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[Teeth of the Dilmun-times. Umm an-Nar (2500 B.C.). Al-Bahrain (2000 B.C.)].
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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.
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.
Biodiversity of the genus Fusarium in saline soil habitats.
Fusarium species assemblage and diversity were investigated in eight different contrasting extreme saline soil habitats of the hot arid desert environment of Bahrain. Saline habitats are located towards the central-southern part of Bahrain and featured by high electrical conductivity, slightly alkaline sandy soil, poor in nutrient sources and water holding capacity and mainly dominated by a salt-tolerant flora. Quantification of data for the recovery of Fusarium species was based on morphological characters and counts by a series of ten fold dilutions plate method and direct soil plating, using two selective media supplemented with different NaCl concentrations. A total of 68 isolates, fluctuated between 1 and 23 per soil sample, were recovered among all habitats mostly at 0 and 5% NaCl concentrations, while no recovery was achieved at 20 and 25%. Grouping of these isolates has resulted in only five species (F. solani, F. oxysporum, F. chlamydosporum, F. equiseti and F. compactum), all of which were previously reported from the arid terrestrial habitats of Bahrain. F. solani was the most predominant species, based on relative density, frequency of occurrence and dominance values, followed by F. oxysporum, a finding consistent with other similar arid Sahara ecosystems. Evaluation of data, supported by analysis of diversity indices and community coefficients, revealed that desert mountain habitat followed by burial mounds habitat were highly homogeneous coupled with maximum species richness, diversity indices and evenness, whereas soil habitats like cliffs, coastal and Al-Lowzy pit were the poorest. Moreover, in vitro tests showed that among other fusaria, F. solani exhibited the highest tolerance to increase NaCl concentrations (25%) and temperature (28.3 mm linear growth at 35 degrees C). At 10% NaCl concentrations, significant reduction in linear growth extensions suppressed all species accompanied by massive thick-walled, drought-resistant chlamydospores formation, indicating that species are mainly thermo-osmotolerant. Fusarium species recoveries were negatively significantly correlated (p < 0.05), with soil edaphic factors including salinity (r = -0.849) and soil moisture (r = -0.711). It is thus, proposed that inter and intra specific variation in the Fusarium species community, in particular soil niche, is an outcome of the influence of bioclimatic, multi-soil-edaphic and biotic factors.
The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.
In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually developing themselves; proper student selection and the creation of a culture of student/faculty partnerships in education and in building an international reputation and credibility by cooperating with reputable international universities and organizations.
Varied prevalence of factor V G1691A (Leiden) and prothrombin G20210A single nucleotide polymorphisms among Arabs.
BACKGROUND: Factor V G1691A (FV-Leiden) and prothrombin (PRT) G20210A single nucleotide polymorphisms (SNPs) are major inherited risk factors of venous thromboembolism. In view of the heterogeneity in their world distribution and lack of sufficient information about their distribution among Arabs, we addressed the prevalence of both SNPs in 4 distinct Arab populations (Lebanon, Tunisia, Bahrain, and Saudi Arabia). METHODS: Study subjects comprised 698 Lebanese, 313 Tunisian, 194 Bahraini, and 149 Saudi Arabian healthy subjects; genotyping was done by PCR-RFLP using Mnl I and Hind III for FV-Leiden and PRT G20210A, respectively. RESULTS: The prevalence of the mutant A alleles of FV-Leiden and PRT G20210A were significantly higher among Lebanese (0.0788 and 0.0136) and Tunisians (0.0351 and 0.0128), as compared to Bahraini (0.0155 and 0.0052) and Saudi (0.0101 and 0.000) subjects. Higher frequency of the FV-Leiden G/A and A/A genotypes were seen in Lebanon (13.8 and 1.0%), followed by Tunisia (5.8 and 0.6%), Bahrain (3.1 and 0.0%) and Saudi Arabia ((2.0 and 0.0%). All PRT G20210A positive cases were in the heterozygote (G/A) state, and these comprised 3.6% for Lebanon, 2.6% for Tunisia, 1.0% for Bahrain. The carrier rate of FV-Leiden was significantly higher among Lebanese compared to the other populations (p < 0.001), while the difference in the prevalence of FV-Leiden between the other populations was not statistically different. With the exception of Lebanese-Saudi (p = 0.038), the prevalence of PRT G20210A was similar among the study communities. Furthermore, the overall average genetic differentiation between populations (estimated with the F(ST)) was 0.0022 for FV-Leiden and 0.005 for PRT G20210A. CONCLUSIONS: These results further confirm the heterogeneity in FV-Leiden and PRT G20210A distribution among Arabs, and recommend potential institution of prophylactic measures for carriers of either or both SNPs.
The incidence of lung cancer in the Gulf Cooperation Council countries.
BACKGROUND: Lung cancer is the most common cancer in the world, with an estimated number of 1.3 million new cases as of 2002. This is the first report from the countries that comprise the Gulf Cooperation Council (GCC). PATIENTS AND METHODS: All the primary lung cancer cases registered in the Gulf Center for Cancer Registration during 1998 to 2001 were used to calculate the age-standardized incidence rate (ASR) per 100,000 person-years by the direct standardization method. RESULTS: Overall, there were 1607 (1261 males, 346 females) primary lung cancer cases registered during this period with the male to female ratio of 3.6:1. The highest ASR was in Bahrain (34.3 for males, 12.1 for females) followed by Qatar (18.5 for males, 5.5 for females) and Kuwait (13.8 for males, 4.0 for females); the lowest rate was in Saudi Arabia (4.8 for males, 1.3 for females). The mean age at diagnosis for males ranged from 68.7 years in Bahrain to 59.2 years in Oman. For females it ranged from 68.2 years in Bahrain to 58.0 years in Oman. Squamous cell carcinoma in males (except in Qatar) and adenocarcinoma in females were the predominant histological type. CONCLUSIONS: Cancer of the lung is one of the common cancers among males in all the GCC countries and ranks second among Bahraini females. Adenocarcinomas were more common in women than men.
Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population.
The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.
Speed, speed limits and road traffic accidents under free flow conditions.
The relationship between various measures of traffic speed, under free flow conditions, and accident rate is investigated for two groups of sites, one in the Tyne and Wear county of the UK and the other in Bahrain. The effect of speed limits on traffic speed is estimated for both groups of sites. In Bahrain, there is statistically significant evidence of an association between mean speed and accident rate. In Tyne and Wear the statistical evidence is weaker, and points to a stronger relationship between accidents and the variability of traffic speeds. In both areas, there is an apparent decrease in accident rate if the percentage of heavy vehicles increases, with the speed distribution held constant. In both areas the effect of speed limits is to reduce the mean speed of traffic by at least one quarter. Higher speeds are associated with longer trips.
Lifestyle and the risk of acute myocardial infarction in a Gulf Arab population.
BACKGROUND: Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30-79 years. METHODS: Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors. RESULTS: Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.24-5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82-9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73-6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI. CONCLUSION: There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.
Prevalence of risk factors for cardiovascular diseases among men and women in an Arab Gulf community.
A cross-sectional study was conducted to estimate the prevalence of major risk factors for cardiovascular diseases (CVD) among the adult population in Bahrain, an Arab Gulf country. A total sample of 516 subjects aged 30-79 years was selected proportionally from all geographical areas of Bahrain. Findings revealed that current smokers represented 32% of men and 20% of women (P < 0.001). However, a relatively high percentage of women were exposed to inhalation of other family member tobacco smoking compared to men (29% and 44% among men and women, respectively). Obesity, hypertension and diabetes were highly prevalent and significantly more reported among women than men. Of women, 79.6% were overweight or obese compared to 56% of men. Sedentary lifestyle patterns (Lack of physical exercise and daily watching of television) were also highly reported. About 12.1% of men and 15.7% of women did not consume fresh fruits. The corresponding percentages for fresh vegetables were 8.4% and 5.5%, respectively. The prevalence of well established risk factors for CVD such as smoking, obesity, inactivity, diabetes and hypertension were high and indicates the need for a national health policy to prevent and control the CVD.
High prevalence of diabetes in Bahrainis. Associations with ethnicity and raised plasma cholesterol.
OBJECTIVE: To determine prevalence of diabetes and associated risk factors in the population of Bahrain. RESEARCH DESIGN AND METHODS: A cross-sectional study of 2,128 Bahrainis aged 40-69 years was conducted. RESULTS: Age-standardized prevalence of diabetes was 25% in Jaafari Arabs, 48% in Sunni Arabs, and 23% in Iranians. In multivariate analyses, positive family history of diabetes, low educational status, waist girth, plasma cholesterol, and, in women, postmenopausal status were independently associated with diabetes. Adjusting for these factors did not account for the difference in prevalence between Jaafari and Sunni Arabs. There was no association between diabetes and parental consanguinity. Mean plasma cholesterol was 0.5 mmol/l higher in diabetic than in normoglycemic participants, 0.5 mmol/l higher in Sunni than in Jaafari Arabs, and, excluding diabetic individuals, 0.2 mmol/l higher in those with a positive family history of diabetes than in those with a negative family history. Although 28% of participants had BMI > or = 30 kg/m2, only 42% of these obese individuals rated themselves as overweight. In men, obesity was inversely related to physical activity at work. In women, obesity was associated with high parity and inversely associated with employment outside the home. CONCLUSIONS: The high rates of diabetes in Bahrain and other Arabian Peninsula populations appear to be part of a familial syndrome that includes raised plasma cholesterol levels. Risk is related to ethnic origin but not to parental consanguinity. Despite the high rates of diabetes, obesity is still perceived as a desirable attribute in this population.
Risk factors of uterine rupture.
OBJECTIVE: To determine the incidence of uterine rupture in Ministry of Health Hospitals in Bahrain and to find the risk factors associated with this obstetrical tragedy. METHODS: A case control study was conducted on all the cases of uterine rupture in Ministry of Health Hospitals in Bahrain during the period 1st of January 1990 until 31st of December 1999. The following risk factors which, were studied, included parity, gestational age, previous cesarean delivery, previous cesarean section for cephalopelvic disproportion, previous evacuation of the uterus, induction and or augmentation of labor, malpresentation, duration of the labor, type of the delivery and birth weight. RESULTS: Forty-five uterine ruptures were reported during the study period with an incidence of 1 in 2213 deliveries. Previous cesarean delivery, prior cesarean section for cephalopelvic disproportion, malpresentation, induction and augmentation of labor were found to be significant risk factors for uterine rupture. While high parity, previous evacuation of the uterus, duration of labor, type of the delivery, birth and weight were not associated with uterine rupture. CONCLUSION: An Obstetrician should be careful in monitoring the progress of labor in women with previous cesarean delivery to avoid the occurrence of a ruptured uterus. Oxytocin or prostaglandin or both should be used judiciously to prevent catastrophic uterine rupture.
Blood lipids and body fat in Bahraini women.
OBJECTIVE: The aim of this study was to examine some biomedical parameters of a representative sample from the population of overweight and obese, and average weight Bahraini women visiting 2 health centers in Bahrain. METHODS: This study was conducted over a period of 4 months in 2 health centers in the urban city of Muharraq in Bahrain, namely Muharraq Health Center and Shaikh Salman Health Center. The association was examined between body mass index, and the distribution of body fat determined by the waist hip ratio. Serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, as well as glucose levels were measured. RESULTS: The 2 groups of pre-menopausal women selected for this study were of similar age (mean of 30.4 and 30.7 years) but differed significantly in their body mass index values; however, their mean waist hip ratio was similar (0.80 and 0.82). The type of obesity shown by these Bahraini women was not associated with an elevation of serum glucose concentrations, or with significant differences in either serum cholesterol or triglyceride concentrations. There was however, a statistically significant difference between the 2 groups with respect to the level of high-density lipoprotein cholesterol, which was lower in the obese group, compared with the lean counterparts. Furthermore, the ratio of high-density lipoprotein to low-density lipoprotein cholesterol was significantly lower in the obese subjects, compared with the controls. CONCLUSION: Obesity in a group of Bahraini women was associated with indices predisposing to coronary heart disease, and this has public health implications.
Factors associated with immediate relapse among Bahraini heroin abusers.
Demographic characteristics and factors associated with immediate relapse to heroin use among 40 male Bahraini heroin abusers were studied 1 week after discharge from the Drug and Alcohol Rehabilitation Unit in Bahrain. The mean age of the patients was 32.7 years, the age at which drug abuse began ranged from 12 years to 31 years, and the age range of regular use was 15-37 years. More than half the patients were single, unemployed, unskilled labourers with secondary-school education. The vast majority used heroin intravenously. Negative emotional states and drug-related cues were seen by the majority of the subjects as influential in their immediate relapse after discharge. Findings suggest that the treatment and rehabilitation unit in Bahrain should look into the issues of after-care.
Health attitudes of school teachers.
OBJECTIVE: Teachers' health attitudes are usually a reflection of their knowledge, beliefs and perceptions on health. Such attitudes could be disseminated from teachers to their pupils, who represent the fastest growing segment of the population. Health promotion in society will depend, among other factors, on this segment. School teachers therefore, should have proper attitudes and be knowledgeable with regards to health issues. The purpose of this study was to assess school teachers' health attitudes and perceptions. METHODS: This study was conducted in Bahrain during 1997 through to 1998. A random sample of 49 schools were selected and all the teachers (N=1140) serving in those schools were chosen. Information regarding their health attitudes was collected using a pre-tested questionnaire. RESULTS: One thousand one hundred and forty teachers with age ranging from 20-58-years responded to the questionnaire. Results indicated that teachers in Bahrain lack appropriate health attitudes and knowledge. CONCLUSION: There is a need for an in service training of teachers in order to promote their health attitudes, that can reflect on the attitude of their pupils.
Poliomyelitis survey in Middle-East countries.
The poliomyelitis survey was started in 1976 in Bahrain and Kuwait. For each paralytic case, diagnosis was done by virus isolation, neutralizing antibody titration and specific IgM characterization. More than 90% of the infants who were ill were less than 2 years old. In Bahrain, 17 paralytic cases in 1976 and 12 in 1977 occurred between January and July (annual incidence was respectively 7.7 and 5.4/100,000). The first epidemic was due to poliovirus type 2, the second one to poliovirus type1. From 29 cases, 13 occurred in vaccinated infants of which 9 received 3 or 4 oral vaccine doses. For 3 infants, paralysis occurred less than one month after vaccination. All the isolates were wild polioviruses (rct). In Kuwait, 119 cases were examined, and of them, 57 occurred between August 76 and May 77 (incidence 5.7/100,000). Poliovirus type 1 was responsible for 61% of cases, type 2 for 5% and type 3 for 12%. From October 1976 to December 1977, 350 stools samples were collected from contacts: 19% of them carried poliovirus (12% type 1, 1% type 2 and 6% type 3). All the viruses isolated from both paralytic cases and contacts were wild strains (rct). Of 119 cases, 35 occurred in vaccinated infants from which 4 had received 3 or 4 oral vaccine doses. For 11 infants paralysis occurred less than one month after vaccination. The virus spread was evaluated (i) just before vaccination in 337 infants or children from June to December 76: 8% carried poliovirus Sabin-like strains (and 18% non polioviruses), and (ii) one month after vaccination in 75 infants: 37% carried poliovirus Sabin-like strains.