Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Assessment of Medical Students’ Readiness for Self-directed Learning112686610.21608/ejcm.2018.6866ENJournal Article20180510Background:Importance of self-directed learning (SDL) has been discussed over a long time. More recently, SDL has been described as the most effective mode of learning for individuals in the information age as it is the way for coping with the constant changes in knowledge.Objective: This study aimed at exploring the SDL readiness of the students of the second year undergraduate medical students.Methods:The study was a descriptive cross-sectional one conducted at IbnSina National College for Medical Studies (ISNC) on all the second year medical students during the academic year 2014-2015. We used the self-directed learning readiness scale (SDLRS) developed by Fisher et al (2001) which contained 40 items grouped under 3 sub-scales: Self-management, Desire for Learning, and Self-control. Descriptive statistics together with regression analysis were applied using SPSS v.20.Results:The mean score for students in SDL readiness was 159.25<br />(range: 117 to 193), with 76.2% of students who got scores ≥ 150 and 23.8% of them who got scores < 150. Among three subscales, “Self-control” got the highest mean score (4.15) followed by “Desire for Learning” (4.07), while “Self-management” got the lowest mean score (3.69) on a 5-point scale. Females got higher SDLRS scores than males. There was a positive linear relationship between GPA and SDLRS score.Conclusion:Studentsin ISNC showed a satisfactory degree of readiness for self-directed learning, which was positively related to the academic achievement represented by GPA. Females showed significantly more readiness than males.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Accuracy of blood pressure-to-height ratio for screening elevated blood pressure in Egyptian adolescents aged 11-15 years1329686710.21608/ejcm.2018.6867ENJournal Article20180510Objective: This study aims to validate measures of blood pressure-to-height ratios (BPHR) in<br />screening for elevated blood pressure (EBP) in a sample of the Egyptian adolescence aged 11-<br />15 years.Methods: A cross sectional study was conducted on a sample of 1707 students aged<br />11-15 years. Elevated blood pressure was defined according to the international gold standard<br />definition. Systolic and diastolic BPHR (SBPHR and DBPHR) were calculated for boys and<br />girls, and their ability to identify EBP has been determined by the area under the curve of the<br />receiver operator characteristic curves. Sex-specific optimal cut-off points were determined<br />along the curve, and their sensitivity, specificity, positive and negative predictive values<br />(PPVs, and NPVs), and positive and negative likelihood ratios (LR+, and LR-) were<br />estimated. Results: The accuracy of SBPHR and DBPHR in diagnosing EBP in both sexes<br />ranged from 0.906 to 0.981. For diagnosing systolic and diastolic pre-hypertension (pre-<br />HTN), the optimal cut-off points were: 0.69, 0.44 in boys, and 0.71, 0.46 in girls respectively.<br />For diagnosing systolic and diastolic hypertension (HTN), the corresponding values were<br />0.75, 0.49, and 0.75, 0.50 respectively. These determined cut-off points revealed high<br />sensitivity (0.88-1.00), moderate to high specificity (0.77-0.95), high NPVs (0.99-1.00), low<br />PPVs (0.15-0.38), and variable likelihood ratio values (LR+: 3.8-20.0, and LR-: 0.0-<br />.36.0).Conclusion: Blood pressure-to-height ratios are considered of high accuracy in<br />identifying pre-HTN and HTN in the Egyptian adolescents aged 11-15 years. Further research<br />is needed for examining the performance of the BPHR in other age groups, in high risk<br />adolescents, and for examining the performance of modified ratios.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Hypertension and Dyslipidemia among Type II Diabetic Patients and Related Risk Factors and Complications3143686810.21608/ejcm.2018.6868ENJournal Article20180510Background:Diabetics are likely to develop hypertension. Hypertension occurs in about 70%<br />of type II diabetics moreover, it clusters with other cardiovascular risk factors such as obesity,<br />insulin resistance and dyslipidemia.Objective:To estimate the prevalence of hypertension and<br />dyslipidemia amongtype II diabetic patients and to identify common risk factors and<br />complications of type II diabetes with hypertension.Methods:A Cross sectional study was<br />conducted on type II diabetics attending outpatient clinics at Zagazig University and El-Ahrar<br />Hospitals.Participants were selected by systematic random sampling. Data were collected<br />about participants’ socio-demographic characteristics, life style risk factors, andexistent<br />diabetic complications.Blood pressure, Body Mass Index,serum fasting glucose, total<br />cholesterol, and triglyceride levels were measured.Results:Prevalence of hypertension,<br />hypercholesterolemia and hypertriglyceridemia were 68%, 57.3%, and 47% respectively.<br />Hypertension significantly occurred among female, elderly,and low social patientsand<br />associated with family history of DM, physical inactivity or not following diabetic diet.<br />Diabetic hypertensive patients were significantly obese and havinghigh cholesterol and<br />fasting blood sugar (FBS). They were significantly complicated with FBS >300 mg/dl, ocular<br />and cardiovascular diseases.Conclusion:There was increased prevalence of hypertension and<br />dyslipidemia among type II diabetics. Hypertension was common in low social old aged<br />obese diabetic patients not following diabetic diet and regular exercise and those with high<br />cholesterol and fasting blood sugar. Hypertensive diabetics were prone to many complications<br />as hyperglycemia, ocular problems and CVD.Recommendations:Further studies are needed<br />to explore related risk factors of hypertension and dyslipidemia among type II diabetics,<br />Health education programs are recommended for both clinicians and diabetic patients for<br />early detection and management of hypertension and dyslipidemia.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Predictors of Stunting among Children Attending the National Nutrition Institute in Egypt4560686910.21608/ejcm.2018.6869ENJournal Article20180510Back ground: Child malnutrition is a major public health problem in low income and middle<br />income countries especially among marginalized populations. Stunting contributes to 14.5%<br />of annual deaths and 12.6% of disability adjusted life years (DALYS) in under-5 years<br />children. Objective: To identify factors contributing to stunting among a sample of children.<br />Methods: A case control study was conducted at the National Nutrition Institute, Egypt. The<br />study recruited 300 children aged 2-8 years, 148 stunted children as cases and 152 nonstunted<br />as control. Anthropometric measurements were assessed, socio economic status was<br />evaluated, dietary assessment was done using 24 hours recall and food frequency<br />questionnaire, previous feeding practices, and morbidities in the last two weeks were<br />assessed. Results: Four logistic regression models were developed to predict stunting based<br />on the framework developed by the WHO. Mothers’ education was the only socioeconomic<br />predictor of stunting where low maternal education attainment was associated with stunting.<br />Formula feeding during first six moth of life was associated with reduced stunting. Children<br />with history of delayed milestones were 2.4 times more likely to be stunted (p=0.002) while<br />children with history of rickets were four times more likely to be stunted (p=0.007). Both<br />anemia and chest infection increased the risk of being stunting by two folds. Dietary<br />predictors included milk, meat and calcium consumption where meeting milk and meat<br />groups recommendation reduced risk of being stunted by 80% and 40% while reduced<br />calcium intake by 1 mg increase risk of being stunting by 1%. Conclusion: maternal<br />education, previous formula feeding, previous morbidities and decrease intake of milk and<br />meat groups are significant predictors for stunting.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Burnout Syndrome: Determinants and Predictors among Medical Students of Tanta University, Egypt6173687010.21608/ejcm.2018.6870ENJournal Article20180510Objective: to study the magnitude of burnout syndrome, its determinants and predictors<br />among medical students of Tanta University.Methods:A cross-sectional study was<br />conducted using The Copenhagen Burnout Inventory (CBI) and a structured sociodemographic<br />questionnaire.Results:Burnout syndrome was diagnosed in 79.9% of the<br />studied students. 56.8 % and 60% of them suffered personal and work-related burnout<br />respectively, whereas 38.2% and 28.9% suffered teacher and colleague burnout<br />correspondingly.A significant association was found between all subscales of burnout and<br />thoughts of quitting the course.Significant association was also evident between personal,<br />work and colleagues related burnout and difficulties in achieving academic goals.The odds<br />of having burnout were2.4 significantly greater for thoughts of quitting the medicine<br />study. It was 1.9 times significantly higher with difficulty to achieve academic goals and<br />was1.7 higher among students at the clinical stage. Burnout was higher among students<br />who were dissatisfied with studying medicine.Conclusion:Burnout and/or its subscales<br />were quite obvious amongst Medical Students of Tanta University especiallyat the clinical<br />level of study.Disappointment with coursework and difficulties in achieving academic<br />goalslead somestudents totake medication because of studying or thinkquitting the<br />programEgyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Fruit and Vegetable Consumption among Medical Students in an Egyptian University: Knowledge, Practice, and Attitude towards Accessible Healthy Food7593687110.21608/ejcm.2018.6871ENJournal Article20180510Background: Diet rich in fruits and vegetables is associated with a decreased risk for many chronic diseases. Several studies have shown low fruit and vegetable consumption among university students. The burden of disease associated with inadequate nutrition negatively affects their health. Objectives: Assessment of fruit and vegetable (F&V) consumption among medical students, knowledge of daily requirements, perceptions of benefits, barriers and motives for (F&V) consumption and identify their acceptance of accessible healthy food.<br />Methods: A self-administered questionnaire adapted from Food Attitudes and Behaviors Survey (FAB) was completed by 473 students. Scores were calculated for knowledge, benefits, barriers and motives. Food events were done in between teaching sessions and in the faculty campus where healthy stuffs were provided. Students' acceptance of healthy food was assessed by those who got food items during events and those who expressed willingness to try food stuffs in future events. Results: Knowledge of the recommended five daily servings for F&V was recalled by 8.2% of students, 110 (23.26%) consumed 5 servings of F&V daily. Mean knowledge score percent was 28.11±26.69 and higher among males (P < 0.01). Mean benefit score percent was 83.9±11.7, for barriers 61.75±16.55 and for motivation 59.79±19.83. Males as well as smokers had higher mean barrier score (P < 0.01). Healthy food items were tried by 35.7% of students. Fresh orange juice, green salad and banana were the most requested items. Almost 44% expressed willingness to try healthy food in future events. Conclusion and recommendation: Medical students have infrequent F&V consumption; however, they have motives to consume them. A high frequency of students accepts presence of healthy food environment. Wider access is recommended.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Diagnosis of Occupational Asthma in Flour Mills at South Cairo95103687210.21608/ejcm.2018.6872ENJournal Article20180510Introduction: Occupational asthma is an international problem affecting largenumber of<br />workers. Few studies were done on occupational asthma in Egypt focusing mainly on asthma<br />symptoms and not on spirometric tests.Objective: The present study investigated the presence<br />of occupational asthma (BA) among workers at flour mills of south Cairo as there was a lack<br />of data. Methods: The participants (n=120) were recruited from flour mills at South Cairo. A<br />questionnaire, clinical examination, chest x-ray,spirometry, bronchodilator test andpeak flow<br />rate variabilitytest were done. Occupational asthma was diagnosed according to GINA<br />guidelines. Results: This study showed that 25% of mills workers had asthma related to<br />work.The asthma symptoms appearduring work which showed improvement after leaving<br />workplace. It showed also reversibility in FEV1,PEFR as well as diurnal PEFR variability<br />characteristics of occupational asthma. It revealed also that asthmatic workers had lower level<br />of spirometric parameters in relation to non-asthmatic. Conclusion: Asthma questionnaire<br />followed by ventilatory function test assessing reversibility and variability can be used for<br />early diagnosis of occupational asthma in Egypt.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Optimizing Clinical Diagnosis and Antibiotic Prescribing for Common Respiratory Tract Infections, Fanara Family Health Center- Rural Egypt105115687310.21608/ejcm.2018.6873ENJournal Article20180510Background: Antibiotic prescribing for respiratory tract infections (RTI) by primary care<br />doctors has received renewed interest due to the continuing emergence of antibiotic<br />resistance, increased incidence of adverse effects and the attendant cost to healthcare<br />especially in developing countries like Egypt. Despite the majority of these infections<br />being viral it seems that many determinants other than the etiology are the main factors<br />that influence a high rate of prescribing antibiotic for these self-limiting infections.<br />Objective: We aimed to assess the impact of a physician- based educational intervention<br />to improve clinical diagnosis of bacterial causes of RTIs and reduce unnecessary antibiotic<br />prescription for these infections. Methods: This is a clinical trial, where 11 family<br />medicine residents working at a rural family health center in Egypt participated in an<br />educational program to improve their antibiotic prescribing skills when treating common<br />RTI. Their patterns of prescribing antibiotic have been studied among all patients 3<br />months old or above who attended the family center with RTI, for 2 months before and<br />after the educational intervention (1st of December 2015 to 10th of March 2016). The<br />educational intervention comprised 4 hours, 2 lectures and another 4 hours, 2 small group<br />discussions in updated management of RTI and health education principles based mainly<br />on NICE guidelines and Health Belief Model (HBM) respectively. The primary outcome<br />was measuring the impact of the educational intervention on rates of prescribing antibiotic<br />for 4 RTI [Acute otitis media (AOM), tonsillopharyngitis, rhino sinusitis and acute<br />bronchitis], the appropriateness of using clinical diagnostic criteria of bacterial causes of<br />these infections and the appropriate selection of antibiotic when its use was justified.<br />Results: The overall antibiotic prescription was significantly reduced (8.3%) from base<br />line ( 80.3%( to post intervention (72%) period, (P=0.007). This reduction was significant<br />for both tonsillopharyngitis (12.2%, P=0.019) and otitis media (14.2%, P= 0.033). There<br />were also significant improvement in using clinical diagnostic criteria for bacterial causes<br />of the four studied RTI with 12.5% overall improvement (P=0.001). There was also<br />improvement in the overall appropriateness of selecting first line antibiotic when its use<br />was justified this improvement was achieved for both tonsillopharyngitis (17.8%, P=<br />0.004) and AOM (P= <0.001). Conclusion: Clinical diagnosis of bacterial causes of<br />common RTIs and appropriate antibiotic use for these infections can be improved<br />in primary health care settings using a physician based educational program.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Role of School Teachers in Pupils’ Mental Health Promotion117129687410.21608/ejcm.2018.6874ENJournal Article20180510Background: Mental health is an integral and essential component of health.School<br />teachers should have an effective role in promoting mental health of their students.<br />Objective: To investigate teachers` attitude towards their role in pupils’ mental health<br />promotion, and identify barriers they may encounter.Methods:Multistage random<br />sampling was undertaken, where Misr El Gededa and El Nozha Educational Zones were<br />selected randomly from education zones in Cairo governorate. Twenty two (22)schools<br />were selected from different strata of governmental, experimental and private schools in<br />the preparatory stage for boys and girls. All available school teachers were invited to<br />complete a self-administered questionnaire including questions aboutpersonal<br />characteristics, work related qualifications andteachers’ cognitive, affective and behavior<br />attitude towards pupils mental health promotion. Results:382 teachers (95.5%) agreed<br />that teachers play an influential role in recognizing pupils with mental health problems,<br />389 teacher (97.25%) agreed that referring pupils with mental health problems for<br />appropriate early support reduces their risk of developing mental health problems, 374<br />(93.5%) agreed that schools hold a unique position in positively affecting the mental<br />health of pupils and nearly 350 teachers(88%) reported inadequatetrainingto recognize the<br />earlysigns of pupils’mental healthproblems, concerns over workload and lack of services<br />that promote teachers mental health to mitigate the workload before expecting from them to<br />promote pupils' mental health as barriers to pupils mental health promotion. Total scores of<br />the three dimensions of attitude (cognitive, affective and behavioral) were as regard the<br />following variables the two educational zones, different school types, educational stages,<br />graduation college, and taking educational diploma among those graduated from college<br />other than graduation college, attending activities about pupils` mental health,teaching for<br />special needs pupils and teaching for pupils with mentalhealth problems.Conclusion:Most<br />of teachers had positive attitude toward their role in pupils` mental health promotion.<br />Recommendation:Implementation of a training program for teachers on a screening tool<br />to pick up cases that need specialized help and activation of the role of teachers in<br />participation in health promoting activities with their pupils.Egyptian Community Medicine AssociationThe Egyptian Journal of Community Medicine1110-186536120180101Knowledge of Radiology Technicians Regarding Radiation Health Hazards and Radiation Safety Measures in Ain-Shams University Hospitals131140687510.21608/ejcm.2018.6875ENJournal Article20180510Background: Radiation exposure in hospitals accounts for the largest number of workers<br />occupationally exposed to radiation, hence radiation safety practice in medicine is<br />mandatory. Objective:The study aim was to measure the knowledge of radiology<br />technicians regarding radiation health hazards and radiation safety in Ain-Shams<br />university hospitals in Egypt. Methodology:61 radiology technicians participated in the<br />study, technicians were recruited from Ain-Shams university<br />hospitals.Results:Technicians’ radiation knowledge score was10.53 ± 3.8. No association<br />was found between technicians’ age, gender, duration of experience in radiology,<br />attending radiation safety courses or workplace and the radiation knowledge score.<br />Conclusion and Recommendations: It is recommended to provide radiation safety<br />courses.