High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Effect of Fortification of Biscuits with Flaxseed on Omega 3 and Calcium Content of the Products58661990110.21608/jhiph.2018.19901ENHeba ElshehyDepartment of Nutrition, Faculty of Allied Medical Sciences, Pharos University, Alexandria, EgyptNeveen AgamyDepartment of Nutrition (Food Analysis Specialty), High Institute of Public Health, Alexandria University, Alexandria, EgyptHanaa IsmailDepartment of Nutrition (Food Analysis Specialty), High Institute of Public Health, Alexandria University, Alexandria, EgyptJournal Article20181127<strong>Background:</strong> Consumer’s interest in healthy eating shifted towards the potential health benefits of specific foods and food ingredients. Flaxseed has a unique fatty acid profile. It is high in omega-3 fatty acid and calcium.<br /> <strong>Objective(s):</strong> The purpose of this study was to highlight the nutritional quality of flaxseed and effect of fortification of biscuits on omega 3 and calcium content of products.<br /> <strong>Methods</strong>: Different flaxseed concentrations (0%, 10%, 20% and 30%) were used in the preparation of fortified biscuits. Proximate analysis of flaxseed and produced biscuits was performed to determine moisture, fat, total ash, crude protein, crude fiber and carbohydrate content. Sensory evaluation of produced biscuits was done to assess color, taste, odor, texture, over-all acceptability and residual after taste. Omega-3 and calcium content of flaxseed and produced biscuits was determined.<br /> <strong>Results</strong>: In our study, the changes in chemical composition of biscuits fortified with flaxseed showed that the addition of flaxseed to wheat flour significantly increased protein, fat and ash content, meanwhile, decreased the content of carbohydrates. Biscuit samples made from substitution of wheat flour with flaxseed up to 20% were acceptable and gave nearly similar scores to the control. Our results indicated that flaxseed was rich in polyunsaturated fatty acids (60.43 %) with omega-3 representing 47.22%. Biscuits fortified with flaxseed revealed that omega-3 content of flaxseed fortified biscuits was significantly higher than the control biscuits. In our study, the calcium content of the grinded flaxseed was 188.9 mg/100g. Control biscuits which were formulated from wheat flour contained 25.6 mg/100g calcium. Whereas, biscuits fortified with 10 %, 20% and 30% flaxseed exhibited significantly higher contents of calcium (168.3, 175.0 and 179.1 respectively).<br /> <strong>Conclusion</strong>: The use of flaxseed in dietary products can be recommended as functional food. Substitution of wheat flour in biscuits with 20% flaxseed was acceptable by panelists. Enrichment of diets with flaxseed for better utilization of ω-3 fatty acids and calcium for better bone health is recommended.https://jhiphalexu.journals.ekb.eg/article_19901_08e58c58d1b03591a2088877cdae1a3f.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Traffic Air Quality Health Index in a Selected Street, Alexandria67761990310.21608/jhiph.2018.19903ENEman AbdellatefDepartment of Occupational Health and Air Pollution, High Institute of Public Health, Alexandria University, Alexandria, EgyptGehan ZakiDepartment of Occupational Health and Air Pollution, High Institute of Public Health, Alexandria University, Alexandria, EgyptAhmed IssaDepartment of Occupational Health and Air Pollution, High Institute of Public Health, Alexandria University, Alexandria, EgyptJournal Article20181127<strong>Background:</strong> Air Quality Health Index (AQHI) is a scale, which was designed in Canada to help people to understand how the air quality affects their health. It measures the relationship between the air quality and health on a scale from 1 to 10+. <br /> <strong>Aim</strong>: The aim of this study was to assess traffic AQHI on one street in Alexandria, Egypt at different seasonal conditions.<br /> <strong>Methods: </strong>This was a time-series study that was conducted during the period from January 1 to December 31, 2016 at Ibrahim Sherif Street. It was accomplished by three-hour air sampling of respirable particulates (PM10), nitrogen dioxide (NO<sub>2</sub>), sulfur dioxide (SO<sub>2</sub>) and ground-level ozone (O<sub>3</sub>), during the morning rush hours. A total of 156 samples for each pollutant covered all seasonal variations and activities. After laboratory analysis, the added health risks (%AR) and AQHI were calculated using the Hong Kong equation.<br /> <strong>Results</strong>: The uppermost median value of %AR was during April [72.9 (23.4)] and the minimum was during January [32.2 (10.0)]. The traffic AQHIs in the study setting were of the serious category 10+ in almost all sampling days. The maximum %AR was during spring [70.0 (19.7)], and the minimum was during winter [40.6 (19.0)].<br /> <strong>Conclusion:</strong> From the results of the present study, we can conclude that; the highest %AR was during April, and the minimum was during January. The traffic AQHIs in the study setting were of the serious category 10+ in almost all sampling days. The most dominating pollutant affecting the %AR and AQHI was the PM10.https://jhiphalexu.journals.ekb.eg/article_19903_761f91188f79d8dc16722183c0c0892f.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Evaluation of Leading Safety Performance of Primary School Buildings in Alexandria, Egypt: Cross-Sectional Study77841991310.21608/jhiph.2018.19913ENGehan ZakiDepartment of Occupational Health and Air Pollution, High Institute of Public Health, Alexandria University, EgyptKholoud TayelDepartment of Family Health, High Institute of Public Health, Alexandria University, EgyptMayada RedaDepartment of Environmental Health, High Institute of Public Health, Alexandria University, Egypt Hamdan Bin Mohammed Smart University, Dubai, UAEAleya MahmoudDepartment of Environmental Health, High Institute of Public Health, Alexandria University, EgyptEngy LabibFellow of Department of Environmental Health, High Institute of Public Health, Alexandria University, EgyptJournal Article20181127<strong>Background:</strong> Unsafe school buildings may adversely affect students, teachers, administrative workers, cleaning workers, and visitors.<br /> <strong>Objective(s):</strong> The aim of the present study was to evaluate the leading safety performance of public, private, and experimental primary school buildings in Alexandria, Egypt.<br /> <strong>Methods:</strong> A cross-sectional study was conducted in 30 primary schools in Alexandria selected by stratified cluster sampling. Two observational checklists were designed, validated, and used; including school building safety inspection checklist (SBSIC), and classroom safety inspection checklist (CSIC). The completed checklists were reviewed and coded. The safety performances (SP) for each category and for the overall checklists were then calculated.<br /> <strong>Results: </strong>The SP in private primary schools and classrooms [(66.1±13.0%), (68.7±12.5)] were higher than that of experimental [(59.9±14.0%), (65.1±14.2%)] and public ones [(39.3±7.8%), (46.0±11.8%) respectively]. The most common causes of reduced school SP were "the absence of protective measures against vectors & insects," "the non-daily refuse disposal," "the non-inspected play areas." Other causes included "the irregular fire drills," "the absence of the alarm system," "the non-earthed electrical equipment," "the absence of emergency plan," and "the unmarked tripping/slipping locations." The most frequent unsafe classroom conditions were "the absence of classroom alarm point," "the on-board glare," and "the non-compliant windows to class area ratios."<br /> <strong>Conclusion:</strong> Many safety violations were found to occur in Alexandria primary schools. This would cause a reduction of the safety performance and consequently a lack of safety management. Safety performance in private schools was better than that in experimental and public ones.https://jhiphalexu.journals.ekb.eg/article_19913_8e65a695adb6e8ffcd23e74a55fd75ad.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Attitude of Surgeons Working in General Governmental Hospitals Towards Informed Consent, Kuwait85911991410.21608/jhiph.2018.19914ENSaadoun AlazmiDepartment of Medical Records, College of Health Sciences, Public Authority for Applied Education and Training, KuwaitJournal Article20181128<strong>Background:</strong> Informed consent in medical practice means an acceptance of a medical or surgical intervention by the patient during hospital care. It helps patients to discuss with treating doctors about their conditions. Informed consent is considered crucial. It is a mutual understanding and agreement between care providers and patients. During informed consent process the patient is required to be informed about everything of the proposed intervention and this depends on the knowledge of the care provider in collecting and providing information to patient.
<strong>Objective(s): </strong> To assess the attitude of surgeons working in General Governmental hospitals towards informed consent in Kuwait.
<strong>Methods:</strong> A cross-sectional study was conducted from January to June 2016 in secondary health care hospitals. A self-administered questionnaire about informed consent for surgery was completed by 353 randomly selected surgeons working at various surgical specialties in five governmental general hospitals in Kuwait. The questionnaire was developed to examine the surgeons' attitudes towards informed consent. They were asked to respond to each question by Yes (agreeing) or No (disagreeing) or Unsure. The responses of the surgeons to each statement were calculated using Statistical package SPSS version 21.
<strong>Results: </strong>Public surgeons considered informed consent routinely achieved in their current practice (87.8%). They thought that all doctors should receive formal training on informed consent (79.3 %), while only 35.7% of them actually received training on informed consent. On the other hand, most public surgeons thought that written information leaflets should be provided for patients during informed consent (82.2%). However, only 41.1% of them provided their patients with leaflets during informed consent. Furthermore, 83% of public surgeons thought that the main purpose of informed consent is to provide the surgeon with greater protection against litigation. Similarly, 89.5% public surgeons thought that the main purpose of informed consent is to respect the patient’s right of autonomy. The majority of surgeons thought that the main purpose of informed consent is to improve the doctor patient relationship (83.0 %), and 81.0% of public surgeons thought that the main purpose of informed consent is to improve the patient’s compliance with medical care. Lower percentages thought that informed consent may be unnecessary because most patients depend on their doctor to make the decision for them (24.4%). Finally, 85.6% of public surgeons thought that the doctor who is going to perform the operation, should do the informed consent. More than half of the surgeons thought that the patients age, level of education, the patient’s clinical presentation whether emergency or elective, the complexity and duration of surgery, social class and the need for referral to another doctor or hospital, affects the amount of information given during informed consent.
<strong>Conclusion: </strong>Surgeons in general public hospitals should be more aware of the informed consent guidelines and they should adhere to them. In addition, introduction of formal training on informed consent in all hospitals is recommended and making written information more widely available is important.https://jhiphalexu.journals.ekb.eg/article_19914_a30feac727671bf2cf479bf0230bb7ad.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Patients’ Perception of Informed Consent for Surgical Operations in Kuwait92961991510.21608/jhiph.2018.19915ENSaadoun AlazmiDepartment of Medical Records, College of Health Sciences, Public Authority for Applied Education and Training, KuwaitJournal Article20181128<strong>Background </strong>Informed consent is part of every surgeon’s daily practice. Surgical patients often need accurate information about their operation. The most important goal of informed consent is to inform patients about risks, benefits and expectations of the operation and help the patients make the final decision about their healthcare.<br /> <strong>Objective:</strong> To assess the patients’ perception of informed consent for surgical operations and to determine their expectations about the information given in Kuwait. <br /> <strong>Methods:</strong> A cross-sectional study was conducted from January to June 2016 in all six governmental general hospitals and two private hospitals in the state of Kuwait. 805 adult patients hospitalized in surgical departments participated in the study by completion of self-administered questionnaires about their perception of informed consent.<br /> <strong>Results:</strong> The mean age of participants was 35.6 years, males constituted 48.3% of the sample, 49.2% were Kuwaiti residents, 79.2% were secondary or higher educated and 73.4% were married. 69.9% of patients believed that it was a legal requirement. While, 37.0% thought that signing the consent meant waving their rights to any compensation, 72.3% thought that the consent form protects the patient's rights. 72.9% believed that signing the consent form confirms that the operation and its effects have been explained to them. 76.4% signed the consent form so that they can undergo the required operative procedure. 82.0% believed that consent forms are necessary, while 59.5% believed that consent forms protect the doctor against being sued. Many of the patients (78.5%) thought that, a relative could sign on their behalf, if they can’t sign the consent form, 57.6% of the patients were happy to allow doctors to determine their treatment but they wanted to know about their condition, the treatment and the important side effects. 26.5% wanted to make final decision themselves after discussion of pros and cons of the treatment. Only 15.9% trusted their doctor to take the right decision and did not think that detailed explanation was necessary.<br /> <strong>Conclusion</strong>: The findings of this study show that informed consent was perceived differently by patients, which seems that consent procedures appear inadequate and hence consenting in its current form is not informed and should be re-evaluated to achieve patient autonomy.https://jhiphalexu.journals.ekb.eg/article_19915_dfa0ec879356704efb58be7d2d97d3ca.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Awareness of Married Adults about Congenital Anomalies in a Rural Village, Assiut971061991610.21608/jhiph.2018.19916ENHala Abou FaddanPublic Health and Community Medicine Department, Assiut University, EgyptTaghreed IsmailPublic Health and Community Medicine Department, Assiut University, EgyptJournal Article20181128<strong>Background:</strong> Congenital anomalies (CA) are significant causes of infant morbidity, mortality and disability.<br /> <strong>Objective(s): </strong>To assess the knowledge and attitude regarding congenital anomalies and their associated factors among married adults.<br /> <strong>Methods</strong>: A community based cross sectional study was conducted on <strong>633</strong> currently married inhabitants in a rural village, Assiut. An interview was used for data collection via a semi-structured questionnaire.<br /> <strong>Results</strong>: Most participants (96.7%) had ever heard about CA, 20.1% of participants had good knowledge, whereas 73.0% of them hadpositive attitude. Factors significantly affecting knowledge were family history of CA, educational level, and gender. The same factors were also significantly affecting the attitude towards CA in addition to age.<br /> <strong>Conclusion:</strong> Only one fifth of participants had good knowledge about CA. Family history of CA, educational level, and gender are significant factors affecting both knowledge and attitude.<br /> <strong>Recommendation:</strong> To increase the awareness about CA among the public in general and increase the role of health care providers in raising awareness and counseling about CA.https://jhiphalexu.journals.ekb.eg/article_19916_d8bdec7607f7190b3a8af1ea9fa613ad.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Assessment of Drug Use in Family Health Facilities in Alexandria1071131991710.21608/jhiph.2018.19917ENBothaina DeghediTropical Health Department (Primary Health Care Speciality), High Institute of Public Health,
Alexandria University, EgyptOla AklTropical Health Department (Primary Health Care Speciality), High Institute of Public Health,
Alexandria University, EgyptNoha MoustafaTropical Health Department (Primary Health Care Speciality), High Institute of Public Health,
Alexandria University, EgyptNourhan MostafaTropical Health Department (Primary Health Care Speciality), High Institute of Public Health,
Alexandria University, EgyptJournal Article20181128<strong>Background: </strong>Rational use of drugs is an essential element in achieving quality of health and medical care for the patients and the community. However irrational use of medicines is still a worldwide problem.
<strong>Objective(s): </strong>Assessment of drug use in family health facilities in Alexandria, through application of drug use indicators including; prescribing indicators, patient care indicators and health facility indicators.
<strong>Methods: </strong>A cross-sectional descriptive study was conducted in eight randomly selected family health facilities (FHFs) distributed in four randomly selected health care districts in Alexandria Governorate. An observational checklist and interview questionnaire designed based on World Health Organization/ International Network of Rational Use of Drugs (WHO/INRUD) drug use indicators and WHO guide to good prescribing were used for data collection. 600 patients were interviewed, and 240 consultation sessions and drug dispensing processes were observed.
<strong>Results: </strong>The most deficient drug use indicators were the patient care indicators, as none of the drugs were adequately labelled, the average consultation time was 5.7 ± 2.9 minutes (compared to the optimal value ≥ 20 minutes) and the mean % of adequate patients’ knowledge was 56 ± 49.7. As regards health facility indicators, availability of key drugs in stock was unsatisfactory, as the mean % was 66.3 ± 47.6. On the other hand, prescribing indicators were considered satisfactory.
<strong>Conclusion: </strong>We may conclude that patient care indicators were the most deficient among drug use indicators, especially labelling of drugs, consultation time and patients’ knowledge, in addition to availability of key drugs in stock. We may recommend that rational drug prescribing should be included in the national practice guidelines of family practice.https://jhiphalexu.journals.ekb.eg/article_19917_0534cd268982818210ad4b25f8627430.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060148220181001Mammography Screening Utilization Behavior among Egyptian Female Employees in Alexandria1141241991810.21608/jhiph.2018.19918ENSeham DiabAlexandria Regional Center for Women’s and Health Development, Ministry of Health and Population, EgyptIman WahdanDepartment of Epidemiology, High Institute of Public Health, Alexandria University, EgyptEnsaf Abdel GawwadDepartment of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, EgyptSunny SallamDepartment of Epidemiology, High Institute of Public Health, Alexandria University, EgyptJournal Article20181128<strong>Background: </strong>Breast cancer (BC) has become a health priority due to its increasing incidence. It is curable when detected at an early stage, so there is an urgent need for its early detection. Mammography screening (MS) is the main recommended test for early detection of BC.
<strong>Objectives: </strong>The aim of the study was to assess MS utilization behavior among female employees and to identify some factors based on the Health Belief Model that determines the likelihood of MS utilization behavior in terms of: health beliefs, knowledge about BC and its risk factors, and access and need for MS.
<strong>Methods: </strong>The study was conducted among 400 female employees aged 40 years and older in four workplace sectors in Alexandria using a cross sectional approach. A predesigned interview questionnaire was used to collect socio-demographic data, habits, reproductive history, family history, culture affiliation, access to MS, reproductive health screening behavior, MS utilization behavior, need for MS, knowledge about BC and MS, perceptions towards BC and MS, perceived threat (susceptibility and severity), perceived benefits and perceived barriers to MS, (personal barriers, economic barriers, health care system barriers).
<strong>Results: </strong>More than two thirds of females (69.7%) had bad MS utilization. Seventy two percent of females had poor knowledge about BC protective factors, signs and symptoms and risk factors of BC and about MS. The perception of the studied females was high concerning susceptibility and seriousness of BC and benefits of screening but there were some perceived personal, economic and health care system barriers to MS. Multiple linear regression analysis of the factors predicting MS utilization shows that age, accessibility, perceived need, total knowledge of BC, MS, and occupation sector were the significant predictors.
<strong>Conclusion:</strong> The majority of female employees had poor knowledge about BC and MS. Increasing the females’ knowledge about BC and accessibility to screening areas are important strategies influencing their decisions about whether or not to participate in cancer preventive practices.https://jhiphalexu.journals.ekb.eg/article_19918_75ace6e3aeb8db9208120aa7288a5591.pdf