Jinan Usta

Imperforate hymen : report of an unusual familial occurrence

Background: Although imperforate hymen occurs in approximately 0.1¶ of female newborns, familial occurrence of imperforate hymen has been reported only once. Cases: We report two families in which imperforate hymen was diagnosed in three siblings of each family. One family is described in detail; the patients were two postmenarchal young women and one premenarchal girl. Conclusion: Imperforate hymen usually occurs sporadically but can be familial. We advise screening all female newborns and children for vaginal patency, especially family members of an affected child. Identification of other families with a similar problem might point to a specific mode of inheritance.(Obstet Gynecol 1993;82:655-6)

Involving the health care system in domestic violence: What women want.

PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODS We undertook a qualitative focus group study. Health care professionals in 6 primary health care centers routinely screened women for domestic violence using the HITS (Hurt, Insult, Threaten, Scream) instrument. At each center, 12 women who were screened (regardless of the result) were recruited to participate in a focus group discussion. RESULTS Most of the 72 women encouraged involvement of the health care system in the management of domestic violence and considered it to be a “socially accepted way to break the silence.” Women expected health care professionals to have an “active conscience”; to be open minded, ready to listen, and unhurried; and to respect confidentiality. Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence. CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women.

Assessment of reproductive health and violence against women among displaced Syrians in Lebanon

BackgroundThe current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.MethodsWe conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.ResultsWe interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.ConclusionsThis study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

Osteitis pubis: an unusual postpartum presentation

IntroductionOsteitis pubis is a poorly understood and uncommon disorder rarely associated with spontaneous delivery.Case reportWe present a case consistent with osteitis pubis that followed a normal vaginal delivery and where symptoms developed earlier than ever previously reported.DiscussionThe potential benefit of low molecular heparin is discussed.

Addressing domestic violence in primary care: what the physician needs to know

Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge on adequately managing cases of DV and on appropriate ways to help survivors is commonly presented as a barrier. This article presents the magnitude of the problem of DV in the Arab world, highlights the role of the primary care physician in addressing this problem, and provides practical steps that can guide the clinician in the Arab world in giving a comprehensive and culturally sensitive service to the survivors of DV.Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge on adequately managing cases of DV and on appropriate ways to help survivors is commonly presented as a barrier. This article presents the magnitude of the problem of DV in the Arab world, highlights the role of the primary care physician in addressing this problem, and provides practical steps that can guide the clinician in the Arab world in giving a comprehensive and culturally sensitive service to the survivors of DV.

Economic Abuse in Lebanon Experiences and Perceptions

This article explores the experiences and perceptions of Lebanese women and men with economic abuse. Data were drawn from focus group discussions and face-to-face interviews with men, women and social workers. The findings reveal that Lebanese women experience many forms of economic abuse, including the withholding of earnings, restricted involvement in the labor force, and limited purchasing decisions. Inheritance laws and practices still favor men over women. Women tolerate economic abuse to avoid more serious forms of abuse and ensure family stability. Practical implications of the findings are presented.

Exposure to Violence and Children's Desensitization Attitudes in Lebanon.

Children exposed to multiple sources of violence may become desensitized, increasing the possibility of them imitating the aggressive behaviors they watch and considering such behavior as normal. The purpose of this article is to assess the association between exposure to various types of violence (including war) and desensitization in Lebanese children. A cross-sectional design with 207 school-aged children assessed exposure to violence using three surveys: (a) violence in the media (the Media Preference survey), (b) exposure to violence (the KID-SAVE survey), and (c) desensitization attitudes (the Attitude Toward Violence–Child Version). Children were between 8 and 12 years old, 56% were males, and 70%were from middle socioeconomic status (SES) backgrounds. Seventy-six percent of children reported being exposed to violence, with more exposure in males and in the lower SES group. Impact, however, was greater on girls. The predictors of attitude toward violence were “Frequency” of exposure, “Impact” of exposure, and the amount of violence viewed on television. Children are massively exposed to violence in Lebanon resulting in desensitization, which may habituate them to accept violence as normal and put them at risk for imitating violent behaviors.

Women and Health in Refugee Settings: The Case of Displaced Syrian Women in Lebanon

The current conflict and humanitarian crisis in Syria continue to displace thousands of Syrians to neighboring countries, including Lebanon. This chapter examines the relation between refugee status, reproductive health outcomes, and domestic violence. We conducted a rapid needs assessment from June to August 2012 in Lebanon to collect information on Syrian women’s current reproductive health status; their reproductive history before the conflict; their need for services; their experience with sexual and gender-based violence; and their help-seeking behaviors. We interviewed 452 displaced Syrian women aged 18–45 who have been in Lebanon for an average of 5.1 (±3.7) months. Additionally, 29 women participated in three focus group discussions. Of the 452 women surveyed, 74 were pregnant during the conflict, and several of them were pregnant more than once since the beginning of the conflict. Preterm delivery was highly reported (27 %), as well as pregnancy-related problems, including anemia, abdominal pain, and bleeding. As for reproductive health, menstrual irregularity, dysmenorrhea, and symptoms of reproductive tract infections were common. Moreover, 31 % of women had personal experience of violence (physical, sexual, or psychological), and many reported currently experiencing intimate partner violence. A conceptual framework is proposed to show how multiple factors may interplay to affect the reproductive health of women and their exposure to violence, with stress and mental distress being the main mitigating factors. Provision of psychological support within humanitarian aid is proposed to alleviate the effect of war and displacement.

Postgraduate Educational Program for Primary Care Physicians in Remote Areas in Lebanon.

Introduction: Continuing medical education (CME) is a requirement in many developed countries. Lebanon lacks such a rule; hence, the dictum “once a doctor always a doctor” holds. This article describes a pioneering postgraduate educational program for primary care physicians in remote areas of Lebanon. Method: The Lebanese Society of Family Medicine introduced a 2‐year structured CME program to four remote Lebanese areas. Thirteen family physicians provided 33 activities to 1,073 primary care physicians tackling 22 subjects chosen from a list of 53 common clinical problems approved by community medical leaders. Each attendee was requested to complete an evaluation form at the end of each session. Results: The activities were attended by 1,073 physicians, 914 of whom filled out the evaluation forms (85.2% response rate). The analysis of the response of the attendees revealed that 65% of the attendees completely agreed that they benefited from the activities, 68% completely agreed that the presentations were clear, 86% thought that the methods used were adequate, 57% agreed completely that the presenters were prepared, and 69% replied that enough time was available for interction. Discussion: The CME programs were conducted with minimal costs. They were well received by attendees. It is recommended that the Lebanese health authorities make CME a requirement to promote the knowledge and behavior of primary care physicians and improve health.

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Abstract 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.