Health-Care Associated Infection Rates among Adult Patients in Bahrain Military Hospital: A cross sectional survey

Background/Objective: Health-care associated infections cause substantial morbidity and mortality with their prevalence varying between countries and hospitals. There are no published studies of health-care associated infections in hospitals in Bahrain and few in general military hospitals.Setting: Bahrain Defense Force Hospital.Design: Survey.The aim study is to establish the prevalence of health-care associated infections in a general military hospital in Bahrain.Method: A cross-sectional survey of a random sample of 500 medical records in the Bahrain Defence Force Hospital was carried out to ascertain the prevalence of health-care associated infections.Result: Four health-care associated infections were recorded – a prevalence of 0.87% (95% CI 0.34-2.22). Two of the infections were surgical site infections while the other two were skin infections.Conclusion: This study revealed that the prevalence of health-care associated infections is lower than recorded in most published studies

Quality of life of Bahraini women with breast cancer: a cross sectional study.

BACKGROUND: Breast cancer can impact survivors in many aspects of their life. Scarce information is currently available on the quality of life of cancer survivors in Bahrain. The objective of this study is to describe the quality of life of Bahraini women with breast cancer and its association with their sociodemographic and clinical data. METHODS: This is a cross sectional study in which the European Organization for Research and Treatment of Cancer Quality of Life Cancer Specific version translated into Arabic was administered to a random sample of 337 Bahraini women with breast cancer. Relevant descriptive statistics were computed for all items. The equality of means across the categories of each categorical independent variable was tested using parametric tests (ANOVA and independent t-test) or non-parametric tests (Kruskal Wallis and Mann Whitney tests) of association where appropriate. RESULTS: Of the total sample, 239 consented to participation. The mean and median age of participants were 50.2 (SD ± 11.1) and 48.0 respectively. Participants had a mean score for global health of 63.9 (95% CI 61.21-66.66). Among functional scales, social functioning scored the highest (Mean 77.5 [95% CI 73.65-81.38]) whereas emotional functioning scored the lowest (63.4 [95% CI 59.12-67.71]). The most distressing symptom on the symptom scales was fatigability (Mean 35.2 [95% CI 31.38-39.18]). Using the disease specific tool it was found that sexual functioning scored the lowest (Mean 25.9 [95% CI 70.23-77.90]). On the symptom scale, upset due to hair loss scored the highest (Mean 46.3 [95% CI 37.82-54.84]). Significant mean differences were noted for many functional and symptom scales. CONCLUSION: Bahraini breast cancer survivors reported favorable overall global quality of life. Factors associated with a major reduction in all domains of quality of life included the presence of metastases, having had a mastectomy as opposed to a lumpectomy and a shorter time elapsed since diagnosis. Poorest functioning was noted in the emotional and sexual domains. The most bothersome symptoms were fatigability, upset due to hair loss and arm symptoms. This study identifies the categories of women at risk of poorer quality of life after breast cancer and the issues that most need to be addressed in this Middle East society

The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study

BACKGROUND: CAM use is widespread, especially among patients with diabetes. The Gulf States have a high prevalence of diabetes, alongside a long tradition of CAM use. The aim of this study is to establish the prevalence of CAM use among patients with diabetes mellitus in Bahrain and to examine the characteristics of the CAM users. METHODS: A questionnaire was developed and administered to a convenience sample of patients with diabetes (n = 402) above the age of 20 attending two hospital diabetes clinics. Data were analysed using descriptive statistics and non-parametric tests of association. RESULTS: 63% of responders utilized CAM within the previous 12 months. CAM users were more likely to be female, to have had diabetes for longer and to have complications of their diabetes. 64% of CAM users stated that they had used CAM for managing their diabetic condition, with 46% of these having used it solely for their diabetes. Respondents using CAM to manage their diabetes were more likely to be male, to be using CAM on a daily basis and to have informed their physician of their CAM use. CONCLUSIONS: There is a high rate of CAM use in patients with diabetes attending two hospital diabetes clinics in Bahrain. There is also a high rate of non-disclosure of CAM use to physicians. There is a continuing need for health professionals to be more aware and better trained in order to inform their decision making and communication related to CAM use

Reducing health risk in family members of patients with type 2 diabetes: views of first degree relatives

BACKGROUND: Patients with type 2 diabetes can have an important role in discussing health risk within families. This study aimed to establish the acceptability to first degree relatives towards their relative with type 2 diabetes intervening as health promoters in their own families, using the Health Belief Model as a theoretical framework for evaluation. METHODS: Cross-sectional questionnaire design. Survey questionnaire for first degree relative (sibling or child) mailed to a random sample of patients with type 2 diabetes registered with an urban hospital diabetes clinic (n = 607 eligible patients). Patients were asked to pass on questionnaires to one to two first degree relatives. RESULTS: Questionnaires were returned from 257 families (42% response rate) with two responses provided by 107 families (a total of 364 questionnaires). The majority (94%) of first degree relatives of patients with type 2 diabetes would like to be informed about reducing their risk. Half (48%) of respondents reported being spoken to by a relative with type 2 diabetes about their risk of diabetes. Those spoken to were more likely to see themselves at risk of diabetes, to worry about developing diabetes and to view diabetes as a serious condition. CONCLUSIONS: A role for patients with type 2 diabetes in discussing health risk in their family appears to be acceptable to many relatives. Discussion of risk and interventions to reduce health risk with their relatives should be encouraged in patients with type 2 diabetes

Clinical Audit of Diabetes Care in the Bahrain Defence Forces Hospital

Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in June 2010. The medical records of 287 patients with diabetes were reviewed electronically and manually for process and outcome measures, and a statistical analysis was performed. Results: Of the patients, 47% were male, with a median age of 54 years, and 5% had type 1 diabetes. Measured processes, including haemoglobin A1c, blood pressure, lipids, creatinine and weight, were recorded in over 90% of the patients. Smoking (8%) and the patient’s body mass index (19%) were less frequently recorded. Screening for complications was low, with retinal screening in 42%, foot inspection in 22% and microalbuminuria in 23% of patients. Conclusion: This study shows that the implementation of recognised evidence-based practice continues to pose challenges in routine clinical care. Screening levels for the complications of diabetes were low in this hospital diabetes clinic. It is important to implement a systematic approach to diabetes care to improve the quality of care of patients with diabetes which could lead to a lowering of cardiovascular risk and a reduction in healthcare costs in the long term

Does Sickle Cell Disease Protect Against Diabetes Mellitus? : Cross-sectional study

Objectives: The co-existence of diabetes mellitus (DM) and sickle cell disease (SCD) is rare. This study aimed to explore whether SCD patients have the same DM prevalence as the general population in a country with a high prevalence of DM. Methods: This cross-sectional study included all SCD adult patients admitted to Salmaniya Medical Complex, Bahrain, between 2003 and 2010 (n = 2,204). A random sample (n = 520) was taken to establish the prevalence of DM. Laboratory records were examined to determine the presence of DM. Results: There were 376 SCD patients with complete records; of these, 24 (6.4%) had DM. The age- and sex-standardised prevalence of DM was 8.3%. Conclusion: While the prevalence of DM in SCD patients in Bahrain was high, it was lower than expected in this population. SCD may have a protective effect towards DM development. However, the impact of these two conditions on vascular diseases suggest a need for screening and aggressive treatment in this population

Psychological interventions for women with non-metastatic breast cancer (Review)

Background: Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. Objectives: To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with nonmetastatic breast cancer. Search methods: We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. Selection criteria: Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. Data collection and analysis: Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. Main results: Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I2 = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I2 = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I2 = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I2 = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I2 = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. Authors’ conclusions: A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies

Comparison of landscape approaches to define spatial patterns of hillslope-scale sediment delivery ratio

A sediment delivery ratio (SDR) is that fraction of gross erosion that is transported from a given catchment in a given time interval. In essence, a SDR is a scaling factor that relates sediment availability and deposition at different spatial scales. In this paper, we focus on hillslope-scale SDR, i.e. the ratio of sediment produced from hillslopes to that delivered to the stream network. Factors that affect hillslope water movement, and thus entrainment or deposition of sediments, ultimately affecting the SDR, include upslope area, climate, topography, and soil cover. In erosion models, SDR is usually treated as a constant parameter. However, the use of spatially variable SDRs could improve the spatial prediction of the critical sources of sediment, i.e. identification of those areas directly affecting stream water quality. Such information would improve prioritisation of natural resource management effort and investment. Recent literature has described several landscape approaches to represent SDR variability in space, some of which account only for topography, whilst others consider topography and soil cover characteristics. The aim of this study was to evaluate four landscape approaches for their ability to depict spatial patterns of SDR in the Avon-Richardson catchment in the semi-arid Wimmera region (Victoria, South-east Australia). Erosion was assessed using a semi-distributed model (CatchMODS) with disaggregation based in subcatchments of around 40 km2 area. Hillslope gross erosion was assessed with a RUSLE approach. By applying the four landscape approaches using DEM and estimates of land use cover, four landscape index subcatchment distributions were calculated. These were normalised into standard distributions. Then, a sigmoid function was used to transform the standardised indices into SDR-index distributions ranging from zero to one. Finally, subcatchment SDRs were estimated as the product of the SDR-index by a whole-of-catchment SDR value that was estimated by calibration against sediment loads measured at five gauging stations of the study area. The major sources of hillslope erosion were modelled to be located in the southern hilly areas of the catchment. However, a topographic convergence approach predicted as well important contribution of hillslope-erosion sediment loads coming from the eastern flatter cropping land. The introduction of landscape-variable SDRs improved the overall goodness-of-fit of modelled versus observed sediment loads at five gauging stations located in the catchment for only the topographic convergence approach. However, the limited number of observations (11), the location of some gauging stations downstream of active gully erosion, and the lack of gauging stations monitoring the north-eastern part of the catchment hindered the assessment of which spatial distribution of hillslope erosion best represented the real catchment conditions. Further research is needed to define the relationship between landscape indices and SDR; and to evaluate the spatial distribution of erosion against more complete field evidence

Will People With Type 2 Diabetes Speak to Family Members About Health Risk?

OBJECTIVE—This study aimed to assess the potential for communication of familial risk by patients with type 2 diabetes

Are All These Rules Necessary? Extension Pesticide Programming with a Regulatory Purpose

Indiana\u27s private applicator recertification program includes state-required, pesticide regulatory topics. This article explores the relationship between Indiana private applicators\u27 dual attitudes towards pesticide handling practices and the pesticide regulations that mandate those practices. Newly recertified private applicators in northwest Indiana were surveyed by a mailed questionnaire. Respondents valued responsible pesticide management practices, but were collectively undecided about regulatory oversight of their pesticide handling activities. These results suggest that Extension pesticide safety educators involved in compliance education may improve their training curriculum by including material on the underlying benefits, personal and social, of pesticide regulation