Awareness of hypertension guidelines among family physicians in primary health care

Background: Only 14% of patients on treatment achieve the recommended blood pressure target. Guidelines aim to assist clinicians in the management of patients with hypertension.Objectives: The primary purpose of the study was to survey family physicians(FPs) in Kuwait about their awareness, and to understand better their reasons for not implementing specific guidance within the WHO/ISH guidelines.Methods: This study is a cross-sectional survey that was carried out in the five health regions of Kuwait. All PHC physicians who were currently working as FPs were asked to participate in the study. Data were collected using a structured questionnaire of clinically oriented questions formulated on the basis of the 1999 World Health Organization/International Society of Hypertension (WHO/ISH), as standard reference.Results: The study revealed that 49.1% and 42.1% of FPs were very familiar or somewhat familiar with the guidelines respectively, 92.1% were in agreement, and 79.8% indicated that they always or usually follow these guidelines when treating patients. Regarding the correct choice of the guideline statements, only 8.8% of the FPs choose correctly less than ten of the 20 statements, 64% choose 10 to less than 15, and only 27.2% choose > 15 statements. When asked about perceived patient barriers to blood pressure control, 84.0% of the respondents ranked overcrowded clinics as important or most important barrier to blood pressure control while, 87.4% considered lack of patient knowledge as important or most important barrier. Non availability of the drugs in the clinic was considered by 88.4% of the physicians, and poor adherence to antihypertensive drugs by 90.1%.Conclusion: There is a need to establish nationwide educational and quality monitoring programs to facilitate the correct implementation of hypertension guidelines in PHC clinical practices in Kuwait.Keywords:  Family physicians; Awareness; Hypertension; Guideline

Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample

Abstract Background An understanding of depressive symptomatology from the perspective of confirmatory factor analysis (CFA) could facilitate valid and interpretable comparisons across cultures. The objectives of the study were: (i) using the responses of a sample of Arab college students to the Beck Depression Inventory (BDI-II) in CFA, to compare the "goodness of fit" indices of the original dimensional three-and two-factor first-order models, and their modifications, with the corresponding hierarchical models (i.e., higher - order and bifactor models); (ii) to assess the psychometric characteristics of the BDI-II, including convergent/discriminant validity with the Hopkins Symptom Checklist (HSCL-25). Method Participants (N = 624) were Kuwaiti national college students, who completed the questionnaires in class. CFA was done by AMOS, version 16. Eleven models were compared using eight "fit" indices. Results In CFA, all the models met most "fit" criteria. While the higher-order model did not provide improved fit over the dimensional first - order factor models, the bifactor model (BFM) had the best fit indices (CMNI/DF = 1.73; GFI = 0.96; RMSEA = 0.034). All regression weights of the dimensional models were significantly different from zero (P Conclusion The broadly adequate fit of the various models indicates that they have some merit and implies that the relationship between the domains of depression probably contains hierarchical and dimensional elements. The bifactor model is emerging as the best way to account for the clinical heterogeneity of depression. The psychometric characteristics of the BDI-II lend support to our CFA results.</p

Oral manifestations of systemic disease

While the majority of disorders of the mouth are centred upon the direct action of plaque, the oral tissues can be subject to change or damage as a consequence of disease that predominantly affects other body systems. Such oral manifestations of systemic disease can be highly variable in both frequency and presentation. As lifespan increases and medical care becomes ever more complex and effective it is likely that the numbers of individuals with oral manifestations of systemic disease will continue to rise. The present article provides a succinct review of oral manifestations of systemic disease. In view of this article being part of a wider BDJ themed issue on the subject of oral medicine, this review focuses upon oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease

Effect of bitumen addition on the long-term permeability of sabkha soil

This study investigates the effect of bitumen addition on the long-term permeability of bitumen mixed sabkha soil. Results will be used to evaluate the effectiveness of using the bitumen mixed sabkha soil as hydraulic barriers to leachate percolation. Eight percent bitumen (by dry weight of sabkha) was selected as a mixing percentage based on density results obtained from modified Proctor tests carried out on sabkha soil samples mixed with different bitumen contents. Long-term permeability studies using distilled water were carried out on undisturbed, natural compacted and 8% bitumen mixed sabkha soil samples. The results displayed significant reduction in the initial and long term permeability values of the 8% bitumen mixed sabkha, as compared to the natural compacted sabkha soil. The reduced permeability values of the 8% bitumen sabkha soil are still higher than the recommended value for soil liners. The results also clearly show that sabkha soil compaction, which is the general practice for liners preparation in Kuwait, is not an effective process

Effect of bitumen addition on the long-term permeability of sabkha soil

This study investigates the effect of bitumen addition on the long-term permeability of bitumen mixed sabkha soil. Results will be used to evaluate the effectiveness of using the bitumen mixed sabkha soil as hydraulic barriers to leachate percolation. Eight percent bitumen (by dry weight of sabkha) was selected as a mixing percentage based on density results obtained from modified Proctor tests carried out on sabkha soil samples mixed with different bitumen contents. Long-term permeability studies using distilled water were carried out on undisturbed, natural compacted and 8% bitumen mixed sabkha soil samples. The results displayed significant reduction in the initial and long term permeability values of the 8% bitumen mixed sabkha, as compared to the natural compacted sabkha soil. The reduced permeability values of the 8% bitumen sabkha soil are still higher than the recommended value for soil liners. The results also clearly show that sabkha soil compaction, which is the general practice for liners preparation in Kuwait, is not an effective process