Medical laboratory sciences graduates: are they satisfied at work?

OBJECTIVE: In this study, the overall job satisfaction of medical laboratory scientist graduates of one Kuwaiti University was examined in relation to the environment and organizational features of their places of employment. MATERIALS AND METHODS: A questionnaire was distributed to 105 graduates of the Medical Laboratory Sciences (MLS) Department, Faculty of Allied Health Sciences, Kuwait University from the years 1982 to 2001 who are currently working in Ministry of Health hospitals. Of those, 85 questionnaires were returned and this was a response rate of 80 percent. RESULTS: Fifty-six percent of respondents were satisfied overall with their jobs, but 44% were not satisfied. Overall job satisfaction was found to be associated with having the opportunity of applying their academic knowledge and laboratory skills to their work when job conditions were conducive to the work and there was collegiality in the laboratory. Reporting to only one supervisor also showed a positive relationship with overall job satisfaction. In contrast, perceptions of unhealthy working conditions, where employees tended to be a hindrance to another employee, were associated with lower overall job satisfaction. Forty-nine percent of all respondents reported that they were not satisfied with organizational practice, 44% were not satisfied with the work environment, and 39% were not satisfied with their autonomy and freedom to work. CONCLUSION: A high percentage of laboratory technologists were not satisfied overall with their jobs or with specific aspects of their jobs. Particularly important in this respect were whether technologists felt that their work appropriately used their knowledge, feelings of technical competency, work related rules/procedures, and presence of unhealthy competition. These issues of health worker dissatisfaction need to be addressed by the health authority managers responsible for these services and by academics who train MLS workers.

Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians.

The objectives of this study were to describe and compare the clinical characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) in Middle East Arab (MEA) and South Asian (SA) patients diagnosed in our unit. Fifty-eight consecutive patients diagnosed with SpA were studied after classifying them into MEA and SA. They were further classified as per disease diagnosis. Excluding three patients with miscellaneous ethnicity, there were 29 MEA and 26 SA patients. Seventy-two percent of MEA patients were males (vs 92% of SA patients). Of the 29 patients with MEA ethnicity, 17 had AS and 9 had USpA. Of the 26 patients with SA ethnicity, 10 had AS and 14 had USpA. Fifty-nine percent of MEA patients had AS (vs 39% of SA patients). Mean age at onset in AS patients was similar in the two ethnic groups. However, in patients with USpA, mean age at onset was somewhat lower at 21.8 years in the MEA group compared with 29.4 years in the SA group. Family history in first-degree relatives was significantly more common in MEA patients. Weight loss, inflammatory spinal pain, gluteal pain, and enthesopathy were equally common in both ethnic groups. Knee, ankle, and metatarsophalangeal joint involvement was less common in MEA patients. There were no significant differences in the occurrence of syndesmophytes, bamboo spine, and sacroiliitis in the two ethnic groups. HLA-B27 positivity rates in MEA patients were 87% for AS and 67% for USpA compared to 75 and 71%, respectively, in SA patients. It is concluded that some significant new findings have arisen from this study: the majority of MEA patients presented with AS, whereas the majority of SA patients had a picture of USpA. Family history was more common in MEA patients. Peripheral arthritis was less common in MEA patients. Worldwide, this is the first study to show that there are significant differences in the clinical expression of the various SpA in MEA patients compared to SA patients.

Occupation and blood pressure: a study in rural and urban communities in Dhaka.

One thousand six hundred and ninety six males and females living in Dhaka city and a nearby village were grouped according to their age and occupation. The subjects blood pressure and occupation were recorded. The study revealed that occupation had a significant effect on both diastolic and systolic blood pressure, specially in relation to social status, Age, smoking, BMI appeared to modulate the blood pressure.

Study of proteinuria in a community.

Proteinuria of more than 500 mg/dl were present in 3% of all age groups in the village Pandhua. It is directly correlated with hypertension, scabies and recurrent history of tonsillitis. If any body suffers from hypertension, pyoderma and scabatic lesion the chances to have proteinuria is 86%.

Fasting cut-offs in determining the prevalence of diabetes and intermediate glucose abnormality in a non-obese population.

The study was undertaken to compare the effect of ADA and WHO criteria for screening of diabetes mellitus (DM) and intermediate glucose abnormality (Impaired fasting glucose/Impaired glucose tolerance-IFG/IGT) and to explore an acceptable fasting cut-off in a population-based study. Ten suburb villages with a population of 11,895 were selected purposively. Of the total 6235 eligible (> or = 20y) subjects, 4144 volunteered. We took height, weight, hip- and waist-girth, blood pressure and fasting blood glucose (FBG). All participants were classified into Group-1 (Gr-1: n=453) and Group-2 (Gr-2: n=3691), based on FBG above and below 5.4 mmol/l, respectively. All from Gr-1 and 610 randomized subjects from Gr-2 were investigated for oral glucose tolerance test (OGTT), HbA1c and lipids. The mean (SD) of age, body mass index (BMI) and FBG of all participants was 37.6 (15.2) y, 19.4 (2.9), and 4.7 (0.9) mmol/l, respectively. The prevalence of diabetes and IFG/IGT using American Diabetes Association (ADA) criteria were compared with WHO criteria separately in Gr-1 and Gr-2. For group-1, ADA criteria could diagnose 5.9% as diabetes and 2.1% as IFG, whereas, WHO criteria diagnosed 11.5% diabetes and 19% IGT. Likewise, in Gr-2, ADA detected much less than WHO criteria (DM: 0.3 vs. 2.3%; IFG/IGT 1.0 vs. 14.6%). We compared fasting and 2 hours post-load glucose (2-hBG) values according to percentiles. We found that 11.1 of 2-hBG corresponded with a fasting value that lies between 90 to 95th percentile, equivalent to 5.1-5.7 mmol/l. Using receiver operating characteristics (ROC) curve, we determined the cut-offs 4.6 - 5.4 mmol/l for IFG and > or = 5.5 for diabetes. Taking age and BMI into account the kappa agreements were better between the estimated cut-offs and the given 2-hBG values. The ADA cut-offs were found ineffective for screening. We proposed the modified fasting cut-offs for screening IFG and diabetes among the non-obese population.

Determinants of job satisfaction among selected care providers in Kuwait.

The study reports job satisfaction among a sample of 370 physicians, nurses, pharmacists, and medical laboratory technologists in the Ministry of Health hospitals in Kuwait. Job satisfaction was measured using Dunnette's scale. The respondents in all four categories were satisfied with all aspects of their jobs except salary. The medical laboratory technologists were, however, dissatisfied with professional advancement as well. The physicians were found to be most satisfied, closely followed by nurses and pharmacists, while medical laboratory technologists were least satisfied. Multivariate analysis was used to assess the net effects of background and work environment characteristics on overall job satisfaction. Introduction to job, in-service training, and monthly income had significant positive effects on overall job satisfaction. These findings may have serious implications for health care delivery systems that recruit expatriate care providers.

Reasons and correlates of contraceptive discontinuation in Kuwait.

OBJECTIVES: (1) To examine the probability of discontinuation of various methods within 1, 2, and three years of use and the reasons for discontinuation; 2) to analyse the socio-demographic correlates of discontinuation. METHODS: Data from a survey of Kuwaiti women in reproductive ages conducted in 1999 were used. Information on duration of use of modern and traditional methods, and reasons for discontinuation during the 72 months before the survey were analysed. Probabilities of discontinuation were estimated through multiple decrement life table analysis. RESULTS: After 1 year, 30% of modern and 40% of traditional method users had discontinued; after 3 years, discontinuation increased to 66 and 70%, respectively. After 36 months, only 40% of IUD users discontinued compared with 74% of oral contraceptive users. The desire to become pregnant was the leading reason for discontinuation of most modern methods, while method failure was an equally important reason for traditional methods. Discontinuation was significantly more frequent among higher parity, non-working and Bedouin women, and among those who said Islam disapproves of contraception. DISCUSSION: Contraception is used largely for spacing. More than two-thirds of the women studied had discontinued most methods after three years, except the IUD, which was used only by about 10% of them. Traditional methods are often discontinued due to method failure and may result in an unintended pregnancy. Better counselling is warranted for traditional methods. Health care for managing side effects of modern methods also needs improvement.

Decentralized data management in nutritional surveillance for timely warning and intervention.

In this paper we describe a theoretical approach for decentralized data management in sentinel community nutritional surveillance systems for timely warning and intervention, by using customized computer programs. By making the data available at lower levels first, the decentralized data management system builds the institutional capacity at regional level and allows rapid and appropriate action by decision-makers. In addition, it facilitates the flow of information and strengthens the involvement of field staff. Reports from field experiences should further demonstrate the feasibility, efficacy, costs and benefits of customized data management computer programs.

Infant and child mortality levels and trends in Bangladesh.

Infant and child mortality levels and trends in Bangladesh are examined using data from the 1989 Bangladesh Fertility Survey. Both infant and child mortality declined from the mid 1970s but infant mortality declined more quickly. The level of infant mortality in 1989 was around 100 per 1000 live births while child mortality (5q0) was 200 per 1000 live births. Life table analysis confirms the change in infant and child mortality. The decline in infant mortality is attributed to the introduction of improved public health measures and access to maternal and child health services.

PIP: A comparison was made in infant and child mortality levels in Bangladesh based on the 1989 Bangladesh Fertility Survey. An analysis of data quality revealed that the data was of high quality, but mortality omissions were greatest in the years prior to 1970. Infant mortality declined since 1975, and both declined sharply during the period 1975-89. Comparisons with the sample vital registration data from the Bureau of Statistics and with data from the Matlab Surveillance System showed the same declining trends but variations. The best measures were children ever born and surviving. Direct estimation showed lower levels of mortality, and indirect estimation showed higher levels. Indirect estimation based on the 1989 Fertility Survey and the 1989 Contraceptive Prevalence Survey established infant mortality at 121-127 per 1000 births. Direct estimation showed 100 per 1000. Child mortality was directly estimated at 175 per 1000 and indirectly estimated at 200 per 1000. Infant mortality began to decline from the 1973-77 birth cohort (155-160 per 1000). For the cohort born during 1983-87, infant mortality had declined to 112 per 1000. Indirect estimation for 1983-87 showed 137-47 per 1000. The decline in child mortality between the decades of the 1960s and 1980s was 20%. A high degree of consistency was found between reports of mortality from women 45-49 years old in 1989 and from reports of women 30-34 years old in 1976: 231 compared to 253; data was implied from the South Asian model life table. Child mortality declined from 260 deaths per 1000 in the late 1960s to 250 in the early 1970s and 200 in 1985. The risk of dying declined from the oldest to the youngest cohort.

A profile of contraceptive non-use in Kuwait: implications for health and health care.

OBJECTIVES: To analyze the characteristics of women who have never used contraception, and do not intend to use it in the future; examine the factors affecting such behavior and intentions; and discuss their health implications. METHODS: Survey data from a nationally representative random sample of Kuwaiti households, collected in a study conducted in 1999 and containing 1502 currently married women, were analyzed using logistic regression analysis. RESULTS: Based on the present study, 19% of women had never used contraception and 50% were not using contraception when interviewed. Among current non-users, 42% did not intend to use contraception, and 31% were unsure about use during the following year. Negative attitudes of the respondents and their husbands were the critical factors in non-use and future intentions for non-use. Never-users were older (average age 37.8 years) and of higher parity (6.2) than other women. CONCLUSION: Being older and of higher parity, never-users constitute a high-risk group that may be in need of counseling. Also, negative attitudes towards contraception need modification.

Factors associated with delivery complications in rural Bangladesh.

OBJECTIVES: There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. METHODS: A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. RESULTS AND CONCLUSIONS: It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.

The differentials and determinants of perinatal mortality in rural Bangladesh.

OBJECTIVE: In Bangladesh, the perinatal mortality is very high. This study examined the differentials and determinants of perinatal mortality in rural Bangladesh. METHODS: The study was based on the prospective data on maternal morbidity collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). This prospective study was conducted during the period November 1992 to December 1993. In this study, the factors associated with perinatal deaths were examined, employing differential and multivariate analyses. RESULTS: It was found that assisted delivery caused higher risks of stillbirth and death among live births during the first week of life. It was also observed that five or more pregnancies, prior to the index pregnancy, were positively associated with perinatal death. CONCLUSION: If the delivery is assisted or there are complications in delivery, then it is likely that the incidence of perinatal mortality will increase sharply. If the newborn baby was given colostrum, then perinatal mortality decreased to a great extent.