Quality assessment of primary health care services provided for diabetes mellitus control in Alexandria.

Diabetes is a growing health problem worldwide. It is recognized as a particular threat to public health of the third world communities, particularly those living in rapidly developing countries. Therefore, the present study was conducted aiming at: assessment of the quality of primary health care (PHC) services provided for the control of diabetes mellitus (DM) in Alexandria; and opportunistic screening of high risk individuals attending PHC facilities for DM. Accordingly, the availability of human and nonhuman resources for DM control in two rural and two urban PHC centers in Alexandria (one of them was serving a desert area) was assessed by a pre-designed checklist 920 adult PHC attendants were screened for risk factors of DM. Individuals having more than one of the following risk factors: age above 50 years, overweight (body mass index > or =27 kg/m2), family history of DM in first degree relatives, history of hypertension, hypertension (systolic blood pressure > or =140 mm Hg and /or diastolic blood pressure > or =90 mm Hg), history of hyperlipidemia and history of gestational diabetes or birth of a large sized baby in females- were subjected to random capillary blood glucose (RCBG) testing. Cases were considered likely diabetic if RCBG was >200 mg/dl The performance of all PHC physicians examining and managing 560 diabetic patients was observed over a period of two months. One fourth of the diabetic cases were checked for the level of glycaemic control by fasting capillary blood glucose testing. The results revealed that 61.7% of the studied PHC attendants were at risk of developing DM and 14% were likely diabetic, with an urban: desert ratio of 2:1 The following factors were found to be independently associated with an increasing risk of DM occurrence among males: overweight (about 14 folds), family history of DM (9 folds), age above 50 years and history of hypertension (4 folds each). Whereas, among females the following risk factors were found: family history of DM (8 folds), history of gestational diabetes (6 folds) and overweight (4 folds). The majority of diabetic patients were poorly examined, investigated and managed; and an optimal level of glycaemic control was achieved in only 12.9% of the cases, as the PHC physicians didn't follow a model treatment plan for DM and due to unavailability of some equipment, laboratory facilities and essential drugs.

The role of primary health care in patient education for diabetes control.

The major components of diabetes management are dietary therapy, exercise and drug treatment. Therefore, education of people with diabetes is the cornerstone of management. The aim of the present work was to study the role of primary health care (PHC) in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all 88 PHC physicians and 104 nurses working in the two rural health centers and two randomly chosen urban health centers of Alexandria governorate were assessed by pre-designed self-administered questionnaire. All diabetic patients over 20 years of age attending the study health facilities over a period of two months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. They amounted to 560 diabetic patients. The results revealed that the PHC physicians had sufficient knowledge about causes and complications of the disease, but insufficient knowledge about diagnosis and management, as only 10.2% & 4.5% of the physicians recognized the importance of regular exercise and patient education for diabetes management. Some misconceptions and false beliefs were observed among PHC nurses, as many of them considered diabetes a contagious disease or primarily caused by stress; that liver failure, hearing impairment and splenomegaly are among the complications of diabetes and that young age and immunodeficiency disorders are among the risk factors for developing diabetes. Moreover, most of them believed that the amount of carbohydrates given to diabetic patients should be reduced or even completely restricted; that vitamins are essential for all diabetic patients and that hot-water bottles are good for providing warmth to the diabetic feet. They also disagreed on the use of artificial sweeteners as sugar substitutes. Most of the diabetic patients had poor knowledge about diabetes and its management (85.7%) and a negative attitude towards self-management (61.6%) and only 23.6% of them were satisfied with the services provided by the PHC facilities for diabetes control. They were mainly dissatisfied with the role of PHC physicians in patient education. Some misconceptions and false beliefs were also recognized among diabetic patients. Many of them considered diabetes a contagious disease or primarily caused by stress. They didn't know the importance of regular exercise in diabetes control. They also believed in the efficacy of herbal therapy in diabetes control; that vitamins are essential for all people with diabetes; that water intake should be decreased when passing large amounts of urine, that anti-diabetic drugs should be stopped during associated illnesses and that patients on insulin treatment can't be shifted to oral drugs. Moreover, they believed that the amount of carbohydrates in diet should be reduced or even restricted and that the amount of proteins should not be reduced. They also refused the use of artificial sweeteners as sugar substitutes. Thus, it may be concluded that there is a serious gap in the provision of basic educational services to the majority of diabetic patients attending PHC facilities in Alexandria.

Quality assessment of the primary health care services provided for ARI control in Alexandria.

The aim of the present study was to assess the quality of services provided for acute respiratory infections (ARI) control in Alexandria after about five years of its integration into primary health care (PHC). The ARI training coverage of actively practicing physicians was only 35% and of nurses 37.5%, due to inappropriate allocation of trained human resources. The knowledge of trained PHC physicians was slightly better than that of untrained staff and both were unsatisfactory. The main deficiency was in detecting the dangerous signs and in classifying "cough or difficult breathing", which resulted in missing all cases of "severe pneumonia" and "very severe disease" needing referral to higher levels, in order to reduce the ARI specific mortality rates. The rate of oral antibiotic abuse reached about 55%, which was much higher than that found in the ARI annual report 1997 and is more likely to be the true figure. On the other hand, long acting penicillin was underutilized, due to fear of its allergic reaction and oral antibiotics were used instead of it. Therefore, the later were unavailable at the PHC facilities for about 7 months, mainly during winter and spring time.

Bonding of laminate veneer materials to enamel.

The purpose of this study is to examine the effect of enamel surface pretreatment on the shear bond strength of tooth colored restorative materials bonded to human enamel with different luting systems. Forty-two extracted human molars were used in this study. Buttons, 6 x 3 mm., of two types of composite resin (Silux# & Visio-Gem@) and 5 x 3 mm. buttons of dental porcelain, were prepared. The prepared buttons were attached to the buccal, lingual and proximal surfaces of extracted molars. The enamel surfaces were cut in some groups while left uncut in other groups. One, or a combination of two, of the following luting materials was used with the composite resin groups: Chemically-cured Scotchbond#; Light-cured Scotchbond#; Visio-Gem; Visio-Gem Glaze@ and Conclude@. For the porcelain groups, Scotchprime#, Conclude, Silux, and Visio-Gem were used as luting materials. Samples were tested on an Instron testing machine. Single factor analysis of variance of the data obtained that: a) In the Silux groups there is no significant difference in shear bond strength between cut and uncut enamel with different luting systems; b) Among the Visio-Gem groups the highest shear bond strength is obtained with the cut enamel surface when a combination of Visio-Gem and Visio-Gem Glaze was used as luting material; c) The porcelain groups show the highest shear bond strength with the enamel surfaces trimmed flat and the use of a combination of Scotchprime and Conclude as luting material.