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PubMed2002

Prescribing pattern of antihypertensive drugs by family physicians and general practitioners in the primary care setting in Bahrain.

The aim was to determine whether there are differences among family physicians (FPs) and general practitioners (GPs) in terms of their preference for different classes of antihypertensives, either alone or in combinations, in uncomplicated cases of hypertension and to determine the extent of adherence to WHO/ISH guidelines. We have analysed prescribing of antihypertensives by qualified family physicians (FPs) (n=77) and compared this with that of general practitioners (GPs) (n =41) by auditing 1791 prescriptions of FPs and 914 prescriptions of GPs, issued to patients with uncomplicated hypertension, at 15 out of 20 health centres in Bahrain. The choice of antihypertensive(s) by FPs and GPs was comparable and conformed with the WHO/ISH guidelines as regards preference for: (i) beta-blockers, angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) as monotherapy; (ii) two-drug combinations (diuretic-beta-blocker; beta-blocker-CCB); (iii) three-drug combinations (diuretic-beta-blocker-CCB; diuretic-beta-blocker-ACE inhibitor; beta-blocker- ACE inhibitor-CCBs), and (iv) choice of drug used for the elderly either alone (CCBs) or as combinations (diuretic-beta-blocker; beta-blocker-CCB and diuretic-beta-blocker-ACE inhibitor; diuretic-beta-blocker-CCB). In several instances prescribing by both FPs and GPs was not in accordance with the WHO/ISH guidelines: reluctance to prescribe diuretics as monotherapy; use of suboptimal combinations (beta-blocker-ACE inhibitor); and extensive use of beta-blockers and irrational use of immediate-release nifedipine in elderly. A statistically significant prescribing difference between FPs and GPs was evident in the following: beta-blockers as monotherapy (P =0.01), diuretic-CCB (P=0.046), and diuretic-CCB-methyldopa (P=0.01) combination, and immediate-release nifedipine monotherapy in the elderly (P=0.027), were prescribed more often by the GPs. However, beta-blocker-ACE inhibitor-CCB combination was more often prescribed by FPs (P=0.046). Remarkable differences in prescribing pattern of antihypertensives between the FPs and GPs were evident. Although the general pattern supported a superior prescribing profile of the FPs as expected, there is a need for improved prescribing by both GPs and FPs. Educational programmes, both graduate and residency training, and continuing professional education, should specifically address these deficiencies in order to assure quality primary health care.

Adrenergic beta-Antagonists↗
PubMed2003

Assaults and nonpatient-induced injuries among psychiatric nursing staff in Bahrain.

This retrospective study of incident reports at the psychiatric hospital in Bahrain was carried out to describe nursing staff injuries that were reported during 1992-1999. The average assault rate (4.4%) was much lower than that reported in Western countries. Of the 111 injuries, 44.0% occurred in wards assigned for patients with acute conditions, 27.5% in chronic condition wards, 5.5% in outpatients, and 22.9% in the community. Staff assaults by patients constituted 60.4% of all injuries, of which 64.2% occurred in the 1992-1995 period. The assault rate was highest in 1992 (6.8/100) and lowest in 1998 (1.1/100), while the rate for all injuries was highest in 1994 (12.0/100) and lowest in 1998 (3.3/100). Bahraini staff had higher assault (7.0/100) and total injury (14.8/100) rates than the non-Bahraini (5.5, 6.8/100, respectively). Odds ratios for assaults vs. nonpatient-induced injuries indicated that assaults were 2.3 times (95% CI: 1.05-4.95) more likely to occur in males, 5 times more likely (95% CI: 1.99-12.15) in non-Bahraini, 1.79 times more likely (95% CI: 0.81-3.95) in staff nurses, and 2.3 times more likely (95% CI: 1.05-5.01) in the evening. Suggestions for reducing assaults and nonpatient-induced injuries are discussed.

Adult↗
PubMed1997

Lead levels in deciduous teeth of children in Bahrain.

To determine lead exposure among children in Bahrain, a total of 280 shed deciduous whole teeth were collected from 269 children. Teeth were analyzed for lead concentrations using atomic absorption spectrophotometry with electrothermal atomization. Children were between 5 and 15 years old. The study period extended from July 1993 to April 1994. The study showed that the overall mean tooth-lead level was 4.3 micrograms/g dry weight with a range of 0.1-60.8 micrograms/g dry weight. The cumulative frequency distribution revealed that 35% of the teeth had a lead concentration of more than 4 micrograms/g dry weight. The tooth-lead concentrations differed according to the tooth type age. The child's sex, nationality, area of residence and socio-economic status had no impact on tooth-lead level. In conclusion, lead is present in toxic concentrations in 35% of the teeth of the children studied. Urgent measures are needed to eliminate lead from gasoline, paint and other sources in the environment.

Adolescent↗
PubMedDate not supplied

Weight, height, body mass index and prevalence of obesity among the adult population in Bahrain.

PRIMARY OBJECTIVES: To determine anthropometric measurements (weight, height, body mass index, BMI), and the prevalence of overweight and obesity based on BMI. METHODS AND PROCEDURES: A cross-sectional survey of 514 Bahraini native adults aged 30-79 years was selected from households using clustering sampling technique. OUTCOMES AND RESULTS: Findings indicate that Bahraini adults were shorter but heavier, and have higher mean BMI than their Western counterparts, suggesting a trend to obesity. The overall prevalence of overweight and obesity was 35.2% and 21.2% for men, while that for women was 31% and 48.7%, respectively. CONCLUSIONS: The results of this study confirmed the data in other Arabian Gulf countries, as obesity is a major public health problem among the adult population. Anthropometrics provided in this study can be used as baseline data for the adult population of Bahrain.

Adult↗
PubMedDate not supplied

Growth patterns of school-children in Bahrain.

The aim of this study is to assess physical growth of school children in Bahrain. Cross-sectional data on 1593 children (818 boys and 775 girls), aged 6.5 to 18.5 years were collected in 1986. Anthropometric measures included height, weight, mid-arm circumference, triceps, biceps, subscapular and suprailiac skinfold thickness. At all ages median (P50) heights and weights of Bahraini boys and girls are below the 50th percentiles of the North American reference standard (NCHS). Median heights of both Bahraini sexes falls between the 25th and 5th percentiles of the reference data. As for weight, the median of boys fluctuates between the 25th and 5th percentiles, while that of girls fluctuates between the 50th and 10th percentiles of the standard. When compared to the American standard, median triceps skinfold of Bahraini boys and girls falls between the 50th and 25th percentiles. The median arm circumference of both sexes is close to the 5th percentiles. In general, the skinfold measurements indicate a high subcutaneous fat store, suggesting a lack of muscle development. Health, genetic and other factors associated with growth patterns of Bahraini children are discussed.

Adipose Tissue↗
PubMed2006

Association of the methylenetetrahydrofolate reductase A1298C but not the C677T single nucleotide polymorphism with sickle cell disease in Bahrain.

The association of methylenetetrahydrofolate reductase (MTHFR) gene mutations, C677T and A1298C, together with changes in homocysteine (Hcy) levels was investigated in 106 sickle cell disease patients and 156 healthy controls from Bahrain. The mutation analysis was done by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). While the frequencies of the mutant alleles C677T and A1298C were comparable between patients and controls, the frequency of the A1298C (C/C) (p = 0.03) but not C677T (T/T) (p = 0.67) genotype, and of the 677T/1298C haplotype were significantly higher in the patients (p = 0.05). Homocysteine levels were normal in all subjects. This suggests that the A1298C, but not C677T, mutation is associated with the genotype of sickle cell disease.

Adolescent↗
PubMed2005

Proximate and mineral composition of crab meat consumed in Bahrain.

The proximate, mineral and heavy metals of raw and cooked crab meat, Portunus pelagicus, consumed in Bahrain were studied. The crab meat contains a good level of protein (17.5-18.8%), with very low proportion of fat (0.6-1.4%). The levels of sodium, potassium, calcium and phosphorus were found to be higher than other minerals. Traces of heavy metals (lead, mercury, cadmium) were also reported. Traditional cooking had a considerable effect on proximate and mineral contents of crab meat.

Animals↗
PubMed2004

Teaching medical ethics: implementation and evaluation of a new course during residency training in bahrain.

AIM: This paper describes the development, implementation and evaluation of a new biomedical ethics course. The major educational goal was to enable the participants to critically analyse and resolve ethical dilemmas based on sound ethical and moral reasoning. BACKGROUND: The course was developed and implemented in the Family Practice Residency Program (FPRP) in the Kingdom of Bahrain. METHODOLOGY: Thirty-six family physician trainees participated in this course in May 2002 and January 2003. The curriculum was divided into five sessions, and each session had specific objectives, contents and teaching methods. The course was evaluated using pre- and post-tests, direct observation of participants and overall course assessment. RESULTS: Evaluations demonstrated that the participants scored higher in the post-test than in the pre-test. There was a significant statistical difference between the mean scores of both tests. After completing the course, participants produced more justifiable decisions than those generated at the beginning and felt more confident discussing and reasoning their decisions based on sound ethical and moral concepts. CONCLUSION: Our experience had demonstrated that the trainees benefited from a structured curriculum in biomedical ethics. We believe that the development and implementation of our course may serve as a case study for training and teaching postgraduates in the area of medical ethics.

Adult↗
PubMed1990

Nutritional disorders associated with affluence in Bahrain.

In this paper the nutritional disorders associated with affluence in Bahrain are reviewed and analysed. Heart diseases, obesity, diabetes mellitus, cancer, and dental caries are becoming the main public health problems in the country. The major aetiological factors leading to such a situation are change in lifestyle, high per capita income, change in food consumption patterns, and ineffective preventive measures. Programmes to control the disease of affluence should be given a high priority in any health plan. Emphasis should be placed on initiating intervention nutrition programmes, training health staff and carrying out epidemiological studies.

Adolescent↗
PubMed1995

Occupational injuries in Bahrain.

A study was conducted to show the problem of occupational injuries in Bahrain and try to highlight some solutions that may help to prevent or reduce workplace hazards. The data for occupational injuries between 1988 to 1991 from the social insurance records were reviewed and analysed. The data were summarized, grouped and tabulated according to age, sex, nationality, work place, type of injuries, cause and site of injury. Data were analysed statistically, frequencies were computed and results represented graphically. The study shows that there was a decline in the number of injuries in 1990 and 1991 due to a slow-down of economic activities in general in the Arabian Gulf region during the Gulf War. It also shows that Asian workers are at a high risk of occupational injuries.

Accidents, Occupational↗
PubMed1998

Cystic fibrosis in bahrain incidence, phenotype, and outcome.

To identify the incidence and evaluate the causes of high mortality among Bahraini children with cystic fibrosis, we studied, retrospectively, 25 patients diagnosed as proven cases of cystic fibrosis at Sulmaniya Medical Center, the main referral center on the island, from January 1978 to December 1995. With extrapolation of the study data to the general population, the incidence of cystic fibrosis in Bahrain is at least one in 5800 and the prevalence is at least 3 in 100,000 population. Consanguineous marriage is documented in 80 per cent of the cases. Cystic fibrosis in Bahraini children is phenotypically severe, this is inferred from early age of presentation (mean of 2 months +/- 1 month) and early age of diagnosis (mean 4 +/- 1 month), development of pancreatic insufficiency by 1 year of age in all of the study patients, failure to thrive in 96 per cent of the patients, hypoalbuminemia in 48 per cent, meconium ileus in 20 per cent, progressive lung disease in 84 per cent at an early age, and early colonization with Pseudomonas aeruginosa. Age-specific mortality in the first year of life showed dramatic decline from 80 per cent between 1981 and 1985 to 50 per cent from 1986 to 1990, and to 9 per cent from 1991 to 1995. This improvement in survival is believed to be due to increased awareness among medical professionals and improved treatment.

Bahrain↗
PubMed2006

Rational use of antimicrobials in infants in primary care of Bahrain.

This nationwide prescription-based study was undertaken to evaluate antimicrobial prescribing for infants, and to identify prescribing errors in infants in 20 primary care health centres of Bahrain. Data was collected on a daily basis by pharmacists in May 2004. Antimicrobials ranked the 5th most common drugs prescribed in infants; beta-lactams, notably amoxycillin and cephalexin, comprised 81.6% of overall prescribed antimicrobials. Antimicrobials were prescribed to approximately one out of four infants (23.8%), prescribed more often to infants aged 9-12 months of age. Approximately one-fifth (22%) of infants received antimicrobials at subtherapeutic daily doses. The prescribing errors were related to dosage (39.2%), strength/doses (26.4%), frequency of dosing (19.2%), and duration of therapy (4.5%). Antimicrobial dosage prescribed in relation to infants' age revealed a positive correlation for amoxycillin (r = 0.264; p < 0.0001), cephalexin (r = 0.223; p = 0.029), erythromycin (r = 0.127; p = 0.284), and a negative correlation for metronidazole (r = -0.183; p = 0.415). Overt use of antimicrobials in infants, and prescription-writing errors (in dosages and frequency of dosing) were common in primary care. Dosage adjustment in relation to developmental stages of infants has received inadequate attention. Effective strategies to improve prescription writing skills are urgently required.

Anti-Infective Agents↗
PubMed1989

The epidemiology of trauma in an intensive care unit in Bahrain.

Injuries resulting from trauma are over-represented in Bahrain's intensive care unit beds. Using data from 1984 and 1985, this study examines the most severe etiologic agents and high-risk population groups among ICU trauma patients. Road traffic accidents were the principal cause of admission, accounting for 57% of all injury admissions. Most occurred in pedestrians suffering from severe head injury. Poisonings were the second largest category, followed by falls. In comparison with medical cases admitted to the ICU during the same 2-year period, the trauma cases included a disproportionate number of children and males in their most productive years of life, further adding to the economic burden which injuries have inflicted on this small country. The authors call for a new approach, namely passive prevention such as environmental modifications and legislation and tertiary prevention such as improvement of the country's underutilized ambulance service.

Accidental Falls↗
PubMedDate not supplied

Chromosomal resistance to antibiotics in gonococci from Bahrain.

Ninety-one isolates of non-penicillinase-producing Neisseria gonorrhoeae from patients in Bahrain were tested for serotype, auxotype, and antibiotic susceptibility. Ten serovars and three auxotypes were found. Of the 91 isolates, 49 (54%) were serovar IB-5/7, 59 (65%) had a penicillin MIC greater than or equal to 1 mg/l, 39 (45%) had a cefuroxime MIC greater than or equal to 0.5 mg/l, and 63 (69%) had a tetracycline MIC of greater than or equal to 4 mg/l. No spectinomycin or high-level tetracycline resistance was seen. Seventy of the 91 isolates were tested against ciprofloxacin and ceftriaxone, and 40 (57%) and 26 (37%) had MICs greater than or equal to 0.03 mg/l, respectively. DNA from two penicillin-resistant isolates was capable of transforming recipient strain FA19 to donor level of penicillin and cephalosporin resistance in four steps. The first three steps were indicative of the acquisition of known resistance mutations. The existence of the fourth level transformants, with the ability of donor DNA to transform strain FA140 to higher levels of resistance, suggest the presence of another resistance mutation.

Anti-Bacterial Agents↗
PubMed2005

Evaluation of drug therapy and risk factors in diabetic hypertensives: a study of the quality of care provided in diabetic clinics in Bahrain.

OBJECTIVE: To evaluate control of blood pressure (BP) and diabetes and the associated risk factors in diabetic hypertensives treated by diabetic clinic primary care physicians. METHODS: A retrospective analysis of the medical records of diabetic hypertensives from six primary care diabetic clinics in Bahrain. RESULTS: The recommended BP target <130/<85 mmHg and of glycosylated haemoglobin (HbA1C) <7% were achieved in 7.5% and 14.5%, respectively. Most of the patients with uncontrolled BP and HbA(1C) were at high cardiovascular risk. More patients were on antihypertensive monotherapy than on combination therapy (60.6% vs. 36.7%; P<0.0001). The recommended two- and three-antihypertensive drug combinations were less often prescribed. In high-risk patients glycaemic control achieved was poor: antidiabetic combination therapy vs. monotherapy did not significantly differ. Inappropriate prescribing practices, such as the use of immediate-release nifedipine monotherapy, use of sulphonylurea instead of metformin in obese patients, and a trend towards prescribing of glyburide rather than a gliclazide in the elderly, were observed. Lipid-lowering (13.5%) and antiplatelet (12.8%) drugs were infrequently prescribed. CONCLUSIONS: Hypertension and diabetes in patients treated at the primary care diabetic clinics were inadequately controlled. In several instances, mono- and combination antihypertensives prescribed were irrational. Lipid-lowering and platelet aggregation inhibition strategies have received little attention. Intensive antihypertensive and antidiabetic complementary combination therapy should be encouraged. Continuous professional education of diabetic clinic physicians and expert-supervised diabetic clinics are desirable.

Adult↗
PubMed1992

Pregnancy in sickle cell disease in Bahrain.

OBJECTIVE: To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. DESIGN: A case-control study. SETTING: Ministry of Health hospitals in Bahrain. SUBJECTS: 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity. MAIN OUTCOME MEASURES: The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statistics in the index and control women. RESULTS: Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. CONCLUSION: Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.

Adult↗
PubMed1988

Maternal mortality in Bahrain with special reference to sickle cell disease.

The maternal mortality in Bahrain during the 10-year period, 1977-1986, was 33.9 per 100,000 livebirths; the second 5-year period showed a significant reduction (26.9) compared to the first 5-year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.

Anemia, Sickle Cell↗
PubMed1993

Avian pox in birds of prey (order Falconiformes) in Bahrain.

Avian pox is an important disease in birds of prey in Bahrain. A live pigeon pox vaccine was administered to hunting falcons (Falco species) together with other therapeutic methods to arrest the development of primary stage pox lesions and for the treatment of well established secondary stage pox lesions. Quarantine and general hygiene procedures were also used as an integral part of the management and control of the disease.

Animals↗