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© 2022 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd., Half of the global overweight/obese adult population have metabolic-dysfunction-associated fatty liver disease (MAFLD), with prevalence rising, even among non-obese individuals. This increase is observed globally and mostly in low- and low-middleincome countries of Africa, Asia and South America and represents a great worldwide burden on healthcare expenditures. Lifestyle changes and a healthy diet are still the cornerstone in the clinical management of these patients as approved medications are presently lacking.

Background: Febrile convulsion (FC) in under five children is a common presentation in family medicine and pediatric clinics. Lack of parental knowledge regarding FC leads to anxiety and fear and improper management.Objective: To improve parental knowledge and practice regarding febrile convulsions through implementing health educational program.Patients and methods: A quasi experiment, one group pre/post-test study enrolled 300 parents 21-50 years old attended two family health facilities, Menoufia Governorate, Egypt, with their children (aged from birth to six years old). Data were collected through a predesigned questionnaire that included personal and socio-economic status, family history of febrile convulsions or epilepsy, questions about parental beliefs regarding causes of febrile convulsions, knowledge about febrile convulsions and recommended and non-recommended practices for febrile convulsion. Health educational program was implemented and parent's knowledge and practice about febrile convulsions was assessed before and after educational program.Results: Among 300 participants aged from 21-50 years old with a mean age of 31.57 ± 6.98 years, majority of them (85%) and (62%) had unsatisfactory knowledge and appropriate knowledge about home management of FC respectively. There was a statistically significant improvement in the perceptions of the participants regards to the causes of febrile convulsions pre- and post- intervention. There was a statistically significant improvement in the level of knowledge, practice and home management of convulsions before and after education. The mean level of knowledge and practice was statistically significantly higher after intervention.Conclusion: There was significant improvement of parental perception, knowledge and practice regarding FC in preschool children after educational program.

Background: Laparoscopic Cholecystectomy is one of the most common surgical procedures. Quality of life (QOL) is a concept reflecting physical, social, and emotional attitudes. Surgical operation, as a traumatic treatment procedure, could affect QOL of the patients as well as treating them. Therefore, surgeons should try their best to improve patient’s QOL in addition to focus on the more traditional outcomes of mortality, morbidity, and laboratory findings. Objectives: The aims of the current work were to determine risk factors for calcular cholecystitis and assess the determinants of quality of life after laparoscopic cholecystectomy. Patients and methods: This cross-sectional study included a total of 200 patients prepared for laparoscopic cholecystectomy, attending at Department of Surgery, Menoufia University Hospital, Egypt. Patients were first introduced and consented for the study at the surgery outpatients’ clinics during the preoperative settings and guided to fill out the chosen questionnaires and filling out other important information. Patients’ understanding and readiness to fill out the questionnaire without help were assessed. Assistance was offered accordingly. Results: The demographic of the studied population shows predominant female distribution which was about three times their fellow Males. Mean age was 43 years. Presence of comorbidity in 41.5% of patients. There was a statistically significant difference between the preoperative scores and 3 months postoperative in all domains as the total score of Gastrointestinal Quality of Life index (GIQLI) improved by about ten points. Conclusion: It could be concluded thatwith no doubt laparoscopic cholecystectomy positively affected the Quality of life. Patients subjectively had significant improvement of their symptoms. Some social determinants can predict postoperative outcomes.

Background: Acne is a common chronic inflammatory disease of the skin. Vitamin-D is fat soluble vitamin with immunomodulatory function, its deficiency has been noticed in various skin diseases. Objectives: assess frequency of serum vitamin-D deficiency among acne vulgaris patients and the effect of vitamin-D supplementation on acne grading. Method: the study was conducted on two phases, phase I was a cross-sectional study included measuring serum vitamin D level for 80 acne patients attending dermatology clinic at Menoufia University Hospital. Phase II was case control study where studied acne patients with vitamin-D deficiency (66 patients) were randomly divided into two groups; one group (33 patients) were treated with free Oral vitamin-D 2000IU/ tablet for 2 months in addition to regular acne treatment. The other group (33 patients) received traditional treatment for acne without vitamin-D supplementation and both groups were followed up clinically for two months. Results: frequency of vitamin-D deficiency among studied patients was 82.5%, there was statistically significant relationship between vitamin-D deficiency and severity of acne. Vitamin-D deficiency is significantly prevalent among female patients (98.4%). There was significant improvement in acne grading after vitamin-D supplementation Conclusion and recommendation: There’s significant relation between vitamin-D deficiency and severity of acne vulgaris and vitamin -D has a good role in management of acne. So. It is recommended to evaluate the serum level of vitamin D in acne patients and provide vitamin D supplementation to vitamin D deficient patients beside topical treatments for acne.

Background: Patient-doctor relationship and patient satisfaction are important engines that improve patient compliance and hence the health outcome. There are widely used instruments to measure patient-doctor relationship and patient satisfaction for primary health care purposes. Researchers lack a validated Arabic instrument that is tailored to the Arab population. So, it is important to translate and validate Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18) questionnaires into the Arabic language. Objectives: Is therefore to develop, evaluate, and validate a self-reported measure of Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18). Subject and Method: The Arabic version of PDRQ-9 and the PSQ-18 was translated from the English one with back to back translation. They were pilot tested statistically to ensure the psychometric properties (reliability and validity) and the appropriateness for the adult participants in the Arab countries. The Arabic questionnaires were administered to 434 adult participant attending primary health care facilities and hospitals in Suez Governorate, Egypt. Results: Exploratory factor analysis suggested two factors, comprising of 27 items in total. Good model fit was demonstrated through confirmatory factor analysis, with measurement invariance analyses demonstrating equivalent factor structures across. Internal consistency for the PDRQ-9 ranged between (α= 0.981-0.975) for the total scores and that for PSQ-18 ranged between (α = 0.986-0.984). Conclusion: Initial testing of the Arabic versions of the PDRQ-9 and PSQ-18 suggests that these questionnaires have satisfactory psychometric properties.

COVID-19 has become a major global public health threat. It started from Wuhan a province of China in December 2019 and has spread in every country of the globe with over 100 million people currently infected and over three million deaths as of May 2021. Nearly a year on, with many town and cities are in lockdown and with all public health measures to minimize transmission of the virus SARS-COV-2 and the scientific achievements with many vaccines developed in record time, the transmission in the second wave is still strong with new variants of the virus emerging. The pandemic has caused a serious impact on the economic, social, political, and cultural dynamics of people, globally. The majority of people with mild and moderate symptoms of COVID-19 seek primary care (PC) service as the entry point for getting medical intervention, reducing flow to hospital care. Currently, primary care settings are facing major challenges including lack of funds, poor infrastructure in some countries, and shortage of health care workers and equipment. Most, if not all primary care centers are not designed to separate people with the virus. The pandemic so far shows that strengthening primary care as the first point of contact with the health system is vital. The health systems of the future cannot be resilient without strong primary care for all, capable of meeting population health needs and aspiration for good health and well-being. [ABSTRACT FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Early marriage is a violation of the basic human rights and is considered a public health problem. It has a profound range of physical, intellectual, psychological and social consequences on the teenager girls and their future children. Objectives: The current study aimed to assess the prevalence of early marriage and the associated social and health hazard. Methods: A cross-sectional study was conducted among 1080 married women in the most deprived areas in Menoufia Governorate. All women were interviewed personally using a structured valid reliable Arabic questionnaire. It assessed the socio-demographic characteristics of the participants and their husbands, the socioeconomic state, social and health hazards of early marriage. Results: About 48% of women were married before the age of 18 years. The early marriage was significantly higher among illiterate women (59.9%), those who were housewives (99.1%), and married to illiterate husbands (48%). The main social hazards among the early married group were the conflicts with the husband’s family and isolation of women from her family. While anemia and recurrent chest problems were the main health hazards among their first child. Conclusion: Early marriage has a wide prevalence in the selected areas. It was more prevalent among low-educated women, housewives, and married to low-educated husbands. It is continued to cause different social and health consequences for women and their children. Early marriage is a prevailing problem that needs a plan of action to be implemented with the support of the policymakers.

Background: Smoking is a public health problem with a rising prevalence. A large percentage of smokers start smoking during adolescence, affecting their school achievement. Objectives: The current study is aiming to 1. Assess prevalence of smoking among school students in an Egyptian rural area.2. Identify different types of smoking among them. 3. Identify the causes of being smoking an issue of concern. Methods: the study was a cross sectional study in which sample size was calculated and three hundred students (in the academic year 20162017) were randomly selected from Monshaat Sultan preparatory and secondary school students and proportionally allocated. A predesigned questionnaire was used to determine socioeconomic status of them, pattern and condition of smoking among them. Children`s scores were revised in school records.Results: Prevalence of smoking among adolescent students was 14%, about 52% of them were secondary school students, and 44.2 % of them were incorporated in work. Smoking substances among smokers were cigarettes (86%) followed by hashish (4.7%) & St-El hosn (4.7%). Mean scholastic achievement among smoking students was (2.11±0.87) compared to (3.37±0.49) among non-smokers and lastly the frequency of smoking among working children was high as bout (78%) of daily smokers were working. Conclusion: This study concluded that smoking among adolescents is an issue of concern due to its prevalence, which was 14% in an Egyptian rural area also due to its drawbacks on scholastic achievements of smoking children who were incorporated in child work to get money for buying cigarettes.

Chronic occupational exposure to organophosphorus pesticides (OPs) is consistently associated with deficits on behavioral tests when compared to unexposed comparison groups. However, a dose-response relationship has yet to be established, leading some to doubt an association between occupational OP exposure and behavioral deficits. Pesticide application teams in Egypt who are primarily exposed to one OP, chlorpyrifos (CPF), were recruited into a field assessment. Trail Making A and the more challenging Trail Making B tests were administered to 54 engineers (who supervise the pesticide application process, usually from the side of the field), 59 technicians (who guide the pesticide applicators in the field), 31 applicators (who mix and apply pesticides using knapsack sprayers), and 150 controls (who did not work in the fields) at two different times during the OP application season as well as immediately after applications had ended and 1.5 months later. All participants were males since only males work on pesticide application teams in Egypt. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of CPF, confirmed the pattern of lower to higher CPF exposures from engineers to technicians to applicators, and these were all greater than urinary metabolite levels in controls. A consistent relationship between job title and performance speed on the behavioral task was observed: Controls had the best (fastest) performance on Trail Making A and B tests throughout the application season, and applicators had significantly slower performance than engineers on Trail Making A (p = 0.015) and B (p = 0.003). However, individual urinary TCPy, blood acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) levels did not predict individual performance. This study identifies a dose-related effect based on job title, which serves as a surrogate for chronic exposure in that differing job titles exhibit varying group exposure levels. The results establish that chronic occupational exposure to chlorpyrifos is neurotoxic and suggest that the classic biomarkers of recent CPF exposure are not predictive of chronic exposure effects.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.

Objectives Acute rhinosinusitis (ARS) is a common pediatric problem. Our aim was to determine the efficacy of normal nasal saline irrigation (NSI) with or without amoxicillin in treatment of acute rhinosinusitis (ARS) in children. Methods It is a prospective randomized, blind placebo-controlled trial. Children with uncomplicated ARS were recruited. One group received (amoxacillin 100 mg/kg/day) and 0.9% NSI. The second group received placebo and 0.9% NSI. The primary outcome was the effect of treatment on clinical response. Secondary outcomes included: Rating of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), middle meatus (MM) bacteriological and cytological cellular responses and adverse effects. Results Sixty two patients with ARS were eligible for the study. In amoxicillin group (31 patients); clinical cure was observed in 26 (83.9%) in comparison to 22 (71%) patients in NSI without antibiotics group (31 patients) (p = 0.22). No differences between both groups in the reported nasal symptom scores and total symptoms scores improvements at day 7 (p = 0.09 and 0.65) and day 14 (p = 0.29 and 0.14), respectively. The mean total PRQLQ values had no differences between both groups after the 2 weeks of treatment (p = 0.06). At day 7, MM neutrophils reduced significantly in amoxicillin group in comparison to placebo group (p = 0.004). At day 14, the MM cytological content had no differences between both groups (p = 0.07). Normal NSI with placebo has less reported adverse effects than amoxicillin and nasal saline irrigations (p = 0.005). Conclusions NSI can be used alone with the same clinical, bacteriological and cytological cellular changes efficacy and with higher safety profile than amoxicillin after 14 days of treatment in uncomplicated clinically diagnosed ARS in children.

Objective The objective of this study was to assess the quality of diarrheal management practice and its relation to the sociodemographic characteristics of under-5-year-old children's caregivers. Background Diarrhea among under-5-year-oldchildren is a serious public health problem in many developing countries, including Egypt. Adequate diarrhea management approaches including the increased use of oral rehydration solution (ORS), extra fluid intake, and continued feeding are cost-effective in reducing the child mortality associated with diarrhea and the overall burden of the disease. Patients and methods A cross-sectional study was conducted on 100 under-5-year-oldchildren's caregivers in Munshaat Sultan village. All the studied children were evaluated through a questionnaire that involved questions about the history of diarrhea within two weeks before the interview, sociodemographic characteristics, and questions to classify the quality of diarrheal management practices into good, fair, or poor on the basis of mothers' reports for children with diarrhea, using WHO/United Nations International Children's Emergency Fund recommendations for appropriate treatment. Results Good diarrhea management practice was present among 36% of caregivers. About 24, 3, and 1% of children were given ORS and continued feeding, continued feeding and extra fluids, and ORS and extra fluids, respectively. There was a statistically significant difference between the quality of diarrheal management practice and mother's education, number of children in the family, socioeconomic standard, and child age. Children were given ORS, antibiotic, antidiarrheal medicine, and zinc in 43, 67, 52, and 21%, respectively. Conclusion Too many children are not receiving adequate management for diarrhea. Hence, the efforts should be increased to improve the quality of care for childhood diarrhea in both health facilities and at the community level.

AimTo explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation.BackgroundResearch is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries.MethodsAn online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region.FindingsSeventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research.ConclusionAlthough many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

BackgroundThe health sector has always relied on technologies. According to World Health Organization, they form the backbone of the services to prevent, diagnose, and treat illness and disease. It is increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.Aim of the studyThis was to assess the current situation of information and communication technologies (ICTs) in primary healthcare in the terms of describing and classifying the existing work, identify gaps and exploring the personal experiences and the challenges of ICTs application in the primary healthcare.Subjects and methodsA mixed research method in the form of sequential explanatory design was applied. In the quantitative phase a cross-sectional study was conducted among 172 family physicians using a predesigned questionnaire. Followed by qualitative data collection among 35 participants through focused group discussions.ResultsNearly half of the physicians have ICTs in their work and they were trained on it. None of them developed a community-based research using ICTs technology. Training on ICTs showed a statistically significant difference regarding the availability and the type of ICTs present in the workplace (PConclusionsICTs resources are underutilized by health information professionals. Lack of funds, risk of instability of the electric supply and lack of incentives for ICTs users were the most common barriers to ICTs implementation thus a steady steps toward budget allocation and continuous training is needed.

Background: The use of computer and internet is increasing day after day. It can lead to a state that appears to be as disorder with wide range of definitions and diagnosis as problematic, pathological internet using up to internet addiction. The purpose of this study: was to estimate the prevalence and risk factors of Pathological internet use among Menoufia medical students and effect on their academic achievement. Method: Case control study nested in cross sectional study was conducted. The estimated sample was 369 students. Predesigned questionnaire used including socioeconomic status, validated twenty questions Young scale to assess the condition of internet using in the last six months, risk factor and the previous students' year result. Result: About 48.5% of students were included in pathological internet user. The main causes for internet using were chatting and games 43.1%. Risk factors were being males, from urban area, middle and high socioeconomic status, availability of internet at home, private laptop and private android mobile were. There was significant negative correlation between problematic internet use and academic achievement. The main predictor of pathological internet use in this study was availability of android mobile. Conclusion: The pathological/problematic internet use was prevalent among 48.5% of the studied students however the students with pathological internet use showed significant better academic grade than the other group. Implications and Contribution: There is wide use of internet for studying activities among medical school students. The use of internet for long period may cause variable degrees of dependence on the computer and internet use. So there is need to study the effect of their use on the academic achievement and weight the benefit to the hazards.

Neurobehavioral deficits have been reported in Egyptian pesticide application teams using organophosphorus (OP) pesticides, but whether these effects are related to OP pesticide exposures has yet to be established. In preparation for a comprehensive study of the relationship between OP pesticide dose and neurobehavioral deficits, we assessed exposure within this population. We conducted occupational surveys and workplace observations, and collected air, dermal patch and biological samples from applicators, technicians and engineers involved in chlorpyrifos applications during cotton production to test the hypotheses that: (1) dermal exposure was an important contributor to internal dose and varied across body regions; and (2) substantial differences would be seen across the three job categories. Applicators were substantially younger and had shorter exposure histories than did technicians and engineers. Applicators and technicians were observed to have relatively high levels of skin or clothing contact with pesticide-treated foliage as they walked through the fields. Both dermal patch loadings of chlorpyrifos and measurements of a chlorpyrifos-specific metabolite (TCPy) in urine confirmed substantial exposure to and skin absorption of chlorpyrifos that varied according to job category; and dermal patch loading was significantly higher on the thighs than on the forearms. These findings support our hypotheses and support the need for research to examine neurobehavioral performance and exposures in this population. More importantly, the exposures reported here are sufficiently high to recommend urgent changes in work practices amongst these workers.

PurposeThis study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students.MethodA total of 555 children (6–12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools.ResultsThe screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice.ConclusionsThe prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Objective The aim of this study was to determine the risk factors of maternal depression and/or anxiety among women attending the primary health care facilities in El-Fayum city. Background Women suffering from depression and/or anxiety during pregnancy are at an increased risk for postpartum depression throughout the perinatal period. Patients and methods This study was a nested case-control cross-sectional survey conducted among women attending primary health care centers in El-Fayum city. Results The strongest risk factors of maternal depression and/or anxiety were presence of previous history of psychiatric illness (including antenatal and postnatal depression) to the woman or one of her family members, stressful life events or physical problems during pregnancy and early postpartum, and low levels of social support. History of abortion or miscarriage showed statistically significant results and was considered as an important risk factor (52% of the depressed cases had a previous history of abortion in comparison with controls). Logistic regression analysis was used to determine significant risk factors of maternal depression where the main risk factors for maternal depression and/or anxiety were history of abortion or miscarriage (odds ratio 4.1) and history of previous psychiatric illness (odds ratio 2.7) (including antenatal depression and postnatal depression). Conclusion Investigating perinatal stress and depression and identification of risk factors of these conditions may reduce the risk for postpartum chronic anxiety or undiagnosed depression.

Background: Culturally appropriate educational intervention was developed and directed towards agricultural families to improve knowledge and practice of agricultural families in order to protect their children from exposure to pesticides. Methods: Parents [n=297] were randomly assigned into either lecture or video training group. Ability to recall information or improve practices among parents was evaluated in 3 consecutive sessions [2 weeks and 1 month apart]. Results: All participating families were using pesticides inside homes and in the fields. All families were using space insect killers inside homes [main ingredients include tetramethrin, sumithrin, pyrethrin, and piperonyl butoxide] in different forms. Pesticides applied in the field are organophosphates [57.9%], carbamates [41.4%], and pyrethroids [28.5%]. In both lecture and video training groups, knowledge scores of participants improved significantly in the second and third sessions, as compared to the first session. Although practice scores of both groups improved in subsequent sessions, the changes were not significant. Discussion: Using non-traditional appropriately designed educational interventions that depend more on visual memory is more likely to ensure sustainability of the gained knowledge as well as practice.

Aims: To identify neurobehavioural deficits among workers exposed to organophosphorous (OP) pesticides in their occupation. Methods: This study was conducted during the period when pesticides were applied to cotton crops in the fields in Menoufiya Governorate, Egypt. Fifty two occupationally exposed male workers were compared to 50 unexposed male controls who were similar in age, socioeconomic class, and years of education (⩾12 years). All participants completed a questionnaire (assessing personal, occupational, and medical histories), general and neurological clinical examination, neurobehavioural test battery (including tests for verbal abstraction, problem solving, attention, memory, and visuomotor speed), personality assessment, and serological analysis for serum acetylcholinesterase. Results: After correcting for confounders of age and education, the exposed participants exhibited significantly lower performance than controls on six neurobehavioural tests (Similarities, Digit Symbol, Trailmaking part A and B, Letter Cancellation, Digit Span, and Benton Visual Retention). A longer duration of work with pesticides was associated with lower performance on most neurobehavioural tests after adjusting for multiple comparisons. Although serum acetylcholinesterase was significantly lower in the exposed than the control participants, it was not significantly correlated with either neurobehavioural performance or neurological abnormalities. Conclusions: Occupational exposure to OP pesticides was associated with deficits in a wider array of neurobehavioural functions than previously reported, perhaps because of higher exposure in this population. Moderate chronic OP exposure may not only affect visuomotor speed as reported previously, but also verbal abstraction, attention, and memory.

Objectives The objective of this study was to study the prevalence of stunted growth in children under 5 years of age (in primary healthcare) in a rural area, in Qualyoubia governorate. Background Stunting remains an important problem in Egypt, where ∼ one-third of children under 5 years of age are affected. Patients and methods This is a cross-sectional study that was conducted on 1255 cases. All studied children were subjected to history taking, complete physical examination [height (cm), length (cm), weight (kg)], and laboratory investigations (measurement of hemoglobin level). Then, the stunting group was compared with the control group regarding their different characteristics according to national Egyptian growth chart. Results The prevalence of stunted growth in children under 5 years of age was 13.32%; stunted growth was significantly associated with age of children (stunting was more in children aged

Background Disruptive behavior disorders (DBDs) are psychiatric disorders of children and adolescents, including oppositional defiant disorder (ODD) and conduct disorder (CD). It is associated with an increased risk for negative developmental outcomes including substance abuse, school problems, and antisocial or criminal violence. Objective The objective of this study was to assess the prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, its types, and its risk factors. Participants and methods A cross-sectional study was conducted on 348 basic-learning schoolchildren and their parents, as well as their teachers. Children were subjected to mini-kids interview for diagnosis of DBDs and then 'Parenting Manner Scale' for the detection of parenting style. Parents and teachers rated the child's behavior at home and school, respectively, during the past 6 months. Parents were subjected to the socioeconomic status scale. Results Prevalence of DBDs was 14.9%. The prevalence of ODD and CD was 8 and 6.9%, respectively. Mean age was significantly lower among patients (11.69 ± 1.6), with male sex predominance (69.2%). Low socioeconomic level (67.3%), interparental conflicts (36.5%), single parent (51.9%), and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases. Overprotection (28.8 and 28.8%), discrimination between siblings (28.8 and 28.8%), and authoritarian parenting styles (17.3 and 19.2%), were significantly more prevalent among cases. Conclusion Prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt, was 14.9%. Its types were ODD and CD represented by 8 and 6.9%, respectively. Risk factors for DBDs among the studied group were low socioeconomic status, low parental education, father smoking, parental conflicts, family history of neuropsychiatric disorders, and bad parental styles among fathers and mothers (overprotection, discrimination, authoritarian, and hesitancy).

Objective The objective of this study was to evaluate the compliance to congenital hypothyroidism (CH) therapy and the effect of noncompliance on the physical and mental development. Background CH is the most common preventable cause of mental retardation in children. Early treatment and high compliance are important prognostic factors for mental and physical development in children with CH. Patients and methods A prospective study design was conducted in the Endocrinology Outpatient Clinics in Sharkia Governorate health insurance center. The participants were 120 newborns and infants with CH and their mothers (patients), and 120 age-matched volunteers of healthy infants and children and their mothers (control). Data were collected using multistructured questionnaires for determining the socioeconomic state, clinical picture, personal, family and obstetric history, and Morisky Medication Adherence Scale (MMAS 8) to assess compliance. Assessment of physical growth was carried out through anthropometric measurements and assessment of mental development was conducted using Vineland-II scale for infants below 2 years and using Stanford–Binet 5 Intelligence scales for individuals of 2 years and older. Review of the results of investigations at diagnosis and during the follow-up visits are provided. Results Two-thirds of the patient families were highly compliant. There was a very high significant difference between different compliance grades and between patients and control groups as regards the parameters of mental and physical development. No significant difference was found between the highly compliant cases and control. Conclusion Compliance to therapy in our patients and/or their family was reasonable. High compliance to treatment was an important prognostic factor for normal mental and physical development in patients with CH.

Background Sexual harassment (SH) of students has recently become a topic of interest to researchers and the general public alike. Although numerous studies document its frequency, the development of conceptual models identifying the prevalence and consequences of harassment has proceeded at a slower pace. Objectives The study aimed at studying the prevalence of SH among female students of Menoufia University and its effects. Patients and methods A cross-sectional study was carried out on 1940 female university students (972 students in practical faculties and 968 students in theoretical ones), over a period of 7 months, between 15 March to 30 October 2015. The interview sites included classes of Menoufia University. Results The study shows the effectiveness of community-based targeted questionnaires in identifying SH among 1940 female university students. The prevalence of SH was 65.3% among the total studied number (64.6% in practical faculties and 65.9% among theoretical ones) (P = 0.548). The prevalence of different types of SH was as follows: verbal type, 76.5%; following, 12.8%; touching, 20.3%; and physical violence, 1.1%. A number of risk factors were behind exposure to SH, such as wearing tight clothes (odds ratio = 2.88, 2.01–4.11) and wearing hot colors (odds ratio = 2.11, 1.65–2.70). The effects of SH were as follows: feeling insecure (56.7%), depression (25.0%), self- reproach (15%), revenge desire (9.3), and denial (8.9%). Conclusion SH is prevalent in Menoufia Governorate with many serious effects.

Objective This study aimed to assess the risk factors for erectile dysfunction (ED) and the sociodemographic characteristics of patients with ED in Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital. Background ED is a common disorder that affects the quality of life (QoL) of millions of people worldwide. Numerous factors can disrupt erectile function – for example, age, smoking, cardiovascular disease, and diabetes mellitus (DM). Patients and methods This was a cross-sectional study that was conducted on 169 patients with ED from Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital during the period 1 December 2015 to 31 May 2016. Information on sociodemographic data, risk factors for ED, and effect of ED on QoL was collected using self-administered questionnaires: a sociodemographic questionnaire, the International Index of Erectile Dysfunction (IIEF) questionnaire, a risk factors questionnaire, and the shorter version of the World Health Organization Quality of Life questionnaire. Results The main sociodemographic characteristics affecting ED were age of the patient (P = 0.001) and age of the patient's wife (P = 0.0001). The main risk factors for ED were lifestyle risk factors such as smoking (P = 0.000) and obesity (P = 0.005), medical conditions such as DM (P = 0.0001), hypertension (P = 0.0002), heart disease (P = 0.019), dyslipidemia (P = 0.013), lower urinary tract symptoms (P = 0.005), and hypogonadism (P = 0.004), intake of drugs (β-blockers (P = 0.000), insulin (P = 0.016), psychiatric drugs (P = 0.006), and silymarin (P = 0.001)), and penile and pelvis injury (P = 0.032). Pychogenic factor was present in most cases of ED. In patients with ED other domains of IIEF, including orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (89.7%) were reduced. Also ED negatively affected all domains of QoL. Conclusion According to our results, the main risk factors are aging, cardiovascular disease, DM, dyslipidemia, lifestyle issues (such as smoking and obesity), penile or pelvic injury, and side effects from medication. ED has a significant negative impact on other domains of IIEF and on the QoL.

Chlorpyrifos (CPF) and profenofos (PFF) are organophosphorus (OP) insecticides that are applied seasonally in Egypt to cotton fields. Urinary trichloro-2-pyridinol (TCPy), a specific CPF metabolite, and 4-bromo-2-chlorophenol (BCP), a specific PFF metabolite, are biomarkers of exposure, while inhibition of blood butyrylcholinesterase (BChE) and acetylcholinesterase (AChE) activities are effect biomarkers that may be associated with neurotoxicity. Urinary TCPy and BCP and blood BChE and AChE activities were measured in 37 adult Egyptian Ministry of Agriculture workers during and after 9-17 consecutive days of CPF application followed by an application of PFF (9-11 days), and a second CPF application (5 days) in 2008. During the OP applications, urinary TCPy and BCP levels were significantly higher than baseline levels, remained elevated following the application periods, and were associated with an exposure related inhibition of blood BChE and AChE. Analysis of blood AChE levels before and after the PFF application period suggests that individual workers with peak BCP levels greater than 1000 μg/g creatinine exhibited further inhibition of blood AChE with PFF application, demonstrating that PFF exposure had a negative impact on AChE activity in this highly exposed worker population. While large interindividual differences in exposure were observed throughout this longitudinal study (peak urinary BCP and peak TCPy levels for individuals ranging from 13.4 to 8052 and 16.4 to 30,107 μg/g creatinine, respectively), these urinary biomarkers were highly correlated within workers (r=0.75, p

Pyrethroids are neurotoxic insecticides that exert their effects by prolonging the open time of sodium channels, which increases the duration of neuronal excitation. α-cypermethrin (αCM) is derived from the 8-stereoisomers that together make up the pyrethroid cypermethrin, which is one of the most common pyrethroids being used in agriculture throughout the world. The objective of this study was to characterize the occupational exposure to αCM in a cohort of Egyptian agriculture workers (n=37) before, during and after 6 to 10 consecutive days of application of αCM to cotton fields. Daily spot urine specimens were collected and analyzed by GC-MS NCI for the αCM metabolites 3-phenoxybenzoic acid (3-PBA) and cis-3-(2’,2’-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA). Prior to αCM application, median urinary levels of 3-PBA (4.59 nmol/g creatinine) were greater than cis-DCCA (0.33 nmole/g creatinine) demonstrating low background exposures to pyrethroids. During the application period for αCM, median urinary levels of both biomarkers increased (13.44 nmol 3-PBA/g creatinine and 7.76 nmol cis-DCCA/g creatinine) and ranged from 2.3–93.96 nmol 3-PBA/g creatinine and 0.09–90.94 nmol cis-DCCA/g creatinine, demonstrating that workers had a wide range of exposures to αCM. The data also demonstrate that pesticide applicators had greater exposures to αCM than workers who play a supporting role in the seasonal application of pesticides on the cotton crop. Urinary cis-DCCA and 3-PBA concentrations were elevated at 7–11 days after the cessation of αCM application, compared to baseline levels. This study is the first to use these biomarkers to quantify occupational exposures specifically to αCM. This urinary biomarker data will be useful for estimating daily internal dose, comparing exposures across job categories within the Egyptian pesticide application teams, and for modeling human exposures to αCM.

Background. Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral problem in children. Global variations in diagnostic criteria and rating scales of ADHD either by DSM-IV or ICD 10 may contribute to variations in its prevalence. Objectives. The study was conducted to estimate the prevalence of ADHD and to determine its risk factors. Methodology. A cross-section comparative study was conducted in a randomly selected four primary schools in Menoufia governorate, Egypt. All children after a valid consent of their parents (N. 1362) were subjected to complete history taking, medical and psychological assessment, and IQ estimation. Their parents and teachers were subjected to the corresponding Arabic forms of Conner’s questionnaire. Suspected cases were confirmed and categorized by DSM-IV criteria. The sample was divided into cases and controls to study the risk factors. Results. Prevalence of ADHD was 6.9% and the male : female ratio was 3.5 : 1. The main risk factors were neonatal problems (OR=4.3), family history of psychiatric and medical illnesses (OR=3.5 and 2.8), and male gender (OR=2.9). Conclusion. Prevalence of ADHD among Menoufia school children was 6.9%. Dealing with its risk factors is mandatory for prevention, early management, and better outcome.

Profenofos is a direct acting phosphorothioate organophosphorus (OP) pesticide capable of inhibiting β-esterases such as acetylcholinesterase, butyrylcholinesterase, and carboxylesterase. Profenofos is known to be detoxified to the biologically inactive metabolite, 4-bromo-2-chlorophenol (BCP); however, limited data are available regarding the use of urinary BCP as an exposure biomarker in humans. A pilot study conducted in Egyptian agriculture workers, demonstrated that urinary BCP levels prior to application (3.3–30.0 μg/g creatinine) were elevated to 34.5-3566 μg/g creatinine during the time workers were applying profenofos to cotton fields. Subsequently, the in vitro enzymatic formation of BCP was examined using pooled human liver microsomes and recombinant human cytochrome P-450s (CYPs) incubated with profenofos. Of the nine human CYPs studied, only CYPs 3A4, 2B6, and 2C19 were able to metabolize profenofos to BCP. Kinetic studies indicated that CYP 2C19 has the lowest Km, 0.516 μM followed by 2B6 (Km = 1.02 μM) and 3A4 (Km = 18.9 μM). The Vmax for BCP formation was 47.9, 25.1, and 19.2 nmol/min/nmol CYP for CYP2B6, 2C19, and 3A4, respectively. Intrinsic clearance (Vmax/Km) values of 48.8, 46.9, and 1.02 ml/min/nmol CYP 2C19, 2B6, and 3A4, respectively, indicate that CYP2C19 and CYP2B6 are primarily responsible for the detoxification of profenofos. These findings support the use of urinary BCP as a biomarker of exposure to profenofos in humans and suggest polymorphisms in CYP 2C19 and CYP 2B6 as potential biomarkers of susceptibility.

Objectives The aim of this study was to compare adherence to antihypertensive medication between adult and elderly patients and factors affecting it. Background Poor medication adherence is the most important cause of uncontrolled blood pressure. It is estimated that 50-70% of people do not take their antihypertensive medication as prescribed. Therefore, understanding barriers to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. Literature and methods This was a cross-sectional study conducted in Munshaat Sultan family health center, Menoufia governorate. A total of 120 hypertensive patients who attended the family health clinics during the period of the study were included. They were classified on the basis of age into adult patients aged 21-59 years and elderly patients aged 60 years or older and into adherent and nonadherent on the basis of adherence. A predesigned questionnaire was used to assess their adherence to medication using the Morisky scale and factors affecting it, such as patient, physician, disease, and drug. Results An overall 60.34% of elderly patient were adherent to medication, which was higher compared with adherence among adult patients (29.03%). There was statistically significant difference between the two groups as regards sex, education, and presence of family members helpful in reminding about medication, patients' belief about medication causing addiction, patient satisfaction toward healthcare providers and facility, frequency of drug doses, duration of hypertension, presence of another chronic illness, and hypertension complication. Conclusion In both groups, adherence was higher among patients who were married, patients having family members helpful in reminding medication, those receiving antihypertensive medication once daily, and those who had acceptable waiting time; therefore, interventions enhancing doctor - patient communication and empowering the patient have the potential to improve the adherence of hypertensive patients' medication and can consequently reduce hypertension-related costs.

Objective The aim of this study was to determine the impact of an educational program in terms of the knowledge, attitudes, and practices of organophosphorus (OP) pesticides among women in rural areas. Background OP pesticides are used widely in developing countries despite their known toxicity. Unsafe use of pesticides is common in developing countries. In Egypt, many pesticides are used to control pests in agriculture. Patients and methods A quasi interventional study was carried out that included 40 pregnant women exposed to OP pesticides. The study was carried out during the period from the 1 July 2012 to the end of June 2013. Knowledge, attitudes, and practices of OP pesticide exposure were assessed using a predesigned questionnaire. A postintervention evaluation was carried out after 6 months. Results The mean ΁ SD age of the participants was 26.3 ΁ 3.93 years. The majority of knowledge parameters including source of knowledge, route of entry, symptoms of long-term OP pesticide exposure or toxicity, and parameters related to all attitudes improved significantly after the implementation of a health education program ( P P Conclusion The level of knowledge, attitudes, and practices of OP pesticides were low. The educational sessions improved the level of knowledge, attitudes, and practices among the participants.

Background: Burnout carries a potential negative effect on the individual’s psychological and physical health, as well as an organization’s effectiveness. Therefore, it is recognized worldwide as a major challenge to workers’ health and the functioning of their organizations. Objectives: Determine the prevalence of burnout among physicians in the primary health care facilities and identify the physical predictors of burnout syndrome. Participants & Methods: The study was a cross sectional study conducted on 76 physicians in El Kanater El Kharaia distract PHC units & centers in Qalubia Governorate, Egypt. It was conducted in the context of 10 months. All the participants were interviewed using Maslach burnout inventory. Results: Nearly 66.7% of the general practioners (GPs) had high burnout while only 26.7% of specialists had high burnout. Emotional exhaustion was higher in GPs than family physician and specialist. It was 80.7%, 75% and 46.7% respectively (p value < 0.001). High depersonalization was in GPs resembling 89.5% compared to 50% and 40% in family physician and specialist respectively (p value < 0.001). Nearly two third of the specialists had high personal accomplishment in comparison to 40.3% and 22% in GPs & family physicians. Multivariate regression analysis showed that the most relevant risk factor for burnout was low income and the most relevant physical predictors for burnout were being angry and being hurry (p value < 0.05). Conclusion: Primary care physicians suffer from burnout more than family physicians and specialists. High burnout was prevalent with those under 30 years old and less than 5 years of experience.

Translational research is needed to understand and predict the neurotoxic consequences associated with repeated occupational exposures to organophosphorus pesticides (OPs). In this report, we describe a research strategy for identifying biomarkers of OP neurotoxicity, and we characterize pesticide application workers in Egypt's Menoufia Governorate who serve as our anchor human population for developing a parallel animal model with similar exposures and behavioral deficits and for examining the influence of human polymorphisms in cytochrome P450 (CYP) and paraoxonase 1 (PON1) enzymes on OP metabolism and toxicity. This population has previously been shown to have high occupational exposures and to exhibit a broad range of neurobehavioral deficits. In addition to observational studies of work practices in the field, questionnaires on demographics, lifestyle and work practices were administered to 146 Egyptian pesticide application workers applying pesticides to the cotton crop. Survey results indicated that the application workforce uses standard operating procedures and standardized equipment provided by Egypt's Ministry of Agriculture, which provides a workforce with a stable work history. We also found that few workers report using personal protective equipment (PPE), which likely contributes to the relatively high exposures reported in these application workers. In summary, this population provides a unique opportunity for identifying biomarkers of OP-induced neurotoxicity associated with occupational exposure.

Culturally appropriate educational intervention was developed and directed toward agricultural families to improve knowledge and practice of agricultural families in order to protect their children from exposure to pesticides. Parents ( n = 297) were randomly assigned into either lecture or video training group. Ability to recall information or improve practices among parents was evaluated in three consecutive sessions (2 weeks and 1 month apart). All participating families were using pesticides inside homes and in the fields. All families were using flying insect killers inside homes (main ingredients include tetramethrin, sumithrin, pyrethrin, piperonyl butoxide) in different forms. Pesticides applied in the fields are organophosphates (57.9%), carbamates (41.4%), and pyrethroids (28.5%). In both lecture and video training groups, knowledge scores of participants improved significantly in the second and third sessions, as compared to the first session. Although practice scores of both groups improved in subsequent sessions, the changes were not significant. Using non-traditional appropriately designed educational interventions that depend more on visual memory is more likely to ensure sustainability of the gained knowledge as well as practice.

Objectives The main aim of this study was to improve the referral system. The specific aims were to determine the referral rate, to study its current status as well as to identify the obstacles at family health facilities in Shebein El-Koum District, Menoufia Governorate, Egypt. Background The referral system is a process that ensures accessibility to higher levels of medical care for patients attending the primary healthcare facility. Referral is usually sought to obtain expert professional advice, undergo a diagnostic technique, seek a therapeutic intervention, or receive inpatient care when these are not available at the referring site. The referral system aims to provide efficient, effective, affordable, and equitable community-based healthcare services. For a successful referral, there must be first and foremost geographical access to referral care facilities, referral staff must be trained to provide high-quality care, services must be affordable, and essential drugs, supplies, and equipment must be available. Participants and methods A cross-sectional study was carried out from 1st of March 2011 to the end of April 2013 in all rural and urban family health units/centers (No. 23 and 4, respectively) of Shebein El-Koum District, which was selected randomly to represent Menoufia Governorate, Egypt. All the managers (No. 25), family physicians (No. 125), and nurses (No. 186) at the site of the study were subjected to a predesigned questionnaire for complete assessment of the current status of the referral system. Results The referral rate was significantly higher in urban versus rural areas (16.2 and 11.2%, respectively). The usage of referral letter is the main means of referral; the highest referral rate was among adults and the lowest was among adolescents. There was no significant difference in the referral rate in terms of sex in either urban or rural facilities. Training of the physicians is considered an important factor for quality assurance of the referral system. Conclusion We found that the highest referral rate was found among adults; however, the lowest referral rate was found among adolescents. The rate was high for ENT and Ophthalmology Clinics. Lack of training and availability of means of transportation and absence of feedback were the most common obstacles for the referral process.

Objective The aim of the study was to assess the knowledge and attitude of Menoufia University students toward premarital care (PMC). Background PMC is a worthwhile activity to prevent reproductive health hazards, sexual dysfunction, marital distress, divorce, and family breakdown; hence, it will save the society and allow people to enjoy life. Patients and methods The study was a cross-sectional study conducted in Menoufia University faculties in Shebin Elkom city during the period from October 2012 to May 2013; the sample size was 345 students selected through stratified random sample by the proportional allocation method through predesigned questionnaire used for assessment of students' knowledge and attitude toward PMC services using SPSS for data analysis. Results Students from practical faculties showed more proper knowledge about items of PMC services, examination, and investigation components than students from theoretical faculties, with statistically significant difference. Students from practical faculties showed more positive attitude toward the usefulness and necessity of the service than students from theoretical faculties, with statistically significant difference between the two groups. There was nonsignificant difference in the overall knowledge among students of practical and theoretical faculties regarding PMC (c2 = 1.49 and P = 0.83), but there was significant difference in their overall attitude (c2 = 30.76 and P = 0.000). There was nonsignificant difference between male and female students regarding their overall knowledge (c2 = 3.86 and P = 0.43) and their overall attitude (c2 = 5.22 and P = 0.27) regarding PMC. There was nonsignificant difference between urban and rural students regarding their overall knowledge (c2 = 8.47 and P = 0.99) toward PMC, but there was significant difference in their overall attitude (c2 = 10.91 and P = 0.03) regarding PMC. Conclusion PMC is a multidimensional issue that plays a very important role in minimizing marital difficulties; although the majority of participants had favorable and positive attitude about PMC services, they showed no sufficient knowledge in some aspects of PMC services.

Objective The aim of the study was to determine the prevalence and risk factors of proteinuria among type 2 diabetic patients in Menoufia governorate. Background Type 2 diabetes is the leading cause of end-stage renal disease worldwide. Microalbuminuria or incipient diabetic nephropathy is one of the initial clinical manifestations of early diabetic nephropathy. Patients and methods A total of 234 type 2 diabetic patients were included in this study; they attended the outpatient clinics of the Family Health Center of 'Kafr Tanbedy' and Internal Medicine Department of Faculty of Medicine, Menoufia University, for routine follow-up. Patients were classified according to their urinary albumin-to-creatinine ratio (ACR) as having normoalbuminuria (ACR Results Prevalence of microalbuminuria (incipient diabetic nephropathy) was 34.2% and that of macroalbuminuria (overt diabetic nephropathy) was 12.8% in the studied group. Conclusion The overall prevalence rate of albuminuria was considerably high (47.01%) among the studied diabetic patients. Therefore, regular screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).