Relation between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes.

Background: The relationship between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes is unclear. Objective: The objective of the current study is to investigate the relationship between skin disorders and diabetic microangiopathic changes in pediatric and adolescent patients with type 1 diabetes. Patients and methods: Eighty patients with type 1 diabetes and 50 healthy controls were enrolled in the study. All recruited patients were followed up monthly for a total period of 12 month. Monthly visit included thorough clinical examination with system review, as well as whole-body cutaneous examination. HbA1c was assessed every 3 month. Twenty-four hours urine was collected for measurement of urinary albumin. Results: Fifty percent of the screened diabetic cohort had diabetic nephropathy (DN). The overall prevalence of cutaneous lesion among the studied diabetic cohort was high (72.5%), with cutaneous infections (40%) and xerosis (30%) being the most prevalent. The frequency of cutaneous infections, xerosis and rubeosis faciei was higher in patients with nephropathy than in those without nephropathy. Conclusion: cutaneous affection in patients with diabetes may be a clue to the presence of associated microangioapthic complications. The significant association between diabetic nephropathy and cutaneous lesions support the concept that cutaneous lesion in diabetes is a reflection of diabetic angiopathy, highlighting the importance of identifying patients at risk of other microvascular complications.

Musculoskeletal disorders among bank office workers in Kuwait.

This cross-sectional observational study assessed the pattern of musculoskeletal disorder (MSDs) suffered by bank office workers in Kuwait. A self-administered validated questionnaire was used that included the Nordic musculoskeletal questionnaire and 12-item general health questionnaire (GHQ12). Of 750 employees, 80% suffered at least 1 episode of MSD during the previous year and 42% suffered at least 1 disabling episode. The most affected body parts were the neck (53.5%), lower back (51.1%), shoulders (49.2%) and upper back (38.4%). Nationality, GHQ12 score, smoking and sex were significant predictors of MSDs during the previous year, while alcohol drinking, marital status, GHQ12 score, years in Kuwait and sex were significant predictors of disabling MSDs during the previous year.

Musculoskeletal disorders among bank office workers in Kuwait

This cross-sectional observational study assessed the pattern of musculoskeletal disorders [MSDs] suffered by bank office workers in Kuwait. A self-administered validated questionnaire was used that included the Nordic musculoskeletal questionnaire and 12-item general health questionnaire [GHQ12]. Of 750 employees, 80% suffered at least 1 episode of MSD during the previous year and 42% suffered at least 1 disabling episode. The most affected body parts were the neck [53.5%], lower back [51.1%], shoulders [49.2%] and upper back [38.4%]. Nationality, GHQ12 score, smoking and sex were significant predictors of MSDs during the previous year, while alcohol drinking, marital status, GHQ12 score, years in Kuwait and sex were significant predictors of disabling MSDs during the previous year

Factors affecting the quality of life of hypertensive patients.

Using the Hypertension Health Status Inventory and multivariate analysis, predictors of quality of life were determined for a random selection of 316 hypertensive patients. Controlling for the effects of demographic and socioeconomic factors and existing co-morbidity, a better quality of life was independently predicted by achieving a controlled blood pressure and absence of target organ complications. Neither the number of antihypertensive drugs received nor the dose frequency affected patients' quality of life. Presence of drug side-effects independently predicted a lower quality of life in the physical and emotional domains but not on aspects of daily living. The independent predictors explained 25%-30% of the variation in the quality of life of hypertensive patients. The study highlights the role of achieving blood pressure control to ensure a better quality of life for hypertensive patients.

Factors affecting the quality of life of hypertensive patients

Using the Hypertension Health Status Inventory and multivariate analysis, predictors of quality of life were determined for a r and om selection of 316 hypertensive patients. Controlling for the effects of demographic and socioeconomic factors and existing co-morbidity, a better quality of life was independently predicted by achieving a controlled blood pressure and absence of target organ complications. Neither the number of antihypertensive drugs received nor the dose frequency affected patients' quality of life. Presence of drug side-effects independently predicted a lower quality of life in the physical and emotional domains but not on aspects of daily living. The independent predictors explained 25%-30% of the variation in the quality of life of hypertensive patients. The study highlights the role of achieving blood pressure control to ensure a better quality of life for hypertensive patients

Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria.

A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure.

Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria

A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure

Impact of schistosomiasis on quality of life and productivity of workers.

The effect of schistosomiasis on quality of life (QOL) and productivity of workers was examined. In a textile factory in Alexandria, Egypt, personal, occupational and sociodemographic data were collected from 172 workers with schistosomiasis and 172 workers without schistosomiasis. Several indicators of productivity and the World Health Organization QOL brief were used to determine the impact of schistosomiasis. The disease affected the general, physical and independence, psychological and spiritual, and social domains of QOL. Although the productivity score of workers with schistosomiasis did not differ significantly from the control group, they had significantly lower additional hours of work and lower total incentives/month. A significant relationship was found between severity of schistosomiasis and QOL domains and productivity indicators.

Impact of schistosomiasis on quality of life and productivity of workers

The effect of schistosomiasis on quality of life [QOL] and productivity of workers was examined. In a textile factory in Alexandria, Egypt, personal, occupational and sociodemographic data were collected from 172 workers with schistosomiasis and 172 workers without schistosomiasis. Several indicators of productivity and the World Health Organization QOL brief were used to determine the impact of schistosomiasis. The disease affected the general, physical and independence, psychological and spiritual, and social domains of QOL. Although the productivity score of workers with schistosomiasis did not differ significantly from the control group, they had significantly lower additional hours of work and lower total incentives/month. A significant relationship was found between severity of schistosomiasis and QOL domains and productivity indicators

Pattern and cost of medical care for workers with schistosomiasis.

This study describes the pattern of medical care provided to workers with schistosomiasis, estimate the total medical cost and to identify the proportional rates of sickness retirement attributed to schistosomiasis. The observational approach was adopted for this study 170 schistosomiasis workers and a similar number of controls were included in this study. An interviewing schedule and a special format were designed for collecting personal, medical and early retirement data. The results revealed that the mean total cost in the outpatient clinics was significantly higher for schistosomiasis workers than their controls (320.2 " 330.11 versus 210.8 " 260.01 L.E). The hospital cost was also higher for schistosomiasis workers compared with their controls (265.9 " 674.47 vs 195.8 " 629.72 L.E) but this differencewas not statistically significant. More than 80% of the total hospital cost was spent on bed cost. The average operative cost/worker was significantly higher among the schistosomiasis workers than the control workers (7.08 " 22.07 vs 2.35 " 5.2 L.E). The total medical cost (outpatient and hospital) was significantly higher for workers with schistosomiasis compared with their controls (586.02" 845.77 vs 406.57 " 694.34). The total number of workers who retired because of sickness disability other than schistosomiasis increased from 1994 to 1998 with a ratio of 2.54 while those who retired because of schistosomiasis and its complications increased with a ratio of 3.64.

Impact of type and stage of schistosomiasis on quality of life and productivity of infected workers.

All workers with schistosomiasis (205 workers) during the field period (April 1998 to March 1999) were included. The study tools included an interviewing schedule, the WHO QOL-brief and a production data format specially designed to obtain data about the productivity of the workers. The data revealed that 78.8% of the schistosomiasis workers suffered from Schistosoma mansoni while only 7.6% suffered from S. haematobium and 13.5% had a mixed infection. Workers infected with S. mansoni tended to have lower mean percent of all the QOL domains and productivity indicators compared with workers infected with S. haematobium but these differences were not statistically significant. Workers with complications of schistosomiasis had significantly lower values for the QOL physical, social relationship and environmental domains (55.27 +/- 15.59, 74.94 +/- 5.34 and 56.39 +/- 15.09 versus 61.38 +/- 5.74, 79.36 +/- 11.96 and 61.64 +/- 7.74 respectively). Moreover, the production score was significantly lower in the workers with complication compared with workers free from schistosomiasis complications. The mean percent of QOL domains decreased as the stage of schistosomiasis increased from stage 1 to stage 4, this was statistically significant for the physical and independence domain. The mean additional hours and production scores decreased successively from stage 1 to stage 4 of schistosomiasis. Thus, special attention should be paid to schistosomiasis workers for early detection and treatment of complications to improve the QOL and increase the productivity of those workers. The impact of the stage of schistosomiasis on productivity and QOL of workers needs further research with a wide spectrum of workload in different industries.

Violence among schoolchildren in Alexandria.

Violent behaviour among school students and its predictors were investigated. Selected children (2170) were requested to complete a self-administered questionnaire. Initiating violent assaults in the 18 months prior to the study was reported by 51.0% of boys and 20.9% of girls. Multivariate logistic regression analysis pointed to 16 predictive variables for violent behaviour; few were related to family background whereas the majority were related to the children themselves. Violent assaults were more likely to be initiated by boys and those who were dangerously daring and risk-takers, often fought verbally, threatened to attack others, were cruel to animals, disrupted class discipline, were truant from school or ran away from home and were disciplined by corporal punishment by their parents and their teachers. School-based prevention and intervention programmes addressing modifiable predictors should be considered.

Epidemiological and risk predictors of severity of school injuries.

Accidents are the leading cause of morbidity and mortality among schoolchildren. Epidemiological and risk predictors of injury severity were investigated among all school injuries presenting at the Students' Hospital in Alexandria during the scholastic year 1996-97. In all, 3422 injured pupils were surveyed. Age, nature of injury, place and mechanism of school injury and referral method were significant risk predictors for hospitalization. Age, referral method and nature of injury were significant predictors of referral to specialized health services. Injury severity score was significantly predicted by the presence of acute disease during time of injury, place and mechanism of injury as well as by provision of first aid and referral method and time.

Knowledge and perception of professionals towards school injuries.

As injuries remain a threat to children everywhere including school, this study was undertaken to reveal the knowledge and perceptions of school physicians, nurses, teachers and social workers regarding school injuries. To accomplish this aim, all school-based clinics operated by a physician were identified. All physicians and nurses were included in this survey. In addition, a teacher or a social worker was randomly selected from the same school. They were requested to fill in a questionnaire to collect relevant information. Findings indicate that school injury is not perceived as a priority problem by all social workers and 68.5% of teachers. Moreover, its economic burden was not perceived by one third of physicians and nurses. Regarding associated risk factors, more than 80% of the surveyed professionals recognized nine out of the 16 stated factors as a risk for school injuries. However, less than 80% viewed that the risk of school injury is higher in technical schools, schools which include more than one educational stage as well as in the evening shift. Moreover, less than 80% of nurses recognized that a higher risk is associated with poorly kept school building, primary schools and methods of transportation. Furthermore, less than 80% of teachers recognized that boys are at a much higher risk of injuries. Surveyed professionals ranked increase supervision, continuous maintenance of school building as well as health education activities as priority preventive strategies. Mass media was the method of health education that received the highest priority while the least were pupils' activities and the organization of an injury prevention day. It can be concluded that, school professionals, exceptionally teachers and social workers need to be aware of the extent of school injuries and the risks associated with their occurrence. Such awareness is the key issue in ensuring the safety of children while they are at school. Moreover, it is indispensable for the planning and implementation of effective preventive strategies. They should also recognize that pupils' involvement is a highly effective mean of creating awareness about safety and to encourage them to take the responsibility of their safety as well as that of other pupils. Organized training programs directed to all personnel in the area of school injuries are deemed essential.

Epidemiological and risk predictors of severity of school injuries

Accidents are the leading cause of morbidity and mortality among schoolchildren. Epidemiological and risk predictors of injury severity were investigated among all school injuries presenting at the Students' Hospital in Alexandria during the scholastic year 1996-97. In all, 3422 injured pupils were surveyed. Age, nature of injury, place and mechanism of school injury and referral method were significant risk predictors for hospitalization. Age, referral method and nature of injury were significant predictors of referral to specialized health services. Injury severity score was significantly predicted by the presence of acute disease during time of injury, place and mechanism of injury as well as by provision of first aid and referral method and time

Violence among schoolchildren in Alexandria

Violent behaviour among school students and its predictors were investigated. Selected children [2170] were requested to complete a self-administered questionnaire. Initiating violent assaults in the 18 months prior to the study was reported by 51.0% of boys and 20.9% of girls. Multivariate logistic regression analysis pointed to 16 predictive variables for violent behaviour; few were related to family background whereas the majority were related to the children themselves. Violent assaults were more likely to be initiated by boys and those who were dangerously daring and risk-takers, often fought verbally, threatened to attack others, were cruel to animals, disrupted class discipline, were truant from school or ran away from home and were disciplined by corporal punishment by their parents and their teachers. School-based prevention and intervention programmes addressing modifiable predictors should be considered

Children experiencing violence. I: Parental use of corporal punishment.

OBJECTIVE: This study was undertaken to reveal the prevalence of corporal punishment in Alexandria and its' correlates with family background and child's behavior and characteristics. METHODS: A cross sectional survey targeting preparatory and secondary school children was conducted. The multistage random sample technique was adopted to select a representative sample of this population. Subjects were requested to complete a self-administered questionnaire to collect relevant information. Data were analyzed using the univariate and multivariate analyses. RESULTS: This study revealed that more than one-third (37.47%) of children were disciplined physically in the form of beating and a few were also burned or tied. In 25.83% of them, this harsh discipline led to physical injuries of variable degrees of severity amounting to fractures, loss of consciousness, and permanent disability. Predictive family background for the use of corporal punishment were: living in an apartment shared with strangers; high crowding index; constant fights and quarrels between family members; lack of regular relation with relatives and acquaintance as well as an income insufficient to meet the family basic needs. Predictive child's characteristics and behavior included young age; disobedience; telling lies; destroying others' belongings; acting disrespectfully to parents; communicating poorly with their parents; running away from home; and poor school achievement, in addition to other determinants. CONCLUSION: A proportion of children are subjected to extreme physical brutality amounting to abuse in a disciplinary context. Parents' education and the establishment of effective parent-child communication are deemed essential to combat this phenomenon.

Children experiencing violence. II: Prevalence and determinants of corporal punishment in schools.

OBJECTIVE: This study was undertaken to reveal the prevalence and determinants of corporal punishment in preparatory (middle) and secondary (high) schools in Alexandria. METHODS: A cross sectional survey targeting preparatory and secondary school students enrolled in main stream public schools was conducted. The multistage random sample technique was adopted to select a priori estimated sample of this population. They were requested to fill a self administered questionnaire to collect relevant information. Data were analyzed using the univariate and multivariate analyses. RESULTS: A substantial proportion of boys (79.96%) and girls (61.53%) incurred physical punishment at the hand of their teachers. Teachers were using their hands, sticks, straps, shoes, and kicks to inflict such punishment without sparing a part of their students' body. Physical injuries were reported by a significantly higher percentage of boys (chi 2(1) = 12.26, p = .00046) the most common being bumps and contusions followed by wounds and fractures. Moreover, it was only among boys that serious injuries such as loss of consciousness and concussion were encountered. Both univariate and multivariate analyses revealed that corporal punishment was more likely to be used in preparatory schools and on boys. Such means of punishment were also predicted by students' undesirable behavior as well as their poor achievement in academic tasks. CONCLUSION: This study indicates that corporal punishment in school is used extensively to discipline students whose behavior doesn't conform with the desired standard of educational institutions. However, since it is no longer perceived as a method of discipline, other alternatives can be used providing that teachers are equipped with the necessary skills for its application.

Epidemiology of school injuries in Alexandria.

This study was conducted to reveal the magnitude of school injuries in Alexandria, their epidemiological patterns and outcomes. All pupils attending the casualty department of Alexandria Students' Hospital during the scholastic year 1996-1997 with school injuries were included in this study. An interview questionnaire and a transfer sheet were used to collect relevant information. Data were analyzed and the 5% level was taken to judge the significance of the obtained results. During the study period, 3422 pupils sustained school injuries yielding a rate of 4.25 per 1000. This rate was significantly higher among boys (6.43 per 1000) as well as in secondary schools (8.11 per 1000). Most of these injuries occurred inside the school (72.0%). In relation to school activity, injuries occurred more frequently during breaks (28.1%), school trips (27.8%) and teaching sessions (25.6%). Falls were responsible for 52.3% of the injuries followed by struck by or against (25.2%), while 11.9% were due to road traffic accidents. The most commonly affected sites were the upper (46.2%) and lower (32.1%) limbs as well as the head and neck (16.6%). High proportions of the resulting injuries were minor, however, severe injuries namely, fractures (23.2%) and brain concussions (2.8%) were encountered. Significant differences were observed in this respect in relation to the pupils' gender and educational stage. Only 12.5% of the cases were hospitalized. All recovered completely except four cases of leg amputation and no deaths were recorded. School injuries appear to be a priority area for primary preventive activities. School personnel should receive safety rounds to recognize the potential environmental hazards. Stringent supervision is required in areas and during activities with high frequency of injuries. Moreover, safety education should be incorporated in the curriculum and activities involving school children.

Personal factors and working conditions as predictors of work injuries among industrial workers.

The purpose of this study was to determine the personal factors and working conditions that predict work injuries among industrial workers. To fulfill this aim, a case control study was conducted including 2003 industrial workers who sustained a work injury and an equal number of controls. All were subjected to an interview questionnaire to collect relevant information. Moreover, records were reviewed to obtain the medical history of enrolled workers. Data revealed that workers in the index and control groups are comparable in respect to their sociodemographic characteristics. The multivariate logistic regression analysis pointed out that safety training significantly reduces the risk of work accidents among industrial workers. On the other hand, work accidents are more likely to occur in the main working shift. Moreover, workers who suffer from chronic health problems calling for surgical treatment, as well as those who reported family problems, are more likely to experience work accidents. These workers should receive considerable attention to reduce the extent of work injuries. More importantly, safety-training programs are mandatory for accident prevention in industrial settings.