Background: Improving dietary practice alone without the adherence to other diabetic selfmanagement elements can improve glycemic control and may reduce glycosylated hemoglobin (HbA1c) by 1% to 2%. However, diabetic patients usually have poor adherence to follow appropriate and long-term dietary practice. Objective: To evaluate the factors influencing dietary practice and to evaluate the relationship between patients' dietary practice and level of HbA1c. Design: A cross-sectional study. Setting: Five Health Centers, Bahrain. Method: The study was performed in Bahrain during 2011; it included 400 type 2 diabetic patients. The sample was selected from the diabetic clinics of the primary health care centers. Only the adult patients who attended the clinic at least twice were included in the study. Result: The majority of the sample was 50 years old with low educational level. Most of them were overweight and obese and had poor HbA1c level (>7%). However, patients had good family support and high motivation to see a dietician and to follow diet regimen if given. Despite all previous indications to reinforce diabetic self-management education, specifically dietary advice, 56 (14%) denied receiving any dietary advice. The majority received their dietary advice from doctors and only 65 (16.3%) received advice from the diabetic nurse. Most patients never have been referred neither to a dietician nor to a health educator (318 (79.5%), 338 (84.5%) respectively). Although, patients had mainly average and good dietary practice, it may not indicate the actual dietary habits of the studied patients due to some limitations in the study. The two main barriers to dietary regimen are "it takes efforts" were 183 (45.8%) and "being busy" were 178 (45.5%). Conclusion: Although the majority of the diabetic patients were poorly controlled, most had average and good dietary practice score. There was positive relationship between the dietary practice and the HbA1c level. The lack of proper professional dietary assessment, follow-up and advice by the health care providers are the main influence on dietary practice of type 2 diabetic patients in Bahrain.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.

Background: Domestic abuse against a female is considered an anomalous deportment; however it is still an obnubilated quandary. Its prevalence rate is very high reaching up to 59% in certain communities. This study was done with the main objective of ascertaining the rate of women abuse in both Al-Dammam and Al-Ahsa cities of Saudi Arabia and to explore the associated risk factors to it. Materials and methods:A cross-sectional study was conducted on a convenient sample of 348 married Saudi women aged between 18 and 50 years, who have one child or more and live in the designated cities. The data were amassed by betokens of a pre-designed questionnaire. Results:The prevalence of women abuse was found to be around 19%, but reached to 33% when added to it the response of women to the abuse cognate questions. The highest rate was among women aged 40 years and older. The most mundane type of abuse was that of multiple types that accounted to 49% (which included verbal, physical and others). Vituperation accounted for 35.8% and physical, emotional, and psychological accounted for 7.5% each. Abuse was higher among lower educated couples and in families with poor economic status. Only a moiety of the abused women sought help, and most did so from their families (71%) and friends (17.8). Very few reported to the police. Conclusion:The prevalence of abuse against women is underestimated, as many women did not admit frankly being abused while they did answer abuse cognate questions. Since this type of violence affects the stability of the family and the well-being of the victim, it is recommended to establish utilize multi disciplinary programs aiming at raising the cognizance level of the society against this eccentric demeanor. Educating current and future couples and opportune training of health care providers are very efficacious implements in early discovery and revelation of assistance to the abused female.

Insofar as genetic susceptibility to type 1 diabetes is associated with HLA class II genes, with certain allelic combinations conferring disease susceptibility or resistance, this study assessed the distributions of HLA-DR and -DQ among 107 unrelated patients with type 1 diabetes and 88 healthy controls from Bahrain, all of Arab origin. The HLA-DRB and -DQB genotypes were determined by PCR-sequence-specific priming. The following alleles showed the strongest association with type 1 diabetes among patients versus controls according to their frequencies: DRB1*030101 (0.430 versus 0.097; P < 0.001), DRB1*040101 (0.243 versus 0.034; P < 0.001), DQB1*0201 (0.467 versus 0.193; P < 0.001), and DQB1*0302 (0.229 versus 0.091; P < 0.001). When the frequencies of alleles in controls were compared to those in patients, negative associations were seen for DRB1*100101 (0.085 versus 0.014; P < 0.001), DRB1*110101 (0.210 versus 0.060; P < 0.001), DQB1*030101 (0.170 versus 0.075; P ‫؍‬ 0.006), and DQB1*050101 (0.335 versus 0.121; P < 0.001). In addition, the DRB1*030101-DQB1*0201 (70.1 versus 22.7%; P < 0.001) and DRB1*030101-DQB1*0302 (21.5 versus 0.0%; P < 0.001) genotypes were more prevalent among patients, thereby conferring disease susceptibility, whereas the DRB1*100101-DQB1*050101 (20.5 versus 2.8%; P < 0.001), DRB1*110101-DQB1*030101 (28.4 versus 8.4%; P < 0.001), and DRB1*110101-DQB1*050101 (30.7 versus 0.9%; P < 0.001) genotypes were more prevalent among controls, thus assigning a protective role. These results confirm the association of specific HLA-DR and -DQ alleles and haplotypes with type 1 diabetes and may underline several characteristics that distinguish Bahraini patients from other Caucasians patients.Type 1 diabetes is an autoimmune disease characterized by insulin insufficiency resulting from a progressive immunologic destruction of insulin-secreting pancreatic ␤ islet cells by autoreactive leukocytes and their mediators (2). Although the exact the nature of the inducing agent(s) and the sequence of events leading to the destruction of ␤ islet cells and, subsequently, hyperglycemia are not completely understood, it is well established that susceptibility to type 1 diabetes is determined by environmental and genetic factors (7,25). Many susceptibility loci have been described previously, including the HLA (IDDM1) and insulin (IDDM2) gene regions (2, 5, 18), while other loci will undoubtedly be identified in the future.Mapping studies with genes from patients with type 1 diabetes confirmed the association of specific major histocompatibility complex class II alleles with the risk of disease development (5, 14, 25). It was proposed that both susceptible and protective alleles at the DRB1, DQA1, and DQB1 loci were associated with the pathogenesis of the disease (14, 20), exemplified by the strong association of the HLA-DR3 and -DR4 and the HLA-DQA1 and -DQB1 alleles with type 1 diabetes (9, 16) and the negative association of the HLA-DR2 and DQB1*0602 alleles with type 1 diabetes (21). It was also apparent that ...

BACKGROUNDTobacco smoking is one of the important health problems among school-age children. Wrong perceptions promoted by tobacco industry sponsorship increase smoking initiation amongst adolescents despite awareness of the risks involved. School teachers’ awareness of the hazards of smoking and school educational programs and curricula on control and prevention of diseases caused by smoking help in discouraging students from smoking. We assessed school teachers’ knowledge of the effects of smoking and attitudes towards smoking.METHODSOf the 152 schools in the Kingdom of Bahrain with a total of 3360 teachers, a random sample of 49 schools was selected. A questionnaire was distributed to all teachers working in these schools to collect information about their smoking habits and their knowledge of smoking-related health issues.RESULTSThe prevalence of smoking amongst Bahraini school teachers is low (7%). The majority of smokers were males (94%). Only 3.07% of the sample population were ex-smokers. In general the teachers had good knowledge of the effects of smoking on health, but some 9.5% had wrong concepts, believing that smoking does not have any harmful effect.CONCLUSIONSchool teachers are a main source of health information for students. Therefore, any anti-smoking campaign should involve continuous teacher training to increase their awareness of the hazards of smoking.

Procedures for selecting students who are most likely to succeed academically in the initial year at an innovative medical school deserve further study and probably should include both academic performance and non-academic attributes.

Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.

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