High Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Antioxidants and Tumor Necrosis Factor-α in Patients with Pulmonary Tuberculosis5966132062310.21608/jhiph.2010.20623ENNeveen HusseinApplied Medical Chemistry Department, Medical Research Institute, Alexandria University, Alexandria, EgyptAbeer GhazalMicrobiology Department, Medical Research Institute. Alexandria University, Alexandria, EgyptRania El SharkawyChemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, EgyptJournal Article20181206<strong>Background: </strong>Tuberculosis (TB), is one of the major common air born infectious bacterial diseases which remains a major worldwide health problem with global mortality. <strong>Objective:</strong> To evaluate the efficiency of serum samples compared to sputum for the early diagnosis of TB, and to evaluate the levels of superoxide dismutase (SOD), catalase (CAT), total antioxidant status (TAS) and tumor necrosis factor-a (TNF-a) in patients with pulmonary tuberculosis (PTB).<strong> Methods:</strong> One hundred patients with clinically suspected PTB and 25 healthy individuals were enrolled in the study. According to the bacteriological results, 78 patients were diagnosed as having PTB infection. These cases were categorized into 69 culture positive cases [sputum and serum PCR positive patients (n=42), sputum PCR positive and serum PCR negative patients (n=16) and sputum and serum PCR negative patients (n=11)] and 9 culture negative and sputum PCR positive cases with radiological lung abnormalities suggestive for PTB. For these 78 cases, erythrocyte SOD, CAT, serum TAS and TNF-a were determined.Twenty two patients were culture negative and negative for both sputum and serum PCR. They had no PTB and were not involved in biochemical studies.<strong> Results:</strong> In all 78 PTB patients, erythrocyte SOD, CAT and serum TAS levels were statistically lower than controls (<em>p</em><0.05), while TNF-a was highly significantly increased (p=0.001). There was a significant direct linear correlation between SOD and CAT and TAS (<em>p</em><0.0001, r= 0.78; <em>p</em><0.0001, r= 0.88; <em>p</em><0.0001, r=0.80 respectively) and a significant reverse linear correlation between TNF-a and SOD, CAT and TAS level (p<0.0001, r=-0.55; p<0.0001, r=-0.51; p<0.0001, r=-0.65 respectively).<strong> Conclusion:</strong> Although the sputum culture is still the gold standard for the diagnosis of patients with PTB, sputum PCR is an efficient method that could be used as an alternative to the culture for the rapid identification of PTB cases. The lower levels of SOD, CAT and TAS may be improved by the antioxidant therapy which may help in better prognosis. Anti TNF-α therapy may help in decreasing the elevated level of TNF-α shown in all PTB patients.https://jhiphalexu.journals.ekb.eg/article_20623_7282d3054459f8d156fcaf107305ede7.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Junior Physicians, Are They Equipped to Manage Diabetes? Situation Analysis at Kasr El-Aini Hospital, Cairo University6146362062410.21608/jhiph.2010.20624ENShaimaa AbdelazizDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptDouaa ElderwiDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptFatma Abou HashimaDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptYosra ElshaikhDepartment of Public Health and Community Medicine, Faculty of Medicine, Helwan University Hospital, Helwan, EgyptJournal Article20181206<strong>Background</strong>: Diabetes is a chronic illness that requires continuing medical care and patient self management education to prevent acute complications and to reduce the risk of long-term complications. <strong>Objective: </strong>Toassess junior physicians' competencies (knowledge, attitude and skills) as regards care of diabetic patients and to evaluate efficacy of the existing system in the form of gap analysis for Faculty of Medicine curricula and practical training courses. <strong>Methods:</strong> A cross sectional study was conducted on 310 junior physicians, working at Kasr El-Aini Hospital, Faculty of Medicine, Cairo University. Two hundred and fifty house officers attending the rotations of internal medicine and general surgery and sixty residents from these departments were included.Research instrument was a questionnaire that inquired about four discrete areas: demographic data, knowledge, attitude and practice (KAP) domains in the field of diabetes and its complications. A scoring system was developed for every question. These scores were then converted into percentages and a mean of the total scores was calculated for each domain. Cut-off level of 60% or more was identified as the acceptable level. The undergraduate curricula courses specifications and intended learning outcomes (ILOs) for the subjects studied in the six years of medical education (year 2008-2009) were reviewed. <strong>Results:</strong> In our study 53.6% of the house officers and 55% of the residents were males. Two thirds of both groups had family history of diabetes. Regarding knowledge, the mean percent score of residents was significantly higher than that of house officers (41.4±6.4 and 38.1±6.0 respectively, <em>p</em><0.001). Yet, both groups could not reach the 60% acceptable level of correct answers on any of the four areas of the knowledge domain. Our results revealed that the junior physicians had good attitudetowards management of diabetes and its complications with a mean percent score of 81.2±5.7. A significant positive linear relationship was observed between knowledge and attitude scores of the junior physicians (r=0.093, <em>p</em><0.001). The majority of them had undesirable practice abilities. Mean percent score of the residents’ practices was significantly higher than that of the house officers (<em>p</em><0.05). Reviewing the undergraduate curricula ILOs and postgraduate log book for the house officers and comparing them with the international guidelines revealed that the six years undergraduate curricula of Faculty of Medicine covered all the topics and acquired skills about diabetes and its complications, while there was shortage in the house officers’ training log book regarding management skills for diabetes. <strong>Conclusion:</strong> This study has explored several aspects of diabetes related KAP of junior physicians. It highlights the need for improvement in their practices for treating and educating diabetics.https://jhiphalexu.journals.ekb.eg/article_20624_91738ebf3f5c629b88702deb93e06538.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Relationship Between Leadership Styles and Emotional Intelligence of Head Nurses at Mansoura University Hospitals6376552062510.21608/jhiph.2010.20625ENWafaa SleemDepartment of Nursing Administration, Faculty of Nursing, Mansoura University, Mansoura, EgyptYosr ElmasriDepartment of Psychiatric & Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, EgyptJournal Article20181206<strong>Background: </strong>Leaders who are able to use emotions to guide decision making are able to motivate subordinates by engaging in activities facilitated by emotions and are able to encourage open minded idea generation, decision making and planning because they can consider multiple points of views. <strong>Objectives:</strong> This study was conducted to explore the relationship between leadership styles and emotional intelligence of head nurses at Mansoura University Hospitals.<strong> Methods:</strong> A descriptive exploratory design was used for head nurses working in Oncology Hospital, Gastroenterology Hospital and Emergency Hospital (54 head nurses on the job). Three tools were used for data collection: characteristics data sheet of the head nurses, Multifactor Leadership Questionnaire (MLQ) and Leahy Emotional Schema Scale (LESS). <strong>Results:</strong> It revealed that emotional intelligence differed among the studied nurses in the three hospitals. A statistically significant relation was found between the studied head nurses’ age and “sometimes” and “almost” use of transformational leadership style. There were no statistically significant relations between leadership styles and emotional intelligence of head nurses and their years of experience, and the emotional intelligence was not significantly correlated with leadership styles among the studied head nurses. <strong>Conclusion and</strong> <strong>Recommendations:</strong> It is recommended to provide the head nurses with needed support programs for adding emotional intelligence training to be happier, more committed to their organization, achieve greater success and perform better in the workplace in order to enhance their leadership style. https://jhiphalexu.journals.ekb.eg/article_20625_bda296f84bf2a6894005eb343d67f105.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001The Effect of Dietary Counselling on the Health Status of End-stage Renal Failure Patients6566762062610.21608/jhiph.2010.20626ENIbrahim HegazyDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptHanan El RaghyDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptShaimaa Abdel-AzizDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptEman El HabashyDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptJournal Article20181206<strong>Background:</strong> Chronic renal failure is becoming one of the most impacting diseases on the Egyptian population, alongside with cardiovascular and hepatic diseases, diabetes mellitus and cancers. Studies support the importance of dietary management on different aspects related to end-stage renal failure<strong> (</strong>ESRF) and other studies also suggest that active nutritional counselling can improve certain important biochemical parameters and fluid overload problems in patients on maintenance haemodialysis (HD). <strong>Objectives:</strong> To assess the effect of dietary counselling on the overall health status of ESRF patients subjected to haemodialysis, particularly their renal functions. <strong>Methods:</strong> A pretest-posttest study was conducted through several phases; Phase 1: Pre-intervention assessment using; an interview questionnaire to collect socio-demographic, nutritional knowledge and dietary pattern data; Malnutrition Inflammation Score (MIS); Karnofsky Performance Scale (KPS) and anthropometric measurements. Phase 2: Implementation of nutritional counselling sessions communicating evidence-based practices. All patients were given one-to-one nutritional counselling over a six-month period. Phase 3: Post-intervention reassessment of patients using phase one tools. Sampling: A sex-stratified random sample of about 50% of all patients attending El-Harem Centre for Dialysis (82) during the period from October, 1<sup>st</sup> 2008 till March, 31<sup>st</sup> 2009 were included. Intervention participants totalled 41 ESRF patients. <strong>Results:</strong> In this study, 97.5 % of patients were considered mildly to moderately malnourished. Multiple malnutrition problems detected among these patients were protein-energy malnutrition, hypocalcaemia, anaemia and hyperphosphataemia. Nutritional counselling sessions resulted in statistically significant changes in the Malnutrition Inflammation Score (MIS) and Karnofsky Performance Scale (KPS) of the patients, the patients' nutrition related knowledge and to some extent their dietary practice. <strong>Conclusion:</strong> Providing one-to-one nutritional counselling is an effective intervention that can improve the ESRF patients' nutrition related knowledge and practice as well as their compliance to the dietary guidelines for the dialysis patients, which in turn can improve their health status and daily performance. https://jhiphalexu.journals.ekb.eg/article_20626_2527bae710671bdb78bbd363fa628ddb.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Accuracy of Pediatricians’ Screening and Referral for Early Childhood Caries after a Training Program6776902062710.21608/jhiph.2010.20627ENTaghareed ElhosenyHealth Administration and Behavioural Sciences Department (Hospital Administration Division), High Institute of Public Health, Alexandria University, Alexandria, EgyptSara ElshazlySenior consultant pedodontist, Ministry of Health, Alexandria, EgyptJournal Article20181206<strong>Background: </strong>Training of pediatricians on early childhood caries (ECC) screening and referral during their medical pediatric practice has been suggested to promote childhood dental care. <strong>Objective:</strong> To assess the accuracy of pediatricians in detection of ECC and trauma and to estimate the rate of referral after being trained by a pedodontist.<strong> Methods: </strong>The study was conducted atpediatric outpatient clinics of a governmental pediatric hospital in Alexandria, Egypt. Dental examination of 137 children- six to thirty six months of age was carried out independently by a pedodontist and pediatricians to identify cases of ECC and trauma after a training program for physicians about diagnosis of dental caries and referral needs. <strong>Results: </strong>Fifty dental conditions were detected among 33.6% of the children (46 children) with a rate of 36.5%. The rate of ECC among children was 27.7% with pre-cavitated caries as the most common type (16.1%). The mean age of children with ECC is significantly higher than that of children without ECC (<em>t</em>=3.23, <em>p</em>=0.002). The rate of dental trauma was 9%. The positive predictive value of pediatricians’ detection of ECC was 100%, the sensitivity was 94.74%and the specificity was 100%. The children referred for dental care by pediatricians represented 88 % of those referred by the pedodontist. <strong>Conclusion: </strong>Pediatricians can achieve high accuracy of identification of cases with ECC and of cases in need for dental referral through inservice training.https://jhiphalexu.journals.ekb.eg/article_20627_fea8594884ad53ef02fbe44f9bb90201.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Determinants of the Risk for Diabetic Foot Ulceration in Sohag University Hospital6917042062810.21608/jhiph.2010.20628ENMohamed AlsenbesyInternal Medicine Department, Faculty of Medicine, Sohag University, Sohag, EgyptAli KasemInternal Medicine Department, Faculty of Medicine, Sohag University, Sohag, EgyptSameh ZaytounDepartment of Community Medicine, Facult of Medicine, South Valley University, EgyptJournal Article20181206<strong>Background</strong>: One of the most common complications of diabetes in the lower extremity is the diabetic foot ulceration (DFU). <strong>O</strong><strong>bjective</strong><strong>:</strong> To identify the determinants of the risk for diabetic foot ulceration (DFU) in terms of peripheral neuropathy (PN) or peripheral vascular disease (PVD) among a sample of diabetic foot patients. <strong>Methods:</strong> A cross sectional study included 100 diabetic foot patients attending Sohag University Hospital for follow up during the period from January 2009 to January 2010. They were subjected to complete medical history taking and thorough clinical examination. Diabetic Neuropathy Symptoms (DNS) along with the Diabetic Neuropathy Examination (DNE) scores were used together to define and assess PN. PVD diagnosis was based on identification of claudication pain symptoms; absent or weak foot pulses on palpation of the dorsalis pedis and/or the tibialis posterior arteries; coldness of skin; and finally confirmed by arterial doppler of lower limbs. <strong>Results</strong><strong>:</strong> The mean age of the patients was 57.92±9.2 years; 65% were males and 79% lived in rural areas. The majority (79%) had type 2 DM with mean disease-duration of 13.4±6.9 years. Fifty percent of the study patients were smokers and ex-smokers, 33% were hypertensive and 24% had previous history of foot ulceration or amputation. Male gender, old age, low socioeconomic status, smoking, hypertension, type 2 DM, long duration of DM, uncontrolled DM, and previous history of foot ulceration, amputation or other diabetic complications were all significant determinants of PN and PVD; two major risk factors of DFU.https://jhiphalexu.journals.ekb.eg/article_20628_e26b70d2e56ef1f7e34a667297ef7efe.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Pesticides in Indoor Dust and Shallow Groundwater in Rural Egypt7057232062910.21608/jhiph.2010.20629ENSalwa AbdallahDepartment of Mammalian and Aquatic Toxicology, Central Agricultural Pesticides Laboratory (CAPL), Agricultural Research Center, Ministry of Agriculture, EgyptKhaled Abdel-HalimDepartment of Mammalian and Aquatic Toxicology, Central Agricultural Pesticides Laboratory (CAPL), Agricultural Research Center, Ministry of Agriculture, EgyptJournal Article20181206<strong>Objective: </strong>This study was designed to examine the existence of pesticide residues in both indoor dust and consumable subsurface shallow ground water and its association with community health in an agro-ecosystem in the Nile Delta Region.<strong> Methods: </strong>Pesticide exposure via consumption of shallow groundwater and contact with indoor dust were assessed in 7 villages in the Nile Delta of Egypt. Hand-pumped water and households’ dust samples were collected on a spatio-temporal monitoring basis. A total of 50 households were randomly selected and residents were interviewed using a structured questionnaire to determine pesticide usage, exposure pathways and behavioral/health risk factors. <strong>Results: </strong>Analyses revealed that the examined shallow groundwater and indoor dust samples failed to realize the respective standards of safety in most cases. Pesticide residues detected in indoor dust were more abundant than those in groundwater. Pyrethroid compounds represented the highest residues detected in indoor dust samples, where their mean levels were 4.75, 2.69, and 15.21 ppm for permethrin, cypermethrin, and cyahalothrin respectively. DDT, HCH and endosulfan were also detected in many samples in mean concentrations of 10.42, 36.01 and 33.68 ppb; respectively. As for the link between environmental contamination and community health, through our field questionnaire, the villagers stated that water-related diseases particularly diarrhea and infectious hepatitis were predominant. <strong>Conclusion</strong>: Age, living in close proximity to agricultural fields, excessive use of pesticides indoors without adequate aeration, lack of awareness and poor water quality, represented the major risk factors. More exposure/risk assessment studies related to the Egyptian setting are necessary to enhance drinking water regulations and lower the health risks of pesticide exposure.https://jhiphalexu.journals.ekb.eg/article_20629_b8882ca2707d445d058653431849de36.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Effect of Two Different Positions on Parturients’ Perception of Labor Pains Intensity7247382063010.21608/jhiph.2010.20630ENWafaa RashadDepartment of Obstetric and Gynecologic Nursing, Faculty of Nursing, Alexandria University, Alexandria, EgyptFatma ShuaibDepartment of Obstetric and Gynecologic Nursing, Faculty of Nursing, Alexandria University, Alexandria, EgyptJournal Article20181206<span style="font-family: arial,helvetica,sans-serif; font-size: x-small;"><strong><span style="font-family: Verdana;">B</span>ackground: </strong>Labor is a local process that involves the abdomen and reproductive organs, but its intensity is so great that almost all body systems are affected.One of the various systems in which major changes occur in response to labor is in the neurological system, which is related to pain. Position assumed during childbirth affects the woman's anatomic and physiologic adaptations to labor. <strong>Objective:</strong> To determine the effect of two different positions on parturients’ perception of labor pains intensity. <strong>Methods:</strong> A randomized, crossover study was conducted at the delivery room affiliated to King Fahd University Hospital in Saudi Arabia Kingdom. It included 84 parturient primiparae who were randomly assigned to one of two groups, in which either side-lying or sitting position was first used then alternate with the other position to avoid order effect. Group 1 started in the sitting position for 15 minutes, and then they were asked to reposition themselves in the side-lying position. Group 2 started in the side-lying position for 15 minutes, and then they were asked to reposition themselves in the sitting position. An interview and physical assessment sheet was developed and used by the researchers to collect data about general characteristics as well as general and local physical assessment.The Visual Analogue Scale (VAS)was also used tomeasure the intensity of labor pains as perceived by participants in each position. <strong>Results:</strong> The results of the study revealed that mean pain score was statistically decreased in side-lying position among group 1, while it was statistically increased in sitting position among group 2, although sitting position statistically enhanced cervical dilatation and rupture of membranes among group 2. <strong>Conclusion:</strong> Side-lying position significantly reduces the intensity of labor pains during the active phase of labor. </span>https://jhiphalexu.journals.ekb.eg/article_20630_829af0a835b3305f7184f106b6dc78b0.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Health–Related Practices among Some Egyptian School Children during The H1N1 Pandemic7397502063110.21608/jhiph.2010.20631ENLaila KamelDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptArwa El ShafieDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptRehab AbdelhaiDepartment of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, EgyptSoha AbdelazimMinistry of Health and population, EgyptJournal Article20181206<strong>Background: </strong>Swine influenza was recognized as a threatening health problem in the world. Thus, The Ministry of Health and population in Egypt took aggressive actions to prevent this serious health hazard. Several interventions were directed to schools. <strong>Objective:</strong> The aim of this study was to assess H1N1 healthy practices in schools, identify knowledge, attitude and practice (KAP) of school children and teachers, regarding health education (HE) messages and to assess the school environment. <strong>Methods:</strong> A descriptive study was conducted in four schools in Giza governorate: three language/private and one public. A structured questionnaire assessed the school students KAP (n=300). Training on prevention of H1N1 was received by 75% of the school team. A semi-structured in depth interview explored the perception of school team (n=32) regarding H1N1 and an observation checklist assessed the school environment. <strong>Results: </strong>The study revealed that the Health Education Campaign raised health awareness of students about personal cleanliness especially hand washing (46.9%). Additionally, 87.5% of the school staff admitted improvement of the school environment during implementation of this campaign. Primary grade students were generally better in following instructions and obeying orders regarding personal cleanliness than those in preparatory grades (<em>p</em><0.01). Vaccination did not achieve complete coverage (9.7%). <strong>Conclusion and Recommendations:</strong> Health education is reasonably effective in promoting some healthy practices in schools and among students. H1N vaccination coverage is jeopardized by the mass media interferences. There is great need for plans to emergency epidemic conditions and for continuous school environment supervision. Mass media should provide accurate information.https://jhiphalexu.journals.ekb.eg/article_20631_96b116c65755fc20edb80753ac86fb37.pdfHigh Institute of Public Health, Alexandria UniversityJournal of High Institute of Public Health2357-060140420101001Maternal and Neonatal Outcomes of Induction of Labor with Vaginal Misoprostol Versus Intravenous Oxytocin7517672063210.21608/jhiph.2010.20632ENMervat ZaghaloulDepartment of Maternity, Obstetrics and Gynecological Nursing, Faculty of nursing, Port-Said University, Port-Said, EgyptJournal Article20181206<strong>Background: </strong>There are many different situations in obstetrics where there is the need for labor induction in women with unripe cervices. This indication stems from a situation where the continuation of pregnancy may be life-threatening for the mother and/or fetus. <strong>Objective: </strong>To compare maternal and neonatal outcomes of induction of labor with vaginal misoprostol versus intravenous oxytocin. <strong>Methods:</strong> A follow up study was conducted at the delivery unit of Ismailia University Hospital. The study subjects included two equal groups of women, group I (50) who received vaginal misoprostol and group II (50) who received oxytocin infusion. A structured interviewing schedule and an observation checklist were developed, validated and used to collect data related to maternal and neonatal outcomes. <strong>Results:</strong> Uterine contractions of longer duration (>70-90 seconds) and strong intensity were found to be significantly higher in the misoprostol group compared to the oxytocin group (<em>p</em><0.01). Within the first 12 hours, the misoprostol group recorded statistically significant higher rates of normal fetal heart rate and of vaginal delivery compared to the oxytocin group (<em>p=</em>0.003, 0.008 respectively). On the other hand, the incidence of cesarean delivery was higher in the oxytocin group compared to the misoprostol group. <strong>Conclusion and Recommendations:</strong> Misoprostol 25μg vaginally (every 4 hours, up to 200 μg) is more safe and efficient for cervical ripening than oxytocin infusion. It is recommended for parturient women with Bishop score ≤4.https://jhiphalexu.journals.ekb.eg/article_20632_f08e5f0f561231cb9fcad1030324aaf1.pdf