Assessment of the Prevalence of Head Lice Infestation and Parents' Attitudes Towards Its Management: A School-based Epidemiological Study in Istanbul, Türkiye

OBJECTIVE: Head lice infestation (HLI), caused by Pediculus humanus capitis, is an important public health problem worldwide, especially in primary school children. The aim of this study is to investigate HLI level, related factors, and families' knowledge levels and attitudes about HLI in two primary schools in a relatively low socio-economic region in Istanbul. METHODS: A questionnaire on HLI was developed initially and delivered to all children and parents in the school. A total of 340 primary school students, aged between 6-12, were enrolled in the study after the consent of their parents. Their hair were examined for HLI with special combs at their schools, and free anti-lice shampoos were given to parents of positive children. A total of 951 completed questionnaires were received and evaluated with chi-square test using the SPSS® 17.0 program, and the differences of p<0.05 were considered significant. RESULTS: Number of boys in the study was slightly higher than the girls (176 vs. 164). HLI was detected in 32 (9.4%) of 340 children; seven had live adult lice on their hair while 25 had only the nits. HLI was obviously more common in girls (16.4%), compared to boys (2.8%). Analysis of 951 questionnaires revealed a statistically significant difference between HLI and infrequent bathing (p<0.05). The differences between HLI and the education levels of parents, income, the number of siblings and in contact with animals were not found to be significant (p>0.05). CONCLUSION: HLI is still a common health problem, especially in girls in primary schools. Parents are aware of the relationship between the hygiene and prevention against HLI, but low socio-economic resources seem to be important determinants. Regular combing and training activities in primary schools, in coordination with the local authorities and parents are no doubt useful in reducing the incidence of HLI among the children.

Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a sub-tropical region: a quasi-experimental study.

BACKGROUND: Pediculosis is an important social challenge that can be caused by human head louse, Pediculus humanus capitis. This infestation is cosmopolitan, especially in countries with low hygiene and sanitation. Regular health education classes for students and their parents are required to reduce this infestation in schools and families. This study aimed to evaluate the impact of a health education intervention program on reducing head lice among pupils of an elementary school. METHODS: In a quasi-experimental study, a total of 880 elementary school girls were screened for pediculosis in (2017-2018). The prevalence of pediculosis follow-up continued monthly until the end of the school year after a two months educational intervention course. Visual inspection was applied for initial diagnosis of infection. The suspected cases were confirmed by wood lamp and potassium hydroxide (KOH) microscopic examination. Also eight questions about diagnostic, epidemiology, treatment and prevention were answered in a questionnaire by 50 volunteer parents before and after the training intervention course, to evaluate their general knowledge and measure the effectiveness of learning. All data were statistically analyzed using SPSS software (version 20.0, SPSS, Inc., Chicago, IL, USA). McNemar's test was also applied to investigate the prevalence rate before and after the intervention. A p -value of less than 0.05 was considered as statistically significant. RESULTS: At the beginning of study, pre-intervention prevalence of pediculosis among pupils was 8.4% (49/594). The mean age in all pupils was 9.86 ± 1.83 years old and the most infestation was shown in fourth-grade students with 10 years old. Analysis of statistics demonstrated a significant difference between having infestation and the number of members in the families. Post-intervention phase led to a decreased prevalence of pediculosis in pupils to 3% (8/594) (p-value < 0.05). Based on statistical analysis of questions before and after the training in the questionnaire, a significant increase of parental knowledge was observed on the prevention program of pediculosis (p-value < 0.001). CONCLUSION: The prevalence of pediculosis was significantly reduced following the educational interventions in the school. The applied interventions may be implemented in other residual centers to get rid of this important infestation.

International recommendations for an effective control of head louse infestations.

Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse- and nit-removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no-nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children.

Efficacy of Peer Education for Adopting Preventive Behaviors against Head Lice Infestation in Female Elementary School Students: A Randomised Controlled Trial.

BACKGROUND: Pediculosis is a common parasitic infestation in students worldwide, including Iran. This condition is more prevalent in populous and deprived communities with poor personal hygiene. This study sought to assess the efficacy of peer education for adopting preventive behaviors against pediculosis in female elementary school students based on the Health Belief Model (HBM). METHODS: A total of 179 female fifth grade students were selected using multistage random sampling and were randomly allocated to control and intervention groups. A standard questionnaire was designed and administered to collect baseline information. An educational intervention was then designed based on the conducted needs assessment. The educational program consisted of three sessions, held by peers for the intervention group. The questionnaire was re-administered one month after the intervention. Independent and paired t-test, Pearson's correlation coefficient, and regression analysis were applied as appropriate. RESULTS: The two groups had no significant differences in the scores of knowledge, HBM constructs, or behavior before the intervention. After the intervention, however, the mean scores of all parameters significantly improved in the intervention group. CONCLUSION: Peer education based on HBM is an effective strategy to promote preventive behaviors against pediculosis in among fifth grade female elementary school students in Iran.

Device-related pressure ulcers from a biomechanical perspective.

Pressure ulcers (PUs) in the pediatric population are inherently different from those in adults, in their risk factors and etiology, with more than 50% of the cases related to contact with medical equipment at the care setting. The aims of this study were to: (i) Determine the mechanical loads in the scalp of a newborn lying supine, near a wedged encephalogram electrode or wire, which is deforming the scalp at the occiput. (ii) Evaluate the effect of a doughnut-shaped headrest on the mechanical state of tissues at the same site. We used finite element computational modeling to simulate a realistic three-dimensional head of a newborn interacting with the above devices. We examined effective (von Mises) stresses, shear stresses and strain energy density (SED) in the fat and skin tissues at the occipital region. The interfering wire resulted in the worse mechanical conditions in the soft tissues, compared to the lodged electrode and use of a doughnut-shaped headrest, with 345% and 50% increase in effective stresses in skin and fat tissues, respectively. Considering that elevated and localized tissue deformations, stresses and SED indicate a risk for PUs, our simulations suggest that misplaced medical devices, and using a doughnut-shaped headrest, impose an actual risk for developing device-related PUs. We conclude that guidelines for pediatric clinical care should recommend routine inspection of the medical device placement to prevent harmful contact conditions with the patient. Furthermore, improved design of medical equipment for pediatric settings is needed in order to protect these fragile young patients from PUs.

Using Feily's method prevented scalp necrosis in three patients incline to the scalp recipient necrosis; what is new in prevention of scalp necrosis?

Serious complications arising from surgical hair restoration are relatively uncommon following well-performed and well-planned surgery by skillful surgical techniques, good communication, and postoperative follow-up. Surgical complications often categorized as those which occur in the donor site and the recipient site. In this paper among recipient area complication we focused on recipient area necrosis that arises when an increased number of recipient grafts are utilized and de-vascularization of the scalp occurs as a result of the large wound area due to the dense packing splitting of recipient skin. Recently, Feily et al. explained an interesting method to prevent development of recipient area necrosis following a hair transplant procedure. Herein we reported three cases of dense hair transplantation using the Feilys method that after slitting they troubled by unusual long lasting dark areas on the scalp and they need more than 24 hr's patience for prevention of scalp necrosis.

The use of scalp cooling for chemotherapy-induced hair loss.

Chemotherapy-induced hair loss is a common and distressing side effect of cancer therapy and is one of the major unmet challenges in cancer management. Scalp cooling can prevent chemotherapy-induced hair loss in some cancer patients with solid tumours receiving certain chemotherapy regimens. Recent evidence indicates that this technique does not increase the risk of scalp metastasis. A reduction in post-chemotherapy infusion duration of scalp cooling and the advancement in cool cap technology may assist clinicians in promoting scalp cooling to cancer patients. This article discusses recent research, scalp cooling guidelines, products available and implications for nurses and their organisations in providing scalp cooling. It also considers recent advancements in identifying genes associated with chemotherapy-induced hair loss and international research collaborations including a registry and a 'chemotherapy-induced hair loss action group'--all striving to improve the patient experience of chemotherapy-induced hair loss.

The potential application of plant essential oils to control Pediculus humanus capitis (Anoplura: Pediculidae).

The human head louse, Pediculus humanus capitis (Anoplura: Pediculidae), is an ectoparasite confined to the scalp and human hairs. The repeated use of insecticides for the control of head lice during past decades has resulted in the development of marked levels of resistance. Natural compounds such as essential oils (EOs) have been suggested as alternative sources for insect control agents. In order to introduce a new pediculicide based on EOs, the effectiveness of the product and their effects on human being must be analyzed. In consequence, the biological activity of EOs from the leaves and fruits of Schinus areira (Anacardiaceae) and the leaves of Thymus vulgaris (Lamiaceae), Aloysia polystachya and Aloysia citriodora (Verbenacea) were evaluated against the eggs and adults of P. humanus capitis by fumigant and contact toxicity bioassays. Additionally, dermal corrosion/irritation tests were performed on New Zealand albino rabbits. In a fumigant bioassay, EOs from the leaves and fruits of S. areira were the most toxic against P. humanus capitis adults while these EOs and T. vulgaris were the most effective against the eggs. In contact bioassay, the EO from T. vulgaris was the most toxic against both stages. In the corrosion/irritation tests, the EOs did not produce dermal effects. According to the results, the essential oils from the leaves of T. vulgaris would be a valid tool for the management of P. humanus capitis. This EO produces a high knockdown effect in adults (followed by mortality) and toxicity in the eggs when it is applied for 21 min at a low concentration.

Treatment of head lice (Pediculus humanus capitis) infestation: is regular combing alone with a special detection comb effective at all levels?

Head lice infestation (HLI) caused by Pediculus humanus capitis has been a public health problem worldwide. Specially designed combs are used to identify head lice, while anti-lice products are applied on the scalp for treatment. In the present study, we aimed to test whether combing only by precision detection comb (PDC) or metal pin comb (MPC) could be effective alternatives to the use of anti-lice products in children. A total of 560 children from two rural schools in Turkey were screened. In the PDC trial, children were combed every second day for 14 days, while in the MPC trial, combing was performed once in every four days for 15 days. Children were divided into two groups (dry combing and wet combing) for both trials and results were compared. The results showed no significant differences between dry and wet combing strategies for both combs for the removal of head lice (p > 0.05). The number of adult head lice declined significantly on each subsequent combing day in both approaches, except on day 15 in the MPC trial. In the end, no louse was found in 54.1 and 48.9% of children in the PDC and MPC trials, respectively. Since family members of infested children were not available, they were not checked for HLI. Four times combing within 2 weeks with MPC combs was found effective for both treatment of low HLI and prevention of heavy HLI. In conclusion, regular combing by special combs decreases HLI level in children and is safely applicable as long-term treatment.

Wet combing for the eradication of head lice.

Manual removal (using conditioner and comb or a wet comb) can be used in the treatment of head lice. Head lice infestation (Pediculosis humanus capitis) is a common problem. It is diagnosed by visualising the lice. As half of people infested with head lice will not scratch, all people in contact with a person affected with head lice should be manually checked for infestations. Wet combing is easily and safely performed at home, but persistence is needed. This article describes the process of head lice removal using a wet comb. It has NHMRC Level 2 evidence of efficacy and no serious adverse effects have been reported.

Evaluation of a health education program for head lice infestation in female primary school students in Chabahar City, Iran.

BACKGROUND: An important health problem in students is pediculosis capitis (head lice infestation) which causes physical, mental, and social complications. Social stigma induces feeling of shame, anger, and embarrassment for families and may prevent people from coming forward. METHODS: This study was a quasi-experimental (case - control) study which was done during periods of 2008 - 2009. Data collection tools were questionnaire, checklist, and head examination. Two schools were randomly selected among female primary schools in Chabahar, where 153 students were divided into case and control groups. After collecting the data, an educational program was designed and performed in the experimental group and was evaluated after two months. RESULTS: The results showed a significant difference in knowledge, attitude, and practice of the students in the case group, before and after the intervention (P < 0.0001), but  in the control group it was not significant (P > 0.05) .The infestation rate was 69.3% in the case group before the intervention, and 82.1 % in the control group, which decreased to 26.7% in the case group after the education (P < 0.0001), but there was no significant difference in the control group (P < 0.05). CONCLUSION: The health education program had a positive effect on the reduction of pediculosis capitis among students; thus, it is suggested to perform and evaluate educational programs in students and their parents.

Losing the louse: how to manage this common infestation in children.

This article aims to provide an overview of the symptoms, diagnosis, and treatment for lice infestations in children. Management of the condition by parents in the home is presented, as well as ways to prevent spread in the community. Nurses in acute care, outpatient, and school settings may use this information to teach families how to prevent a lice infestation and treat an infestation when it occurs.

Advancements in the treatment of head lice in pediatrics.

Head lice infestations occur commonly each year in children of all socioeconomic statuses. However, head lice have become more of a nuisance as resistance to first-line agents, such as permethrin 1% and pyrethrins, has increased. Newer topical products provide unique mechanisms of action without current signs of resistance. As with older agents, proper application of products must be emphasized to ensure that treatment is effective. In addition, nonpharmacologic measures should be taken to avoid reinfestation in the patient and to prevent the spread of lice to close personal contacts.

Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia.

PURPOSE: The patient impact of chemotherapy-induced alopecia (CIA) is high. Scalp cooling is applied to reduce CIA. The potential optimum post-infusion cooling times (PICTs) are currently unknown. METHODS: Scalp cooling was applied in 53 patients receiving docetaxel chemotherapy with 90-min PICT (observational part). Also 15 non-scalp-cooled patients were included. If hair preservation was observed in >80 % of the patients, randomisation between 45 and 90-min PICT was planned. Patients reported tolerance of scalp cooling and use of head covering. RESULTS: Observational study: 81 % of scalp-cooled patients did not require head covering versus 27 % of non-scalp-cooled patients. Randomised study: 79 % of 38 patients with 90-min PICT did not need head covering versus 95 % of 38 patients with 45-min PICT (p = 0.04). Scalp cooling was very well tolerated (visual analogue scale = 79). CONCLUSION: A 45-min PICT can be recommended in 3-weekly docetaxel regimens with a dose of 75 or 100 mg/m(2), administered in 60 min. The shorter PICT is a major advantage in time investment for patients. Patients (women and men) who receive docetaxel, except combined with doxorubicin and cyclophosphamide (taxotere, adriamycin and cyclophosphamide (TAC)) should be informed about the protective effect and high tolerability of scalp cooling in avoiding CIA.

Pediculosis capitis among primary-school children in Mafraq Governorate, Jordan.

Pediculosis capitis (head lice infestation) is a worldwide public health concern affecting mostly primary-school children. In a cross-sectional study in 2009/2010, the prevalence of pediculosis capitis and some risk factors for infestation were investigated among 1550 randomly selected primary-school children in Mafraq governorate, Jordan. The prevalence of pediculosis capitis was 26.6%. There were significant differences in the prevalence between girls (34.7%) and boys (19.6%), rural (31.2%) and urban (23.5%) residents, and history of infestation in the previous year (57.4%) versus no history (11.5%), as well as between children of different ages, family size and income (P<0.001). Longer hair length, lack of bathing facilities, low frequency of hair-washing and bathing, and sharing of articles (e.g. combs, scarves) were significantly associated with infestation (P<0.001). The prevalence of infestation was higher than reported in previous studies in Jordan (< 14%). Programmes are needed to increase awareness of pediculosis capitis and the importance of good personal hygiene.

Hats off to success: changing head lice policy.

Pediculosis at school is an emotional and contentious issue. Many school nurses do not feel prepared to take on the task of changing long-standing school policy, even in the light of solid evidence to do so. This article explores one school nurse's experience in changing lice policy for her district.