Air quality and seasonal variations in consultations for respiratory, allergic, dermatological and gastrointestinal diseases in Bahrain, 2007.

Environmental health data in Bahrain are scarce. This study in 4 governorates of Bahrain aimed to establish baseline data on the seasonal prevalence of certain disease groups that are sensitive to climate (respiratory, allergic, dermatological and non-specific gastrointestinal diseases) over a 1-year period and to record local climate and air pollutant data for the same year. A 5% sample of medical records for those who attended primary health-care centres during 2007 was taken. Visit rates for all 4 diseases had peaks, in spring and in autumn, with the lowest rates in the summer season when the average temperatures were highest and average humidity was lower. Respiratory-related visits were highest when the air concentrations of SO2 were highest. An ongoing surveillance system for climate-sensitive diseases should be initiated to monitor and relate health and environmental trends.

Air quality and seasonal variations in consultations for respiratory, allergic, dermatological and gastrointestinal diseases in Bahrain, 2007

إن البيانات حول الصحة البيئية شحيحة في البحرين. وقد أجرى الباحثان هذه الدراسة في 4 محافظات في البحرين بهدف توطيد بيانات خط الأساس حول معدل الانتشار الفصلي لبعض مجموعات الأمراض ذات الحساسية الفصلية [أمراض تنفسية، وأليرجية، وجلدية، وأمراض هضمية غير نوعية]، وذلك على مدى سنة كاملة، مع تسجيل البيانات حول المناخ المحلي وملوثات الهواء في السنة ذاتها. وقد أخذت عينة مقدارها 5% من السجلات الطبية لمن حصر إلى مراكز الرعاية الصحية الأولية خال عام 2007 . وقد اتضح أن الزيارات للأمراض الأربعة تبلغ ذروتها في فصلي الربيع وفي الخريف وتصل إلى حضيضها في فصل الصيف عندما تبلغ درجات الحرارة ذروتها وتكون الرطوبة أقل. وقد كانت الزيارات ذات الصلة بالأمراض التنفسية في ذروتها عندما بلغ تركيز ثنائي أكسيد الكبريتSO[2]، ذروته، مما يدل على وجوب إنشاء نظام ترصد مستمر للأمراض الحساسة للمناخ لرصد الاتجاهات البيئية والصحية ذات الصلة بها

ABSTRACT Environmental health data in Bahrain are scarce. This study in 4 governorates of Bahrain aimed to establish baseline data on the seasonal prevalence of certain disease groups that are sensitive to climate (respiratory, allergic, dermatological and non-specific gastrointestinal diseases) over a 1-year period and to record local climate and air pollutant data for the same year. A 5% sample of medical records for those who attended primary health-care centres during 2007 was taken. Visit rates for all 4 diseases had peaks, in spring and in autumn, with the lowest rates in the summer season when the average temperatures were highest and average humidity was lower. Respiratory-related visits were highest when the air concentrations of SO2 were highest. An ongoing surveillance system for climate-sensitive diseases should be initiated to monitor and relate health and environmental trends.

RÉSUMÉ Les données sur la salubrité de l'environnement sont rares à Bahreïn. La présente étude menée dans quatre gouvernorats de Bahreïn visait à recueillir des données initiales sur la prévalence saisonnière de certains groupes de maladies qui sont sensibles au climat (maladies respiratoires, allergiques, dermatologiques et troubles gastrointestinaux non spécifiques) sur une période d'un an et à enregistrer les données sur le climat local et les polluants atmosphériques pour la même année. Un échantillon de 5 % des dossiers médicaux des patients ayant consulté dans des centres de soins de santé primaires en 2007 a été sélectionné. Les fréquences de consultation pour les quatre groupes de maladies avaient des pics, au printemps et en automne, et des creux pendant la saison d'été, lorsque les températures moyennes étaint les plus élevées et que le taux d'humidité était le plus faible. Les consultations pour un motif respiratoire étaient plus nombreuses lorsque la concentration atmosphérique en dioxyde de soufre était la plus élevée. Un système de surveillance permanent pour les maladies sensibles au climat devrait être instauré pour surveiller et corréler les tendances sanitaires et environnementales.

Prevalence of risk factors for cardiovascular diseases among men and women in an Arab Gulf community.

A cross-sectional study was conducted to estimate the prevalence of major risk factors for cardiovascular diseases (CVD) among the adult population in Bahrain, an Arab Gulf country. A total sample of 516 subjects aged 30-79 years was selected proportionally from all geographical areas of Bahrain. Findings revealed that current smokers represented 32% of men and 20% of women (P < 0.001). However, a relatively high percentage of women were exposed to inhalation of other family member tobacco smoking compared to men (29% and 44% among men and women, respectively). Obesity, hypertension and diabetes were highly prevalent and significantly more reported among women than men. Of women, 79.6% were overweight or obese compared to 56% of men. Sedentary lifestyle patterns (Lack of physical exercise and daily watching of television) were also highly reported. About 12.1% of men and 15.7% of women did not consume fresh fruits. The corresponding percentages for fresh vegetables were 8.4% and 5.5%, respectively. The prevalence of well established risk factors for CVD such as smoking, obesity, inactivity, diabetes and hypertension were high and indicates the need for a national health policy to prevent and control the CVD.

Lifestyle and the risk of acute myocardial infarction in a Gulf Arab population.

BACKGROUND: Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30-79 years. METHODS: Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors. RESULTS: Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.24-5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82-9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73-6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI. CONCLUSION: There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.

Hypertension control and the risk of myocardial infarction and stroke: a population-based study.

A population-based case-control study was performed to determine the importance of the presence of hypertension and the control of blood pressure level during treatment for hypertension on the occurrence of acute myocardial infarction (AMI) and stroke in persons aged 35-69 years in the Hunter Region community. Patients with a first episode of AMI or stroke were identified from community-based heart attack and stroke registers and compared with control subjects obtained from a random population sample from the same community. Twenty per cent of control subjects were currently receiving treatment for hypertension compared with 37% of patients with myocardial infarction (odds ratio adjusted for age, sex and several other possible confounding variables, 2.6; 95% confidence interval (CI), 1.9-3.4) and 51% of patients with stroke (adjusted odds ratio, 3.5; 95% CI, 2.3-54). Among those who had ever been told they had hypertension, 71%, 73% and 59% of patients with AMI, patients with stroke and control subjects, respectively, were receiving treatment at the time of the AMI or the stroke or at the time of the survey (control subjects). For those receiving treatment for hypertension, blood pressure levels were obtained from the records of their general practitioner. Despite similar pretreatment levels the last recorded blood pressure level (either before the survey of the development of AMI or stroke) was higher among those who developed AMI or stroke than those in the control group. Those with a treated diastolic blood pressure of less than 80 mmHg appeared to be at a higher risk of both AMI and stroke than those with a treated diastolic blood pressure level of 80-89 mmHg, but the difference was not statistically significant. Randomised controlled trials do not show a reduction in rates of AMI in response to a reduction of blood pressure. Nevertheless our findings suggest that the presence of hypertension and poor control of blood pressure levels despite treatment may be important aetiologically both for AMI and stroke occurrence.

Death from myocardial infarction: what are the benefits of early arrival at hospital and thrombolysis?

The potential benefits of early hospital care in the event of myocardial infarction were investigated in a community-based study of all suspected cases of heart attack among people aged under 70 years in the Hunter Region of New South Wales. Between August 1984 and December 1985 acute care data were collected for 1029 cardiovascular events classified as definite myocardial infarction or sudden coronary death; 516 (50%) resulted in death within 28 days from the onset of symptoms and 325 of these deaths (63%) occurred outside hospital. Of 703 people who are known to have reached hospital alive 205 (29%) did so more than four hours after the onset of symptoms. At the time of the study fewer than 1% of patients received streptokinase. To estimate the potential benefits of increased medical care an optimistic scenario was considered in which patients who arrived at hospital more than four hours after the onset of symptoms received medical attention earlier and all eligible patients received thrombolysis. Based on the results of the Second International Study of Infarct Survival (ISIS-2), if streptokinase and aspirin had been used 14% of deaths would have been averted. If, in addition, patients had arrived at hospital earlier and received optimal benefit from thrombolysis another 13% of deaths could have been avoided. These results provide a broader perspective of the potential benefits of improved medical care than can be obtained from hospital-based studies that deal only with those heart attack victims who survive long enough to reach hospital alive.

Declining mortality from ischemic heart disease and cerebrovascular disease in Australia.

The authors examined the patterns of mortality from ischemic heart disease and cerebrovascular disease in Australia for men and women aged 30-84 years during the period 1950-1986 to assess the relative contributions of period and cohort effects on changes in the mortality rates. Death rates for ischemic heart disease increased from 1950 to the late 1960s and then declined. Although the relative magnitude of the decline was greater among younger age groups, decreasing mortality rates were experienced in all age groups, including the oldest. The period effect was dominant so that each successive cohort experienced lower age-specific mortality rates after the late 1960s. Death rates for cerebrovascular disease for both sexes and all age groups have declined since the early 1950s, although the rate of change was less in 1961-1971 and greater before and after this period. No cohort effect was demonstrated for either disease. Changes in diet, decreasing prevalence of cigarette smoking, and increasing treatment of hypertension throughout the period and improved coronary care from the late 1960s onward are all consistent with the mortality trends.

Blood pressure measurement in an Australian population.

A postal survey of a random sample of 1200 persons who lived in the Hunter Region of New South Wales was undertaken in order to determine their experiences of blood pressure measurement and treatment for hypertension. The corrected response rate was 89%. Ninety per cent of the 962 respondents had visited a doctor in the previous year and 69% of them reported a blood pressure measurement at their last visit. Eighty-nine per cent of the 962 respondents reported that they had undergone a blood pressure measurement in the past three years. Although 79% of the respondents reported a blood pressure measurement in the past year, only 59% of men who were aged 45 years or less had experienced such a measurement during that period. Women were more likely than were men to have had their blood pressure measured and to report a knowledge of and treatment for hypertension. As these findings suggest that a large proportion of the population has experienced a blood pressure measurement in the past three years, it appears that most of the hypertension in the community has already been detected. The value of blood pressure screening is questioned, although it would appear that a need remains for an improvement in the detection of hypertension in men under 45 years of age. The prevalence of hypertension in the community remains high in spite of the degree of attention that is paid to it by the medical profession. It is imperative to explore the possibilities for the primary prevention of hypertension.

Hypertension and the risk of ischaemic heart disease.

The magnitude of the effect of hypertension as a risk factor for acute myocardial infarction (AMI) was estimated in 250 patients who presented with a first AMI who were aged 35-64 years (199 survivals and 51 deaths within 24 h), whose names were obtained from a community-based register of myocardial infarctions in the Hunter Region of New South Wales. The cases were matched by sex, age and residential area, and control subjects were obtained from a random population sample from the same region. A history of hypertension (odds ratio, 5.5; 95% confidence limits, 3.4 and 8.9) and treatment for hypertension (odds ratio, 4.2; 95% confidence limits, 2.5 and 7.2) were each significantly (P less than 0.0001) associated with an increased risk of AMI--persons with treated or untreated hypertension were four to five times more likely to develop AMI than were persons without hypertension. Adjustment for smoking did not affect the association between hypertension and the incidence of AMI. Cigarette smoking appears to have had less influence on the incidence of AMI (odds ratio, 1.7; 95% confidence limits, 1.1 and 2.4; P less than 0.01) than did a history of hypertension. Twenty-four per cent of the first AMIs that occurred in the study population were attributable to hypertension (after adjustment for smoking) and twenty-seven per cent were attributable to smoking (after adjustment for hypertension).