Christy Costanian

Physical activity in adults with and without diabetes: from the ‘high-risk’ approach to the ‘population-based’ approach of prevention

BackgroundThe prevalence rates of physical inactivity and diabetes in the MENA region are among the highest in the world. However, studies that focus on factors that influence the pattern of physical activity in the region remain very scarce. This study aimed to determine the prevalence and correlates of physical activity in the general population and among subjects with and without diabetes in Lebanon, a small middle-income country in the MENA region.MethodsWe conducted a cross-sectional nation-wide study of 2,195 randomly selected adults aged 25 years and older. Participants completed a comprehensive questionnaire based on the WHO-STEPwise guidelines. Physical activity was assessed using the International Physical Activity Questionnaire. Type 2 diabetes risk factors examined were age ≥ 45 years, BMI ≥ 25 kg/m2, hypertension, hyperlipidemia, cardiovascular disease and family history of diabetes.ResultsClose to 10% of adults with diabetes were physically active versus 23·4% without diabetes. Prevalence rates of physical activity declined consistently as the number of diabetes risk factors increased. Odds ratios for physical activity were lower among the educated (0.75, 95% CI= 0.57–0.98), those who owned at least one car (0.71, 95% CI= 0.57–0.88) and those who resided in the capital city (0.62, 95% CI 0.47–0.83). Health professionals gave ‘advice to exercise’ most to patients with or at highest risk for diabetes, and these were more likely to engage in physical activity than those without diabetes receiving the same advice, net of the effect of other covariates (OR=3.68 and 1.17, respectively).ConclusionsThe inverse associations between physical activity and SES indicators suggest a negative influence of urbanization on activity levels of Lebanese adults. The missed opportunity for clinical primary preventive services for the majority non-diabetic population calls for population-based public health approaches that promote physical activity as a routine lifestyle in the general population.

Prevalence, correlates and management of type 2 diabetes mellitus in Lebanon: Findings from a national population-based study

AIMS This study aims to examine the prevalence, associated risk factors and complications of diabetes, as well management and preventive care in Lebanon, a small, middle-income country of the Mediterranean region. METHODS Using a comprehensive multi-dimensional questionnaire, a cross-sectional national survey of 2195 Lebanese adults aged ≥25 years was conducted based on the WHO STEPwise guidelines. The outcome variable, diabetes, was self-reported. Measures for diabetes management included frequency of blood glucose testing and regular eye and foot exams. Macrovascular and microvascular complications were also recorded. RESULTS The prevalence of type 2 diabetes was 8.5% (95%CI=7.3-9.7). Factors associated with an increased risk of having diabetes were: being divorced or widowed (OR=2.56; 95%CI=1.07-5.42) compared to single, being obese (OR=1.50, 95%CI=1.00-2.57), and having a family history of diabetes (OR=3.40;95%CI=2.48-5.19). Vigorous physical activity significantly decreased the odds of diabetes (OR=0.42; 95%CI=0.24-0.72). Diabetes management and self-care goals were as follows: 82% were not measuring their blood sugar via dextro on a daily basis, 64.2% did not have a foot exam within the past year, and 52.4% did not obtain the recommended yearly eye exam. The most common complications included heart disease (27.8%) and retinopathy (16.6%). CONCLUSIONS Prevalence of diabetes in Lebanon was comparable to that found in the West, yet remained lower than estimates in other resource-rich neighboring countries. Adherence to management and self-care measures was sub-optimal resulting in high complication rates. Contextual factors play a role in increasing diabetes risk. Population-based interventions to enhance and promote self-management behaviors are essential to improve complication rates.

Prevalence and factors associated with irritable bowel syndrome among university students in Lebanon: Findings from a cross-sectional study

AIM To describe the bowel habits and the prevalence of irritable bowel syndrome (IBS) and to investigate the influence of health behavior and social factors on IBS prevalence in university students. METHODS This cross-sectional study was conducted at five major universities in Greater Beirut and its suburbs, between February and June 2014. Using a convenience sample, a total of 813 students aged 18 years old and above participated in this study. Participants were asked to complete a comprehensive anonymous questionnaire which detailed characteristics on socio-demographic, health-related, and lifestyle factors, as well as IBS. The ROME III criteria were used as a tool to ascertain IBS. A χ(2) test was used to determine differences between categorical variables; stepwise logistic regression was used to measure the association between IBS and its risk factors. RESULTS An overall prevalence of IBS of 20% was recorded among university students. The bivariate analysis showed that females were significantly more likely to report having IBS than males (29.1% vs 18.2%, P < 0.01). Those living at the school dormitory or in a private residence (39.5%) were more likely to have IBS than those living with their families (16.3%) (P < 0.01). The multivariate analysis showed that those who had a relatively high family income level (US

Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey.

> 2000) were almost 6 times more likely to report having IBS than their counterparts. CONCLUSION This is the first study to describe the nature of IBS among young adults in Lebanon. The prevalence of IBS among university students in our sample was higher than that reported in the West.

Dietary habits and Helicobacter pylori infection: a cross sectional study at a Lebanese hospital

Objective:This study aims to investigate predictors of inadequate prenatal care (PNC) use among pregnant women in Canada.Study Design:Data for this secondary analysis was drawn from the Maternity Experiences Survey, a cross sectional, nationally representative survey that assessed peri- and post-natal experiences of mothers aged 15 and above in the Canadian provinces and territories. PNC use was measured by the Adequacy of Prenatal Care Utilization Index. Multivariate logistic regression analysis was conducted to determine socio-economic, demographic, maternal, delivery related and health service characteristics associated with inadequate PNC use.Results:Prevalence of inadequate PNC was at 18.9%. Regression analysis revealed that mothers who were immigrants (odds ratio (OR)=1.40; 95% (confidence interval) CI: 1.13–1.74), primiparous (OR=1.22; 95% CI: 1.04–1.44), smoked (OR=1.33; 95% CI: 1.04–1.69) or consumed alcohol (OR=1.32; 95% CI: 1.03–1.68) during their pregnancy were more likely to receive inadequate PNC. Mothers with a family doctor as PNC provider versus those with an obstetrician (OR=1.26; 95% CI: 1.08–1.48) were more likely to have inadequate PNC.Conclusions:This is the first nationwide study in Canada to examine the factors associated with inadequate PNC use. Results of this study may help design interventions that target women with profiles of socio-demographic and behavioral risk to optimize their PNC use.

Hormone therapy use in the Canadian Longitudinal Study on Aging: a cross-sectional analysis

BackgroundTo examine the association between dietary habits and Helicobacter pylori (H. pylori) infection among patients at a tertiary healthcare center in Lebanon.MethodsThis cross-sectional study was conducted on 294 patients in 2016, at a hospital in Northern Lebanon. Participants were interviewed using a structured questionnaire to collect information on socio-demographic and lifestyle characteristics; dietary habits were ascertained via a short food frequency questionnaire (FFQ). H. pylori status (positive vs. negative) was determined after upper GI endoscopy where gastric biopsy specimens from the antrum, body, and fundus region were collected and then sent for pathology analysis. Multivariable logistic regression was conducted to identify the association between socio-demographic, lifestyle, dietary and other health-related variables with H pylori infection.ResultsThe prevalence of H. pylori infection was found to be 52.4% in this sample. Results of the multivariable analysis showed that H. pylori infection risk was higher among participants with a university education or above (OR = 2.74; CI = 1.17–6.44), those with a history of peptic ulcers (OR = 3.80; CI = 1.80–8.01), gastric adenocarcinoma (OR = 3.99; CI = 1.35–11.83) and vitamin D level below normal (OR = 29.14; CI = 11.77–72.13). In contrast, hyperglycemia was protective against H. pylori (OR = 0.18; CI = 0.03–0.89). No relationship between dietary habits and H. pylori infection was found in the adjusted analysis.ConclusionsSocio-demographic and clinical variables are found to be associated with H. pylori, but not with dietary factors. Further studies are needed to investigate the effect of diet on H. pylori risk.

Factors associated with complementary and alternative medicine use among women at midlife

Objective: The aim of the study was to assess the prevalence and factors associated with hormone therapy (HT) use among Canadian women. Methods: Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging (CLSA) was used for this analysis. The main outcome was HT use among women aged 45-85 years, defined as current, past, and never users. Multinomial logistic regression models were used to examine the differences between current, past, and never HT users in terms of sociodemographic, health behavior, and health-related variables. Results: Overall, 9.5% of the sample reported current use of HT, whereas 21.9% reported past use. The main factors associated with a lower likelihood of current HT use were older age (>80 y), nonwhite ethnic background, current employment, regular smoking, obesity, and breast cancer. By contrast, alcohol consumption, and the presence of allergies or mood disorders were positively associated with current HT use. Conclusions: These findings provide a recent national picture of HT use in Canada that may be used to inform opportunities for improved physician–patient communication regarding menopause management.

Sleep patterns and disorders among university students in Lebanon.

Abstract Hormone replacement therapy (HRT) has been established as the first-line treatment for women experiencing menopausal symptoms. The use of complementary and alternative medicine (CAM), however, is becoming increasingly popular among women at midlife for management of such symptoms. Despite the equivocal evidence of CAM’s efficacy in the reduction and alleviation of menopausal symptoms in placebo-controlled, randomized trials, 50% of women at midlife use CAM. To date, several large, population-based studies have focused upon CAM use amongst menopausal women and the factors associated with the adoption of such therapies. By identifying women in the menopausal transition who tend to use CAM, this narrative review highlights evidence that aids women at this stage of life make better and individualized treatment choices to relieve these symptoms. The available evidence suggests that the prevalence of CAM use among menopausal women is high world-wide, but there is a paucity of high-quality studies that adequately assess the factors associated with its use. Further studies are needed to confirm the characteristics of women who employ CAM to manage their night sweats and hot flushes. Results of this study might enable the development of policies catering to the needs of those women and provide a resource to support their decision-making regarding treatment options.