results 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). Conclusion 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.

Domestic violence screening among primary health care workers in Kuwait

Abstract Background 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. Objectives 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. Subjects and methods 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. Results 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. Conclusion 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.

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

Abstract Background 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. Objective The aim of the study is to reveal the extent of knowledge and perception of nurses about PEFM and factors affecting their knowledge. Methods 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%. Results 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. Conclusion 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.

Perception of primary care physicians about guidelines of bronchial asthma

Abstract Background Adopting clear guidelines for diagnosis and management of bronchial asthma could improve the medical care services administered to asthmatic patients. This can be reflected on amelioration of manifestations, decrease of attacks of asthma and hence decrease the medical burden of the disease. Objectives The current study was designed to evaluate the adherence of primary health care physicians to the recommendations of the National Protocol for Management of Asthma in Kuwait and the factors affecting this adoption, reveal their knowledge, attitude and practices about bronchial asthma, and identify barriers for caring of asthmatic patients. Subjects and methods The target population was primary health care physicians. All the primary health care physicians of two randomly selected health districts, out of five, were included. Out of 376 physicians available during the field period, 250 agreed to share in this study with an overall response rate of 66.5%. Results The results showed that only 37.2% of the studied primary health care physicians were adhering to asthma guidelines. Level of education, Knowledge about asthma, and clinical practice proved to be significant predictors of adherence to asthma guidelines. Although physicians had a high positive attitude toward asthma yet, they have poor knowledge and practice scores. The most common institutional barriers were improper follow up system and lack of spirometers, while heavy workload and lack of training were the main barriers related to health staff. Non compliance of patients to management and follow up schedules were on the top of barriers related to patients. Conclusion Physicians at the primary health care centers had a low adherence rate to asthma guidelines. Although they had high positive attitude toward asthma yet their knowledge and practice need improvement. To enhance adequate medical care to asthmatics; focus should be concentrated on increasing awareness and task based on job training of physicians as well as providing lung ventilation measuring equipment and improving the follow up system of bronchial asthma.