Quality of life of patients with oral and pharyngeal malignancies

The target population was cases of oral and pharyngeal cancer in Alexandria and El Behira regions. Data were collected through all accessible archives. Data about quality of life [QoL] were collected through interviewing 171 subjects using the Arabic version of "Functional Living Interview Questionnaire for Cancer" [FLIC]. It consists of 22 items translated into Arabic language, and was checked for reliability and validity. Only 12 questions were found suitable for use after testing the questionnaire. Responses are coded on a 7 point Likert scale. Questions included pain, psychic stress, and ability to work and do household activities. The initial scale's structure identified a two-factor model: functional including 6 questions, and psychological including 6 questions. The grand total score was calculated as the sum of responses to the 12 items. The total score of the scale range is 12 to 84 points. The median was used for demarcation between what was considered as "good" response, and what was considered as "poor" QoL. Quality of life displayed higher "good" frequencies among those 30-60 years old. Males, and rural cases expressed better QoL than females and urban. Married were of better QoL compared to single patients. The educated showed higher frequency of "good" compared to un-educated. Employees and professionals reported better QoL. Stage categories showed significant indirect correlation with QoL scores. The best QoL according to total or psychological mean scores was recorded for pharyngeal-otherwise [pharyngeal of a mysterious origin] or lip cases, while the worst were for the floor of the mouth. Lip cases showed the best QoL scores through the functional domain. According to treatment; surgery showed the best QoL, while chemotherapy showed the worst. When it came to chronic irradiation complications; those without complications expressed the best QoL. All those treatment complications showed significant associations with dichotomous leveling of QoL. Logistic regression showed that stage, late surgical complications, and response to treatment were the most important predictors of QoL

Chronic occupational exposure to lead and its impact on oral health

Chronic Lead exposure favours the formation of cheilitis, fissures, ulcers and epithelial desquamation of the tongue, palate and other parts of the oral mucous membranes. The tissues of oral cavity may be affected by toxic agents either by direct action as in exposure to sulfuric acid fumes or through systemic exposure as in poisoning with heavy metals e.g. lead.. The Present study aimed to investigate the oral health condition of industrial workers exposed to lead in Alexandria governorate. The samples included all workers chronically exposed to lead fumes or dust in a storage battery plant [400 workers] and working in seven departments where lead exposure was present. These departments were evaluated environmentally for lead in air and their workers for lead in blood. Oral medical examinations were carried out according to the items of WHO sheet designed for oral health survey with some modifications. Results of the present study revealed that chronic exposure to lead significantly affects oral health condition among exposed workers and strongly correlates with increasing level of blood lead among them. It can be concluded that the most common adverse effects of lead on dental health of exposed workers were the significant increase in the prevalence of periodontal diseases [gingivitis and periodontitis expressed as PI] and in the prevalence of decay [caries], missed and filled teeth [expressed as DMFT index] and dental abrasions. Moreover, these findings were found to be related to lead concentration in air in the studied departments and to blood lead level. On the other hand, exposure to lead was found to have insignificant effect on calculus formation [expressed as CI-S] or oral debris [expressed as [DI-S]or both together expressed as [OHI-S]

Meta-analysis of survival models of lung cancer

Lung cancer is a common disease that is difficult to treat successfully. Despite the continuous improvement and development of diagnostic method, the disease is still diagnosed in advanced stages. The present study aimed to calculate the 5-years survival rate of patients with lung cancer, to construct different models of survival rates according to different factors and to perform a meta-analysis involving systematic statistical pooling of eligible studies concerning survival of lung cancer. A longitudinal retrospective study was conducted in the treatment centers of Faculty of Medicine and Gamal Abd-El Nasser Hospital. All available records of patients diagnosed and confirmed pathologically as lung cancer during the years 1992 to 2001,were reviewed, the total number amounted to 1099 patients, these patients were followed up for one year till the end of 2002. Life table revealed that the cumulative probability of survival was 18.7% and 16.7%, respectively at 36 -<42 month and 42 -<48 month. No one survived up to 5 years. The median survival time was 7.97 months.Kaplan-Meier survival curves yielded that the lowest probability of survival throughout the studied period was noticed among those aged 70 years or more, with stage IV and patients who were treated with radiotherapy alone. Cox regression delineated three significant predictors for survival within 5 years, which were age of patients, stage of tumor and grade of differentiation. Results of meta-analysis demonstrated that pooling the results of different studies yielded a trend toward a reduced relative risk of death by 22% among patients with stage I compared to stage II, and reduced relative risk of 33% for patients with stage I compared to stage III. It is essential to improve the strategies for prevention of smoking and health education program for cessation of smoking early for smokers. Diagnosis staging and development of a management plan should be completed quickly as possible. Focuses on the treatment of patients with lung cancer with chemotherapy and radiotherapy

Predictors of personality disorders among Alexandria University students

Personality disorders [PDs] represent a common and serious public health problem. The aim of the present work was to determine the prevalence of different PDs among first grade students of Alexandria University and to investigate some ecological factors of the problem. A cross-sectional study was carried out and included 1086 students. The Arabic Version of Personality Diagnostic Questionnaire-4+ [PDQ-4+] was applied. Results revealed that more than one quarter of the studied sample had at least one PD [26.1%]. Cluster C was the most frequently occurring [24.9%]. The commonest subtypes recorded were avoidant PD [20.4%] and obsessive-compulsive PD [20.2%] followed by paranoid PD [15.0%]. Significant predictors of PD delineated on the logistic regression analysis were mainly psychosocial factors including parental inconsistent discipline, intrafamilial conflicts, parental rejection and control, decreased familial and friends social support, and sexual abuse. A positive history of conduct disorder, chronic medical illness or psychiatric problem also significantly predicted the occurrence of PD. Lack of freedom in college selection and smoking emerged as recent events that predicted the PD status of students

Statistical analysis of referrals by general practitioner at health insurance organization clinics in Alexandria

Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners [GP] at Health Insurance Organization [HIO] clinics in Alexandria. The study was conducted at 18 Health Insurance Organization [HIO] comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO [8-17%] revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant

Statistical process control for referrals by general practitioner at health insurance organization clinics in Alexandria

Quality control is the application of statistical techniques to a process in an effort to identify and minimize both random and non-random sources of variation. The present study aimed at the application of Statistical Process Control [SPC] to analyze the referrals by General Practitioners [GP] at Health Insurance Organization [HIO] clinics in Alexandria. Retrospective analysis of records and cross sectional interview to 180 GPs were done. Using the control charts [p chart], the present study confirmed the presence of substantial variation in referral rates from GPs to specialists; more than 60% of variation was of the special cause, which revealed that the process of referral in Alexandria [HIO] was completely out of statistical control. Control charts for referrals by GPs classified by different GP characteristics or organizational factors revealed much variation, which suggested that the variation was at the level of individual GPs. Furthermore, the p chart for each GP separately; which yielded a fewer number of points out of control [outliers], with an average of 4 points. For 26 GPs, there was no points out of control, those GPs were slightly older than those having points out of control. Otherwise, there was no significant difference between them. The revised p chart for those 26 GPs together yielded a centerline of 9.7%, upper control limit of 12.0% and lower control limit of 7.4%. Those limits were in good agreement with the limits specified by HIO; they can be suggested to be the new specification limits after some training programs

Reliability, validity and psychometric properties of the Arabic Version of the Center for Epidemiological Studies-Depression [CES-D] scale

This study aimed to assess the reliability, validity and psychometric properties of an Arabic version of the Center for Epidemiological Studies-Depression [CES-D] scale. The participants were 1186 secondary school adolescents aged 15-17 years in Alexandria Governorate. They were subjected to the Arabic version of Child Depression Inventory [CDI], CES-D and Coppersmith self-esteem. The results revealed that 9.5% of the students were moderately to severely depressed according to the CDI cutoff score. Using the receiver operating characteristic [ROC] curve, a cutoff point of 25 subjects produced the best overall screening efficiency. The internal consistency of the scale was acceptable. The test-retest reliability was satisfactory. Factor analysis extracted four factors that explained 50.08% of variability; namely, negative effect/cognitive symptoms, interpersonal difficulties, reduced positive affects and somatic complaints with an acceptable reliability. A concurrent validity was supported by significant high Spearman's correlation between CDI and CES-D scores and a convergent validity was confirmed by inverse moderate correlation between CES-D scores and Coppersmith self-esteem scale scores

Measurement of kap concerining hepatitis B among secondary school students in Alexandria

Hepatitis B infection is a serious health problem throughout the world. Success in the prevention of this disease with its fatal consequences depends to a large extent on the adolescents level of knowledge and their awareness about it. As well as their attitude and different risk behavior they might practice at this age. The aim of the present study was to assess the secondary school students level of knowledge about hepatitis B and to record their perceptions, attitudes and practices towards it. Also to identify their health locus of control towards the disease. The studied sample included 643 students of both sexes representing different senior levels in one educational sector in Alexandria. The used technique was self-administered questionnaire. Results revealed that [55. 2%] of the studied sample had fair level of knowledge about hepatitis B Girls had more negative attitude towards the disease than boys. About one half of the students [50.4%] were not vaccinated against the disease. Also, the majority of students had internal health locus of control regarding hepatitis B. It is recommended to integrate knowledge about hepatitis B within formal and informal school programs. Community campaigns for vaccinating the adolescents against the disease should be carried out

Assessment of students' knowledge attitude and practice concerning cancer and its prevention

Cancer is a serious public health issue, but it is increasingly regarded as preventable. The present study was conducted to assess students knowledge, attitude and practice about cancer. A questionnaire was developed by the researchers and completed by 896 secondary school students from the middle zone of Alexandria Governorate. Females had a significantly higher awareness than males as regards the relationship between not eating vegetables and fruits environmental effects, exposure to irradiation or to the sun for long periods and the hazards of getting cancer. Third grade students were significantly more knowledgeable than the other two grades [H=11.43, p<0.01]. Only 4.5% of the participants had satisfactory levels of knowledge. Students in general expressed strong fear of cancer. Females were more worried than males either about themselves getting cancer or about others having it. More than 50% of the females liked to be friendly with children having cancer as compared to 37% of males. Only 12.3% of the students had a positive attitude towards cancer prevention. Males tended to consume healthier foods than females. Furthermore, 57% of the students demonstrated good practice. School education on cancer is extremely needed for these adolescents in order to correct misconceptions, provide accurate information and to develop a positive attitude towards cancer

Improving students' knowledge, attitude and practice towards cancer prevention through a health education program. Part II

A health education program for cancer risk reduction was conducted among 649 students out of 896 for whom Knowledge, Attitude and Practice [KAP] had been obtained at the initial study. Three hundred and sixteen students acted as the intervented group and three hundred and thirty three were the control group. There was a great improvement in the percentage of correct knowledge answers in the majority of the questions from pre to post tests especially for the questions about the effect of excessive use of fatty foods [76.3%] and excessive use of salty foods [68.0%] on the occurrence of cancer. After the program, at least 87% or more of the students recognized the hazards of risky food, 86.1% knew that mothers who do not breast feed their infants have a greater chance of getting cancer breast, 51.3% responded correctly to the question about the effect of oral contraceptive pills after 40 years. More than 86% recognized the serious effect of prolonged exposure to the sun. A significant shift toward positive attitude was found especially with the item "I am very afraid to know that I have cancer, so I avoid going to the physician" [76.9%]. It was found that 94% of the students agreed that there is a relation between the type of food and cancer. The students showed significant increases in median practice scores from pre to post tests and the larger gain associated with participants in the program [9.97%]. The majority of the students reported increases in their daily consumption of fruits, cereals, leafy vegetables and salad. These significant changes in KAP scores from pre to post tests were noticed for both sexes, different social classes and different educational grades

Estimation of probabilities of pregnancy outcomes: a fetal life table study

The study was carried out with the aim of estimating probabilities of several possible outcomes during successive stages of pregnancy. The study was conducted retrospectively and data were collected from a systematic sample of 30% of records of pregnant mothers whose pregnancy was terminated during the years 1985-1986 in the Health Insurance Hospitals in Alexandria. The total sample was 3685. The collected data were tabulated according to the gestational age in weeks for the purpose of constructing fetal life tables. The overall estimated probability of fetal death was 216.61 per 1000 pregnancies with the highest rates during early weeks of gestation. It was observed that age of mothers, history of previous fetal loss, old primigravidity, multiparty, short interpregnancy intervals, pre- eclamptic toxemia and manual work were among the risk factors which raised the probability of fetal loss