Quality of care provided to children with cerebral palsy, Alexandria, Egypt

Background: Assessing the quality of care has become increasingly important to health care providers, regulators and purchasers of care.

Aims: This study assessed the quality of care provided to children with cerebral palsy attending Alexandria University Children's Hospital, Egypt.

Methods: Paediatric neurology residents [n = 15] who provided care to children with cerebral palsy at the hospital completed a structured checklist assessing their compliance with generic care standards. The medical records of 84 children with cerebral palsy who received care at the hospital were reviewed using the same checklist. Another checklist was completed by the head of the paediatric neurology unit, medical director of the hospital, head of physical medicine and head nurse to assess adherence to process and service improvement standards. Face-to-face interviews were conducted with the caregivers/parents of the children using a client satisfaction questionnaire.

Results: Based on what was reported by health care providers, most did not adhere to the recommended practices in the care of children with cerebral palsy. Review of the medical records also showed a lack of compliance with standards. The mean total satisfaction percentage score of parents/caregivers was 55.43% [SD 18.16]. Satisfaction was particularly low for waiting time, waiting area and availability of required facilities for their child's care.

Conclusions: There is a wide gap between the actual care provided to children with cerebral palsy and the recommended standards. Moreover, the documentation system in the hospital is poor. A quality improvement plan is needed for the provision of care to children with cerebral palsy

Perceived problems of dental students in relation to academic advancement in Alexandria University

The dental school with its strict academic and clinical requirements is often regarded as a highly pressurized difficult environment for students. The stresses of the learning environment may have undesirable consequences, the most important of which is the impairment of effective intellectual function and detriment to learning. Severe depression and anxiety with or without physical symptoms can immobilize students, making them ineffective in dealing with the demands of a difficult academic curriculum. Hence, educators need to be more concerned about the quality of the learning environment which should be engineered carefully in order to maximize each student's learning potential. For such an objective to be accomplished, the perceived problems and potential sources of stress to dental students should be identified. Thus, the aim of the present study was to provide comprehensive information about the perceived problems of dental students with particular emphasis on sex, academic year and school achievement in terms of grade in previous year. A comprehensive dental student problems questionnaire including a list of 64 problem items covering 8 major problem areas related to the different aspects of the educational process and taking account of the student's life situation, interpersonal relationships and personal feelings and behavior was developed. A total of 348 students [183 males and 165 females] completed the questionnaire, with approximately 50% participation from each academic year. The results of the study revealed that students in the Alexandria Faculty of Dentistry exhibited a more or less similar spectrum of perceived problems compared to dental students in other countries. The problem areas identified as most stressful by the majority of students in all academic years were those related to the evaluation system and to time. Problems related to the academic and clinical aspects of the educational process were perceived to be more stressful than those related to life situation and interpersonal relationships. For the different academic years, variations in ranking of problem items within most problem areas could be detected reflecting differences in the academic and clinical requirements of each academic year. Sex and school achievement in terms of grade in previous year were not found to be significantly related to the averages of percentages of students reporting being considerably or severely stressed by the different problem areas. Several recommendations were given in an attempt to reduce the stress bearing upon -dental students by improving the quality of the educational environment, hence maximizing the students learning potential

Mothers and teachers participation in an oral health education program for pre-school children in Kuwait

An oral health education program was conducted in the government nursery schools of two governorates in Kuwait, namely, the Capital and Farwaniya governorates. Oral health education sessions were given to 6421 children in the Capital and 7887 children in Farwaniya nursery schools. Each class in the different schools included in the program received a one hour health education session which consisted of oral health talk of 15 minutes followed by a video film presentation of 15 minutes. Finally the correct method of toothbrushing was demonstrated for each child and supervised brushing was performed by all children. Educational sessions were held for the mothers and teachers in the different schools. Each session extended over 90 minutes to 2 hours and included information and advices regarding the various aspects of oral health. The numbers of mothers and teachers attending the health education sessions were recorded and taken as an index of their willingness to participate and cooperate in efforts for oral health education for their children. The percentages of attending mothers in the different schools of the two governorates ranged from 2.09% to 50.76% with an overall mean attendance of 14.28%. For the teachers, the percentages of attendance in different schools ranged from 14.29% to 100% with an overall mean of 70.66% for the two governorates. The need for motivating mothers and teachers to participate in oral health education programs for young children was evident. Recommendations were given for oral health education programs for preschool children to be more beneficial based on the results and discussion of the present work

Evaluation of the effectiveness of three different toothbrush designs

The plaque removing efficacy of the Dentrust toothbrush with its new wrap-around head design was tested and compared with that of a conventional straight handle toothbrush [Oral-B] and a bi-angled handle toothbrush [Signal - 2]. A total of 150 first grade students [75 girls and 75 boys] with an age range of 10-12 years were randomly chosen from 6 government intermediate schools [3 for girls and 3 for boys] in Kuwait. The students were divided into 6 equal groups [3 for girls and 3 for boys] of 25 students each. Gingivitis and plaque scores were assessed at baseline and at the end of the 4 - weeks study period using the Gingival Index and the plaque Index of Leo and Silness. The 3 types of toothbrushes were assigned randomly to the 3 groups of girls and of boys. The Bass technique of toothbrushing was demonstrated for the children and supervised brushing was performed to assure the correct use of toothbrush. All children were instructed to brush their teeth for 2 minutes twice daily. At the end of the trial, all 3 types of toothbrushes led to significant reductions in gingivitis and plaque scores, both for girls and boys, however they did not differ significantly from each other. Thus, it seems that the proper technique of toothbrushing as well as the thoroughness, perseverance and manipulative skills of the brusher rather than toothbrush design would count more towards better gingival health and oral hygiene

Occupational stress and coping methods among Ministry of Health dentists in Alexandria

The study was carried out on 443 dentists [197 males and 246 females]. The results of the study revealed that, stressors related to occupational risks, especially fear of transmission of infection from patients, were the most frequently reported items to be stressful by the study groups. Stressors related to idealism came second with striving for technical perfection being the most stressful item for all study groups. Taxes [business management and economic stressors] constituted a very important item of stress for dentists with private practice. On the other hand, staff related stressors ranked last for all study groups. The results also revealed no significant association between stress level and any of the independent variables investigated in the present study; namely, sex, having a private practice and duration of experience. Among the various stress coping methods suggested, leaving problems at office, sports and physical exercise and activities with family were the most frequently reported methods to be employed by the interviewed dentists to cope with job stress

Infection control measures in Alexandria Ministry of Health and Health Insurance Organization dental clinics

The study sample comprised 20 of the MOH dental clinics and 27 of the HIO dental clinics in Alexandria. All the chosen clinics were visited by the researchers. A total of 176 MOH dentists [74 males and 102 females] and 83 HIO dentists [36 males and 47 females] participated in the study. A specially designed observational checklist was used to assess the availability of the different international recommended infection control measures in the visited dental clinics. Furthermore, a comprehensive infection control questionnaire was designed to obtain information from all dentists available at the time of the visits regarding the various procedures they use for cross-infection control and to assess their attitudes and perceptions about their own procedures as well as the barriers that may hinder the application of ideal procedures. The results revealed wide disparity between internationally recommended infection control measures and currently employed procedures. It further revealed low levels of compliance of respondent dentists with recommended guidelines

Mothers and teachers participation in oral health education program for per school children in Kuwait

In this study participation of mothers and teachers in an oral health education program for pre-school children was assessed. The program included 6421 children in the capital "Kuwait City" and 7887 children in "Farwaniya" govermorate. Health education sessions were held for the children and for their mothers and teachers. The percentage of attending mothers in different schools ranged from 2.09% to 50.76% in the "Capital" and from 4.96% to 41.38% in "Farwaniya" with an overall average attendance of 14.28% for the two governorates. For the teachers the percentages of attendance in different schools ranged from 14.29% to 94.12% in the "Capital" and from 41.18% to 100% in "Farwaniya" and the overall average for the two governorates was 70.66%. Were discussed and the need for participation of mothers and teachers with active involvement was evident. Recommendations were given for oral health education programs for pre-school children to be more beneficial based on the results and discussion of the present work

Evaluation of the effectiveness of three different toothbrush designs

The plaque removing efficacy of a newly designed toothbrush [Dentrust] was tested and compared with that of a conventional straight handle brush [Oral B] and a biangled handle brush [Signal]. A total of 78, grade two, intermediate school children [39 girls and 39 boys] participated in the study. The children were divided into 6 equal groups [3 for girls and 3 for boys], each group being randomly chosen from each of 3 schools for girls and 3 schools for boys. Plaque and gingivitis were assessed at baseline and at the end of the 3-week study period using the Plaque index and Gingival index of Loe and Silness. The three types of toothbrushes were assigned randomly to the 3 groups of girls and also to the 3 groups of boys. The proper technique of toothbrushing was demonstrated for the children and supervised brushing was performed to assure the correct use of toothbrush. All children were instructed to brush twice daily. At the end of the 3 weeks period, the means for percentages of reduction in gingival index scores for all groups were significantly different from "zero" at the 5% level but did not differ significantly from each other for boys while for girls both the newly designed and curved handle brushes gave significantly better means for percent reduction than the straight handle brush but did not differ significantly from each other. Similarily, the means for percent improvement in plaque index scores following the study period were all significantly different from "zero" but not among themselves. Only with the newly designed brush, girls had significantly more mean reduction than boys. So, it seems that the proper technique of toothbrushing rather than toothbrush design would count more towards better gingival health and oral hygiene

oral hygiene program for a group of institutionalized mentally handicapped children in Kuwait

This program was carried out at the "Rehabilitation Center for the Handicapped" in Schwaik. A total of 68 mentally handicapped children with an age range of 5 to 14 years were included in the study. A specially designed examination chart was used to assess the gingival condition and oral hygiene status of the children. Following the initial examination, scaling was performed for all children with calculus deposits by means of three well trained dental hygienists who were also instructed to brush the children's teeth once daily and to teach the hygiene staff at the rehabilitation center the proper technique of tooth-brushing to ensure the continuity of this dental care after the termination of the program. After one months the children were reassessed to determine the short term effects of the program on their oral health. The means for reduction in gingival, oral debris and oral calculus index scores following the program were all significantly different from "zero" at the 5% level indicating that effective complete plaque removal even once a day can improve gingival health and oral hygiene status among mentally handicapped. Recommendations were given in order to attain an acceptable level of oral health in such vulnerable priority groups

nurse and mother as dental heath educators: their knowledge, attitudes and behaviors

Concerns about the dental health status of the five-years-old children in Egypt stimulated discussion about the prevention of dental caries. Preschool children should be a target group to reduce the prevalence of and try to prevent dental caries in that vulnerable age group. However, questions concerning who should conduct the dental health education remain unanswered. The ideal person to conduct the initial dental health education would be an individual who is readily available, accessible, and acceptable to both mother and child. The nurse, school health visitor and mothers fulfill these criteria. Furthermore, the nurses or school health visitors or mothers have access both to the clients in their own homes and to the community networks. In this way they can be involved with prevention at an individual counseling level as well as with influencing dental health as part of an over all health promotion strategy. The importance of involving the parents especially the mothers in dental health education has been demonstrated. Parents serve as role models as well as assist the young child to care for his teeth. The aim of this study was to identify the knowledge, attitudes and behaviors of the nurses and mothers as dental educators. A questionnaire specially designed for this study was completed by nurses working in schools, hospitals, MCH Centers as well as mothers. Revealed positive attitudes toward dental health education and lack of knowledge. However, tooth brushing was the only dental health behavior mentioned by some of nurses and mothers

Risk factors for pulmonary tuberculosis in different occupations in Gharbia governorate, Egypt

This study was carried out on a group of [256] tuberculous workers admitted at "Tanta and El Mehalla El Kobra Chest Hospital" during the period from December, 1st 1990 to the end of April 1991. A control group of [256] workers matched by age sex was also studied. Significant differences were found between tuberculous workers and the controls with respect to smoking [X2=88.04], bad nutritional status [X2=24.50], overcrowding [X2=88.04], and low socioeconomic level [X2=4.16]. Also, negative history of B.C.G. vaccination [X2=32.82] and psychological disorders [X2=9.32] were significantly related to tuberculous workers. However, no statistically significant differences existed between tuberculous workers and the controls regarding intercurrent diseases [X2=2.50], history of prolonged corticosteroid therapy [X2=2.00], positive family history [X2=2.48], trauma [X2=2.36] and urbanization [X2=1.08]