RESUMO
BACKGROUND: The study addresses the supply and demand for nurses in Kuwait in the light of emerging variables such as increasing population, economic growth, changes in healthcare strategies and expansion of healthcare facilities. OBJECTIVE: To project the future demand for nurses in Kuwait for the years 2007-2020 based on the period 1994-2006. METHODS: Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for nurses was projected using the average nurse to population ratios for the years 1994-2006. FINDINGS: The number of Kuwaiti indigenous nurses is declining at an average decrement rate of 3.3% per annum. There is a gap between the numbers of native and migrant nurses, which will be wider with time. In 2006, native nurses constituted only 6.6% of the nursing workforce; this affects the quality of provided health care owing to language, religions and socio-cultural barriers between foreign nurses and patients. CONCLUSIONS: The supply of indigenous nurses in Kuwait should be increased in order to deliver effective nursing care with shared culture and language in the modern healthcare system of Kuwait. This can be achieved through an improvement in recruitment and retention of indigenous nurses and nursing students.
Assuntos
Pessoal Profissional Estrangeiro/provisão & distribuição , Avaliação das Necessidades/organização & administração , Recursos Humanos de Enfermagem/provisão & distribuição , Recursos Humanos de Enfermagem/tendências , Seleção de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Educação Técnica em Enfermagem , Bacharelado em Enfermagem , Educação de Pós-Graduação em Enfermagem , Previsões , Diretrizes para o Planejamento em Saúde , Humanos , Kuweit , Modelos de Enfermagem , Programas Nacionais de Saúde/organização & administração , Pesquisa em Administração de Enfermagem , Assistentes de Enfermagem/educação , Assistentes de Enfermagem/provisão & distribuição , Recursos Humanos de Enfermagem/educação , Enfermagem Prática/educação , Reorganização de Recursos Humanos/tendências , Crescimento Demográfico , Características de Residência , Sociedades de Enfermagem/organização & administração , Recursos HumanosRESUMO
OBJECTIVE: To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer. SUBJECTS AND METHODS: Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5-60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic (negative finding) and proliferative or hyperplastic (positive findings). The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment. RESULTS: A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients (76 vs. 33%, p < 0.001). The abnormal endometrial changes were further demarcated in both groups into proliferative (54 vs. 26.7%, p = 0.02) and hyperplastic (22 vs. 6.6%, p = NS). In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure (<1 year vs. >/=1 year) and the endometrial abnormalities (46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS). CONCLUSION: The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast.