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PubMed2004

Alcohol use among university students in Lebanon: prevalence, trends and covariates. The IDRAC University Substance Use Monitoring Study (1991 and 1999).

The practical inexistence of research on alcohol use among university students in Lebanon and other Arab countries spurred us at IDRAC to initiate a university-based substance use monitoring study, so far conducted in two phases (1991 and 1999), to assess the prevalence, patterns, trends, and factors associated with the use and abuse of alcohol (and other substances). In both phases, the sample was a stratified cluster, representing 25% (N = 1850) of the student population of two major universities in Lebanon. The rates of lifetime alcohol use and problem use have increased from 1991 to 1999, the increase being higher in younger cohorts and in females. Belief in God and practice of that belief, irrespective of the students' religion, were associated with less frequent experimentation with alcohol. Although more Christians ever drank alcohol, once users, university students (irrespective of their religion) had the same rates of alcohol problem use and dependence. Several other covariates concordant with the international literature were also delineated such as students' anti-social behavior, and family and peer environment.

Adolescent↗
PubMed2006

The policy environment encouraging C-section in Lebanon.

OBJECTIVE: This study aims to analyse the environment encouraging C-section in Lebanon and to reveal approaches that could be adopted for the reduction of this practice, by considering the attitudes, opinions and actions of different stakeholders. METHODS: Semi-structured interviews were conducted with 20 selected key players, including hospital directors, midwives, insurance bodies, syndicates and scientific societies, ministries, international agencies, medical schools, media representatives and women's groups. In addition, a group discussion was conducted with 10 obstetricians. Semi-structured interviews were conducted with a convenience sample of 36 women who had a C-section within 4 months preceding the study. Data was analysed using the Policy Maker software version 2.3. RESULTS: Findings of the study point to the role of multiple factors in shaping the current practices related to C-section deliveries, among which are the organisation of the health care system, the dominance of the private sector, the lack of physician accountability, the minimisation of midwives' roles in the process and women's misconceptions about C-sections. CONCLUSIONS: Involvement of the diversity of players is important to change practices in maternity care in Lebanon, after considering their position and power. Different strategies making use of available opportunities to improve the current situation are discussed.

Cesarean Section↗
PubMed2004

Gender and sexual health in clinical practice in Lebanon.

This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face-to-face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow-up, as these issues are brought up frequently by their women clients. However, results suggest that only one-third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.

Attitude of Health Personnel↗
PubMed2005

Factors influencing development of management strategies for the Abou Ali River in Lebanon I: spatial variation and land use.

Surface water bodies are progressively subject to increasing stress as a result of environmentally degrading processes primarily related to anthropogenic activities. This study assesses and examines the impact of land use and land-based activities on the spatial variation in water quality of the Abou Ali River in North Lebanon. It is the first detailed study of its kind in Lebanon and adds to the existing knowledge by shedding light on a relatively small Mediterranean river in a developing country where there is a paucity of such studies. The assessment was conducted at the end of the dry season in 2002 and 2003 and the end of the wet season in 2003 and 2004. The study has demonstrated the importance of anthropogenic influences on the water quality of the Abou Ali River Basin, as concentrations of most contaminants were higher at locations with greatest human activity. The most adversely affected area was the section of the river that flows through an entirely urbanized and highly populated region, the Tripoli conurbation. Upstream rural sites were enriched by contaminants primarily from non-point sources such as agricultural runoff and poultry litter whereas contaminant concentrations at the urban sites were enriched by a combination of sewage discharge and flow of contaminants from upstream. If the Abou Ali River is to be utilized as a managed water resource and its water quality sustained, point source discharges will require treatment and land use management must be planned to minimize the impact of diffuse source pollution on the river. A high priority should be given to the implementation and enforcement of the precautionary and polluter pays principles. Moreover, an effective legal, economic and institutional framework is required to encourage investment in waste reduction and control and to introduce environmentally sound practices.

Agriculture↗
PubMed2002

Challenging the stereotypes: men, withdrawal, and reproductive health in Lebanon.

In Lebanon, coitus interruptus or withdrawal remains a widely practiced method of family planning. Our research sought to understand the role of men in reproductive health in Lebanon by focusing on this common practice. Our main questions were: Why is it that the practice persists when more effective modern methods of family planning are available? How is the decision taken to practice withdrawal? When is withdrawal practiced and with whom? And, finally, does the practice of withdrawal affect sexual pleasure and the sexual relationship more generally?To answer these questions, we embarked on a small exploratory study using in-depth interviews with 16 open-ended questions. We found that the most important reason for the continuing practice of withdrawal is fear of side effects from other methods. Men and women expect pleasure and fulfillment in sexual relations, but they are willing to limit their pleasure to limit their fertility by means they consider safe. No one prototypical practice of withdrawal seems to exist, and this may explain whether or not the method fails to prevent pregnancy.

Adult↗
PubMedDate not supplied

The epidemiology of leishmaniases in Lebanon.

The prevalence of leishmaniasis in Lebanon was studied in 1993-97 for a Lebanese population sample of about 81,000 subjects (60% rural and 40% urban) constituting roughly 3.4% of the total population. The prevalence of cutaneous leishmaniasis was found to be 0.18% in the rural versus 0.41% in the urban areas. Visceral leishmaniasis was practically non-existent in both environments. In addition, skin tests were done and anti-Leishmania antibodies were sought in a sample of the population at risk in the rural area. Skin tests were positive in 2.5% of the tested subjects, and 1% of the normal population had elevated levels of anti-Leishmania antibodies. The difference between the prevalence of clinical disease and positive skin testing and/or antibodies may be due to the existence of past or present subclinical disease. An unexpected finding was that the prevalent dermotropic parasite in Lebanon belongs to the L. donovani complex. Further characterization of the isolates by molecular techniques and definition of the transmission cycle of this parasite may explain our epidemiological findings.

Adolescent↗
PubMed2003

Consanguinity-associated kidney diseases in Lebanon: an epidemiological study.

Consanguineous marriages are common in many countries of the Middle East including Lebanon. Their impact on the repartition of kidney diseases and on the risk for familial nephritis is not known. We surveyed all of the dialysis centers in Lebanon. Nine hundred and twenty-five (925) patients and their private physicians were asked to answer a questionnaire. More than half of the hemodialysis (HD) patients had an unknown etiology of their kidney disease. Diabetes, polycystic kidney disease (PKD), chronic pyelonephritis and nephrosclerosis (NS) were the most commonly documented diagnoses. Consanguinity was present in 26% of the total HD population. More consanguineous patients with unknown renal etiology were diagnosed with their kidney diseases and initiated on dialysis before the age of 30 when compared with their non-consanguineous counter-parts (45% versus 33%, P<0.02 and 42% versus 27%, P<0.01), respectively. Similarly, consanguineous polycystic patients were diagnosed and started earlier on dialysis when compared with the non-consanguineous population (34% versus 12%, P<0.05 and 28% versus 8%, P<0.05), respectively suggesting a different disease pattern. Furthermore, the risk for family history of kidney disease was noticeable in the non-consanguineous population and significantly higher among the consanguineous patients (12% versus 18%, P<0.04). Consanguinity-associated kidney diseases affected all religious communities, in particular the Muslim and the Druze (36 and 39%), respectively versus 17% of the Christian community. Certain geographical areas were more involved than others such as the North, South and the Bekaa with the highest percentage (40%) in the latter. Socio-economical level was not a contributing factor. We conclude that the documentation of the underlying etiology in end-stage renal diseases (ESRD) seems to be deficient. Furthermore, consanguinity is prevalent in the Lebanese dialysis patients population, in particular the Muslim and the Druze communities. Consanguinity-associated kidney diseases pattern seems to differ from that of the general HD population by disease diagnosis and initiation at a younger age and a significantly higher risk for familial renal disease. It is a cultural phenomenon prevalent predominantly in the rural areas. We recommend a multi-approach including educational, informative and probably legislative strategy in order to limit and hopefully discourage consanguineous marriages.

Adult↗
PubMed2005

[Multisystemic amyloidosis. Clinical study of 39 patients in Lebanon].

OBJECTIVE: Clinical analysis of multisystem amyloidosis in Lebanon, by histological type. METHOD: Retrospective study of 39 cases of multisystem amyloidosis diagnosed histologically in a university hospital center between 1991 and 2002. It analyzed the following clinical data: age, gender, type of presentation, time from symptom onset to diagnosis, clinical features, concomitant diseases, family history of amyloidosis, biopsy sites, presence of urinary or serum monoclonal gammopathy, immunohistochemical type, prognosis and treatment. RESULTS: Median age at diagnosis was 56+/-18 years. The overall ratio of men to woman was 1.4. AL amyloidosis (amyloid light chain) accounted for 54% (21/39) of the cases, AA (amyloid-associated) amyloidosis 36% (14/39), while 10% (4/39) were not typed. Among the 21 cases of AL amyloidosis, 12 were idiopathic (57%) and 9 (43%) were associated with multiple myeloma; among the 14 cases of AA amyloidosis, 7 were associated with familial Mediterranean fever and 5 with chronic disorders. Proteinuria was often the first symptom. The initial manifestations in AL amyloidosis patients with myeloma were more often related to amyloidosis than to myeloma. Renal involvement was seen in 95% (37/39) of all cases (95% of AL versus 93% of AA), proteinuria in 87% of cases and renal failure in 72%. Cardiac amyloidosis (57% of AL versus 7% of AA; p>0.05), infiltration of the tongue (19% of AL versus 0% of AA; p>0.05) and neurological manifestations (24% of AL versus 7% of AA; p>0.05) were more frequent in AL amyloidosis. The 7 patients who died (18%) had AL amyloidosis (5 of them had myeloma). Heart failure was the most frequent cause of death related to amyloid. CONCLUSION: Multisystem amyloidosis is frequent in Lebanon and familial Mediterranean fever is still frequently associated with the secondary type. Accurate diagnosis and classification are essential for the prognosis and treatment of the disease. Poor prognosis was associated with the AL type, especially when accompanied by myeloma, and with cardiac amyloidosis.

Adult↗
PubMed1998

Cancer in Lebanon: an epidemiological review of the American University of Beirut Medical Center Tumor Registry (1983-1994).

PURPOSE: Cancers recorded in the Tumor Registry at the American University of Beirut Medical Center (AUBMC), the largest tertiary care center, in Lebanon were reviewed. METHODS: Results were compared with those from the same center 30 years ago and current data from western Asia. RESULTS: Between 1983 and 1994, 9364 cases were recorded, averaging 780 cases per year, representing more than one-third of the national case-load. Cases were almost equally distributed between males and females. Average age of females was significantly younger (48.7 years) than that of males (52.2 years). Among males, the five most frequently reported cancers were of the lung, bladder, larynx, lymphoma, and leukemia. Among females, the four most frequently reported cancers were of the breast, cervix uteri, lymphoma, and brain, with leukemia and corpus uteri ranking equally as fifth. Over the past 30 years, the frequency of colorectal cancer decreased and that of lung cancer increased in both sexes. Oral cancer decreased dramatically among males. Digestive system cancers in this series were less frequent than in cumulative data from western Asia area. CONCLUSIONS: Cancer dynamics changed little since the 1950s, except regard to cancers related to smoking and diet. Diet differences may explain the lower frequencies of digestive cancers in Lebanon as compared with elsewhere in western Asia. The potential impact of cancer prevention and early detection on highly prevalent cancer types such as lung, larynx, breast, and cervix was highlighted.

Academic Medical Centers↗
PubMed2006

Seroprevalence of toxocariasis in Lebanon: a pilot study.

Toxocariasis is a common helminthic infection that has a worldwide distribution. However, data from Lebanon about the prevalence of this infection are non-existent. We conducted a Toxocara seroprevalence study with 150 subjects attending the outpatient clinics at the American University of Beirut Medical Center between May and June 2004. Serum specimens were tested for anti-Toxocara antibodies by enzyme-linked immunosorbent assay and confirmed by Western blot. Multivariate analysis was performed to identify risk factors for infection. The seroprevalence rate of toxocariasis was 19%. Male gender and below high school education were significantly associated with a positive serological test (odds ratios = 3.1 and 2.8, respectively). Higher numbers of persons in the household, and low family income during childhood, were significant on bivariate analysis only. Toxocariasis is common in Lebanon. A large population-based survey is needed to confirm these results.

Adolescent↗
PubMed1996

Seroprevalence of brucella antibodies among persons in high-risk occupation in Lebanon.

Prevalence of brucella-specific antibodies was measured in 597 persons in high-risk occupations living in 10 regions of Lebanon using the standard agglutination test (SAT), anti-human globulin (Coombs') test (AHGT) and enzyme-linked immunosorbent assay (ELISA) for measuring immunoglobulin G (IgG), IgM and IgA. The study population consisted of butchers (54%), farmers (35%), laboratory technicians (8%), abbatoir workers (2%) and veterinarians (1%), with 82% males and 18% females. The overall seroprevalence based on SAT and AHGT titres of > or = 80 was 1.7% and 15%, respectively, but seroprevalence varied by region from 0-5% in SAT and from 3.4-34% for AHGT. The overall seroprevalence based on ELISA IgG (OD > or = 0.6), IgM (OD > or = 0.6) and IgA (OD > or = 0.3) was 57, 61 and 26%, respectively. The highest seroprevalence was noted in Biqaa (34%), Kisrwan (24%), Shouf (21%), Sidon (16%) and Aley (12%) regions. Nineteen percent of those surveyed reported symptoms that could be associated with brucellosis. We conclude that exposure to brucellosis is high among persons in high-risk occupations from all surveyed regions in Lebanon. Such findings should be used to design control measures especially now that the 17 years of civil strife is over.

Antibodies, Bacterial↗
PubMed2002

Immunity to chickenpox among school adolescents in Lebanon and options for vaccination.

Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15-18 years of age attending schools in Lebanon showed 96.6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97.4%, whereas the negative predictive value was 4.5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.

Adolescent↗
PubMed2000

Human rabies in Lebanon: lessons for control.

Human rabies is known to be endemic in countries bordering Lebanon, but its prevalence in Lebanon has not been studied before. All eight cases of human rabies reported to the Lebanese Ministry of Public Health between 1991 and 1999 were reviewed, as well as three other cases admitted to the American University of Beirut Medical Center. A total of 1102 cases of animal bites to humans, the majority of which were dog bites, were reported to the Ministry of Public Health between 1991 and 1996. In this period, 2487 doses of rabies vaccine were administered to the above group, as post-exposure prophylaxis. Veterinarians, a high risk and educated group, were interviewed, and only 7 out of 72 were found to have been vaccinated. Major improvements in surveillance and reporting, better control of animal rabies, more awareness especially among high risk groups, and regional cooperation, are all needed to prevent and control this deadly infection.

Adolescent↗
PubMed2002

Evaluation of water quality of the Qaraaoun Reservoir, Lebanon: suitability for multipurpose usage.

The increased demand on water resources in Lebanon as a result of: progressive urbanization, socio-economic growth, agricultural activities and development of industries is, according to the national authorities, a major critical factor by the year 2010. Political difficulties in earlier years imply a dearth of pertinent data. The objective of this study was to evaluate water quality of the Qaraaoun Reservoir of the Litani River and assess its feasibility for multi-purpose usage as one of the solutions to the aggravated water problems in Lebanon. Samples were collected from 18 sampling sites at several dates during the dry season. Parameters analysed were, pH, electrical conductivity, TDS, turbidity, alkalinity, Ca, Mg, TH, Cl-, SO4(2-), NH3, NO3(-), PO4(3-), Fe, Al, Na, Zn, Cr, Cu and As. The reported data were in compliance with WHO guidelines, USEPA regulation and EEC directives. Statistical analysis of the data defined three distinct environmental zones and water quality in the central, main zone satisfied most criteria. It is concluded that the reservoir water is fit for multipurpose uses, namely, drinking, domestic, recreational activities, irrigation, fisheries, livestock and industrial, and should be properly managed accordingly.

Agriculture↗
PubMed2003

A comparison of metals in sediments and water in the River Nahr-Ibrahim, Lebanon: 1996 and 1999.

Rivers whose basins are underlain by carbonate rocks exhibit high pH, lower desorption of metals and possess high buffering capacity against acidic inputs to the river. The catchment of River Nahr-Ibrahim, Lebanon, is largely underlain by limestone. Compared to neighbouring countries, Lebanon is relatively fortunate since precipitation is high. However, recently a warming in temperature and a drop in precipitation has occurred, thus causing low water levels in rivers. The objective of this study is to investigate the variation of the total metal content (Fe, Mn, Zn, Cu, Pb and Cd) in bed sediments and water of River Nahr-Ibrahim between 1996 and 1999 (two years); and relate these variations to the effect of changes in human activities and/or due to the variations of precipitation rate, temperature and pH of water. Bed load sediments and stream water were collected simultaneously from five sampling sites. Water pH and temperature were determined in situ. Sediment samples were dried at room temperature and sieved; the sediment size < 75 microns size was retained. Water was analysed for major constituents and trace metals. Metals were extracted from sediments with aqua regia. Metal concentration in water and sediments were determined using ICP-MS technique. Data revealed a drop in metal concentrations (Zn, Cu, Pb, Cd) in sediments at quarry site after its closure. The decrease in precipitation rate, lowering the level of water and the dilution of industrial discharges and decrease in water pH led most probably to the desorption of metals from sediments into the water.

Chemical Precipitation↗
PubMed2000

A general population survey on patterns of benzodiazepine use and dependence in Lebanon.

OBJECTIVE: In Lebanon, benzodiazepines are often available without medical prescription. We aimed to carry out the first community-based pharmaco-epidemiological study on benzodiazepine consumption in the Middle East Area. METHOD: The prevalence of past-month benzodiazepine use was assessed in a 1000-subject randomized sample from the Lebanese community, and risk factors were studied in a group of 496 current users. RESULTS: Benzodiazepine use during the past month was found in 9.6% of subjects. Four variables were significantly associated with use: age higher than 45 years, female sex, cigarette smoking and the existence of a recent life event. Benzodiazepine dependence was found in 50.2% of users. CONCLUSION: Benzodiazepine use in Lebanon is particularly high, and can be related to well-known factors such as female sex and age, but other potent specific variables, such as war stress or the lack of control on drug access, can be hypothesized.

Adolescent↗
PubMed2003

Beta-globin gene cluster haplotypes and HbF levels are not the only modulators of sickle cell disease in Lebanon.

Sickle cell disease (SCD) is an inherited autosomal recessive disorder of the beta-globin chain. Despite the fact that all subjects with SCD have the same single base pair mutation, the severity of the clinical and hematological manifestations is extremely variable. This study examined for the first time in Lebanon the correlation between the clinical manifestation of SCD and the beta-globin gene haplotypes. The haplotypes of 50 patients diagnosed with SCD were determined using polymerase chain reaction amplification of fragments containing nine polymorphic restriction sites around and within the epsilon-Ggamma-Agamma-psibeta-delta-beta-globin gene complex. Most reported haplotypes were found in our population with the Benin haplotype as the most prevalent one. When the patients were divided according to their HbF levels into three groups (Group A: HbF < 5%, Group B: HbF between 5 and 15%, and Group C: HbF > 15%), surprisingly, the highest levels of HbF were associated with the most severe clinical cases. Our findings suggest that fetal hemoglobin levels are important but not the only parameters that affect the severity of the disease. In addition, the high levels of HbF in patients with CAR haplotypes did not seem to ameliorate the severity of symptoms, suggesting that genetic factors other than haplotypes are the major determinants of increased HbF levels in Lebanon.

Adolescent↗
PubMed2003

Tobacco use by university students, Lebanon, 2001.

AIMS: The objective was to determine the prevalence of smoking [cigarettes and/or narghile (i.e. water-pipe)] among university students and to examine multiple correlates. DESIGN: Cross-sectional. SETTING: Beirut, Lebanon. PARTICIPANTS: A proportionate random sample of 1964 students from public and private universities in Beirut, Lebanon. MEASUREMENTS: Participants completed a self-administered anonymous questionnaire that included demographic and scholastic items and health behavioral aspects, including smoking, alcohol, physical activity, weight control measures and seat belt use. FINDINGS: The overall prevalence of smoking was 40% (21.1%, 7.6% and 11.3% of the students were smoking only narghile, only cigarettes and both cigarettes and narghile, respectively). Regression analyses showed that males, those of non-Lebanese origin, pursuing undergraduate degrees, performing risky weight control measures and drinking excessive amounts of alcohol had increased odds of smoking cigarettes. Also, age, high level of paternal education and field of study were significant predictors. Narghile smoking was significantly higher among males who drank excessive alcohol. CONCLUSIONS: The authors advocate a collaborative effort to alleviate the consequences of smoking among university students.

Adult↗