Sore nipples: a multifaceted problem in breastfeeding

A sore nipple is a commonly encountered problem during breastfeeding. Though it is an easily preventable condition, once it happens it can lead to a lot of serial complications. Many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The present work aims at exploring the problem of sore nipples regarding its association with poor lactation management, time of presentation after delivery, bottle and pacifier use and the infection hazards to both members of the mother/infant dyad. This is a case control study where forty nine nursing dyads with mothers complaining of nipple cracks or sores, were compared with fifty one dyads whose mothers had no nipple complaint. Study tools included: physical examination of infants and local breast examination of mothers. Pre-structured questionnaire was asked, demonstrating infant's medical history and including patterns of feeding. Also bacteriologic examination [swabs and cultures] for nipple of the mother, oral cavity of the infants and bottles and/or pacifiers were done. Forty nine [49] cases were included in the group having sore nipples and 51 were included in the control group with no sore nipples. Pattern of feeding significantly affected the event of sore nipples. None of the infants in the sore nipple group was exclusively breast fed, while all of the exclusively breastfed infants [100%] were located in the control group [P= 0.000]. Most of the sore nipple cases [95.9%] showed nipple and oral mucosa colonization to be compared with only 70.6% of the control group [P=0.001]. Nipple culture of pathogenic strains were almost four folds in the case group than in the control group [P=0.004]. Ninety two percent [92%] and 78.6% of the case and control groups' teats showed bacteriologic growth [P=0.596]. 98.5% of each of the nipple cultures and the oral mucosa cultures of those using bottle feeding with the breast showed colonization. 93.3% of each of the nipple cultures and the oral mucosa cultures of those using spoon feeding with the breast showed colonization, while only 11.8% [2 cases] of the exclusively breastfed infants showed colonization in each of their nipple cultures and oral mucosa cultures and these 2 cases were commensals [P=0.000]. There was no statistical difference as regards infants gender, the mode of delivery or maturity at birth [P=0.164, 0.229 and 0.332 respectively] between both groups. Sore nipples are a manifestation of poor lactation management, and are closely associated with the use of bottles and/ or pacifiers and early introduction of supplements even without bottle use. Bottles, pacifiers and other feeding utensils also carry the potential risk of infection to both members of the nursing dyad. The earlier the lactation management to achieve the goal of exclusive breastfeeding appears to be the only safeguard against such problems

Health promotion in primary health care: a model for youth friendly services

The potential role of primary health care [PHC] as a unique setting for health promotion is becoming more recognized. Despite claims to promote health, most health care organizations in Egypt do so within the narrow definition of health. Global concern is growing about the health status of young females. Health services, although available, lack comprehensiveness that addresses the needs of this still shadowed sector of the population. In an attempt to make one of the PHC facilities be more "Youth Friendly", an integrated interventional approach for health promotion, with coordinated efforts from relevant stakeholders, was conducted in a rural PHC facility of Upper Egypt and the community within its catchments area. Targeted young females were initially defined and characterized through an interview based household survey. A total study sample of 671 females aged 12-20 years was included. Health and health care problems were identified through different qualitative and quantitative techniques. This was followed by a sequence of training courses for all the PHC providers, with community and local authority mobilization, and health education sessions for the targeted young females. Results of the study revealed marked community-level improvements and collaboration. At the PHC level, modifications in the organization of the delivery system, by arranging for convenient times to accommodate females were established. In addition, the designed card system enabled documentation of health education and counseling sessions needed by each female. The performance of the healthcare team was progressively improved through training. Significant rising means of knowledge and performance post- training scores were found for various priority topics, with p-values <0.001. At the individual young females' level, there were marked improvements in the utilization of the PHC services, where 62% of the studied group visited the centre more than 12 times during the 6-months post-intervention. This study highlights the strong belief that with changes in the way healthcare is organized, delivered and financed, new practice models beyond the level of the individual could be innovated to provide a holistic approach of health promotion for populations especially the non-regular PHC users

Profile of suicidal behavior among secondary school adolescents in Giza governorate

The aim of this research is to study suicidal behavior and to identify suicidal risk factors among Egyptian school adolescents. 303 secondary school students attending three secondary school at El Haram District, Giza Governorate were randomly selected. Suicide probability Scale [SPS] that assesses suicide risk in adolescents was used. Results elaborated that suicidal probability was distributed as: sub clinical [n=91, 30.3%], mild [n=128, 42.24%], moderate [n=57, 18.82%] and severe [n=27, 8.91%]. Perception of students to their home and school environment was a modulator in the distribution of students within the different SPS categories. Father- mother relationship [P=0.001], family size [P=0.011] and mother education [P=0.035] were among the factors significantly affecting that distribution. In the school environment, academic failure [P=0.008] and poor peer relationship [P=0.035] were concomitant with students' allocation in the moderate and severe suicidal probability. Moderate to severe suicidal probability was found among students perceiving themselves as suffering from psychological problems [P=0.001]. In the indepth interview with teachers they recommended to adopt interventions to Increase the opportunities that enhance the quality of youths' life and their expectations for a positive future. They agreed that most teachers would cooperate if there was organized educational opportunities on mental health issues. In depth interview with students revealed that they wish adults see them as individuals, not to alienate them from their identity by not allowing them the rights and responsibilities of adulthood, take their problems seriously, and stop dictating what they should do. Recommendations were set that school personnel must have the capacity of identifying and support distressed students and a mental health promotion approach through the curriculum should be encouraged

Communicable diseases prevention and control programs: needs assessment of best practice

Evidence showed that Egypt possesses risk determinants that play a crucial role in the persistence of communicable diseases. The present study is a healthy system research study that aims at identifying the challenges to best practice for prevention and control of group A communicable diseases which includes 15 diseases, according to MOHP surveillance system] at the education [Faculty of Medicine], and health system level [MOHP]. It focuses on situation analysis for the policies and strategies related to prevention and control of communicable diseases in Egypt. Study tools included a structured questionnaire designed to interview physicians and sanitarians working in the District Surveillance Units in Giza and Cairo governorates about prevention and control measures of communicable diseases under the study. In-depth interviews with professors at the Community Medicine Department in faculty of Medicine, Cairo University as well as staff of MOHP-Head Quarters. Content analysis for the community medicine book, MOHP guidelines and WHO publications was also performed. The main results of the in-depth interviews with community medicine department staff, addressed the institutional strengths within the medical schools in terms of enough staff and space and accessibility to field visits. The weaknesses within the medical education are related to overlap/ repetition of the same information. The practical training is not sufficient with shortage in facilities for transportation of students to the field visits. Challenges facing the medical schools include the big examination marks allocated to clinical medicine, compared to community medicine marks. The results of in-depth interviews with the staff of MOHP-HQ indicates the presence of political and institutional support for prevention and control of communicable diseases' programs. The surveillance unit [ESU] suffer many shortcomings. Opportunities are great for MOHP due to favourable change to work with international organizations. Challenges are related to the inadequate response of the private sector, non governmental organizations [NGOS] and the community to communicable diseases' prevention and control programs. The retained knowledge and skills of MOHP-CDC [including ESU] staff at the district level in prevention and control of communicable diseases are influenced to a great extent by the specific political support directed to some diseases [e.g. poliomyelitis] compared to other diseases which are not occupying a priority position in the policy makers' agenda. Additionally, some incorrect knowledge about national standard guidelines for prevention and control of communicable diseases with knowledge gaps between physicians and sanitarians were obvious. The study recommends regular revision and updating of community medicine curricula regarding prevention and control of communicable diseases and developing National Committee for continuous reviewing and updating of the guidelines for prevention and control of communicable diseases in MOHP. It also recommends periodic evaluation of the performance of MOHP-CDC [including ESU] staff at the district level

Risk Factors in Cerebral Stroke [A case Control Study in Kasr-El Aini Hospital]

Stroke is the third leading cause of death in the world, it is the first leading cause of adult disability. Many clinical and laboratory risk factors are accused to be predisposing for the occurrence of stroke such as hypertension, diabetes cardiac diseases and hypercholestrolemia. The current study is a case control study, conducted on 450 subjects attending Kasr El Aini hospitals [150 stroke patients and 300 control subjects]. The objective of this study is to detect these risk factors, and assess their relation to the disabling effects of stroke to be used in the future as alarming signals for early diagnosis. Tools of the study included physical examination, dietary pattern, lab investigations, duplex, ECG and Echo cardiography. Patients group was subjected to additional investigations such as Neurological assessment scales including: Mini Mental State Examination [MMSE], Motoricity Index, Barthel Index and Modified Rankin out come scale. CT scan was also performed. Results showed a statistical significant difference between patient and control groups regarding most clinical and laboratory risk markers. Hypertension, smoking and transient ischemic attacks [TIAs]were considered among the most predominant risk markers among the patient group with a poor outcome on cognitive, motor deficits, and disability. Hypercholestrolemia recorded the worst outcome as regards Modified Rankin disability scale. Moreover, prompt control of these risk factors are associated with lowering these disabilities. Dietary habits played a major role in stoke. The most frequent food categories consumed by the patient group were fats, proteins, and caffeine; yet vegetables, and carbohydrates were the most frequently consumed by control subjects. It is recommended that knowledge about risk factors together with their effects on the outcome of the stroke attack be used in planning of a national preventive program directed to the risk groups and also be included in the primary care facilities for early detection and proper management of such risk markers

Screening for human papillomavirus [HPV] in Egyptian females by the second-generation hybrid capture [HC II] test

Human Papillomavirus [HPV] infection is the main cause of cervical cancers and cervical intraepithelial neoplasias [CIN] worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently developed, the second-generation Hybrid Capture [HC II] test is a non-radioactive, relatively rapid, liquid hybridization assay designed to detect 18 HPV types, divided into high and low-risk groups. This test has an additional advantage, as it is also designed to provide quantitative estimates of the viral load .The aim of the present work, is to detect the rate of HPV infection and its various genotypes among the attendants of Kasr El Aini out patient gynecology clinic, using a non-invasive approach and to provide quantitative estimates of viral load. We evaluated 166 Egyptian females for HPV infection with the HC II test. The mean age of the participants was 37.28 +/- 9.16 years. According to cytology, the females were classified into normal cytology, chronic nonspecific cervicitis and squamous intraepithelial lesions [SILs]. The overall prevalence of HPV DNA in the studied groups was 15.06% [25/166], ranging from 6.6% [7/106] in normal cytology to 18% [9/50] in chronic nonspecific cervicitis to 90% [9/10] in squamous intraepithelial lesions. Among the 25 HPV- positive women, 16 [64%] were infected with high-risk HPV types, 4[16%] were infected with low risk HPV types, while 5[20%] had both types. Twenty-one [84%] of the infected woman harbored at least one high risk HPV type while 9[36%] harbored at least one low risk HPV type. Values of HPV viral load for low risk HPV infecton showed no significant difference for normal and chronic nonspecific cervicitis. But when HPV viral load of high risk HPV infecton was compared in normal, chronic nonspecific cervicitis and SIL a significant difference was found between normal and chronic nonspecific cervicitis, and between chronic nonspecific cervicitis and SIL and between normal and SIL, suggesting an association between viral load and risk of SIL and accordingly risk of cancer. Mixed HPV infection gave high viral load values even in normal smears. The viral load was apparently higher in SIL. From this study we may conclude that HPV testing using HC II assay is a useful tool when combined with cytology in diagnosing high-risk HPV viral types in apparently normal tissues. This may decrease greatly the increasing referral rate for colposcopy. This will reduce the cost services and could contribute to cancer prevention. Thus, this test may facilitate the detection of silent carriers of HPV by a sensitive noninvasive technique; leading to the identification of Egyptian women at risk of cervical neoplasia