Validity and diagnostic accuracy of foot posture Index-6 using radiographic findings as the gold standard to determine paediatric flexible flatfoot between ages of 6-18 years: A cross-sectional study.

BACKGROUND: Diagnosis of flexible flatfoot is usually based upon radiographic or clinical measures. Radiographic measures pose a potential risk of radiation exposure especially in Paediatric population. Clinicians need a valid, accurate, easily used, noninvasive and cost effective measure to evaluate static foot posture clinically. Although, foot posture index-6 (FPI-6) are commonly used in clinical practice, its validity and diagnostic accuracy in evaluation of paediatric flexible flatfoot have not been fully proven yet. OBJECTIVES: To investigate validity and diagnostic accuracy of FPI-6 to determine Paediatric flexible flatfoot between ages of 6-18 years using radiographic findings as the gold standard measure. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6-18 years (mean age ± standard deviation of 12.36 ± 3.39 years). The results of FPI-6 were compared to the gold standard radiographic measures and displayed on the receiver operating characteristic curve. Intra-rater reliability, sensitivity, specificity, predictive values and likelihood ratios were calculated. Posttest probability was calculated from Fagan nomogram. RESULTS: FPI-6 demonstrate high intra-rater reliability (ICC = 0.96) with p value < 0.001. FPI-6 showed a sensitivity of 83.7%, a specificity of 80.4, a positive predictive value of 64.7, a negative predictive value of 92, a positive likelihood ratio of 4.62 and a negative likelihood ratio of 0.20. FPI-6 shows moderate diagnostic accuracy [AUC = 0.82; 95%CI (0.78-0.85)]. CONCLUSION: FPI-6 is valid with moderate diagnostic accuracy to determine paediatric flexible flatfoot between ages of 6-18 years.

Validation of normalized truncated navicular height as a clinical assessment measure of static foot posture to determine flatfoot in children and adolescents: A cross sectional study.

BACKGROUND: Reliability of clinical measures of static foot posture has been widely debated. However, validity of these measures has not been fully established especially in a pediatric population. The purpose of the study was to investigate reliability and validity of normalized truncated navicular height (NTNH) in assessment of static foot posture to determine flatfoot in children and adolescents using radiographic measures as a criterion gold standard measure. METHODS: A sample of 612 participants aged 6-18 years (12.3±3.3) were enrolled in the study. Clinical assessment of static foot posture using NTNH was compared to the gold standard radiographic measures. Reliability, validity and diagnostic accuracy were investigated. The optimal cutoff point for flatfoot using NTNH was calculated. RESULTS: NTNH demonstrated sensitivity of 98.4%, high positive predictive (PV +) value of 89.2%. The positive likelihood ratio was 19 and the negative likelihood ratio was 0.02. The area under the receiver operating curve (AUC) was 0.96 indicating high validity and diagnostic accuracy of NTNH. The optimal cutoff point for diagnosing flatfoot was NTNH≤0.195. CONCLUSION: NTNH is a valid and diagnostically accurate clinical measure of static foot posture in children and adolescents.

Health care providers' views on supervisory visits in family health centers and units in alexandria, egypt.

BACKGROUND: Clinical supervision is considered one of the vital support systems for effective high-quality health services. The quality of the relationship between supervisor and provider is the single most important factor for effective supervision. OBJECTIVES: This study was conducted to identify the health care providers' views in family health centers (FHC) and units (FHU) regarding the supervisory visits in terms of supervisor roles. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted in 20% of FHC and FHU of four randomly selected districts (out of seven administrative districts) affiliated to MOH in Alexandria governorate, Egypt. The study population included all family physicians, pharmacists, and dentists, who were present in the study settings at the time of the study (40 physicians, 23 dentists and 19 pharmacists). A self-administered questionnaire was used and included 11 categories of key supervision practices to be assessed. RESULTS: High rating had the highest percentage for giving feedback to supervisees and facility (57.3%), seeking client input (56.1%), discussing data (53.7%), making suggestions (47.6%), promoting participation of supervisees (46.3%), discussing previous visit (43.9%) and roles of developing rapport with supervisees (36.6%). The highest percentage of moderate rating was accounted for the role of problem identification with supervisees (50.0%). Low rating had the highest percentage for the roles of giving education or on-the-job training (40.2%), problem solving with supervisees (43.9%), and discussing the next visit (44.9%). CONCLUSION AND RECOMMENDATIONS: All newly appointed clinic supervisors should have access to a formal induction program which introduces them to particular aspects of management, leadership and communication skills as well as technical aspects of their job. Training sessions for both supervisors and providers on problem solving, problem identification, and team building are also required.

Developing and validating a tool to assess nurse stress.

Nursing is generally perceived as a demanding profession. There is a rising necessity for healthcare administrators to tackle the aspects leading to nurse stress and work burnout as a means towards maintaining a stable and continuous workforce at healthcare institutions.The study aimed at the development of a reliable and valid tool for measuring nursing staff stress and burnout at the University Hospital of King Faisal University, Saudi Arabia. A cross-sectional descriptive study was designed. All registered high nurses working at the hospital were included in the study. The total number accounted for 260 nurses. The study revealed a valid and reliable scale. Such results were indicated through face validity, content validity, and principal component analysis using the varimax rotation for the fifteen statements included in the questionnaire. The PCA explained 56.4% of the variance and concluded 3 main components under which the statements would be categorized. Dimensions were given suitable headings as follows; work aspects, working conditions, and workload. Reliability was assessed and revealed an internal consistency (Cronbach alpha=0.8) and a split-half Spearman-Brown coefficient for unequal length r= 0.79. In conclusion, the study demonstrated a short valid and reliable scale to assess the stressful areas for nurses. The scale is convenient for use by healthcare managers at different medical situations. Further studies are recommended for the use of the tool on representative samples of Saudi nurses.

Intention to stay and nurses' satisfaction dimensions.

OBJECTIVE: The study was conducted to identify the satisfaction dimensions in relation to anticipated nurse turnover in an academic medical institution using an ordinal regression model. METHODOLOGY: A cross-sectional descriptive study was designed to describe nurse job satisfaction in relation to their intention to stay at King Faisal University's Hospital, Al-Khobar, Saudi Arabia. All nurses available at the time of the study were included (499 nurses in different departments). The response rate was 55.3% (276 questionnaires suitable for analysis). A self-administered questionnaire with 26 items was developed for this study with a five-point Likert scale ranging from 1 = highly dissatisfied to 5 = highly satisfied). RESULTS: Nurses were least satisfied with the hospital's benefits (1.2 ± 0.4), hospital policies (1.4 ± 0.5), bonuses (1.1 ± 0.3), fairness of the performance appraisal system (1.5 ± 0.5) paid time off (1.5 ± 0.5), and recognition of achievements (1.5 ± 0.5). The mean general job satisfaction score was 2.2 ± 0.4. Ordinal regression analysis revealed leadership styles and challenging opportunities as predictive dimensions for the intention to stay. CONCLUSION: There are nurse job satisfaction dimensions other than salary and incentive that may be anticipated with the intention to stay in the health facility. Namely, leadership styles in the health organization and challenging opportunities at work.

Accessibility to the health insurance of the medical union in alexandria.

UNLABELLED: Utilization of care is very important because of its link to access, quality of care and because of its importance to outcome. The aim of the study was to clarify the barriers towards accessibility to the Health Insurance of the Medical Union plan and to explain reasons why participants covered by other health insurance systems are using the Health Insurance Medical Union (HIMU). The study was carried out at the health insurance project situated in Alexandria Medical Syndicate. The insured members of HIMU included four specialties namely; physicians, pharmacists, dentists and veterinarians and their families. The sample amounted to 782 members. The highest reasons for participation in the project were freedom of choice of laboratory and/or radiology clinics 73.9%, affiliated providers (physicians and hospitals) offer good quality care to members 62.6%, and simplicity of getting services and/or referral system 59.2%. Whereas the highest reasons for not participating or continuing with the project were high premiums for members: high premium of parents accounted for the highest percentage (13.8%) followed by that of the spouse 9.3%, then high premium for members 5%, and high premium for children 4.9%. The reason that the period of participation was unsuitable for members (October-November-December) accounted for 4.9%. RECOMMENDATIONS: as a result of reviewing the system of determining premiums there were possibilities of a decrease in the annual premium for those beneficiaries who revealed low subsidies, decreasing cost sharing paid by beneficiaries for both outpatient and inpatient services in some essential services e.g. pregnancy and delivery, as well as vigorous control procedures regarding quality of medical care provided, art of care and price of medical services.

Pattern of utilization of the school health insurance programme in alexandria.

Utilization of health Insurance services by children can be influenced by many factors, such as health care need, availability of transportation, and geographic access to care. Utilization rates may be affected by certain barriers which include: physical unavailability geographical, financial, psychological and socio-cultural or organizational barriers. This study was carried out to study the pattern of utilization of services provided by the Students' Health Insurance Programme in Alexandria by preparatory school students. A cross-sectional descriptive study was performed to identify the understudied variables. A sample of 1121 school students was included. They were from general preparatory schools (public and private) who utilized any health service within the last 6 months prior to the start of the study. A relevant questionnaire was designed for data collection through an interview with the student's parent during a visit to the school clinic. It was found that the highest percentage of public school students preferred to obtain medical services at the school physician clinic (51.2%) whereas, the highest percentage of private school students preferred to obtain medical services at a private physician (74.0%). The highest percentage of both public and private school students had knowledge regarding the time of service (47.0% and 36.5%, respectively). As regards public schools the highest mean satisfaction score was for the dimension of school physician examination (2.20+/-0.6), whereas, the highest mean satisfaction score for private school students was for the dimension of referral procedures to the specialist (2.30+/-0.5). It was concluded that accessibility barriers towards the programme could be handled through, distribution of brochures at the beginning of every scholastic year and further simplification of administrative procedures and paper work cycles adopted by the programme.

Quality of diabetes care in primary care setting in egypt: an example of health sector reform in developing countries.

The aim of this study was to evaluate the extent of provider adherence to evidence-based guidelines for diabetes care and the extent of glycemic, blood pressure, and lipid control in patients with diabetes in a developing country. A retrospective cohort study was carried out to evaluate diabetes care provided under Health Sector Reform Program (HSRP) in a major medical center in Alexandria, Egypt. Data on care provided for 137 patients were abstracted from medical records. Several process measures were studied including annual proportion of patients with measurements of blood glucose, blood pressure, and lipid levels. Patient outcomes on these measures were also examined. Logistic and poisson regressions were used to study factors related to having measurements done and number of measurements respectively. Multilevel analysis was then used to examine rate of change in patient outcomes and factors associated with this rate over one year of follow-up. For 137 patients with diabetes, annual testing was adequate for fasting blood glucose (FBG) (94.1%), blood pressure (100%), foot (92.7%), and fundus examination (86.6%) was adequate. On the other hand less attention was given to total cholesterol (60.6%), triglycerides (52.6%) and albuminuria (10.3%). At the end of 1 year follow-up, 89.2% did not meet the target level of fasting blood glucose of < 130 mg/dl. A total of 40.2% and 46.7% did not meet the goal of 130 mmHg for systolic and 80 mmHg for diastolic blood pressure. Fifty nine percent, and 76.4% did not meet the goal of total cholesterol level of <200 mg/dl, or triglycerides level of <150 mg /dl respectively. There was evidence of suboptimal treatment with insulin, antihypertensive drugs, and lipid- lowering drugs. This study demonstrates that diabetes care provided under HSRP is unsatisfactory. As a result more effort to increase compliance with evidence based guidelines in diabetes care is needed.

Patient preference for providers' gender at a primary health care setting in Alexandria, Egypt.

OBJECTIVE: The aim of this study is to determine patient's gender preferences in choosing general practitioners and specialists for both general and specific health issues at primary health care centers in Alexandria, Egypt. METHODS: A descriptive cross-sectional study was conducted at Smouha Health Center, Alexandria Governorate, Alexandria, Egypt. The study was conducted between the period January -- March 2004. A pre-designed questionnaire was used. The format included 3 main sections, namely, socio-demographic, beliefs towards provider's gender, and providers' preferences of patients. RESULTS: Both male and female patients preferred a male physician for consultation and clinical management of cases. The highest percentage of male patients (81.4%) and female patients (41.0%) preferred physician of the same gender, and such preference was of personal reasons for males (97.9%) and females (96.6%), while basing on traditions and norms for male (62.9%) and female (63.4%). Significant results of the stepwise logistic regression analysis in relation to socio-demographic factors on provider preference revealed that job and income were the significant determinants of gender preference for the sample under study. CONCLUSION: Patients prefer physicians of the same gender, but in actual practice a male physician is believed to be more competent.

Women health in poor urban settings in Alexandria.

The aim of this paper is to investigate women health and status as well as to study gender gap in three poor urban settings in Alexandria. Poor families were identified and invited to participate in the study through the help of local informants. The study included 172 families, 53 from Abu-Kir, 57 from El-Dahreya and 62 from Wadi El-Kamar area. An interviewing questionnaire was used to collect data form the wives as well as their husbands about household family members. Wives and husbands who participated in the study were clinically examined. Their weight and height were measured. For those who accepted to participate, stool, urine and blood analyses were performed. Female to male comparison as well as sex ratio of some parameters were used to investigate gender gap. Results showed that females were the head of the family in 19.8% of the families. In 18% of the families, wives participated in the family income. Illiteracy represented 94.2% among females aged 45+ years, and unemployment was 97.4%. The rate of ill health increased with age from 36% for girls to 90% among older women (45+) compared to 71% among older males. Cardiovascular and orthopedic disorders represented the most reported problems among older females and males. Diarrhea and ARI episodes were rather more frequent among females than among males. About 60% of examined women suffered from obesity, 45% had gynecological problems, 38% had parasitic infections in stool, and 45% had anemia. Female to male sex ratio was low for <6 and 60+ years old. In conclusion, poor women suffer from high burden of socio-economic disadvantage, gender inequality and ill-health.