From public health and demographic research to decision making: An intervention study in Giza Governorate-Egypt, Abd El Razik, Madiha Said, and Salem Marwa Rashad , 2019, Volume 77, p.101704, (2019) AbstractWebsite

The purpose of the current study was to develop an empirical model that shows how various contextual data are analyzed, interpreted and presented as evidence-based information for decision making and action taking. A Pre-test-Posttest intervention study was conducted at the National Population Council (NPC)-Giza governorate (GG) where all data were collected from all governmental organizations on an annual basis at the district level (19 districts), which include 28 indicators. Composite indices and indicators (n = 9) had been ranked and presented as a matrix that assigned districts into three situations: Best (green zone), prospective (yellow zone) and critical (red zone). Intervention: Presentation of the “Districts’ Enactment Matrix” (DEM) for the year 2014 in GG –Regional Council for Population (RCP) quarterly meetings, headed by the governor and attended by representatives of all ministries. The feedback and recommendation for action taking by participants were reported by the researchers. Evaluation of the intervention was done by comparing DEM 2014 and DEM 2016. Results: At the governorate level, short-term strategies were used to improve the situation. All the districts in red zone 2014 and two districts in the yellow zone had demonstrated positive changes in their 28 indicators. Conclusion: The DEM model is a simple tool that facilitates communication between researchers and decision-makers that could be applied in different public health and population programs.

Assessment of nutritional status and disease activity level in Systemic Lupus Erythematosus patients at a tertiary care hospital, Behiry, Mervat Essam, Salem Marwa Rashad, and Alnaggar Alshaimaa R. , 2019, Volume 26, Issue 2, p.97 - 104, (2019) AbstractWebsite

IntroductionNutritional status and unhealthy dietary habits may have an influence on Systemic Lupus Erythematosus (SLE) course and activity.
Objectives
This work aimed to determine the nutritional status and dietary intake of SLE patients and its relation to disease activity.
Material and methods
Sixty-five SLE patients were recruited from Kasr Alainy outpatient clinic from October 2017 to December 2017 in a cross-sectional study. Data were collected using a structured interview questionnaire including inquiry about the socioeconomic status, nutritional status using anthropometric measurements, semi-quantitative food frequency questionnaires (FFQ), and hemoglobin level measurement. Disease activity level was assessed using SLE disease activity index (SLE-DAI).
Results
The median age of the enrolled female patients was 30.0 (24.0–37.0), with median disease duration of 3.0 years (1.0–9.0). BMI assessment revealed that more than three quarters of SLE patients were overweight and obese. The semi-quantitative FFQ revealed a decreased consumption of fresh fruit, vegetables, milk and other dairy products and an increased intake of fats and oils. Disease activity (SLE-DAI) correlated with increased BMI (r=0.299, p=0.016), body weight (r=0.276, p=0.026), and disease duration (r=0.246, p=0.049).
Conclusions
Inadequate nutrient intake and the high percentage of overweight and obesity among SLE patients with excessive consumption of lipids and low intake of fibers were revealed. Also, disease activity (SLE-DAI) correlated with increased BMI.
Resumen
Introducción
El estado nutricional y los hábitos alimenticios poco saludables pueden influir en el curso y la actividad del lupus eritematoso sistémico (LES).
Objetivos
Este trabajo tuvo como objetivo determinar el estado nutricional y la ingesta dietética de los pacientes con LES y su relación con la actividad de la enfermedad.
Material y métodos
Se reclutaron 65 pacientes con LES de la clínica ambulatoria de Kasr Alainy desde octubre de 2017 hasta diciembre de 2017 en un estudio transversal. Los datos se recopilaron mediante un cuestionario de entrevista estructurada que incluía una investigación sobre el estado socioeconómico, el estado nutricional mediante mediciones antropométricas, los cuestionarios de frecuencia de alimentos semicuantitativos (FFQ) y la medición del nivel de hemoglobina. El nivel de actividad de la enfermedad se evaluó utilizando el índice de actividad de la enfermedad del LES (LES-DAI).
Resultados
La mediana de edad de las pacientes reclutadas fue de 30,0 (24,0-37,0) años, con una duración media de la enfermedad de 3,0 años (1,0-9,0). La evaluación del índice de masa corporal (IMC) reveló que más de las tres cuartas partes de las pacientes con LES tenían sobrepeso y eran obesas. La FFQ semicuantitativa reveló una disminución del consumo de frutas frescas, verduras, leche y otros productos lácteos, y una mayor ingesta de grasas y aceites. El índice del LES-DAI se correlacionó con un aumento del IMC (r=0,299; p=0,016), peso corporal (r=0,276; p=0,026) y duración de la enfermedad (r=0,246; p=0,049).
Conclusiones
Se reveló una ingesta inadecuada de nutrientes y el alto porcentaje de sobrepeso y obesidad entre los pacientes con LES con un consumo excesivo de lípidos y una baja ingesta de fibras. Además, la actividad de la enfermedad (LES-DAI) se correlacionó con un aumento del IMC.

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, Frank, Tahvi D., Carter Austin, Jahagirdar Deepa, Biehl Molly H., Douwes-Schultz Dirk, Larson Samantha Leigh, Arora Megha, Dwyer-Lindgren Laura, Steuben Krista M., Abbastabar Hedayat, et al. , The Lancet HIVThe Lancet HIV, 2019, Volume 6, Issue 12, p.e831 - e859, (2019) AbstractWebsite

BackgroundUnderstanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980?2017 and forecast these estimates to 2030 for 195 countries and territories.BackgroundUnderstanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980?2017 and forecast these estimates to 2030 for 195 countries and territories.

Formula Feeding and Associated Factors among a Group of Egyptian Mothers., Tawfik, Safaa, Saied Dina, Mostafa Ola, Salem Marwa, and Habib Eman , Open access Macedonian journal of medical sciences, Volume 7, Issue 11, p.1854-1859, (2019) Abstract

BACKGROUND: Breastfeeding provides an unequalled way of infant nutrition, despite that, the rate of exclusive breastfeeding for the first 6 months in Egypt is only 13%, and the rates of artificial feeding are rising.

AIM: The current study aimed to explore the reasons for the use of artificial feeding among mothers receiving subsidised milk from formula dispensing centres in Egypt, and to detect the reasons behind the use of a formula only for infant feeding rather than mixed breastfeeding and artificial feeding.

METHODS: This exploratory cross-sectional study involved 197 mothers; who attended centres for dispensing subsidised artificial formula at primary health care facilities (PHC) in El-Fayom and Ismailia governorates via a purposive sampling technique. The study spanned over 6-months duration from June till December 2018.

RESULTS: A statistically significant higher percentage of artificial feeding only was noticed in male infants (47.5% in the AF group only versus 28.7% in the mixed feeding group (p = 0.018), and infants aged 6-12 months (47.5% in the AF group only versus 28.7% in the mixed feeding group, p = 0.032). A statistically significant higher percentage of artificial feeding only was noticed among infants born to mothers who have general anaesthesia during labour (67.2% in the AF group only versus 41.9% in the mixed feeding group, p = 0.004), and among infants born to mothers who think that formula feeding is better (13.1% in the AF group only versus 0.7% in the mixed feeding group, or that formula has a similar quality to breast milk (6.6%% in the AF group only versus 4.4% in the mixed feeding group, p = 0.0004. The most common reasons for formula feeding reported by both groups were perceived breast milk insufficiency (60.9%), weak babies (50.3%), and doctors' advice (37%). Previous negative breastfeeding experience and the need for own body privacy were the two reasons which differed statistically in both groups p = 0.004 and 0.008, respectively.

CONCLUSION: Antenatal care education is essential to improve mothers' knowledge and practice of breastfeeding. Baby-friendly hospital initiative implementation is essential to ensure early initiation and continuation of breastfeeding.

Impact of implementation of a modified World Health Organization multimodal hand hygiene strategy in a university teaching hospital., Yousef, Reham H. A., Salem Marwa Rashad, and Mahmoud Ahmed Taher , American journal of infection control, Volume 48, Issue 3, p.249-254, (2020) Abstract

BACKGROUND: Although educational programs could enhance knowledge, practices, and compliance with hand hygiene (HH) for health care workers, the researches focusing on effective methods for educating and increasing the compliance with HH practices are scanty. Consequently, the researchers conducted the present study to assess HH-related knowledge, attitude, and compliance rate after the implementation of a modified version of the World Health Organization (WHO) multimodal strategy was written in the background.

METHODS: A pretest-posttest quasiexperimental study was conducted in a university hospital in Cairo among 84 nurses. The study consisted of 4 phases: baseline assessment, intervention, postintervention assessment, and follow-up phase. The intervention (HH-campaign) consisted of 4 components: infrastructure change, training/education of health care workers, posting visual reminders, and development of institutional safety climate "hand hygiene champions."

RESULTS: HH compliance rate significantly increased from 28% before the intervention to 50% after the intervention and 58% after the follow-up period (P < .001). The knowledge score and the attitude score significantly improved before and after the intervention (P < .001). The use of alcohol handrub significantly increased from 9.5% before the intervention to 65% after the intervention and 76% after the follow-up period.

CONCLUSIONS: Implementation of a modified version of the World Health Organization multimodal strategy successfully doubled HH compliance rates. Tackling a social way of thinking together with regular frequent training and follow-up are essential to sustain adherence to safe HH practices.

Perceived Risk of Cervical Cancer and Barriers to Screening among Secondary School Female Teachers in Al Hassa, Saudi Arabia, Salem, Marwa Rashad, Amin Tarek Tawfik, Alhulaybi Abdulhamid Abdulrahman, Althafar Abdulaziz Sami, and Abdelhai Rehab Ahmed , Asian Pacific journal of cancer prevention : APJCP, 2017 04 01, Volume 18, Issue 4, p.969-979, (2017) Abstract

Background: No previous studies had addressed the perceived risk of cervical cancer (CC) and its influence on
screening practices and perceived barriers in Saudi Arabia. Methods: This cross-sectional study was conducted on 506
randomly selected Saudi female secondary school teachers in Al Hassa, Saudi Arabia to assess their level of knowledge
about risk factors and signs of CC in relation to perceived risk and to characterize CC screening compliance using a
self-administered questionnaire. Results: Of the included female Saudi teachers, 65.4% and 63.4% were considered
less-knowledgeable about CC risk factors and early signs and symptoms respectively. Only 17.2% reported being
previously examined for CC. The majority of participants perceived themselves to be at an average or below average
risk of CC. Residing in urban areas was the strongest predictor of CC screening (Odds ratio ‘OR’= 3.39; 95% confidence
intervals ‘CI= 1.76-6.46; P=0.001). Awareness of risk factors was significantly associated with higher awareness of
signs of CC (OR 2.5; 95% CI=, P=0.001). Exploratory factor analysis showed that personal fears (of screening being
embarrassing) was the major factor that hindered CC screening with a high loading eigenvalue of 4.392, explaining
30.8% of the barriers toward utilization, followed by health care related factors. Conclusion: Secondary school teachers
in Al Hassa, Saudi Arabia showed low perceived risk, poor awareness about risk factors, signs and symptoms of CC
and limited uptake of screening practices. This underlines the need for education programs on CC targeting this group.

Health care providers' perspectives for providing quality infection control measures at the neonatal intensive care unit, Cairo University Hospital., Salem, Marwa Rashad, and Youssef Meray Rene L. , American journal of infection control, 2017 Sep 01, Volume 45, Issue 9, p.e99-e102, (2017) Abstract

BACKGROUND: Health care-associated infections are one of the major causes of morbidity and mortality in neonatal intensive care units (NICUs). This study identified health care providers' perspectives for providing quality infection control measures at a NICU.

METHODS: A qualitative approach was adopted. Participants were selected via a purposive sampling technique. The study group was composed of 3 medical staff who held leadership positions and 10 nurses working in the NICU at Cairo University Hospital. Data were collected using semi-structured interviews.

RESULTS: Responses were analyzed using a thematic content analysis. The priorities identified by thematic analysis were suggestions and barriers for providing quality infection control measures, from the perspectives of health care providers. All interviewees cited shortage in staffing, especially nurses, lack of time to apply infection control standards, limited opportunities for infection control training, and work overload as the main barriers. All interviewees recommended on-going training and the introduction of audiovisual aids and case study approaches.

CONCLUSIONS: Lack of time to apply infection control standards, limited opportunities for infection control training, and work overload are the most commonly perceived barriers. The current infection control system in the NICU is likely to remain ineffective unless these underlying barriers are adequately addressed.

Infection with gram-negative bacteria among children in a tertiary pediatric hospital in Egypt., Labib, John Rene, Ibrahim Sally K., Salem Marwa Rashad, Youssef Meray Rene L., and Meligy Basant , American journal of infection control, 2018 Jul, Volume 46, Issue 7, p.798-801, (2018) Abstract

BACKGROUND: Patients in pediatric intensive care units (PICUs) are susceptible to infections with gram-negative bacteria (GNB).

METHODS: A prospective observational study was conducted in 2 PICUs at Cairo University Hospitals to determine the incidence and outcome of GNB infections over 1 year. Variables of interest included age, gender, isolated organism, susceptibility to antibiotics, and final outcome.

RESULTS: During the study period, 1420 patients were admitted to the PICU; of these, 291 developed GNB infections. The median age of the studied GNB patients was 50 months (interquartile range [IQR], 22-80 months). The mortality rate was 37.1%. Organisms were isolated from blood in the majority (86.6%) of patients, with Klebsiella (36.0%) being the most frequently isolated organism. Among patients with GNB infection, 235 patients, one had a multidrug-resistant (MDR) infection. The length of hospital stay was statistically significantly longer in the MDR group (25 days; IQR, 20-30) than in the non-MDR group (15 days; IQR, 10-20) (P < .01). Mortality was similar in both groups (37.4% vs 35.7% in the MDR and non-MDR groups, respectively; P = .88).

CONCLUSION: This study highlights high rates of pediatric MDR-GNB infections and emphasizes the need for a continuous surveillance system in the management of these critically ill children.

Diagnostic indicator of acute lung injury for pediatric critically ill patients at a tertiary pediatric hospital., Labib, John Rene, Ibrahem Sally Kamal, Sleem Hala Mohamed, Ismail Mohamed M., Abd El Fatah Shaimaa A. M., Salem Marwa Rashad, Abdelaal Amaal A., and Al-Hanafi Hadeel , Medicine, 2018 Mar, Volume 97, Issue 10, p.e9929, (2018) Abstract

Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months. Total of 68 pediatric patients following inclusion criteria were classified into: patients with ALI; with both ALI and sepsis; with sepsis and control patients. They were prospectively followed and their laboratory and immunological workup (at days 1 and 9) was done to measure serum sRAGE levels and detect (sRAGE) genotypes.The age of the included children ranged from 8 to 84 months. Plasma level of sRAGE was significantly higher in plasma from patients with ALI regardless of associated sepsis. Plasma sRAGE levels were positively correlated with lung injury score. When assessing sRAGE genotypes, TA and TT genotypes were significant in most of the ALI with and without sepsis patients.Monitoring levels of sRAGE and genotypes can significantly affect the survival of ALI children.

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