Predictive factors for nutritional behavior among pregnant women attending antenatal care clinic in 6th of October City.

BACKGROUND: Good maternal nutrition during pregnancy is important to ensure health for both the mother and the foetus. This study aimed to assess nutritional knowledge and behavior among a group of Egyptian pregnant women in addition to identify the factors influencing both their nutritional knowledge and behavior. METHODS: This comparative cross sectional study included 300 pregnant women attending the antenatal care clinics in 6th of October University private hospital and El-Hussary primary health care (PHC) unit. The data was collected through a modified nutritional survey that was translated from Spanish to Arabic and revised by language experts for clarity. RESULTS: Almost all of the women attending the private hospital were university educated while about half of the women attending the PHC unit were graduated from technical education. In general, the level of knowledge about food requirements of both groups was satisfactory good; however, neither of them fulfilled the WHO recommendations of food intake during pregnancy or the optimum number of meals per day. The mean of random blood glucose was higher among the women attending the PHC unit; the BMI, mid arm circumference and subcutaneous fat were higher among the same group as well. In regard to fulfilling the WHO recommended servings per day, only starch and fat items were fulfilled by both groups, whereas the other three items (vegetables, fruits and dairy products) were merely included in the diets of both groups. CONCLUSIONS: Healthy behavior among pregnant women in both group were influenced by their educational level, occupation as well as their pre-gestational BMI. Those were the only three significant predictive factors, where women with higher education showed an active lifestyle. In addition, women starting with normal BMI before pregnancy had better healthy behaviours including the choice of healthy diets.

Underlying illness severity and outcome of nosocomial pneumonia: prospective cohort study in intensive care unit.

BACKGROUND: Previous studies have suggested that the final outcome of a patient with nosocomial pneumonia (NP) may depend on the patient's illness severity upon admission to the intensive care unit (ICU). AIM: To investigate the relationship between developing NP during hospitalization in an adult ICU and the risk of death with special focus on illness severity at admission in the unit. METHODS: A prospective cohort study was performed among all patients admitted for at least 24h to the ICU of a university reference hospital in Spain from 2006 to 2009. A stratified univariate study was performed according to the patients' illness severity at admission, estimated using the Acute Physiology And Chronic Health Evaluation (APACHE) II index. To determine whether the NP was independently associated with increased mortality in ICU, a multivariate logistic regression analysis was carried out, adjusting for potential confounders. RESULTS: In all, 4427 patients were studied, of whom 233 acquired NP while admitted. Patients who developed NP had a 2.6 higher risk (95% confidence interval: 2.1-3.0) of dying compared with those who did not develop NP. When stratified by the APACHE II index, the significant association remained at each stratum, although the strength of the association decreased as the value of the index increased. In the multivariate analysis, NP was independently associated with death in the ICU. The interaction between NP and the APACHE II index, with a negative coefficient, was also significant. CONCLUSIONS: Developing NP while admitted to the ICU was independently associated with increased mortality. However, the strength of the association decreased as the severity of patient illness upon admission to the ICU increased, not influencing death of patients with severe APACHE II values.

New measles vaccination schedules in the European countries?

Over the last 5 years, a number of outbreaks of measles have occurred in several European Union (EU) countries. Many of these outbreaks continue and/or continued for more than 1 year after the notification of the first case. Curiously in many of measles outbreaks about 10% of the patients were less than 12 months of age. All these patients according to the current EU countries vaccination calendars were not yet vaccinated against measles. Based on the results of measles outbreaks, especially age of affected patients, we should consider changing measles vaccination schedules in all EU countries. Most of mothers between 30 and 40 years of age are not vaccinated against measles, and many of them are not naturally immune against measles. These mothers do not pose antibodies against measles and in turn do not provide vertical protection for their infants. In conclusion, administrating the first dose of measles vaccine in the EU countries should be considered before 12 months of age, most probably at 9 months of age.

Compliance with haemodialysis practice guidelines in Egypt.

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% (SD 11.2%) overall. Within the 5 separate domains, compliance was: 58.8% (SD 12.4%) for personnel, 68.5% (SD 16.0%) for patient care practices, 61.3% (SD 15.4%) for infection prevention and control, 51.5% (SD 18.2%) for the facility and 56.5% (SD 7.1%) for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities.

Health promotion or pharmacological treatment for chronic diseases?

Over the last years medicine has progressed very rapidly. Communicable diseases, which were the leading causes of mortalities, are not anymore, especially in developed countries. Currently, non-communicable diseases are more prevalent, and most of them are related to changes in our daily habits and degenerative processes. Most of these diseases are chronic, need continuous care and treatment with limited improvement and high costs. The General Assembly of the United Nations in its resolution 65/238 recognized the primary role and responsibility of Governments in responding to the challenge of non-communicable diseases and the essential need for the efforts and engagement of all sectors of society to generate an effective response. Special emphasis has been concentrated on pharmacological treatments for most of chronic non-communicable diseases with the challenge to discover new drugs for treating, in most cases, chronic irreversible degenerative diseases associated with aging. Little care was given to non-pharmacological lines of treatment.

Compliance with haemodialysis practice guidelines in Egypt

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% [SD 11.2%] overall. Within the 5 separate domains, compliance was: 58.8% [SD 12.4%] for personnel, 68.5% [SD 16.0%] for patient care practices, 61.3% [SD 15.4%] for infection prevention and control, 51.5% [SD 18.2%] for the facility and 56.5% [SD 7.1%] for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities

Evaluation of the level of knowledge of Egyptian women of breast cancer and its risk factors. A cross sectional study.

Breast cancer is considered the leading cause of cancer death among females in economically developing countries. Prevalence of breast carcinoma is high in Egypt and the cases of breast cancer constitute 29% of cancer cases treated at the national cancer institute. This study aimed at exploring the level of knowledge of Egyptian females of breast cancer and its risk factors. An interview questionnaire with 22 questions about breast cancer was developed. This questionnaire was previously published as a part of the German multicentre DACH study). A total of 600 female subjects that attended primary health care centres were enrolled in our study. The majority were located in Cairo with the mean age of 40.5 +/- 11.0. Most of our studied sample (94%) has heard about breast cancer as a disease. TV and radio were the main sources of knowledge about the disease (60%). The level of knowledge about breast cancer was limited in 80% of the subjects. Younger age subjects had a higher level of knowledge about breast cancer compared to older subjects with no significant difference statistically. The grade of knowledge about breast cancer was higher among highly educated subjects compared to less educated subjects with significant difference statistically. The highest known risk factors of breast cancer were exposure to X ray (79.5%), hormonal therapy (75.7%) and previous breast cancer disease (70.8%). This study clearly illustrates the need for a health education program directed to Egyptian females to improve the knowledge of breast cancer.

Are patients and healthcare providers satisfied with health sector reform implemented in family health centres?

BACKGROUND: Patients' and healthcare providers' satisfactions are important outcomes for any healthcare programmes. In Egypt, the Health Sector Reform Program (HSRP) has been implemented since 1999 in primary healthcare (PHC) centres adopting the family health approach. OBJECTIVES: To assess the clients' satisfaction towards the overall health services provided by health centres affiliated to HSRP and to evaluate the satisfaction of healthcare providers, physicians, nurses and social workers. METHODOLOGY: Four reformed PHC units were compared with four non-reformed units in the Alexandria governorate regarding patients' and providers' satisfactions. Assessment of the satisfaction was done using survey questionnaire and focus group discussion. The provider survey questionnaire was carried out on all providers working in the selected units. Focus group discussion was done in one reformed health unit and another non-reformed unit. RESULTS: The current study showed that providers in the reformed PHCs were more satisfied than providers in non-reformed PHCs regarding availability of equipments, job satisfaction and income satisfaction. No significant differences were noticed between both groups regarding social relations with either colleagues or directors. The patient satisfaction was higher in accredited family health units compared to non-accredited units in all aspects: cleanness, doctors and nurses, waiting area and waiting time. During the focus group discussion, patients in the accredited PHCs expressed their satisfaction regarding the cleanness, privacy, attitude of doctors and nurses as well the waiting area and waiting time. CONCLUSION: Implemented HSRP in PHC units has had positive implications regarding patients' and providers' satisfactions in most areas studied.

Concerns, perceived impacts and preparedness of health care workers in a referral hospital in Egypt in facing influenza (H1N1) epidemic.

OBJECTIVE: In Egypt, influenza A (H1N1) cases have been detected and deaths have been reported. The aim of this study was to investigate concerns, perceived impacts and preparedness of Physicians and Nurses of Chest Specialty Hospital in Cairo (Egypt) concerning Influenza A (H1N1). METHODS: A questionnaire was applied to a total of 72 Physicians and 41 Nurses from Chest Specialty Hospital in Cairo (Egypt). RESULTS: More than half of physicians (55.6%) were men, while most of nurses (92.7%) were women. The mean age in years of physicians was 36.6 +/- 11.3 compared to 26.5 +/- 8 in nurses. Physicians feel that they are at greater risk by their job to the pandemic 100% compared to 87.6% among nurses and the difference is highly significant. More than one third of the studied physicians reported that they are not ready to face H1N1 pandemic. Residents feel less ready to face the danger of lnfluenza A(H1N1) compared with Consultants and Specialists/Assistant Specialists, with no statistical significant difference. In concordance, Residents reported less Personal Protective Equipment training compared with Consultants and Specialists/Assistant Specialists, with no statistical significant difference. All Consultants received Seasonal Influenza Vaccine compared with Specialists/Assistant Specialists (68.2%) and Residents (44.7%). CONCLUSION: Higher work related and non work related stress was found among physicians compared to nurses, which reflects the demand of more information and training courses for physicians about the pandemic nature and its consequences, complications, and methods infection prevention.

Prevalence and risk factors for hearing disorders in secondary school students in Ismailia, Egypt.

This study estimated the prevalence of hearing disorders and associated risk factors in a 10% sample of all secondary-school students in Ismailia city, Egypt. All participants were given a questionnaire and Weber and Rinne tests for hearing disabilities. Among 2633 students, the prevalence of hearing loss was 22.2%, mostly sensorineural hearing loss. More students at technical schools had mixed sensorineural and conductive hearing loss (46.2%) than students at general (28.6%) or commercial (25.3%) schools. Multivariate logistic regression analysis identified the number of attacks of otitis media, history of ear disease treatment, history of admission to fever hospital and history of ear surgery as independent risk factors for sensorineural hearing loss.

Role of members of university students' unions in tobacco prevention.

INTRODUCTION: In Egypt, each faculty has it own students' union, which represents the students and collaborates in organizing all educational, sporting and social activities. The objectives of the current study were to evaluate the knowledge of members of students' unions about cigarette and Shisha smoking together with assessing their attitudes towards smoking in public places in general and in the university. METHODOLOGY: A random sample of members of Ain Shams University Students' Unions was subjected to an interview questionnaire. All participants were individually interviewed face-to-face by a trained interviewer from March 1, 2005 to April 30, 2005. RESULTS: Our study showed that 34 (31.5%) students were smokers. The mean knowledge score percentage was 79.4 +/- 20.7. Regarding knowledge about Shisha smoking hazards, the majority of the students (84.3%) knew that Shisha smoking is hazardous. The mean attitude score percentage was 56.8 +/- 22.2. Smokers had less mean knowledge as regard smoking hazards compared to non-smokers (p < 0.01). Also, smokers had a lower mean attitude compared to non-smokers (p < 0.001). More than one-third (38.9%) of the interviewed students didn't know if the students' union has a policy for prevention of smoking or not. CONCLUSION: Our findings point that although our students had a moderately high mean knowledge score yet this didn't increase their attitude about the smoking problem in the university and in the community. This supports the notion that, in addition to knowledge about smoking hazards, efforts are needed to change beliefs that allow this offensive habit to continue.

Prevalence and risk factors for hearing disorders in secondary school students in Ismailia, Egypt

This study estimated the prevalence of hearing disorders and associated risk factors in a 10% sample of all secondary-school students in Ismailia city, Egypt. All participants were given a questionnaire and Weber and Rinne tests for hearing disabilities. Among 2633 students, the prevalence of hearing loss was 22.2%, mostly sensorineural hearing loss. More students at technical schools had mixed sensorineural and conductive hearing loss [46.2%] than students at general [28.6%] or commercial [25.3%] schools. Multivariate logistic regression analysis identified the number of attacks of otitis media, history of ear disease treatment, history of admission to fever hospital and history of ear surgery as independent risk factors for sensorineural hearing loss

[Risk factors for Alzheimer's disease]. / Factores de riesgo de la enfermedad de Alzheimer.

AIM: In this review we present and discuss the main risk factors for Alzheimer's disease (AD) reported by epidemiological, genetic and biochemical studies. DEVELOPMENT: The most frequently mentioned factors are: 1. Age. It is the principal marker for the disease risk; 2. Sex. It is estimated that the prevalence of AD is higher in women than in men; 3. Genetics. Although the genetic role has been demonstrated, there is an important genetic heterogeneity; 4. Tobacco. Various studies have found a protective effect, however this effect could be attributed to survival bias; 5. Alcohol. The regular consumption of alcohol was associated with reduced incidence of AD, especially with wine consumption; 6. Family history of dementia. Nearly 40% of persons with AD have family history of dementia; 7. Non steroidal antiinflammatories (NSAIDs). The use of NSAIDS could help in reducing the symptoms of the disease or even avoid them; 8. Craneoencephalic trauma. The role of the craneoencephalic trauma is controversial; 9. Education. The increase of AD in low education persons was published; 10. Diet. The consumption of antioxidants in diet o in supplementary forms appears to be neuroprotector. CONCLUSIONS: The grand variety of published epidemiological studies with different methodology makes it difficult to find homogeneous results. This leaves us controversial impressions about how to prevent the disease.

[Meta-analysis: the science of review in Neurology]. / Metaanálisis: la ciencia de la revisión en Neurología.

INTRODUCTION: The review and continuous analysis of the present knowledge have always been necessary for scientific and clinical practice advance. This study presents the difference between narrative and systematic reviews, the most important points of meta-analysis, and finishes with detailed description of its phases. Our objective was to explain, in simple terms, the technique of meta-analysis and this could permit its application and use in the clinical practice and neurological investigations. DEVELOPMENT: The term meta-analysis was described for the first time by the psychologist Glass in 1967. Since then, the meta-analysis was utilized by many investigators as a technique to combine the results of different studies. The steps of a meta-analysis are: 1. Hypothesis of the study; 2. Localization of the studies of investigation; 3. Selection of the localized studies; 4. Qualitative meta-analysis; 5. Quantitative meta-analysis. Basically, It refers to the numeric combination of data, which were extracted by the reviewers. The mathematical method which will be used to evaluate the effect size should be chosen, also homogeneity and sensibility tests should be done. CONCLUSIONS: Well-designed meta-analysis is accepted as the optimum form to present the results of different studies. The meta-analysis could be of great importance for clinical practice and neurological research.