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PubMed2000

Demand and supply of doctors and dentists in Bahrain, 1998-2005.

We examined the supply and demand of medical doctors and dentists in Bahrain. Demand for physicians and dentists was based on the objective of having a physician-to-population ratio of 1:650, and a dentist-to-population ratio of 1:5000. Analysis of the current workforce and projected graduates in the period 1998-2005 indicated that the supply of Bahraini medical doctors and dentists until the year 2005 will not be sufficient to meet the projected demand in these categories. By the year 2005, Bahraini doctors and dentists will provide 82.5% and 75.9% of medical and dental demands respectively. The remaining 17.2% of physicians and 24.1% of dentists will have to be recruited from abroad. Thus, the prospect of oversupply of Bahrainis among these categories until the year 2005 is highly unlikely.

Bahrain↗
PubMedDate not supplied

Extent of use of immediate-release formulations of calcium channel blockers as antihypertensive monotherapy by primary care physicians: multicentric study from Bahrain.

BACKGROUND: The issue of cardiovascular safety of calcium channel blockers (CCBs) has been widely debated in view of reflex increase in sympathetic activity induced by immediate release (IR) / short acting formulations. It is generally agreed that such CCBs should not be used alone in the management of hypertension. AIMS: We have determined the extent to which primary care physicians prescribe CCBs as monotherapy, especially the immediate release formulations, in the management of uncomplicated hypertension and diabetic hypertension - with an emphasis upon the age of the patients. SETTING, DESIGN AND METHODS: A retrospective prescription-based study was carried out in seven out of 18 Health Centres in Bahrain. The study involved a registered population of 229,300 representing 46% of registered individuals, and 35 physicians representing 43% of all primary care physicians. The data was collected between November 1998 and January 1999 using chronic dispensing cards. RESULTS: In all categories CCBs were the third commonly prescribed antihypertensive as monotherapy, with a prescription rate of 11.1% in uncomplicated hypertension, 18% in diabetic hypertension and 20.1% in elderly patients above 65 years of age. Nifedipine formulations were the most extensively prescribed CCBs. Almost half of the CCB-treated patients were on IR-nifedipine, whereas IR-diltiazem and IR-verapamil, and amlodipine were infrequently prescribed. CONCLUSION: Prescription of IR-formulations of CCBs as monotherapy by primary care physicians does not conform with recommended guidelines. In view of concerns about the safety of such practice, measures to change the prescribing pattern are required.

Adult↗
PubMed2004

Spectrum of malignant lymphomas in Bahrain. Leitmotif of a regional pattern.

OBJECTIVE: To determine the clinicopathologic features of malignant lymphomas in Bahraini patients. METHODS: A retrospective hospital-based study was conducted. All new cases of malignant lymphoma diagnosed during the period January 1996 to December 2001 at the Salmaniya Medical Complex in Bahrain were included in the study. RESULTS: Seventy-two cases met the inclusion criteria. This included 24 (33.3%) cases of Hodgkin's disease (HD) and 48 (66.7%) cases of Non-Hodgkin lymphomas (NHL). A young age at presentation (median 20 years) mixed cellularity histology, lack of extra nodal involvement and rare marrow involvement characterized HD. The majority of NHL showed diffuse high or intermediate grade lesions. A high number of primary extra nodal neoplasms (41.7% of NHL) and frequent involvement of the gastrointestinal tract with Helicobacter pylori-associated gastric lymphomas were notable features among NHL cases. Immunohistochemical staining in 30 cases showed 26 cases (86.7%) of B cell and 4 cases of T cell origin. CONCLUSION: The study highlights common features that distinguish malignant lymphoma reported from countries of the Arabian Gulf region. This pattern distinguishes them from the disease encountered in the Western world.

Adolescent↗
PubMedDate not supplied

Impact of triage in accident and emergency departments in Bahrain.

We aimed to assess the impact of triage by physicians on the workload and expenditure of the Accident and Emergency (AE) Department of Salmaniya Medical Complex, Bahrain. We analysed three sets of data: patient visits to the AE Department over a 9-month period; patient visits 1 year previously; and forecast patient visits over 9 months starting from July 1999. The referral of patients to AE cubicles was reduced by 54.4% after the implementation of the triage, and reduction in the workload was statistically significant. The reduction in health care expenditure was estimated at between 15.3% and 17.3%. We conclude that triage by physicians can be cost-effective and can reduce the AE Department workload, freeing more time to manage life-threatening and urgent cases.

Bahrain↗
PubMed2004

Risk factors of major noncommunicable diseases in Bahrain. The need for a surveillance system.

Noncommunicable diseases NCDs are the major cause of morbidity and mortality in Bahrain. The review examines the prevalence of risk factors of major NCDs from the available literature and determines the impact of the rapid socio economic changes on their burden. It further recommends ways of improving their reporting and monitoring. Smoking, obesity, diabetes, hypertension, hyperlipidemia, physical activity and nutrition are considered. The review points out that data on some of the factors is available but deficient for others. The call for the establishment of an integrated surveillance system using the World Health Organization STEPwise approach is stressed.

Adolescent↗
PubMedDate not supplied

Evaluation of the utilization management programme at Salmaniya Medical Complex, Bahrain.

In 1993, the Ministry of Health in Bahrain implemented a utilization management programme at the largest public hospital in the country, aimed at reducing patients' mean length of stay from 8.3 days in 1993 to 6.0 days in 2000. Time series analysis, using linear trend modelling and the annual disparity reduction rate, were used to estimate performance towards achieving the targets. The study found that the length of stay declined consistently between 1984 and 2000, with a steeper decline in the period 1994-2000, which could be attributed to the utilization management programme. Overall, length of stay was reduced by 20.5% between the two periods, short of the target 27.8% proposed in 1993. Individual clinical departments showed mixed results, with better performance demonstrated by the Departments of Medicine and Surgery.

Bahrain↗
PubMed2003

Student screening for inherited blood disorders in Bahrain.

In Bahrain and neighbouring countries inherited disorders of haemoglobin, i.e. sickle-cell disease, thalassaemias and glucose-6-phosphate dehydrogenase (G6PD) deficiency, are common. As part of the National Student Screening Project to determine the prevalence of genetic blood disorders and raise awareness among young Bahrainis, we screened 11th-grade students from 38 schools (5685 students), organized lectures and distributed information about these disorders. Haemoglobin electrophoresis, high performance liquid chromatography, blood grouping and G6PD deficiency testing were performed. Prevalences were: 1.2% sickle-cell disease; 13.8% sickle-cell trait; 0.09% beta-thalassaemia; 2.9% beta-thalassaemia trait; 23.2% G6PD deficiency; 1.9% G6PD deficiency carrier. Health education, carrier screening and premarital counselling remain the best ways to reduce disease incidence with potentially significant financial savings and social and health benefits.

Adolescent↗
PubMed2005

Diabetic nephropathy in children with type 1 diabetes mellitus in Bahrain.

OBJECTIVE: Children and adolescent patients with type 1 diabetes mellitus (T1DM) may have an increased risk of developing diabetic nephropathy (DNP). The incidence of DNP varies with glycemic control, and peaks after 15-20 years of diabetes and decline thereafter. Microalbuminuria is uncommon before puberty, and usually occurs after 5 years of diabetic duration. Once overt DNP is established, a progressive decline in the glomerular filtration rate and elevation in arterial blood pressure occurs, and it is the most important disorder leading to renal failure in adult patients with diabetes in developed countries. The purpose of this study was to screen all the children and adolescent with T1DM of 5 years duration or more for DNP. METHODS: Between April 2000 and February 2001, all patients with T1DM of more than 5 years, who were diagnosed between years 1985 to 1995 and followed by pediatricians at Salmaniya Medical Complex, Kingdom of Bahrain, were screened for DNP. Medical records were reviewed for demographical data, blood for hemoglobin A1c (HbA1c), fasting sugar and renal function test. The presence of DNP, retinopathy and neuropathy and the medications were also reviewed. DNP was diagnosed by urine microscopy, overnight urine collection for albumin to creatinine ratio, or 24-hour urine for protein, and the medications RESULTS: Diabetic nephropathy was diagnosed in 10 patients (31%), 2 with microalbuminuria (incipient nephropathy), and 8 with proteinuria (clinical nephropathy). Diabetic nephropathy was diagnosed at a mean of 10.5 years after the onset of T1DM. The mean age was 18 years for the DNP. Mean HbA1c was 11.8% for DNP and 10.2% for non-nephropathy group. All the patients with DNP were treated with an angiotensin converting enzyme inhibitor, 5 of them had hypertension. None developed renal failure or retinopathy. CONCLUSION: Microalbuminuria is uncommon before 5 years of the onset of T1DM. Screening for microalbuminuria should be performed in adolescent over 12 years of age, with diabetes of more than 5 years duration and persistent hyperglycemia (HbA1c > 11 %).

Albuminuria↗
PubMed1990

Factors influencing utilization of the curative health services among children aged 6-60 months in Bahrain (Part II).

Two hundred twenty one out of 2587 children aged 6-60 months were selected at random from 8 villages in Western region of Bahrain. The data were collected by interviewing the mothers and checking out the health records. The study revealed that family size, mother's education, socioeconomic status and mother's attitude toward the curative services were significant factors for the use of the curative care. However, no significant relationships were found between the utilization of the curative care and age and sex of child, family structure and the situational factors.

Attitude to Health↗
PubMed1989

Factors influencing utilization of the preventive health services among children aged 6-60 months in Bahrain. Part I.

Two-hundred fifty-eight out of 2587 children aged 6-60 months were randomly selected from eight villages in western region of Bahrain. The data were collected by visiting and interviewing the mothers, and examining the birth certificates for immunizations. Age of the child, family structure, sickness of the child and mother's attitude toward the provided preventive services were significant determinants for the use of preventive care. However, no significant relationships were found between utilization of the preventive care and child sex, family size, mother's education, socioeconomic status and situational factors.

Age Factors↗
PubMed1981

Cholera in Bahrain: epidemiological characteristics of an outbreak.

In the period 10 August 1978-23 January 1979, 913 culture-confirmed cases of cholera caused by Vibrio cholerae, biotype El Tor, serotype Ogawa, occurred in Bahrain. After discovery of the initial cases, others occurred sporadically, and the incidence reached a peak of 25-35 cases per day during the seventh week of the outbreak (16-22 September). The overall attack rate (27 per 10 000) was low and the outbreak subsided without mass immunization campaigns or rigorous border control of persons and imports. Investigation of 746 culture-confirmed cases that occurred in the period 10 August-13 October 1978, showed that cases occurred throughout most areas of the country and mainly affected infants, young children, and adult working-age males. Symptoms were very mild; fewer than 20% of patients required specific rehydration therapy. The highest attack rate (84 per 10 000) occurred in infants less than 1 year of age. No common vehicle or mode of transmission was identified. A matched-pair study of 35 cases and controls showed that adult cases were more likely than controls to have consumed food or beverage outside of the home before becoming ill. V. cholerae was isolated from stored drinking water in the houses of 8 cases but not from numerous samples of food and tap-water. It was presumed that cholera transmission occurred through a complex interaction of mild and asymptomatically infected persons with food, water, and the environment.

Adolescent↗
PubMed1980

Dentition on Bahrain, 2000 B.C.

Teeth and jaws excavated from 25 burial mounds on the island of Bahrain were examined. Dating: 2000 B.C. The number of individuals buried was estimated from the dentition. An approximate determination of the age for death was attempted. Non-metric and metric traits of the teeth were observed. The teeth showed Caucasoid but no Mongoloid traits. They were small, worn at an early age, with a great deal of carious lesions, no multiple fractures, only a little calculus and alveoloclasia but frequent enamel hypoplasia. The mandibles showed fine healing after the widespread antemortem loss of molars, possibly extracted due to the consequence of caries, caused by the consumption of many carbohydrates.

Adolescent↗
PubMed1981

A study of clustering of cases of leukemia, Hodgkin's disease and other lymphomas in Bahrain.

One hundred and twenty five cases of leukemia, Hodgkin's disease, and other lymphomas were compared with 125 matches controls for space, and time and space clustering in the State of Bahrain. These cases and controls were identified from hospital, pathology and death registries over a period of ten years. Thirty-one percent of the cases living in cities had "effective contact' with at least another case compared to 8.7 percent of the city controls, at a distance of "effective contact' equal to or less than 100 meters. no differences were observed as to the number of "effective contacts' between the cases and controls residing in the villages. When the combined data from the villages and urban areas were analyzed using two different methods, no significant clustering could be reported. Although space clustering in the urban areas is attributed to a hypothesized transmissible or exposure factor, the possibility that such clustering is due to some common characteristics of the persons with these conditions has to be considered.

Bahrain↗
PubMed1994

HIV antibodies among intravenous drug users in Bahrain.

A 12-month study was conducted to identify risk factors for human immunodeficiency virus (HIV) infections among intravenous drug users (IDU) attending drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain. Patients provided demographic and behavioural information based on a questionnaire. Two hundred and forty male IDUs participated in the study on voluntary basis. The seroprevalence of HIV was 21.1 per cent. The presence of HIV antibody was associated with educational status, frequency of injecting drugs and needle sharing.

Adult↗
PubMed1994

Giardiasis amongst in-and out-patients in Salmaniya Medical Centre in state of Bahrain.

Giardiasis is the most common protozoan parasite diagnosed in the pathology departments of Health Centres in the State of Bahrain. In 1983 all records of stool parasitology examinations in one of the largest medical centre (Salmaniya Medical Center) were studied, a total of 9664 records. The incidence of Giardia lamblia was 4% (386 cases) of the total records, about 21% of all infected persons by parasites. 100 persons from the above records were serologically examined by CIT with 93% positive results. The incidence of Giardia lamblia amongst the families of infected persons of the 386 cases was higher than the families of non-infected persons.

Adolescent↗
PubMed1996

Heroin addiction in Bahrain: 15 years experience.

This study describes the development and outcome of a new treatment programme for the management of heroin addiction in Bahrain. The problem reached its peak in the early 1980s with several reported deaths and with the involvement of many disciplines in the overall response. In 1983, treatment of all addicts was restricted by law to the government psychiatric hospital. The newly established specialized drug unit was overwhelmed by the number of patients seeking treatment. The lack of sufficient resources and suitably trained staff forced the unit to adopt an outpatient maintenance therapy approach for most of its clients. In 1987, a new comprehensive treatment programme was introduced that relies on a clear philosophy, safe detoxification (using objective scales for withdrawal manifestations) rather than maintenance therapy, followed by psychological and social rehabilitation. A national committee for drug addiction was formed and an intensive programme of education was started at all levels. The results indicate an initial increase at inpatient level but a marked drop of outpatient attendance. The use of the Opioid Objective Withdrawal Manifestations Scale (OOWMS) revealed that only a small number of our patients developed moderate or severe signs of withdrawal that required detoxification, and the rate of dispensed controlled medication was reduced by 99%. The effect of this approach is discussed, with special reference to the need for a collaborative effort from all disciplines in planning, implementing, continuously evaluating and modifying the national programmes for handling the serious problem of addiction.

Bahrain↗
PubMed2001

Paralytic poliomyelitis associated with the Sabin 3 revertant strain of poliovirus in Bahrain.

We report a case of vaccine-associated paralytic poliomyelitis (VAPP) in Bahrain. The case occurred in an 8-week-old infant who had received a dose of oral polio vaccine (OPV) 7 days after birth. She was in contact with two vaccinees who had received OPV during the national immunisation campaign conducted 10 days before her birth. Specimens from the infant were sent to the WHO Collaborating Centre for Virus Reference and Research Laboratory for serological testing and virus detection, including genomic sequencing. Clinical and virological features are presented of a case of VAPP caused by the Sabin 3 strain of poliovirus that had reverted towards neurovirulence. The case represents one in 51,879 first doses of OPV distributed between 1995 and 1998. In order to reduce further the risk of VAPP, the dose of OPV at birth has been discontinued and a sequential schedule of inactivated polio vaccine (IPV) followed by OPV will be recommended.

Antibodies, Viral↗