Prevalence and Factors Influencing Trichotillomania Among Healthcare Workers and Students in Saudi Arabia: A Cross-Sectional Analytical Study

BACKGROUND

 Trichotillomania (TTM) is a psychiatric disorder characterized by repetitive pulling out of one's own hair, in which the scalp, brows, and eyelids are the most common sites. This study aimed to measure the prevalence of TTM among healthcare workers and students and to determine its association with psychiatric disorders.

METHODOLOGY

 This cross-sectional study was conducted among healthcare workers and students in Saudi Arabia. Data were collected through an online self-administered questionnaire. The questionnaire consisted of sociodemographic characteristics, the Massachusetts General Hospital (MGH) Hairpulling Scale to measure TTM, and the Depression and Anxiety Stress Scale (DASS-21) to measure the psychiatric disorders of the participants. A convenience sampling technique was implemented. The sample size was calculated to be 385.

RESULTS

 Of the total 460 participants, 62% (n = 285) were students, 55% were females and 61.7% (n = 284) were aged between 18 and 24 years. The most commonly associated chronic disease was diabetes (n = 34, 7.4%), followed by asthma (n = 30, 6.5%). The prevalence of TTM was 4.8% (n = 22), which was higher among medical students (n = 15, 5.3%) as compared to medical workers (n = 7, 4%). While taking psychiatric medication (AOR = 0.197; 95% CI = 0.076-0.508 p = 0.001) was identified as the protective factor for TTM, previous diagnoses of psychiatric illness (AOR = 4.298; 95% CI = 1.759-10.499; p = 0.001), stress (AOR = 4.759; 95% CI = 1.541-14.695; p = 0.007), and depression (AOR = 3.149; 95% CI = 1.190-8.334; p = 0.021) were recognized as independent risk factors of TTM.

CONCLUSION

 Trichotillomania was less common among health workers and students in Saudi Arabia. However, if trichotillomania is present, the disorder was found to be more common among those with associated psychiatric illnesses, including those who were anxious and depressed. Hence, further research is required to validate the impact of psychiatric conditions on the prevalence of TTM in the study region.

Pregnancy Complications in Pandemics: Is Pregnancy-Related Anxiety a Possible Physiological Risk Factor?

BACKGROUND

Birth and pregnancy complications increased by 10.2% during the 2019 coronavirus (COVID-19) pandemic. Pregnant women are at high risk for anxiety, which might trigger physio-logical stress, leading to pregnancy complications.

AIM

This study aimed to investigate factors leading to antenatal anxiety during the COVID-19 pandemic. We also aimed to discuss our find-ings with regard to the current literature about pregnancy complications.

METHODS

This cross-sectional study interviewed 377 pregnant women and assessed anxiety using a validated 7-item general anxiety disorder (GAD-7) scale. Anxiety was related to physiological and demo-graphic parameters. Anxiety was subdivided into pandemic- and pregnancy-related anxiety to minimize results bias.

RESULTS

Our results showed that 75.3% of pregnant women were anxious. The mean GAD-7 score was 8.28 ± 5. Linear regression analysis showed that for every increase in the number of previous pregnancies, there was a 1.3 increase in anxiety level (p < 0.001). Women with no previous miscarriages were more anxious (p < 0.001). Surprisingly, pregnant women who were previously infected with COVID-19 were 6% less stressed. Pregnant women with comorbid-ities were more stressed (p < 0.001). Low income (p < 0.001) and age (p < 0.05) were the demo-graphic factors most significantly related to increased anxiety.

CONCLUSIONS

The prevalence of pregnancy-related anxiety increased threefold in Saudi Arabia due to the COVID-19 pandemic. Healthcare support should be available remotely during pandemics; pregnant women (especially those with comorbidities) should be educated about the risks of infection and complications to prevent anxiety-related complications during pregnancy.

Practice, awareness and opinion of pharmacists toward disposal of unwanted medications in Kuwait

BACKGROUND

The disposal of unwanted medications has been a concern in many countries, as pharmaceutical waste enters the ecosystem, ultimately having an effect on human health and environment. Earlier studies in Kuwait found that the method of disposal by the public was by disposing in the garbage or by flushing down the drain. In accordance with patient preference and environment safety, it would be appropriate to use local government pharmacies as collection points for proper disposal.

OBJECTIVE

To determine the practice of pharmacists, working in government healthcare sectors, with regard to disposal of returned unwanted medications by the public. This study also aims to assess pharmacists' awareness toward the impact of improper disposal on the environment and to investigate whether pharmacists agree to have their pharmacies as collection points for future take-back programs.

METHOD

A random sample of 144 pharmacists from the six main governmental hospitals and 12 specialized polyclinics in Kuwait, completed a self-administered questionnaire about their practice of disposal, awareness and opinion on using pharmacies as collection points for proper disposal of UMs. Data were analyzed using descriptive statistics.

RESULTS

A total of 144 pharmacists completed the survey. Throwing UMs in the trash was the main method of disposal by majority of the respondents (73%). Only 23 pharmacists disposed UMs according to the guidelines of Ministry of Health, Kuwait (MOH). However, about 82% are aware that improper disposal causes damage to the environment and 97% agree that it is their responsibility to protect the environment. About 86-88% of the pharmacists agree to have government hospital pharmacies and polyclinics as collection points for future take-back programs.

CONCLUSION

Even though the current practice of disposal by majority of pharmacists is inappropriate, they are aware of the damage and acknowledge their responsibilities toward environment protection. Concerned authorities should monitor and implement proper disposal guidelines in all pharmacies. Majority of pharmacists support the idea of having the government pharmacies as collection points for safe disposal of UMs in Kuwait.

Health promotion and education activities of community pharmacists in Kuwait

OBJECTIVES

To investigate self-reported practice of pharmacists regarding health promotion and education activities, explore the barriers that may limit their involvement in health promotion and education, and identify their willingness to participate in continuing education programs related to health education.

SETTING

Community pharmacies in Kuwait.

METHOD

A descriptive cross-sectional study was performed using a pre-tested questionnaire on a sample of 223 community pharmacists.

MAIN OUTCOME MEASURES

The extent of the pharmacists' involvement in counselling patients about health promotion and education topics, their preparation to counsel patients in health promotion and education topics, and their perceived success in changing the patients' health behaviour.

RESULTS

The response rate was 92%. Information on medication use was the most frequent reason for consumers seeking community pharmacists' advice. The majority of respondents believed that behaviour related to the proper use of drugs was very important. There was less agreement on the importance of other health behaviours. Respondents indicated they were involved in counselling patients on health behaviours related to use of drugs as prescribed/directed, weight management, medicine contents and side effects, diet modification and stress reduction, but were less involved in counselling on other health behaviours. Respondents' perception of themselves as "most prepared" to counsel patients closely reflected their involvement. Pharmacists reported high levels of success in helping patients to achieve improvements in using their drugs properly compared to low levels in changing patients' personal health behaviours. The majority of respondents believed that pharmacists had a responsibility for counselling consumers on health behaviours (97%, 95% CI 95-99%), and indicated their willingness to learn more about health promotion (84%, 78-88%). Lack of pharmacists' time was reported by about 58% of respondents as the major barrier limiting pharmacists' provision of health promotion.

CONCLUSION

The role of community pharmacists in health promotion and education is primarily focused on pharmaceutical issues rather than health behaviour modification. The majority of respondents have a positive attitude towards counseling the population on health behaviours and indicated their willingness to learn more about health promotion.

Self-medication practices among diabetic patients in Kuwait

OBJECTIVES

The aim of this study was to estimate the prevalence of self-medication with proprietary medicines and/or herbs among diabetic patients and evaluate factors associated with self-medication among diabetic patients.

SUBJECTS AND METHODS

A total of 104 diabetic patients were selected randomly from eight diabetic clinics from three governorates. Data were collected via face-to-face structured interview of the respondents in the clinics using a developed and piloted questionnaire.

RESULTS

The response rate was 96.2%. Seventy-four percent of the study participants reported that they seek medical consultation when they get an illness, 92% indicated that they know that the use of medicines and/or herbs to treat an illness without a medical consultation can be harmful. Only 13% of the respondents reported that they had used medicine or herbs without medical consultation to treat an illness within the previous 2 months of the study period. Nine percent of the study population reported that they used herbs to treat diabetes, and 2% used them for other illness. Only two (2%) indicated that they used medicines, which were analgesics, diet pills and vitamins. There was no significant association between self-medication with medicines or herbs and the sociodemographic characteristics of the respondents (p > 0.05).

CONCLUSION

The prevalence of self-medication with medicines, including herbs, among diabetic patients in Kuwait is low. Enforcement of a strict prescription policy and coverage of medical consultation and treatment by health insurance may have contributed to low self-medication practices among diabetic patients.

Awareness and perceptions of emergency contraception among retail pharmacists in Kuwait

OBJECTIVE

To describe the awareness and perceptions of hormonal emergency contraception (EC) among retail pharmacists.

SETTING

Private retail pharmacies in Kuwait City.

METHOD

A self-administered questionnaire was developed to elicit pertinent demographic information as well as awareness of and concerns about EC and administered to the senior pharmacist in 51 randomly selected private retail pharmacies.

MAIN OUTCOME MEASURE

Proportion of pharmacists aware of EC and who had recommended EC.

RESULTS

The respondents had a mean (SD) age of 34.2 (7.7) years; 58.8% were male, and all but one were non-Kuwaiti. The median practice experience of the pharmacists was 6 years. Oral contraceptives and male condoms were universally available in the pharmacies, but none stocked emergency contraceptives, female condoms, or diaphragms. Twenty respondents (39.2%; 95% confidence intervals 25.5-53.9%) said they were aware of EC, and 4 (7.8%) that they had ever offered EC. Nine (17.6%) respondents saw EC as offering no advantages over other contraceptive measures and effectiveness was perceived to be low. Most cited concerns were of encouraging irresponsible behaviour and women relying on EC in place of regular contraceptive measures. Religious opposition (41.2%), lack of awareness by clients (51.0%) and lack of awareness by health providers (35.3%) were seen as the most significant obstacles to provision of EC.

CONCLUSION

Knowledge of EC is poor among community pharmacists in Kuwait. Action is needed to address this deficit and to make EC more accessible to women who wish to use it.

Awareness of hormonal emergency contraception among married women in a Kuwaiti family social network

OBJECTIVE

Awareness and use of hormonal emergency contraception are not known in the Arab world. This study investigated awareness and perceptions of hormonal emergency contraception among women within a Kuwaiti extended family and their social contacts.

STUDY DESIGN

A cross-sectional survey was conducted using a self-administered questionnaire which was distributed to 66 married women within a Kuwaiti family's social network. The questionnaire provided a short explanation of hormonal emergency contraception and then elicited the respondent's prior awareness, concerns and perception on future availability.

RESULTS

The mean (S.D.) age of the respondents was 35.1 (6.3) years. Over 30% were currently using oral contraceptives; 28% were using no contraceptive method. Four women (6.1%) had heard of hormonal emergency contraception before, one had used it. Most respondents (65.2%) would not use or inform a friend about hormonal emergency contraception. Main concerns were risks to the health of the woman (83.3%) or the baby (54.5%) or that it was abortifacient (21.2%). However, 90.9% of respondents wanted hormonal emergency contraception to be available.

CONCLUSIONS

Awareness of hormonal emergency contraception is low among Kuwaiti women. Despite some concerns, they feel it should be made available. Health care providers and policymakers should address this situation.

Awareness of and Attitude toward Hormonal Emergency Contraception among Married Women in Kuwait

OBJECTIVE

To describe the awareness of and attitudes toward hormonal emergency contraception among women in Kuwait.

METHODS

A cross-sectional survey was conducted among married women at obstetrics/gynecology outpatient clinics at the government Maternity Hospital in Kuwait. A pretested Arabic self-administered questionnaire was distributed to the women in March 2005. The questionnaire provided a short explanation as to what was meant by hormonal emergency contraception and then elicited whether the respondent was aware of it, what concerns she had, and whether she thought it should be made available in Kuwait.

RESULTS

One hundred three questionnaires were completed. Respondents were mostly Kuwaiti (78%) and non-Bedouin (78%) with postsecondary school education (74%) and a mean (SD) age of 33.1 (7.8) years and a mean (SD) number of children of 2.8 (1.9) About half of the women were not currently using contraceptive methods; 40% of contraceptive users were taking oral contraceptive pills. Bedouin women were more likely than non-Bedouins to use breastfeeding as a contraceptive measure (p = 0.012). Ten women (9.7%, 95% CI 4.8-17.1) reported having heard of hormonal emergency contraception, mostly from informal sources, 1 had used it, and 7 knew of other women who had used it. Only 8 (7.8%) respondents were willing to use or inform a friend about hormonal emergency contraception, but 89.3% thought it should be available in the health system.

CONCLUSIONS

Awareness of hormonal emergency contraception is low among women in Kuwait. Despite concerns and apparent negative attitudes, women believe it should be made available in the health system.

Pharmaceutical care services in hospitals of Kuwait

PURPOSE

To describe the current pharmacy practice in the general public hospitals based on self-reported practice by pharmacists, explore the awareness of the pharmacists of pharmaceutical care concept, identify their willingness to implement pharmaceutical care practice, and identify the barriers that may limit its implementation.

METHODS

Eighty hospital pharmacists working in four general public hospitals were approached to be included in the study. Data were colleted via face-to-face structured interview of the respondents using a pre-tested questionnaire.

RESULTS

The response rate was 76.3%. Thirty five (57.4%) of the respondents had frequently performed interventions on prescriptions through interaction with physicians. Thirty two (52.5%) had frequently provided patient counselling. The knowledge of the respondents about the counseling points for salbutamol inhaler was assessed using a total score of 10, 35 (57.4%) scored = 5. The frequent provision of counseling was non-significantly least common among the > 40 years group compared to youngest age group (OR: 0.7, 0.3-1.9), male gender (0.6, 0.2-1.4) and those with a practice experience of > 20 years (0.4, 0.1-1.2). Forty six (75.4%) of the respondents reported that they were aware of pharmaceutical care concept. Thirty five (76.1%) and 39.1% of those who reported awareness of pharmaceutical care concept indicated that its main focus is the patient and the appropriate objectives of the concept, respectively. The awareness about the patient as the main focus of pharmaceutical care was non-significantly least among the respondents aged 41-60 years (OR: 0.6, 0.2-2.4) and those with a practice experience of 21-40 years (0.3, 0.1-1.0). The main barriers perceived by the participants were lack of time (78%) and lack of staff (71.2%).

CONCLUSION

The current practice of hospital pharmacists in Kuwait needs further improvement in relation to interaction with physicians and patient counselling. The lack of uniformity in the responses regarding the focus and objectives of pharmaceutical care indicates a lack of appropriate understanding in this matter. All respondents have shown high willingness towards the implementation of pharmaceutical care services in their practice.

Self-reported medication use among adolescents in Kuwait

OBJECTIVE

The objectives of this study were to describe and examine the pattern of medication use, including age and gender differences among adolescents in Kuwait, and to establish the sources of information on medicines in this age group.

SUBJECTS AND METHODS

A cross-sectional survey of 1,110 male and female students (14-21 years) from 10 randomly selected public schools in Kuwait was conducted. The prevalence of self-medication was estimated.

RESULTS

The prevalence of self-medication among the high school students was 92%. The prevalence increased by age from 87% among 14-year-olds to 95% among 18-year-olds. Sixty-five percent of medicines used were for pain relief, 54% for respiratory conditions, 39% for allergic conditions, and 37% for dermatological conditions. Twenty-two percent of medicines were nutritional supplements and vitamins, 21% gastrointestinal products, 17% antidandruff products, 15% hair products, 13% for migraine while 8% were for athlete's foot. Pain relief, respiratory, dermatologic and hair products were more prevalent in female adolescents than in male while antidandruff and athlete's foot preparations were used more by male adolescents. The most common sources of information on medicines were parents.

CONCLUSION

The prevalence of self-medication among adolescents in Kuwait is high. Self-medication tended to increase with age and differed between male and female students. Few students consulted pharmacists for information on drugs. There is need to promote the image of the pharmacist in Kuwait as a provider of medication information.

Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis

Although factors influencing sputum smear conversion in tuberculosis have been studied well, the effect of smoking is largely unknown. Excluding those with incomplete history or drug resistant isolates, 339 patients out of the 526 sputum positive patients registered between 1998 and 2000 were studied. At the end of 2 months, smokers and non-smokers converted with almost the same frequency to a negative sputum status {P=0.065, OR (95%CI) 0.47 (0.21-1.06)}. Although gender or age had no effect on sputum conversion with respect to smoking status, expatriate smokers as a whole showed a significant difference. (P=0.039). On applying logistic regression model, smokers with far advanced radiographic abnormalities (P<0.038) or with 3+ smear status (P=0.011), were found to have a less chance of an early smear conversion. In conclusion smoking did not influence sputum smear conversion in tuberculosis. However, as expatriate smokers and smokers with advanced disease showed a delay in smear conversion, smoking should be discouraged in patients with pulmonary tuberculosis.