Accessibility to the health insurance of the medical union in Alexandria

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

Risk factors of puerperal sepsis in Alexandria

Puerperal infections are an important cause of maternal morbidity and mortality in developing nations. Investigators have noted several risk factors for developing puerperal sepsis. However, the relative importance of these risk factors varies and has to be determined for each setting. Therefore the aim of the present work was to determine the risk factors for puerperal sepsis in Alexandria, Egypt. A case-control design was used to study the risk factors of puerperal sepsis in Alexandria. The study included 160 puerperal sepsis cases and 160 controls. Puerperal sepsis cases were recruited from the fever hospital as well as from 3 rural health units and three urban health offices in Alexandria. A pre-designed interviewing questionnaire was used to collect data about risk factors of puerperal sepsis. Logistic regression analysis indicated that very low socio-economic score [OR=6.4], no ANC [OR= 4.5], delivery at a governmental maternity hospital [OR= 203.4], frequent vaginal examinations [OR=5.1], anemia during puerperium [OR= 4.3], unsanitary vaginal douching during puerperium [OR=19.9] and unhygienic preparation of diapers used immediately after delivery [OR= 12.1] were significantly related to the occurrence of puerperal sepsis. Improving infection control measures during delivery, limiting the frequency of vaginal examinations, and avoiding all unhygienic practices related to delivery are strongly recommended

Traumatic dental injuries among primary school children in Alexandria

Children accidents are everyone's responsibility. Accident prevention is everyone's job. Traumatic dental injuries were studied among 6061 primary school children. The males had higher rate of accidents than girls and the accidents were higher among children with illeterate mother or only read and write and not working. Most of injuries occured at street followed by home. Single fractures, maxillary central incisors and enamel dentine type of fracture were the most frequent type of fractures

concept of need and demand and its application to dental care for central security soldiers in Alexandria

The difference between the physicians perception of need for medical services and that of the client has been discussed by many authors. There is always a certain degree of unrecognized need by the client due to incomplete knowledge of the characteristics of disease. Demand on the other hand, depends on the consumer and is basically an economic concept. This study was carried out with the aim of comparing between dental treatment needs as perceived by the dentist and the patient and clarifying the different barriers to transformation of recognized need into effective demand, as well as determining the effect of presence of a free clinic on the percent of met need and barriers to demand. The study was carried out in the three central security zones in Alexandria, only one of which had a clinic. Results revealed that 81.5% of those clinically assessed to need care recognized the need. However, 53.2% of the dental problems were unrecognized and these were mostly the non-painful conditions. The major bulk of filling need for the total sample was unmet [88.2%]. The zone with a clinic had the highest percent of met need for filling while those without a clinic had the highest percent of met need for extraction probably because they do not seek treatment early. The main barriers to utilization in the zones without a clinic were financial and no time for treatment, while for the zone with a clinic it was fear. Finally, it was recommended that soldiers should be educated about early recognition and treatment of dental problems in addition to performance of initial and annual dental examination, as well as provision of a dental clinic to serve the two zones without one

Use of delphi technique in determining certain factors related to drug dependence among youth

The drug dependency problem in Egypt is currently one of the major issues of concern to the public as well as professionals. Lack of comprehensive, reliable date concerning the problem led the researchers to resort to the Delphi technique in gathering the required information from experts involved in the problem. The aim was to reveal expert involved in the problem. The aim was to reveal experts' opinion regarding certain factors responsible for the causation and perpetuation of the drug dependency problem among youth, both currently and in the future [the next 10 years]. Experts were required to rank their answers in order of importance. Because of the multidisciplinary feature of drug dependence, 3 groups of experts were solicited from both Cairo and Alexandria, i.e. Psychiatrists, N.D.C. officers and social workers. Results of the study demonstrated that 72.2% of experts considered the current age of onset of drug intake among youth to be 18 to less than 21 years. In the future, 55.6% expected it to decline to 12 to less than 18 years. Skilled workers' were ranked the most common category of drug users with complete intergroup consensus of opinion, followed by drivers and artists. Cannabis, heroin and synthetic pills were respectively ranked the three most common drugs used currently. In the future, heroin is expected to occupy 1st rank followed by cannabis and synthetic pills. Regarding future use of drugs by youth, 79% of experts expected it to increase

Use of delphi technique in determining certain factors related to drug dependence among youth: part II

Due to the deficiency in the availability of reliable data required for accurate assessment of the drug dependence problem opinion regarding various factors related to the problem. This part of the research was concerned with their opinion regarding: reasons leading to drug dependence among youth, barriers preventing youth from seeking and continuing treatment, as well as experts' recommendation regarding control of the problem. Results of the study revealed that experts considered youth's urg for excitement, challenge and new experience to occupy 1st rank among reasons leading to dependency. This was followed by lack of morals, religious principles and a good example' [2nd rank] and availability of excess quick money' [3rd rank]. Among the barriers preventing youth from seeking treatment, unavailability of adequate treatment centers at reasonable cost', occupied 1st rank with complete intergroup consensus of opinion. Similarly, inadequacy and high cost of treatment' was ranked 1st barrier to continuation of treatment. The four main recommendations expressed for the prevention and control of the problem included, 'organization of attractive public education programs regarding harmful effects of drugs', adequate parental supervision and guidance', development of well supervised, interesting activities to occupy youth's time', as well as proper religious education in schools and universities

Determination of population's opinion regarding utilization of Mahelet Marhoum Hospital

A previous study by Amer et al., [1984], revealed that MMH continuously showed the lowest utilization rates among El-Gharbia hospitals. Therefore, this population survey study was carried out with the aim of revealing the reasons why MM population refrained from using their district hospital. The most frequently mentioned reasons stated by those admitted to other hospitals and those never hospitalized were related to unavailability of doctors, equipment and facilities in MMH. Technical inefficiency was the main reason of dissatisfaction from doctors as mentioned by those admitted to MMH, while lack of "caring" for patients was the major reason of dissatisfaction from nurses and other subprofessionals. Other reasons included geographic inaccessibility of the hospital. Cost formed no barrier to utilization, while problems related to uncleanliness were few. Finally, it was revealed that the higher the level of education of respondents the more inclined they were not to use MMH

Evaluation of DPH program offered by High Institute of Public Health through student's opinion

This study was carried out with the aim of determining students opinion regarding the extent to which the first term curriculum of the DPH program was beneficial to them regarding certain areas. The opinionnaire used was designed with the help of medical education experts at the CED, University of Illinois, Chicago. Results revealed that the courses offered were rated of moderate benefit regarding their value in introducing students to the various disciplines of public health and in preparing them to become members of the P.H. team. The courses were rated minimally beneficial in preparing students for their future jobs. Comments and recommendations offered by students helped to clarify the reasons why ratings were not as high as should be desired. The main reasons referred to the fact that the core course offered too much information in too short a time [77.08% of respondents]. Moreover, students complained that the educational objectives of many courses especially the interdepartmental field work, were never clearly stated to them [56.25%]. They asked that methods of teaching be improved [2.08%] and recommended that all students should be separated from the very start into their specialties [17.7%], since non-medicals find difficulty in understanding lectures [3.12%]. The reasons for the apparent feelings of confusion and loss, lie mainly in the fact that the core course offers a sizeable amount of information to a heterogenous group of attendants who all sit for the same courses. To reach this group and adequately communicate the required knowledge to them, instructors of a special caliber and experience are required. The planning and development of the core course itself should be upgraded following the basic principles of curriculum planning, especially in relation to development of precise, clearly defined educational objectives, both for the program as a whole and for individual courses. This entails maximum cooperation on the part of everyone involved in teaching and development of the curriculum. In fact, most of the teaching staff in the institute have already been exposed to medical education workshops on methods of teaching and curriculum planning. What remains is for them to become adequately convinced to utilize the training they received to the benefit of their students. A situation which might require serious intervention on the side of the institute's administrative body

Estimating the efficiency of utilisation of hospitals in El-Gharbia Governorate

This study was carried out with the aim of determining the efficiency of utilization of hospitals in El Gharbia governorate and estimating the required number of hospital beds which will provide reasonable occupancy rates for each hospital. In addition it was intended to reveal whether a greater number of beds lead to higher utilization rates [Roemer's law]. Results revealed that according to the indices used only a couple of hospitals, along 3 separate years, could be said to operate efficiently. Utilization rates fluctuated between overutilization in some hospitals and underutilization in others due to maldistribution of hospital beds. Using the standard deviation formula based on the Poisson distribution curve, the required number of beds for each individual hospital in the governorate was calculated with its corresponding expected occupancy rate. In all hospitals but 2, this number was much less than the currently available number of beds. Finally, it was found that Roemer's law did not apply perfectly to hospitals of El Gharbia governorate [r[s]=0.07]. However, r[s] rose to 0.53 when Mahelet Marhoum hospital was excluded. This was the only hospital which persistently showed exceptionally low utilization rates, regardless of the measures used

Nutritional analysis of food consumed by patients in two of the medical wards in Tanta university general hospital

This work aimed to study the discrepancies between diet offered by hospital and diet required by patients according to their disease status; to study the discrepancies between diet consumed by patients from [hospital and home] and diet required by these patients and to measure patient acceptability of the food offered by the hospital. All 80 patients admitted to two medical wards [16 beds] in T.U.G.H. in the period of two months were examined and interviewed to obtain the main diagnosis and the actual food items consumed by patients including what was offered by hospital and food brought to patients from their homes and relatives. Each patient was interviewed to know their opinions regarding hospital food and reasons of hospital food refusal. Results revealed that hospital offered diets were different from modified required diets for all groups of patients. Also average amounts of food items consumed by patients [from hospital and home] were significantly different from what was required for each group according to their disease status which were considered harmful to patients. As regards patients opinions concerning hospital food, the study illustrated that most patients were not contented with quantity and quality of meals they recieved and the manner in which they were served

Assessment of the food service department in Tanta university general hospital

This study was carried out to assess the effectiveness of the food service department in TUGH. The food service department in this hospital was purposefully chosen because it had been recently renovated with up to date equipment. Data collection was carried out through the use of three checklists i.e. sanitation, personnel performance and organization and staffing checklists. Results revealed that although modern equipment was available, it was not used either becacuse it was out of order [e.g. refrigerators and electric heating cupboard], still kept in store [insulated trays], or available and in good working condition but left over by kitchen personnel for more old fashioned manual methods [e.g. potatoe peeler and tomatoe squeezer machines]. The physical layout and sanitary condition of the department were also studied, with the results being all way below standard. Again, results of the personnel performance checklist revealed that most of the required activities were not adequately performed. In fact, the highest percentage of tasks done in any one activity reached only 39.05% and this was in tasks related to personnel cleanliness. Finally, the organizational and staffing patterns of the department were compared to the requirements set by the JCAH [1977]. None of the organizational requirements existed in the department, while only a small percentage of the staffing requirements were fulfilled

Medical audit of blood transfusion services in Gamal Abdel-Nasser Hospital

Blood is a scarce and valuable resource and blood transfusion is often a risky procedure. It is therefore essential that blood transfusion be carried only when absolutely necessary. Certain criteria [blood pressure, pulse and Hgb level] must be set to justify each transfusion. From this study it was revealed that almost 1/4 of the cases transfused received unjustifiable transfusions according to the criteria used and 41.67% of cases suffering from post-transfusion reactions could have been spared their suffering since they were unjustifiably transfused. All of this points to the need for more adequate management of blood transfusion services through a "blood utilization review" committee. The most frequent reason for blood transfusion in general as well as for unjustifiable transfusion was correction of anaemia. Only 4.55% of anaemic cases received the correct blood component therapy i.e. packed RBC. Single unit transfusion proved to be a very frequent procedure, despite the numerous controversial opinions regarding its validity. Patient monitoring before and after transfusion proved to be quite inadequate. Finally, the outcome of blood transfusion services provided to patients, as measured by the patients health status on discharge, was found to be below the acceptable level