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).

Nutritional factors affecting the menarcheal state of adolescent school girls in Alexandria.

The nutritional status of adolescents plays a dominant role in determining the maturation status. The aim of the present work was to assess the mean age of menarche and the main nutritional factors affecting it. A cross-sectional study of 1606 girls was conducted in primary and preparatory schools in Alexandria. Every girl was subjected to anthropometric assessment including weight, height, mid upper arm circumference (MUAC), waist circumference, hip circumference and triceps skin-fold thickness. BMI and body fat percentage were calculated. A 24 hours diet recall method was used to assess the dietary intake. The mean age of menarche was 11.98+/-0.96 years. The mean MUAC, triceps skin-fold thickness, waist circumference and hip circumference were significantly higher among menstruating girls as compared to non-menstruating. (p<0.01). Only 7.5% of the females less than the 5th percentile of BMI (thinness) were menstruating, while the corresponding figure for those at or more than 85th percentile (overweight) was 65.6% and this was statistically significant (X 2 (2) =102.8, P<0.001). Girls who attained menstruation demonstrated a higher significant mean percent of body fat (43.40+/-10.0) as compared to non menstruating ones (35.41+/-7.87), ( t=17.09, P<0.001). The oldest age at menarche was noted when the protein, iron and caloric intake was less than 80% of the RDAs. However after adjustment of other variables direct relation was detected between age of girls and their age of menarche and those in private school had earlier age of menarche than those in governmental one. The nutritional status of the adolescents had a significant association with the onset of menstruation and the age at menarche.

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 as 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.

Impact of health education program about reproductive health on knowledge and attitude of female Alexandria University students.

In Egypt, adolescents don't have enough and/or correct knowledge regarding reproductive health. Health education interventions are widely seen as the most appropriate strategy for promoting young people's sexual health. The aim of the present work was to assess the impact of a short-term health education program about reproductive health on knowledge and attitude of female Alexandria university students. Quasi-experimental study (pre-post testing control group) was carried out among 682 female university students living in the university hostels, 354 students represented the intervention group (Ezbet-Saad hostel) who received the program and 328 students constituted the control group (El-Shatby hostel). The study revealed that no one had satisfactory knowledge level while 61.7 % and 38.3% respectively had fair and poor levels. The low knowledge level was more evident regarding the questions about: the meaning of the term 'reproductive health' (only 5.1% gave correct complete answer), the benefits of premarital examination (only 37.9% reported complete answer), the investigations done for the pregnant woman (only 28.3% gave complete answer) the benefits of breast feeding (only 8.2% reported complete answer), methods of family planning (only 36.4% gave complete answer), side effects of female genital mutilation (only 4% reported complete answer), sexually transmitted diseases and methods of protection (only 11.9% and 3.9% reported complete answer). It was evident that 32.6% had an overall positive attitude level, 46.3% were in the neutral level and 21.1% had a negative level. It was also found that students of highly or moderately educated mothers and of high social class reported significantly higher knowledge score about premarital examination, age of marriage and breast-feeding than those of non-educated mothers and of low social class. After the intervention program there was a significant improvement in the majority of knowledge questions from pre to post test in the intervention group and no absolute changes were detected in the control group. The highest percentage of gain scores (33.3%) was detected for knowledge about the term 'reproductive health' and female genital mutilation. A significant gain score of 25% was observed for the knowledge about sexually transmitted diseases. Also there was a gain of 20% in the median score concerning the knowledge about breast feeding and family planning. A significant shift towards a positive attitude was found among the intervention group.