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PubMed2004

Knowledge of and attitudes towards tobacco control among smoking and non-smoking physicians in 2 Gulf Arab states.

OBJECTIVE: The global health professional survey is a project organized by the World Health Organization, to determine the smoking habits, knowledge and attitude towards tobacco control of health professionals in several countries around the world. This paper presents data from Kuwait and Bahrain. METHODS: The survey period was between May 2000 and March 2001. A questionnaire was distributed to all physicians in Bahrain and to a random sample from Kuwait. The responses to knowledge and attitude questions were on a scale of 1-5, (1 strongly agree, 2 agree, 3 unsure, 4 disagree and 5 strongly disagree). RESULTS: Four hundred and seventy physicians from Bahrain and 1095 from Kuwait completed the questionnaire. The prevalence of cigarette smoking in Kuwait was: current smokers 18.4%, previous smokers 15.8%, Bahrain 14.6% and 14.3%. The prevalence of shisha smoking was 12% and 6.4% for Kuwait and Bahrain, (p=0.004). The mean scores of agreement with the association between passive smoking and lung diseases, lower respiratory tract infections in children were 1.6, 1.7 and 1.8, 1.9 for non smoking physicians and smoking physicians (P<0.01). The mean scores of agreement with the following policies: large health warning on cigarette packages, complete ban on tobacco advertisement and an increase in the price of cigarette were 1.3, 1.4, 1.7 and 1.7, 1.7, 2.5 for smoking and non-smoking physicians (p<0.01). CONCLUSION: Smoking physicians have less knowledge and less favorable attitude towards tobacco control compared to non-smokers. There was no difference in the prevalence of cigarette smoking between Kuwait and Bahrain, but the prevalence of shisha smoking was higher in Kuwait.

Adult↗
PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO eastern Mediterranean region, 1995.

There are 23 countries/areas in this Region (Tables 1-3). BCG is used in all but 3 countries (Cyprus, Jordan and Lebanon). Most countries/areas give BCG vaccine at birth, 2 countries (Bahrain and Tunisia) schedule additional doses at school age and Kuwait uses 1 dose at the age of 3 1/2-4 years. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in all countries/areas. Fifteen countries/areas use a fourth dose of DPT vaccine in the second year of age or later (Bahrain, Cyprus, Egypt, Iran [Islamic Republic of], Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, and the United Arab Emirates, the United Nations Relief and Works Agency for Palestine Refugees in the Near East [UNRWA]). Six countries use 5 doses of DPT vaccine, the fifth dose being given at the age of 4-6 years (Bahrain, Cyprus, Iran [Islamic Republic of], Kuwait, Qatar, and Saudi Arabia). One or 2 booster doses of diphtheria-tetanus (DT) vaccine are used in 9 countries/areas from the age of 6-12 years. Td vaccine is used as a booster in Bahrain and Cyprus. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries/areas. Ten countries/areas use an additional dose of OPV at birth (Djibouti, Iran [Islamic Republic of], Iraq, Kuwait, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Syrian Arab Republic, and UNRWA). An additional dose of OPV in the second year of life is used in 15 countries, and additional doses of OPV are recommended in some countries. In UNRWA, the first 2 doses of OPV 2 and 3 months of age are given simultaneously with the inactivated poliovirus vaccine (IPV). Measles vaccine is given in most countries/areas at 9-12 months of age, usually in the form of monovalent measles vaccine. The 2-dose policy is implemented in 12 countries. In 8 countries, the second dose is given as measles-mumps-rubella (MMR) vaccine, and in 3 countries as monovalent measles vaccine. The age for the second dose varies. In 10 countries, it is given at 12-15 months of age, and in the Libyan Arab Jamahiriya at 18 months of age. The United Arab Emirates uses 3 doses. Rubella vaccine is scheduled for girls of 12-13 years of age in Bahrain, the United Arab Emirates and UNRWA and for boys and girls in Kuwait at 12 years of age. Hepatitis B vaccine is used in 15 countries/areas. All these countries use 3 primary doses of vaccine in infancy. The immunization time varies from birth (12 countries/areas) to 9 months of age. In Cyprus, hepatitis B vaccine is used in a 4-dose schedule, including a booster dose given to 5 to 6-year-old children. Tetanus toxoid is used for pregnant or non-pregnant women of childbearing age. It is also given to school-children in the Islamic Republic of Iran. The schedule includes 2-5 doses.

Child↗
PubMed1998

Fatalities and injuries in the Kuwaiti construction industry.

This paper presents an analysis of construction accidents in Kuwait along with accident causation and injuries that can be considered serious or fatal, so that corrective measures can be taken to decrease casualties, resulting in a safer construction industry. The paper evaluates the existing injury and cost reporting-investigation system of construction accidents in government agencies and private firms. This research confirms that construction is the most hazardous industry in Kuwait, with accidents accounting for 48%, 38% and 34% of all disabling injuries and 62%, 38% and 42% of all fatalities in 1994, 1995 and 1996, respectively. These rates are considered high and can be compared to construction accident statistics in the U.S.A. which accounted for 14% of all work-related deaths and 9% of disabling injuries in 1993. Based on the study, falling from a height appears to be the major cause of construction injuries and fatalities in Kuwait. Poor accident records and reporting systems hide the extent of the construction safety problem in Kuwait. In addition, many people at management level are unaware of accident-related costs and the effectiveness of a safety program in reducing project costs.

Accidents, Occupational↗
PubMed2003

Assessment and analysis of industrial liquid waste and sludge disposal at unlined landfill sites in arid climate.

Municipal solid waste disposal sites in arid countries such as Kuwait receive various types of waste materials like sewage sludge, chemical waste and other debris. Large amounts of leachate are expected to be generated due to the improper disposal of industrial wastewater, sewage sludge and chemical wastes with municipal solid waste at landfill sites even though the rainwater is scarce. Almost 95% of all solid waste generated in Kuwait during the last 10 years was dumped in five unlined landfills. The sites accepting liquid waste consist of old sand quarries that do not follow any specific engineering guidelines. With the current practice, contamination of the ground water table is possible due to the close location of the water table beneath the bottom of the waste disposal sites. This study determined the percentage of industrial liquid waste and sludge of the total waste dumped at the landfill sites, analyzed the chemical characteristics of liquid waste stream and contaminated water at disposal sites, and finally evaluated the possible risk posed by the continuous dumping of such wastes at the unlined landfills. Statistical analysis has been performed on the disposal and characterization of industrial wastewater and sludge at five active landfill sites. The chemical analysis shows that all the industrial wastes and sludge have high concentrations of COD, suspended solids, and heavy metals. Results show that from 1993 to 2000, 5.14+/-1.13 million t of total wastes were disposed per year in all active landfill sites in Kuwait. The share of industrial liquid and sludge waste was 1.85+/-0.19 million t representing 37.22+/-6.85% of total waste disposed in all landfill sites. Such wastes contribute to landfill leachate which pollutes groundwater and may enter the food chain causing adverse health effects. Lined evaporation ponds are suggested as an economical and safe solution for industrial wastewater and sludge disposal in the arid climate of Kuwait.

Animals↗
PubMed2006

First report of Streptococcus agalactiae and Lactococcus garvieae from a wild bottlenose dolphin (Tursiops truncatus).

The isolation and characterization of two bacterial species, Streptococcus agalactiae and Lactococcus garvieae, previously unreported in wild marine mammals are described from a freshly dead bottlenose dolphin, Tursiops truncatus, from Kuwait Bay, Kuwait, in September 2001. Conventional and rapid identification systems were used to determine that isolates from muscle and kidney were S. agalactiae and L. garvieae, respectively. The isolates were gram-positive, catalase-negative, oxidase-negative, nonhemolytic cocci. The S. agalactiae was serotyped to group antigen B, whereas the L. garvieae could not be assigned to any serogroup. These Kuwait isolates displayed considerable homogeneity with corresponding American Type Culture Collection (ATCC) type isolates. Although the dolphin S. agalactiae isolate was nonhemolytic, it was biochemically similar to S. agalactiae isolated from mullet sampled in the concurrent Kuwait Bay fish kill. Some biochemical heterogeneity was observed between the dolphin isolates and corresponding mammalian ATCC type isolates, especially with Voges Proskauer, alanine-phenylanaline-proline arylamidase, and alpha-galactosidase tests. Nile tilapia, Oreochromis niloticus, experimentally infected with the dolphin S. agalactiae and L. garvieae isolates experienced 90% and 0% mortalities, respectively. This is the first isolation of S. agalactiae and L. garvieae from a wild marine mammal, and the microbial characteristics established here provide pertinent information for the future isolation of these bacteria.

Animals↗
PubMed2003

Specialty choices of Kuwaiti medical graduates during the last three decades.

INTRODUCTION: This study examined postgraduate specialty training of Kuwaiti medical graduates during 1968 to 1999 and identified their attained professional qualifications to reveal scarcity in some specialties. METHOD: A survey was carried out involving review of the records maintained at the Kuwait Institute for Medical Specialization (KIMS) and the Ministry of Health for all of the trainees who were enrolled in higher training programs for specialization. Information obtained from the records was ascertained through matching with the doctors' career destinations and employment in the recruitment departments of the health sector. RESULTS: A total of 652 Kuwaiti medical graduates attained their higher postgraduate qualifications until 1999. There were more female postgraduates compared with males from 1993 upwards and a drop in 1991 in the number of postgraduates owing to the Gulf War. Specialty differed according to gender: males mostly opted for medicine and surgery, whereas females mainly chose obstetrics and gynecology, pediatrics, and family medicine. The nature of postgraduate qualifications differed according to gender: fewer females undertook academic qualifications. DISCUSSION: The number of Kuwaiti medical graduates with higher professional qualifications significantly increased after 1985 owing to the establishment of KIMS and the Kuwait Faculty of Medicine. The increase in the number of female postgraduates since 1993 is attributable to the social and cultural transitions witnessed by Kuwait. Gender significantly affected the nature of postgraduate studies and the choice of specialty. The pattern of preference of Kuwaiti graduates to specialties was consistent with other parts of the world. Scarcity in some specialties has been revealed and needs to be adjusted.

Career Choice↗
PubMed1997

Environmental surveys conducted in the Gulf region following the Gulf War to identify possible neurobehavioral consequences.

During the 1991 Gulf War, the Iraqi army set Kuwait oil wells on fire. Wells and some oil refineries were burned, resulting in Kuwait and the surrounding Gulf region being exposed to toxic gases. The oil fires reached their peak in February 1991. On March 7, the fires in some fields were still burning at peak strength. Sulfur dioxide, particulates, carbon monoxide, and nitrogen oxides were emitted into the atmosphere. All of these substances can cause adverse health effects, which vary according to concentration and duration of exposure. A survey conducted in Kuwait clinics and emergency rooms showed an increase in upper respiratory irritation consistent with environmental air sampling results, indicating occasional high levels of particulates. Patient visits related to gastrointestinal illness, heart disease, psychiatric illness, chronic bronchitis and emphysema, and bronchiectasis increased during the period following the burning of the oil wells. There was no documented evidence of an increase in visits for acute upper and lower respiratory infections or asthma. Public health workers must recognize the high priority of collecting long-term health data and developing public health systems to assess those data.

Air Pollutants↗
PubMed1994

A retrospective analysis of pathological placental implantation--site and penetration.

OBJECTIVES: To determine the incidence of pathologically implanted placenta, i.e. placenta previa and accreta, at the Maternity Hospital of Kuwait. In addition the study aimed to identify the risk factors for such conditions, and test the hypothesis that previous cesarean section increases the likelihood of abnormal placentation. METHODS: Analysis of all deliveries in the Maternity Hospital of Kuwait with identification of cases of placenta previa, placenta accreta, previous cesarean section and manual removal of placenta. Information was obtained from the medical records of the hospital between 1981 and 1992 except for the period 1990-1991 due to incomplete information as a consequence of the Iraqi invasion. The incidences of these conditions were calculated followed by identification of risk factors for placenta accreta and previa. RESULTS: The incidence of placenta previa was 0.5% and that of placenta accreta 9.5 per 100,000 deliveries. Placenta previa and previous cesarean section were found to be significant predisposing factors for placenta accreta. The increased risk for placenta accreta in the presence of these factors was much less than that reported in the international literature. Abnormal placentation was responsible for 34% of peripartum hysterectomies. CONCLUSIONS: Placenta accreta and previa are major causes of massive obstetric hemorrhage. They are interrelated with a common predisposing factor, cesarean section. Even though the rate of cesarean section and placenta previa is increasing, the incidence of placenta accreta remains stable in Kuwait.

Causality↗
PubMed1987

Unexpected findings amongst the skin test responses to mycobacteria of BCG vaccinated Kuwaiti school children.

A multiple skin test survey was carried out in Kuwait on 1200 school children aged 8-11 years, and on 1228 children aged 12-16 years. With only 15 exceptions, all these children had received vaccination with Japanese BCG just before they started school, 5 years and 9 years earlier respectively. Tuberculin positivity was almost 90% in both groups, with a mean response size of 8.7 mm. This was associated with remarkably high responsiveness to many of the other mycobacterial species investigated. Since this high reactivity was also to Mycobacterium ulcerans, a species most unlikely to be present in Kuwait, it is proposed that this might be due to responsiveness to group ii antigen which is present in all slow growing species. Only M. flavescens and M. rhodesiae amongst the fast growing species, were absent as sensitising organisms. After correction for the supposed reactivity to group ii antigen, M. avium B, M. gordonae, M. ulcerans and M. xenopi amongst the slow growing species, also appeared to be absent from the Kuwait environment. The species most commonly encountered were M. leprae, M. chitae, M. neoaurum, M. diernhoferi, and M. vaccae in this order. This was a remarkable finding for a country assumed to be poor in contact with environmental species, and known to have a very low prevalence of leprosy. As previously reported from Iran, but not confirmed in other places, there was a 95% correlation between responsiveness to Leprosin A and Vaccin. Amongst the slow growing species M. avium A, M. intracellulare, and M. kansasii appear to be frequent sensitising agents, in common with many other places.

Adolescent↗
PubMed2005

Atmospheric vapour phase and particulate phase mercury in a coastal desert climate.

Vapour (T-Hg(v)) and particulate (T-Hg(p)) mercury were measured in the lower atmosphere at a ground station in Kuwait Bay. The concentration of T-Hg(v) varied from 0-86 ng m(-3) with a mean of 3.8 +/- 5.5 ng m(-3)(n= 13 326). About 40% of the measured T-Hg(v) values over Kuwait Bay are higher than the global range (1-3 ng m(-3)). Car exhausts contributed to the increase of T-Hg(v) during the rush hours. However the contribution of T-Hg(v) from air crossing Kuwait Bay exceeds that T-Hg(v) produced by traffic probably because of the effects of the substantial load of industrially-derived mercury in the sediments of this shallow region. Thermal inversions have a major impact on the levels during the evening hours. The concentration of T-Hg(p) varied from 0.00-0.22 ng m(-3) with a mean of 0.03 +/- 0.03 ng m(-3)(n= 175). The T-Hg(p)/T-Hg(v)% ratio varied from 0-11.1 (n= 171) with a mean of 1.0 +/- 1.5%. Meteorological parameters influence the T-Hg(v) and T-Hg(p) concentrations with dust storms having a major impact on T-Hg(p) concentrations.

Air Pollutants↗
PubMed1979

The development of a conceptually based nursing curriculum: an international experiment.

Nursing programmes in the United States of America are based on a conceptual framework. Not only do faculty and students ascribe to the necessity of such programmes but the national accreditation agency also provides its accreditation approval for the institution only after all criteria are met, including the requirement of a well-defined, operationalized and implemented framework. Can a nursing programme be developed in other nations utilizing the esoteric, American-based idea of the necessity for a conceptually based curriculum? The author answers this question. The manuscript presents both the process utilized in selecting a conceptual framwork for a new junior college programme in Kuwait and discusses the selected framework. The idea of a conceptual framework to guide the curriculum was as foreign in Kuwait as it was to nursing curricula in the United States 15 years ago. Though initially rejected by the faculty in Kuwait, the idea of a conceptual framework was reintroduced after much faculty discussion and questions related to nursing knowledge vis-a-vis medical knowledge, and what should be included in and excluded from the programme. By the end of the second year, a definite framework had been operationalized into courses and content. The selection of the framework evolved from faculty participation in the operationalization of the framework. This point is quite significant particularly in an international assignment, as it is the faculty who are left with the monumental task of supporting and continuing the work which has been done. Strategies used to develop and implement a conceptual framework included confrontation of faculty of the existing situation, lectures, seminars, workshops, and the identification of a critical review board.

Concept Formation↗
PubMed1997

Effects of hormone replacement therapy on sexuality in postmenopausal women in a mideast country.

OBJECTIVE: During the postmenopausal period, sexual interest and activity seem to decline, as part of the menopausal effect of oestrogen deficiency. The aim of this study was to evaluate other factors that could contribute to sexual dysfunction and the effect of hormone replacement therapy among postmenopausal women in Kuwait. METHOD: Between June 1992, and June 1994, details of sexual history were compiled from 261 postmenopausal women that attended the Menopause Clinic at the Maternity Hospital, Kuwait. The effect of hormone replacement was analysed from the sexual history and the bacteriology of the lower genital tract. RESULTS: About 71% of the 261 postmenopausal women were still sexually active. Among those not sexually active, 38% had loss of interest, 22% because of divorce or death of husband, 20% from loss of interest by husband, and in 13% because the husbands had impotence from medical problems. Of the sexually active women, 41.1% had reduced libido. Contributing factors included vaginal symptoms like dyspareunia and vaginal dryness, vaginal infection, disturbances in the premenopausal menstrual pattern and disharmony with husbands. About 23 to 45% of the postmenopausal women with oestrogen replacement therapy, had significant relief of their symptoms of sexual dysfunction. Vasomotor symptoms had better response compared to sexual dysfunction (p < 0.01). Natural oestrogen gave slightly better relief of symptoms of sexual dysfunction than other forms of oestrogen therapy. Livial gave complete relief of dyspareunia and vaginal dryness in 9.1% and 3.9% respectively, but none of those with libido and vaginal discharge had any relief. CONCLUSION: There is a decline in sexual response and activity in postmenopausal women in Kuwait. This is however, multifactorial in origin. Although oestrogen replacement therapy gives significant relief in symptoms of sexual dysfunction, other contributory factors should always be evaluated.

Adult↗