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PubMed1979

Bottle feeding as a risk factor for cholera in infants.

To determine risk factors for cholera in infants, a retrospective matched-pair study of 42 cases and their controls was undertaken during an outbreak of El Tor cholera in Bahrain in the autumn of 1978. The highest attack-rate of cholera (125/10 000) occurred in infants in the 6--11 month age-group, which corresponds to the weaning age in this community. Significantly more cases than controls were principally bottle fed (greater than 50% milk intake by bottle) than principally breast fed during the week before onset of illness (p=0.004). Analysis of various patterns of breast and bottle feeding did not determine whether the protection afforded by breast feeding was a negative effect (due to the lack of exposure to contaminated bottle feedings for breast fed infants) or a positive effect (due to protective functions of constituents of human breast milk). Cholera infection (with or without symptoms) among mothers of either case or control infants was uncommon (case mothers 3, control mothers 5), and mean serum vibriocidal and antitoxic antibody levels were similar for the two groups of mothers. These observations suggest that maternal infection did not affect the relative risk of infants having symptomatic cholera.

Antibodies, Bacterial↗
PubMed1989

Mycotic infection of the ear (otomycosis): a prospective study.

Otomycosis (fungal infection of the ear) is not uncommon clinical problem encountered in our ENT practice. It makes up to 6 per cent of all patients with symptoms of ear disease seen in the Outpatient Clinic. Of the 193 patients with a clinical diagnosis of otomycosis, 171 cases produced positive fungal isolates. In this study Aspergillus species (niger and fumigatus) have been the most common fungal pathogens. Various aetiopathological factors have been examined in detail, and the available literature reviewed. The results of the treatment by nine antifungal agents currently available in Bahrain have been analysed.

Adolescent↗
PubMed1992

The potential for medical informatics in the Eastern Mediterranean Region.

This article assesses the potential value of an integrated medical/ hospital information system (IMIS) for the members of the Eastern Mediterranean Region of the World Health Organization, and describes the preliminary results of a feasibility study questionnaire done in December 1989 at Salmaniya Medical Center (SMC) in the state of Bahrain.

Attitude of Health Personnel↗
PubMed2003

Prevalence of overweight and obesity among Bahraini adolescents: a comparison between three different sets of criteria.

OBJECTIVE: The aim of this study is to determine the prevalence of overweight and obesity among Bahraini adolescents using three different sets of criteria/standards. DESIGN: Cross-sectional prevalence study. SETTING: Intermediate and secondary schools in Bahrain. SUBJECTS: The study included a population-representative sample of 506 Bahraini students (249 males and 257 females) between 12 and 17 y of age. The sample was selected using multistage stratified random sampling technique. MEASUREMENT: Anthropometric measurements including weight, height and triceps and subscapular skinfolds were taken on the adolescents. Age was verified against school records. To minimize inter-observer error, weight and height were taken by one person while skinfold was taken by two trained persons (one for each sex). RESULTS: The overall prevalence of obesity among Bahraini boys and girls was high, especially in girls. Obesity was highest (21% in males and 35% in females) when the WHO recommended criteria of BMI for age and skinfolds for age percentiles were applied and lowest (15% in boys and 18% in girls) when the age and sex specific BMI cut-off values of Cole et al were used. Compared with those of WHO criteria, estimates of overweight and obesity prevalence obtained with Must et al and Cole et al were generally close. CONCLUSIONS: Our data revealed a much higher prevalence rate of obesity in the Bahraini adolescent population than was previously reported, especially among girls. The BMI reference values of Must et al and that of Cole et al gave relatively similar estimates and appear to be more practical for use in surveys aimed at estimating the prevalence of overweight and obesity among adolescents than the WHO recommended composite criteria.

Adolescent↗
PubMed2002

Family physicians' and general practitioners' approaches to drug management of diabetic hypertension in primary care.

RATIONALE, AIMS AND OBJECTIVES: To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). METHODS: A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians--77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. RESULTS: As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (37.9%) and beta-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a beta-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a beta-blocker-CCB combination (17.4 vs. 14.9%) or a diuretic-ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a beta-blocker-diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a beta-blocker. Diuretics were less preferred by both FPs and GPs. Beta-blocker-ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB-beta-blocker combinations more often than GPs (P = 0.01), whereas CCB-ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45-64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a beta-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs. CONCLUSIONS: Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care.

Adolescent↗
PubMed2003

Physician gender and antihypertensive prescription pattern in primary care.

OBJECTIVES: To determine: (i) the gender-based differences of physicians in prescribing antihypertensive drugs in the management of hypertension; (ii) the influence of patient comorbidity such as diabetes mellitus on the gender-based pattern of antihypertensive prescription, and (iii) gender-based prescription patterns among family physicians (FPs) and general practitioners (GPs). METHODS: A survey study was carried out at 15 out of 20 health centres in Bahrain during May and June 2000. A total of 3971 prescriptions, issued to 2705 patients with uncomplicated hypertension and 1266 patients with diabetic hypertension by 77 FPs (female = 54, male = 23) and 41 GPs (female = 11, male = 30), were analysed. RESULTS: As monotherapy, female physicians preferred ACE inhibitors (OR: 0.82, CI: 0.68-0.98, P = 0.033). In terms of overall drug utilization (monotherapy + combination therapy): (i) male physicians preferred beta blockers (OR: 1.17, CI: 1.03-1.31, P = 0.014) and diuretics (OR: 1.15, CI: 1.00-1.32, P = 0.047), while female physicians preferred methyldopa (OR: 0.73, CI: 0.56-0.94, P = 0.019); (ii) in uncomplicated hypertension, female physicians preferred calcium channel blockers (OR: 0.83, CI: 0.69-0.99, P = 0.038) and methyldopa (OR: 0.69, CI: 0.49-0.98, P = 0.042), and (iii) in diabetic hypertension, male physicians preferred beta blockers (OR: 1.26, CI: 1.00-1.57, P = 0.047). While female FPs prescribed methyldopa more extensively (OR: 0.66, CI: 0.47-0.92, P = 0.018), male GPs prescribed beta blockers (OR: 1.28, CI: 1.00-1.62, P = 0.046). CONCLUSIONS: Within the same practice setting, gender-based differences in the prescription of antihypertensive drugs were seen. Such preference for a particular class of antihypertensives was also influenced by the presence of comorbidity in patients and, to a limited extent, by the training level of primary care physicians.

Antihypertensive Agents↗
PubMed2003

Reliability and validity of the direct observation clinical encounter examination (DOCEE).

CONTEXT: The College of Medicine and Medical Sciences at the Arabian Gulf University, Bahrain, replaced the traditional long case/short case clinical examination on the final MD examination with a direct observation clinical encounter examination (DOCEE). Each student encountered four real patients. Two pairs of examiners from different disciplines observed the students taking history and conducting physical examinations and jointly assessed their clinical competence. OBJECTIVES: To determine the reliability and validity of the DOCEE by investigating whether examiners agree when scoring, ranking and classifying students; to determine the number of cases and examiners necessary to produce a reliable examination, and to establish whether the examination has content and concurrent validity. SUBJECTS: Fifty-six final year medical students and 22 examiners (in pairs) participated in the DOCEE in 2001. METHODS: Generalisability theory, intraclass correlation, Pearson correlation and kappa were used to study reliability and agreement between the examiners. Case content and Pearson correlation between DOCEE and other examination components were used to study validity. RESULTS: Cronbach's alpha for DOCEE was 0.85. The intraclass and Pearson correlation of scores given by specialists and non-specialists ranged from 0.82 to 0.93. Kappa scores ranged from 0.56 to 1.00. The overall intraclass correlation of students' scores was 0.86. The generalisability coefficient with four cases and two raters was 0.84. Decision studies showed that increasing the cases from one to four improved reliability to above 0.8. However, increasing the number of raters had little impact on reliability. The use of a pre-examination blueprint for selecting the cases improved the content validity. The disattenuated Pearson correlations between DOCEE and other performance measures as a measure of concurrent validity ranged from 0.67 to 0.79. CONCLUSIONS: The DOCEE was shown to have good reliability and interrater agreement between two independent specialist and non-specialist examiners on the scoring, ranking and pass/fail classification of student performance. It has adequate content and concurrent validity and provides unique information about students' clinical competence.

Bahrain↗
PubMed1995

Prevalence of hepatitis B, hepatitis C and human immune deficiency virus markers among patients with hereditary haemolytic anaemias.

To determine the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) markers among Bahraini children with hereditary haemolytic anaemias, a cross-sectional study was conducted at the paediatric outpatient clinic of Sulimaniya Medical Center in the State of Bahrain. A total of 242 patients with hereditary haemolytic anaemias were enrolled in the study: 171 (71%) with sickle cell syndromes, 59 (24%) with beta thalassaemia major and 12 (5%) with alpha thalassaemia. Among the 191 multi-transfused patients, 39 (20.5%) had one or more markers for HBV, 78 (40%) were seropositive for HCV antibody, and three (1.6%) were seropositive for HIV antibody. In contrast, none of the 51 non-transfusion group was seropositive for HBV and HIV antibodies but one patient was seropositive for HCV antibody. HBV, HCV and HIV infections therefore remain a major hazard for children with hereditary haemolytic anaemias, despite blood donor screening. More refined and sensitive tests which would detect infection in all stages of the disease are required. Hepatitis B vaccine should be given to all children with hereditary haemolytic anaemias.

Adolescent↗
PubMed2000

Nutritive value of traditional sweets consumed in the Arab Gulf countries.

Proximate, mineral, fatty acid and cholesterol composition of eight traditional sweets commonly consumed in the Arab Gulf countries were determined. Four sweets were obtained from Bahrain, whereas the other sweets were obtained from Oman. Protein level ranged from 0.2 to 9.0%, while the fat content ranged from 7.9 to 18.0%. In general, the sweets were found to be high in energy content but poor in most minerals. Iron and zinc contents were low (less than 2 and less than 1 mg/100 g for iron and zinc, respectively). Cholesterol was high in four sweets (range from 10.6 to 20.4 mg/100 g), mainly because of the use of animal fat in preparation of these sweets. The fatty acids profiles showed that palmitic and oleic acids were predominant. One sweet (eggbaith) was found to be very high in linoleic (42%) and low in palmitic (9.6%) acids. The study showed that some traditional sweets are nutritious, while others should be consumed with moderation.

Adolescent↗
PubMed2003

Student generated learning objectives: extent of congruence with faculty set objectives and factors influencing their generation.

CONTEXT: A problem-based learning strategy is used for curriculum planning and implementation at the Arabian Gulf University, Bahrain. Problems are constructed in a way that faculty-set objectives are expected to be identified by students during tutorials. Students in small groups, along with a tutor functioning as a facilitator, identify learning issues and define their learning objectives. PURPOSE: We compared objectives identified by student groups with faculty-set objectives to determine extent of congruence, and identified factors that influenced students' ability at identifying faculty-set objectives. METHOD: Male and female students were segregated and randomly grouped. A faculty tutor was allocated for each group. This study was based on 13 problems given to entry-level medical students. Pooled objectives of these problems were classified into four categories: structural, functional, clinical and psychosocial. Univariate analysis of variance was used for comparison, and a p > 0.05 was considered significant. RESULTS: The mean of overall objectives generated by the students was 54.2%, for each problem. Students identified psychosocial learning objectives more readily than structural ones. Female students identified more psychosocial objectives, whereas male students identified more of structural objectives. Tutor characteristics such as medical/non-medical background, and the years of teaching were correlated with categories of learning issues identified. CONCLUSION: Students identify part of the faculty-set learning objectives during tutorials with a faculty tutor acting as a facilitator. Students' gender influences types of learning issues identified. Content expertise of tutors does not influence identification of learning needs by students.

Bahrain↗
PubMed2000

Relation of high blood pressure to glucose intolerance, plasma lipids and educational status in an Arabian Gulf population.

BACKGROUND: In Bahrain and other populations of the Arabian Peninsula, glucose intolerance is associated with raised plasma total cholesterol, postmenopausal status and low educational status. These associations are not generally seen in other populations with high diabetes prevalence. A study was undertaken in order to determine if hypertension in Bahrainis is associated with the same factors as those related to glucose intolerance. METHODS: A cross-sectional survey of 2120 Bahrainis aged 40-69 years. RESULTS: The age-adjusted prevalence of hypertension (defined as current treatment for hypertension, systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) rose with increasing degrees of glucose intolerance. Age- and sex-standardized prevalence of hypertension was 21% (95% CI: 19-24%) in those with normal glucose tolerance, 31% (95% CI: 27-36%) in those with impaired glucose tolerance, and 38% (95% CI: 34-42%) in those with diabetes. In a multivariate analysis adjusting for age and sex, raised blood pressure was independently associated with waist girth, plasma cholesterol, glucose intolerance, family history of hypertension and (in women) postmenopausal status. There was an inverse relationship between blood pressure and educational status that was independent of other variables. This association parallels the inverse relationship of diabetes to educational level and is consistent with low educational level being a marker for socioeconomic deprivation in early life in this population. CONCLUSION: The high prevalence rates of hypertension and diabetes in Bahrainis are manifestations of a pattern of metabolic disturbances that includes raised plasma cholesterol levels. Both hypertension and diabetes are associated with low educational status, which in this population is a marker for socioeconomic deprivation in early life. This suggests that the risk of hypertension may be set by environmental factors in early life.

Adult↗
PubMed1998

Managing health care organizations in an age of rapid change.

Health care managers find their work increasingly difficult, due in part to rapid environmental change that plagues organizational life. Management practices and attitudes that may have been appropriate in previous eras are ineffective today. A study was conducted among managers in the Ministry of Health, State of Bahrain, seeking information about current trends in the macro or external environment that affect the Ministry of Health, as well as internal environmental pressures that may be similar or different. This article provides a clear picture of the context in which managers perform their work and offers recommendations for coping with change in dynamic, complex organizations.

Bahrain↗
PubMed2004

Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?

OBJECTIVES: To determine how well and to what extent blood pressure (BP) is controlled in diabetic hypertensive patients treated by primary care doctors, and to evaluate drug therapy in the backdrop of risk factors and laboratory findings. METHODS: A therapeutic audit of the medical records of diabetic hypertensives from nine primary care health centres in Bahrain. RESULTS: In 266 diabetic hypertensives (82 males and 184 females), the recommended target BP < 130/< 85 mmHg (WHO/ISH guidelines, 1999) was achieved in 20 (9.8%) with a BP of 119 +/- 4/76 +/- 5 mmHg. Among those who did not achieve target BP, 70 (34.5%) lacked systolic BP control (BP = 153 +/- 17/79 +/- 3 mmHg), four (2%) lacked diastolic BP control (BP = 123 +/- 3/86 +/- 3 mmHg) and 109 (53.7%) lacked both systolic and diastolic BP control (BP = 158 +/- 20/94 +/- 7 mmHg). The mean age of the group achieving target BP was significantly lower than the group which lacked systolic BP control (51.6 +/- 9 vs. 63.5 +/- 9 years; P < 0.0001). While there were no significant differences in fasting blood glucose, glycosylated haemoglobin, triglycerides, urea, creatinine, uric acid and serum electrolytes between the group achieving target BP vs. groups without target BP, a significant difference in total cholesterol was seen. PATIENTS: with ischaemic heart disease and/or isolated systolic hypertension did not achieve the target BP. Antihypertensive monotherapy was prescribed in 145 (54.5%) patients, whereas two- and three-drug combinations were prescribed in 32.3 and 8.2% of patients, respectively. As monotherapy, angiotensin-converting enzyme (ACE) inhibitors were the most frequently prescribed drugs followed by beta-blockers, calcium channel blockers (CCBs) and diuretics. As two-drug combinations, an ACE inhibitor with a beta-blocker/diuretic and a beta-blocker with a CCB/diuretic were usually prescribed. CONCLUSIONS: According to the WHO/ISH 1999 guidelines, approximately one out of 10 diabetic hypertensives achieved target BP control. In many instances, the drug therapy prescribed was inappropriate considering the comorbidity in patients and their laboratory findings. Improved BP control is needed in treating high-risk groups such as patients with diabetes mellitus, and efforts should be made to improve the treatment of hypertension in the primary care setting.

Antihypertensive Agents↗
PubMed1986

Congenital malformations and consanguinity.

In this study in Bahrain increased maternal age, high parity, consanguinity and a history of 2 or more previous abortions were found to increase the risk of congenital malformation.

Abortion, Spontaneous↗
PubMed1994

Effect of fluoride in amalgam on secondary caries incidence.

Caries incidence is falling in many developed countries but is believed to be increasing in developing countries. Insofar as treatment for caries is provided, ordinary amalgam restorations are usually the standard choice. These carry a risk of failing due to secondary caries. The aim of this study was to compare the occurrence of secondary caries adjacent to fluoride-containing amalgam with that adjacent to a conventional amalgam under field conditions in Bahrain. Children (n = 415) aged 6-14 yr who required occlusal restorations in two homologous contralateral permanent molar teeth were identified. Using the split-mouth design, one tooth received a fluoride-containing amalgam filling and the other a conventional amalgam restoration. A random method was used to determine which type of filling was placed on each side. After 4 yr, 357 children were still available for examination; of these 5 had to be eliminated from analysis for various reasons. Of the 704 teeth in the analysis, secondary caries had occurred in 135 (86 conventional amalgam, 49 fluoridated amalgam). By comparison with the conventional amalgam, the effectiveness of the fluoride amalgam was 43% (95% C.I. 24.4%, 57.1%) and the net gain 10.3% (95% C.I. 4.75%, 16.3%). The relative risk was 0.570 (95% C.I. 0.444%, 0.731%). Since fluoride amalgam has identical handling properties to conventional amalgam, performs similarly under clinical conditions and costs about the same, it should be the amalgam of choice for restorations in communities where the incidence of secondary caries is high.

Adolescent↗
PubMed2004

Specific HLA-DRB and -DQB alleles and haplotypes confer disease susceptibility or resistance in Bahraini type 1 diabetes patients.

Insofar as genetic susceptibility to type 1 diabetes is associated with HLA class II genes, with certain allelic combinations conferring disease susceptibility or resistance, this study assessed the distributions of HLA-DR and -DQ among 107 unrelated patients with type 1 diabetes and 88 healthy controls from Bahrain, all of Arab origin. The HLA-DRB and -DQB genotypes were determined by PCR-sequence-specific priming. The following alleles showed the strongest association with type 1 diabetes among patients versus controls according to their frequencies: DRB1*030101 (0.430 versus 0.097; P < 0.001), DRB1*040101 (0.243 versus 0.034; P < 0.001), DQB1*0201 (0.467 versus 0.193; P < 0.001), and DQB1*0302 (0.229 versus 0.091; P < 0.001). When the frequencies of alleles in controls were compared to those in patients, negative associations were seen for DRB1*100101 (0.085 versus 0.014; P < 0.001), DRB1*110101 (0.210 versus 0.060; P < 0.001), DQB1*030101 (0.170 versus 0.075; P = 0.006), and DQB1*050101 (0.335 versus 0.121; P < 0.001). In addition, the DRB1*030101-DQB1*0201 (70.1 versus 22.7%; P < 0.001) and DRB1*030101-DQB1*0302 (21.5 versus 0.0%; P < 0.001) genotypes were more prevalent among patients, thereby conferring disease susceptibility, whereas the DRB1*100101-DQB1*050101 (20.5 versus 2.8%; P < 0.001), DRB1*110101-DQB1*030101 (28.4 versus 8.4%; P < 0.001), and DRB1*110101-DQB1*050101 (30.7 versus 0.9%; P < 0.001) genotypes were more prevalent among controls, thus assigning a protective role. These results confirm the association of specific HLA-DR and -DQ alleles and haplotypes with type 1 diabetes and may underline several characteristics that distinguish Bahraini patients from other Caucasians patients.

Adolescent↗
PubMed2006

Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students.

OBJECTIVE: This study was undertaken to determine the knowledge, attitude and practice of self-medication among first-year medical students of the Arabian Gulf University, Bahrain. SUBJECTS AND METHODS: This was an anonymous, questionnaire-based, descriptive study. A prevalidated questionnaire, containing open-ended and close-ended questions, was administered to the subjects. Data were analyzed using SPSS version 12 and the results expressed as counts and percentages. RESULTS: Out of the 134 respondents, 43 (32.1%) were males and 91 (67.9%) were females; their mean age in years +/- SD was 18.01 +/- 0.78. The respondents' knowledge about appropriate self-medication was poor, but knowledge of the benefits and risks of self-medication was adequate. The respondents found self-medication to be time-saving, economical, convenient and providing quick relief in common illnesses. Important disadvantages of self-medication mentioned were the risk of making a wrong diagnosis, inappropriate drug use and adverse effects. The majority (76.9%) of the respondents had a positive attitude favoring self-medication. Self-medication was practiced by 44.8% of the subjects. The most common indications for self-medication were to relieve the symptoms of headache (70.9%), cough, cold and sore throat (53.7%), stomachache (32.8%) and fever (29.9%). Analgesics (81.3%) were the most common drugs used for self-medication. The practice of self-medication was appropriate in only 14.2% of cases. CONCLUSION: Knowledge about appropriate self-medication was poor, attitude towards self-medication was positive, and the practice of self-medication was common and often inappropriate.

Adolescent↗