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PubMed2007

Self-reported oral hygiene habits and oral health problems of Kuwaiti adults.

OBJECTIVE: The aims of this study were to examine self-reported oral hygiene habits and oral health problems of a sample of adult Kuwaitis. MATERIALS AND METHODS: A self-administered, anonymous, structured questionnaire was distributed to 2,400 adult Kuwaiti nationals from all 6 governates of Kuwait assessing socio-demographic variables, oral hygiene habits, and oral health problems. RESULTS: Of the 2,400 questionnaires, 1,925 (80.25%) responded. Of these, 62% reported brushing their teeth at least twice daily, while daily use of dental floss was uncommon (11.8%). Adequate toothbrushing habits were significantly associated with female gender, educational level, non-smoking status, and history of recent preventive dental visits (p = 0.001). The majority of subjects reported multiple oral health problems (64.7% with 2 or more and 41.8% with 3 or more). Factors associated with multiple oral health complaints included younger age, smoking, not having a recent preventive dental visit, and brushing the teeth less than twice daily. CONCLUSIONS: Less than two-thirds of the sampled adult Kuwaitis followed the recommended toothbrushing frequency of twice daily or more, and the majority of subjects have not had a preventive dental visit in the previous 6 months. Furthermore, most subjects reported multiple oral health problems that are mostly preventable through adequate oral hygiene habits and regular preventive dental visits.

Adolescent↗
PubMed1997

Temporal changes in body mass index and prevalence of obesity among Kuwaiti men.

The purpose of this study was to compare temporal changes in BMI (kg/m2) and obesity among adult (aged > or = 18 years) Kuwaiti men using 2 independent cross-sectional samples of 896 and 1,730 subjects, studied for nutritional assessment and for prevalence of obesity in 1980-81 and 1993-94, respectively. The samples were drawn from primary health care (PHC) clinics and measured for body mass index (BMI), and obesity, defined as BMI > 25 (grade 1) and > 30 (grade 2) kg/m2. The results of the study showed that mean BMI (kg/m2) and prevalence of grade 1 and 2 obesity (BMI > 25 and > 30 kg/m2) increased by 10 (2.5 kg/m2), 20.6 and 15.4%, respectively. After controlling for sociodemographic differences between the two study periods, mean BMI was 2 kg/m2 higher in 1993-94 than in 1980-81 and prevalence of obesity (BMI > 25 and > 30 kg/m2) also increased between the two periods (OR = 2.1, 95% CI 1.7-2.7 and OR = 1.9, 95% CI 1.5-2.4, respectively). In conclusion, BMI and prevalence of obesity increased among Kuwaiti men between 1980-81 and 1993-94, due to modernization, affluence and the concomitant changes to sedentary lifestyles. The rates of temporal changes in BMI and in prevalence of obesity were higher in Kuwait than in selected other countries.

Adolescent↗
PubMed1994

Molecular characterization of alpha-thalassemia determinants, beta-thalassemia alleles, and beta S haplotypes among Kuwaiti Arabs.

Using amplification, allele-specific oligonucleotide (ASO) hybridization and DNA sequencing we have documented the molecular basis of 64 alpha- and 123 beta-thalassemia (thal) chromosomes, and the haplotypes of 18 beta S chromosomes from patients followed in three hospitals in Kuwait. Of the 30 chromosomes from 15 patients with Hb H disease, 26 (86.7%) carried the polyadenylation (poly A) signal mutation (AATAAA-->AATAAG) in the alpha 2-globin gene, 3 (10%) had the -alpha (3.7 kb) deletion, and 1 (3.3%) had the pentanucleotide deletion in the 5' IVS-I splice junction (alpha-5nt alpha). As many as 12 different beta-thal mutations were identified; 6 Mediterranean alleles [IVS-II-1 (G-->A), IVS-I-6 (T-->C), codon (CD) 39 (C-->T), IVS-I-110 (G-->A), CD 8 (-AA), and IVS-I-1 (G-->A)] were present in 79 (64.2%) of the chromosomes tested. Four East Indian alleles [IVS-I-5 (G-->C), IVS-I 3' end -25 nt deletion, CDs 8/9 (+G), and 619-bp deletion] were found in 31 (25%), and the two Kurdish/Iranian alleles [CD 44 (-C) and CDs 36/37 (-T)] were found in 13 (10.6%) chromosomes. Fourteen beta S chromosomes carried haplotype No. 31 (Saudi Arabia/India); 3 had haplotype No. 19 (Benin), and 1 was a hybrid with haplotype No. 31-specific characteristics in the locus control region hypersensitive site-2 (LCR-HS-2), and haplotype No. 19-specific mutations in the 5' flanking region of the G gamma-promoter. The patient homozygous for haplotype No. 19 was a Jordanian, while the others were Kuwaiti Arabs. The latter appear to be fairly homogeneous in terms of the prevalent alpha-thal determinants and beta S-haplotypes, but there is considerable heterogeneity of their beta-thal alleles. This has implications for genetic counseling and prenatal diagnosis programs.

Anemia, Sickle Cell↗
PubMed1982

Breast cancer in Arabic women.

A case-control study of breast cancer was conducted in Cairo, Egypt and in Kuwait. This is the first such report from Arabic countries and the most significant finding is the animal incidence rate of 7.67 per 100,000 in Kuwaiti women, which ranks amongst the lowest thus far reported in the world. Factors which contribute to this low rate are a short period of active menstruation, low family history, first childbirth at very early age and most likely significant dietary factors. More than 45% of Egyptian women give birth to a child before the age of 20, with 56.5% of controls and 42.3% of patients (p less than 0.01). Many patients already have extensive disease at time of diagnosis as a result of considerable delay. However, this delay did not result in a high incidence of inflammatory breast carcinoma, such as has been reported in Tunisia.

Adult↗
PubMed1996

Halogen lamp phototoxicity.

BACKGROUND: The radiation from quartz halogen light bulbs has been reported to cause erythema in humans and skin tumors in experimental animals. OBJECTIVE: The objective of this study was to determine the relative risk of injury to humans due to the radiation from these lamps. METHODS: We studied a 12-volt 50-watt quartz halogen lamp. We measured its ultraviolet output spectrum and the biological toxicity of its radiation by means of its pyrimidine dimer-inducing capability. RESULTS: At a 1-cm distance, the 254-nm light output of the lamp is 3 x 10(-7) W/cm2/nm. Solar radiation at this wavelength is undetectable on the earth's surface, i.e., less than 10(-12) W/cm2/nm. At 290 nm, the lamp output is approximately 3 x 10(-6) W/cm2/nm, 5,000 times greater than the summertime sun at 1 p.m. at sea level in Kuwait. The UVB and UVA output of the lamp is roughly similar to the solar output under these conditions. We also measured the pyrimidine dimer-forming potential of the lamps relative to the sun for the purpose of estimating the DNA toxicity of the lamps. At a 7-cm distance the lamp induces approximately 3.9 pyrimidine dimers/100,000 bp/min. This is approximately 4 times more rapid than that of the noontime summer sun in Michigan. CONCLUSIONS: We conclude that direct radiation from these lamps can cause damage to human skin, due to their UVC and UVB output. We estimate that the relative risk to keratinocyte DNA in human skin, in vivo, from exposure to the 50-watt halogen lamp at a distance of 7 cm is between 27 and 400% of the noontime summer sun in Michigan.

DNA↗
PubMed2004

Coping with infertility among Kuwaiti women: cultural perspectives.

BACKGROUND: Although previous studies conducted in western countries have reported that psychological factors are part of the experience of infertility, no study has assessed this relationship in Arab women. AIMS: To examine psychological distress among Kuwaiti women with infertility problems and explore the perceived causes of infertility. METHODS: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. RESULTS: Compared with age-matched pregnant control sample. The infertile women exhibited a significant higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were considered as the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness results in social stigmatization for infertile women and places them at risk of serious social and emotional consequences. CONCLUSIONS: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicates the appropriateness of referring these patients for psychological evaluation. Successful programmes in dealing with infertility in Kuwait need to include the establishment of a community based intervention strategy to educate people about infertility and to give guidelines for treatment options.

Adaptation, Psychological↗
PubMed1983

Life events and depression in transit populations.

Undesirable recent life events in the period of three months preceding primary depressive illness were studied in two Arabian Gulf countries: Qatar (235 patients) and Kuwait (164 patients). Transit population patients, who come to these countries from employment, differ from native patients in the significant predominance of work as a source of recent life events. The difference is discussed in relation to the existential committments and attitudes to work among native and transient populations. Intergenerational conflict as an undesirable recent life event is prevalent among family recent life events in native patients where rapid sociocultural changes are associated with conflict of traditional and modern value systems.

Adult↗
PubMed1991

Conserving blood in preparation for elective surgery.

A prospective study was carried out for a period of 6 months (September 1987 to 28 February 1988) to evaluate the possible misuse of blood transfusion service in the department of surgery, Amiri Teaching Hospital, Kuwait. There was a monthly wastage of 45 +/- 13 units of blood. Five hundred and eleven units of blood were crossmatched but never transfused. The time taken by the blood bank technicians in crossmatching blood which was never used amounted to 54.4% of the normal working hours. An annual loss of about US$25000.00 was calculated to have occurred.

Blood Banks↗
PubMed2003

Are Kuwaitis getting fatter?

The purpose of the study is to compare temporal changes in BMI, overweight (BMI > 25 Kg/m2) and obesity (BMI > 30 Kg/m2) of two independent cross-sectional samples of Kuwaitis studied in 1980-81 and 1993-94. The earlier sample of 2067 (896 men and 1171 women) and the latter sample of 3435 (1730 men and 1705 women) adult Kuwaitis (aged > or = 18 years), were drawn from primary health care (PHC) clinics and studied for nutritional assessment and for prevalence of obesity in 1980-81 and 1993-94, respectively. Weight was measured in kilograms and height in meters to obtain the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared (Kg/m2). BMI > 25 and > 30 Kg/m2 were classified as overweight and obesity, respectively. The results of the study show that mean BMI (Kg/m2) increased significantly (p < 0.001) by 10.0 and 6.2% (2.5 and 1.7 Kg/m2) among men and women, respectively. Prevalence of overweight and obesity (BMI > 25 and > 30 Kg/m2) increased by 20.6 and 15.4% and by 13.7 and 8.4% among men and women, respectively. After controlling for sociodemographic differences between the two study periods, mean BMI was 2.0 and 1.6 Kg/m2 higher in 1993-94 than in 1980-81 among men and women, respectively. Prevalence of overweight and obesity (BMI > 25 and > 30 Kg/m2) also increased among both genders between the two periods (OR = 2.1 , 95% CI 1.7-2.7 and OR = 1.9, 95% CI 1.5-2.4, for men and OR = 2.2, 95% CI 1.6-3.0 and OR = 1.4, 95% CI 2.2 CI 1.0-1.9, for women). It can be concluded that the BMI, prevalence of overweight and obesity increased among Kuwaitis between 1980-81 and 1993-94, probably due to the effects of modernization, affluence, increased food consumption and the concomitant changes to sedentary lifestyles. The rate of temporal changes in BMI and obesity were higher, by comparison, in Kuwait than in selected other countries.

Adolescent↗
PubMed1998

Obesity among Kuwaiti pre-school children aged 0-5 years: prevalence and comparison with the NCHS/CDC reference population.

The purpose of the study was to assess the level of obesity among Kuwaiti pre-school children aged 0-5 years, and compare their nutritional status with the NCHS/CDC reference population. A Cross-sectional multi-stage stratified random sample of 7419 Kuwaiti children (3749 boys and 3670 girls), representing over 5% of the population at studied age was used for the study. Children below 42 months were randomly selected from five maternal and child health clinics, one from each of the five local authority areas of Kuwait. Children 42 months and above were selected from 24 kindergartens, proportionally from the 5 local authority areas. Weights and heights of children were measured. Obesity was defined as weight-for-height (W/H) 2.00 to 5.00 standard deviation (SD) scores of the NCHS/CDC reference population. Underweight and short stature were defined as W/H and height-for-age (H/A) -4.00 to -2.00 SD scores, respectively. Obesity among Kuwaiti pre-school children was found to be 8.2% (7.5% in males and 9.0% in females). Underweight was found to be almost similarly distributed among both genders (4.2% in males and 4.1% in females). Short stature was found to be 5.8% (6.1% in males and 5.6% in females). Kuwaiti pre-school children aged 0-5 years were, for the most part, found to be slightly heavier and shorter than American children of the reference population. The children were also found to be heavier and taller than a decade ago. The nutritional status of the children improved during the last ten years.

Age Distribution↗
PubMed1999

Factors associated with overweight and obesity among Kuwaiti kindergarten children aged 3-5 years.

The purpose of the study was to investigate factors associated with overweight and obesity among Kuwaiti children aged 3-5 years. A cross-sectional sample of 3473 pupils (1748 boys and 1725 girls) was selected for the study from kindergartens using a multi-stage random sampling technique. Overweight and obesity were defined as weight-for-height (W/H) > or = 90th-< 95th and > or = 95th centiles of the NCHS/CDC reference population, respectively. Questionnaires were used to obtain information about birth order, parents' education and occupation, family income, number of servants, eating habits, grandparents and number of persons living at home, number of siblings, socioeconomic status (SES), which was based on parents' education and occupation, family income, area of residence and number of servants. Weight and height were measured and the pupils' dental status was assessed. Factors that were found to be significantly associated with overweight and obesity were gender, age, region (governorate), parents' education, birth order, dental status, eating regular meals and SES. Factors that were significantly associated with overweight and obesity males were age, governorate eating regular meals, number of persons living at home and SES. Among females these factors were governorate, dental status, number of servants and SES. The logistic regression analysis showed that the same factors shared by both genders significantly contributed to the development of overweight and obesity except father's education. This study concludes that ecological factors play an important role in the development of overweight and obesity, especially those related to affluence; Kuwait has been undergoing modernization and increasing affluence and changes to sedentary lifestyle and increased food consumption may have contributed to changes in overweight and obesity among the children.

Age Distribution↗
PubMed2000

The introduction of breast milk donation in a Muslim country.

Breast milk donation (wet-nursing) for full-term babies is a well-known practice in Kuwait, but it has never been organized formally in a neonatal intensive care unit (NICU) for preterm babies. Donor milk banking as conducted in Western society is not considered to be ethical in Muslim society, where the milk donor and the recipient are required to know each other. Human milk is known to decrease the incidence of necrotizing enterocolitis; improve host defenses, digestion, absorption of nutrients, gastrointestinal function, and neurodevelopment of the child; and contribute to maternal physical and psychological well-being. A culturally accepted approach to donor milk banking is proposed as a means of overcoming the ethical issues surrounding milk donation in Muslim society. This report addresses the first step in raising awareness of the valuable contribution of donor milk to preterm babies and the organization of human milk donation for use in an NICU.

Adult↗
PubMed1996

The minimum inhibitory concentration of seventeen antimicrobials for Salmonella isolates from septic patients.

Herein we are reporting, for the first time in Kuwait, the minimum inhibitory concentrations (MICs) of Salmonella blood culture isolates vs. 17 clinically relevant antimicrobial agents. The screening of blood culture specimens was performed with the most advanced Bactec 9240 (Becton Dickinson). From over 20,000 blood cultures, 112 Salmonella isolates were obtained from 67 patients. Their MICs were determined using the automated Vitek microdilution technique (Biomerieux Vitek Inc.). During the whole 1991-1995 study period, the MICs for cefotaxime, ceftazidime, aztreonam, amikacin, gentamicin, ciprofloxacin and imipenem were below their respective susceptibility breakpoints. Resistance to chloramphenicol, ampicillin and cotrimoxazole varied from year to year, from 18% to 50%, except in 1991 when it was nil (1991 was the first year after the Gulf War, with very few newcomers from the Indian subcontinent). All ampicillin-susceptible S. typhi isolates had extremely low MIC values (< or = 0.25 microgram/ml).

Adult↗
PubMed1999

The increase in carbapenem use and emergence of Stenotrophomonas maltophilia as an important nosocomial pathogen.

Carbapenems, being the broadest spectrum antibiotics, may allow those organisms intrinsically resistant to these drugs to be involved more frequently in nosocomial infections. Imipenem was introduced to the specialized hospital units in Kuwait in October, 1992 and meropenem in late 1996. The main objective of this study was to observe prospectively whether, under similar laboratory conditions for microbial isolation/identification while these drugs are in use in the hospital, there is any proportional increase over time in the recovery of Stenotrophomonas maltophilia in relation to the number of yearly admissions and drug use. In addition, we also looked for categories of patients infected by S. maltophilia, type of infection and antibiotic susceptibility. There was an increase in the number of S. maltophilia isolates from 1993 to 1997 significantly correlated with the increase in year-wise consumption of carbapenems (p<0.004). No correlation was observed between yearly number of admissions and both the consumption of carbapenems (p>0.51) and isolation of the organism (p>0.59). Most isolates were from cancer, burns and cardiac patients. The commonest types of infection were wound and septicemia. The organisms were susceptible mostly to ciprofloxacin and co-trimoxazole. The study thus indicates that carbapenem use in a hospital environment may result in emergence of nosocomial infections due to multiresistant S. maltophilia in high risk patients with very limited choice of antibiotics for therapy.

Bacteremia↗
PubMed2005

Apolipoprotein E genotyping among the healthy Kuwaiti population.

Apolipoproteins (lipid-free) are lipid-binding proteins that circulate in the plasma of human blood and are responsible for the clearance of lipoproteins. Apolipoprotein E (ApoE) is one of the several classes of this protein family. It acts as a ligand for the low-density lipid (LDL) receptors and is important for the clearance of very low-density lipid (VLDL) and chylomicron remnants. The APOE gene locus is polymorphic, with three major known alleles, APOE*3, *4, and *2. We investigated the distribution of the allele frequency of the APOE gene locus and describe here the genetic variation in four Kuwaiti subpopulations: Arab origin (Arabian peninsula), Arab Bedouin tribes, Iranian origin, and the heterogeneous population. We also describe the use of Spreadex gels in resolving the amplified and digested products of the APOE gene locus. DNA was extracted from whole blood and subjected to PCR and then to RFLP analysis. Allele and genotype frequencies were estimated for the total population and for each subpopulation. Statistical analysis showed no difference in the allele frequencies between the four groups. The frequency of APOE*3 in the Kuwaiti population was highest (88.4%) followed by the frequency of APOE*4 (6.5%) and APOE*2 (5.1%). The genotype and allele frequencies obtained for the Kuwaiti population fell within the reported worldwide distribution for the APOE gene locus. Moreover, the results obtained in this study showed no statistical difference (p > 0.05) between the APOE allele and genotype frequencies between the subgroups for all six genotypes and three alleles, supporting the assumption of admixture in the Kuwaiti population and that the obtained frequencies were in Hardy-Weinberg equilibrium. Finally, we found that the distribution of the APOE alleles in Kuwait differs somewhat from those reported in other Arab populations, suggesting that the Arabs originating from the Arabian peninsula are different from those of Lebanon, Morocco, and Sudan.

Adolescent↗
PubMed2005

Risk indicators for tooth loss due to periodontal disease.

BACKGROUND: Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study. METHODS: All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses. RESULTS: A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11). CONCLUSION: Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.

Adolescent↗
PubMed2001

Thrombolytic therapy in acute myocardial infarction: practice pattern at an Arab Middle Eastern centre.

OBJECTIVES: We studied the use of thrombolytic treatment at a major hospital in Kuwait. There were three aims to our study. First, to document the rates of use and shortfall of thrombolytic therapy. Secondly, to identify the reasons for the shortfall. Thirdly, to study the influence of age and gender on the shortfall. METHODS AND RESULTS: We retrospectively examined the use of thrombolytic treatment in 983 consecutive patients with the diagnosis of acute myocardial infarction (AMI) during a three-year period, from June 1994 to May 1997. The term "shortfall" refers to the number of patients who were eligible for thrombolytic treatment but did not receive it. Patients were relatively young (59% were < 55 years old). There was a high prevalence of diabetes (39%). We identified 669 patients who were eligible to receive thrombolytic therapy (68% of the total AMI population). Of the eligible population, 625 patients (93.4%) received thrombolytic therapy while 44 patients did not (a shortfall of 6.6% among the eligible population). The reasons for the shortfall were: unknown reasons, retinopathy, and others. The shortfall was higher in women than in men (13% vs. 6%, respectively; p=0.02). The shortfall was higher in older patients than in younger patients (18% vs. 5%, respectively; p=0.0002). CONCLUSIONS: Our thrombolysis rate is one of the highest, and the shortfall is one of the lowest reported rates in the literature. Many eligible women and older patients are not receiving thrombolytic therapy. Changes to thrombolytic therapy use should be implemented to avoid unnecessary shortfall and potential gender and age bias.

Adult↗
PubMed2006

Could missile attacks trigger acute myocardial infarction?

OBJECTIVE: During the Gulf war in 2003, Kuwait was targeted with missile attacks for 10 consecutive days. Our objective is to evaluate the influence of missile attacks on the incidence of acute myocardial infarction (AMI). METHODS AND RESULTS: We retrospectively compared the number of admissions for AMI presenting to a major general hospital during missile attacks period (MAP) in 2003 with four control periods. MAP and each control period consisted of the same number of days (10 days). The four control periods were the 10 days immediately before and after MAP; and the same time period as MAP for the years 2001 and 2002. The number of admissions for AMI was highest during MAP, 21 cases compared to 14-16 cases in the four control periods, with a trend towards increase during MAP (incidence rate ratio = 1.59; 95% CI 0.95 to 2.66, p < 0.07). The number of admissions for AMI during the first 5 days of MAP was significantly higher compared to the first 5 days of the four control periods (incidence rate ratio = 2.43; 95% CI 1.23 to 4.26, p < 0.01). The observed AMI admission rate during the first 5 days of MAP was significantly higher than expected for a 5-day period in the years 2001, 2002 and 2003. This increase was specific to AMI and did not affect other acute cardiac conditions. CONCLUSIONS: Missile attacks were associated with an increase in the incidence of AMI. This increase was specific to AMI and did not influence acute cardiac conditions.

Acute Disease↗