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.

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.

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.

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.

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.

[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.

[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.

Breast cancer risk factors: PCB congeners.

The chronic effects of polychlorinated biphenyls (PCBs) are a public health concern, and a potential relationship with breast cancer has been postulated. The purpose of this study was to examine the possible relationship between PCBs and breast cancer. All women (134) treated by excision biopsy because of breast lump at Reina Sofia University Hospital, Cordoba, Spain over a period of 10 months were included in our study. They were all administered a questionnaire by interview, calculation of body mass index, histopathological examination of excised mass and chemical estimation of PCB congener levels in breast fat. The collected samples were from 65 (48.5%) women with benign lesions and 69 (51.5%) with malignant lesions. The variables associated with malignant lesions on univariate analysis were age, lactation period, overweight, PCB n-28 and PCB n-52. On the multivariate analysis PCB n-28 was found to be the most important risk factor (OR 9.6, 95% CI 3.8-24.4). Other risk factors were identified as age, drinking alcohol, low parity and overweight. If these findings can be confirmed in a large study population, however, they may have important implications for breast cancer risk.

PAH-DNA adducts in a petrol refinery in Egypt.

Epidemiological surveys in occupationally exposed populations postulate that long-term exposure to polycyclic aromatic hydrocarbons (PAHs) is carcinogenic. We studied the ability of PAHs to induce the formation of adducts in the DNA of white blood cells of petrol refinery workers exposed at the workplace. Our study included a random sample of 56 workers exposed to PAHs and 37 non-exposed workers. In the univariate analysis, the DNA adduct level of PAH-exposed workers (42.22 +/- 45.11) was significantly increased (P < 0.05) compared with that in the non-exposed group (20.90 +/- 22.56). However, we could not identify either current smoking or absence of glutathione S-transferase class Mu as possible risk factors for DNA adducts. Linear regression analysis identified degree of exposure to PAHs as the only DNA adducts risk factor. Further research with a larger sample size is under investigation to identify the DNA adduct levels and relationship between the different types of PAHs.

Selenium supplementation for asthma.

BACKGROUND: Selenium deficiency may be important in chronic asthma. Observational studies have demonstrated that patients with chronic asthma may have lower levels of selenium than their control. Nevertheless, selenium supplementation has not been recommended with drug therapy for asthma. This review systematically examines RCTs that evaluated the role of selenium supplementation in chronic asthma. OBJECTIVES: Recognition that chronic asthma can be associated with selenium deficiency has led to the investigation of the role of selenium supplementation in reducing the symptoms and impact of chronic asthma. The objective of this review was to assess the efficacy of selenium supplementation as an adjunct to medication for the treatment of chronic asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register, MEDLINE/PUB MED, and EMBASE. Searches were current as of August 2003. SELECTION CRITERIA: Randomised trials comparing patients with chronic asthma receiving selenium supplementation in conjunction with asthma medication, with patients taking asthma medication only. DATA COLLECTION AND ANALYSIS: Two reviewers applied the study inclusion criteria MAIN RESULTS: One trial with a total of 24 patients suffering from chronic asthma was included. The study reported significant clinical improvement in the selenium-supplemented group, as compared with the placebo group, in terms of a 'clinical evaluation'. However, this improvement could not be validated by significant changes in separate objective parameters of lung function and airway hyper-responsiveness. REVIEWERS' CONCLUSIONS: There is some indication that selenium supplementation may be a useful adjunct to medication for patients with chronic asthma. This conclusion is limited because of insufficient studies and lack of improvement in the clinical parameters of lung function.

[Parkinson's disease, tobacco and age: meta analysis]. / Enfermedad de Parkinson, tabaco y edad: metanálisis.

INTRODUCTION: Epidemiological studies have demonstrated contradictory results about the association between smoking and the risk of Parkinson s disease (PD). OBJECTIVE: Examine the hypothesis of the EUROPARKINSON group that smoking protects against PD only in patients below 75 years of age. MATERIAL AND METHODS: We conducted a meta analysis including all observational studies that were published about this association before January 2001. All languages were included with no restriction for year of publication. Risk estimate and its 95% confidence interval (95% CI) were extracted or calculated for all localized studies in patients below or above 75 years of age. RESULTS: Seventeen studies investigated the association between PD risk and smoking in patients below 75 years of age. Meanwhile, only seven studies investigated the association in patients above 75 years of age. The fixed effect pooled analysis in patients below 75 years of age was 0.59 (95% CI: 0.52 0.67), with insignificant homogeneity test. Patients above 75 years of age had fixed effect pooled analysis of 0.76 (95% CI: 0.59 0.99), with insignificant homogeneity test. CONCLUSIONS: The pooled analysis in patients below 75 years of age clearly demonstrates that smoking is inversely associated with PD risk. The 95% CI of the pooled analysis in patients above 75 years of age is nearly overlapping unity. This result is not in favor for the negative association in old patients, and confirms the hypothesis of the EUROPARKINSON group.

[Young onset Parkinson's disease and smoking: meta-analysis]. / Enfermedad de Parkinson temprana y tabaco: metanálisis.

INTRODUCTION: Previous systemic reviews have reported a protective effect of smoking against Parkinson's disease (PD). However, the protective effect has not been examined before by any systemic review in patients with young onset PD. OBJECTIVE: Examine the association between young onset PD and tobacco smoking. MATERIAL AND METHODS: We conducted a meta-analysis including all published observational studies that investigated this association before January 2003. All languages were included with no restriction for year of publication. Risk estimate and its 95% confidence interval (95% CI) were extracted or calculated for all localized studies in patients with young onset PD. RESULTS: Five case-control studies investigated the association between young onset PD risk and ever smoking. The fixed-effect pooled analysis was 0.55 (95% CI: 0.38 0.81), with insignificant homogeneity test. CONCLUSIONS: This meta-analysis shows a protective effect of tobacco smoking against young onset PD. Our results coincide with the other reviews which did not consider the age of diagnosis of PD. However, it is highly recommended prospective studies for the association between young onset PD risk and ever smoking

[Parkinson s disease risk factors]. / Factores de riesgo en la enfermedad de Parkinson.

AIMS: In this review we present and discuss the main risk factors (RF) for Parkinson s disease (PD) reported by epidemiological and biochemical research. METHODS: The most frequently mentioned RF are: 1. Age: PD is not a pathological condition that is restricted to the elderly, although most people who suffer from it are over 60 years of age; 2. Sex: in most epidemiological studies there are no differences to be found in prevalence of PD according to sex; 3. Genetic: no gene has been identified as being responsible for idiopathic PD. Nevertheless, family antecedents of PD have been identified as RF; 4. Craneoencephalic trauma: this factor can have a systematic bias, since patients seek an explanation for their illness and remember any head injury as its possible cause; 5. Neurotoxins: a great deal of research was focused on the relation between PD and direct or indirect exposition to compounds such as MPTP, used in pesticides; 6. Antioxidants: it is thought that if ingested in sufficiently high quantities, either as part of the diet or in the form of supplements, they might reduce the risk of PD or slow down its progress; 7. Smoking: several studies have shown a negative relation, while other studies found no significant relation. CONCLUSIONS: There are several RF for PD, although no single decisive triggering factor has been found to date. Future research must consider the hypothesis of a multifactor aetiology and take into account the interaction between genetic and environmental factors.

[Parkinson's disease and smoking: coherence and plausibility]. / La enfermedad de Parkinson y el tabaco: coherencia y plausibilidad.

INTRODUCTION: Many studies have shown that smoking is lower in patients with Parkinson s disease. However, in other investigations this was not observed. The various studies involved showed wide variation with regard to methodology, criteria for diagnosis and periods of observation and hence it is difficult to compare them. DEVELOPMENT: The first studies published were designed to examine the effects of smoking in general and information was obtained regarding the possible disorders related to tobacco smoking according to the records of mortality, which may contain errors due to selective mortality and mistaken diagnosis. Most of the studies of cases and controls included prevalent cases which accepted the study, mainly hospital cases. Also it is probable that the prevalent cases of Parkinson s disease do not smoke because of their disorders of movement. CONCLUSIONS: Many researchers have found important information about the pathophysiology of Parkinson s disease and its association with smoking. However, the hypothesis regarding the association between smoking and low risk of Parkinson s disease are various and independent, apart from the hypothesis of a truly biological mechanisms. Since the subject is still controversial, systematic reviews together with epidemiological and experimental studies are necessary.

Evaluation of the effectiveness of routine measles vaccination: case-control study.

A retrospective case-control study was conducted in two primary schools located in eastern region of Cairo to evaluate the protective value of routine measles vaccination. A total of 230 children who had a previous measles illness were identified over 3 months period. Each case was matched to two controls based on age and sex. Vaccination status of the study children was ascertained through reviewing vaccination certificates The overall measles vaccine effectiveness was estimated at 53% (95% CI 71%-26%) There was an association between age of measles vaccination and vaccine effectiveness (VE) Primary vaccination failure due to young age of measles vaccination is the likely explanation of the low measles vaccine effectiveness. Adoption of two-dose measles vaccination policy with the second dose being given at older age needs to be considered to correct the problem of vaccine failure.