Pascale Salameh

Respiratory symptoms in children and exposure to pesticides

In Lebanon, childhood asthma is an important disease and pesticides are commonly used. The objective of this study was to evaluate whether exposure to pesticides has chronic effects on the respiratory health of Lebanese children. A crosssectional study was performed on children from a randomly selected sample of Lebanese public schools. Exposure to pesticides was evaluated by a standardised questionnaire and a residential exposure score, and respiratory symptoms were assessed by using the American Thoracic Society standardised questionnaire. A chronic respiratory disease was reported in 407 (12.4%) out of 3,291 children. The baseline difference in mean age was small but statistically significant. Any exposure to pesticides, including residential, paraoccupational and domestic, was associated with respiratory disease and chronic respiratory symptoms (chronic phlegm, chronic wheezing, ever wheezing), except for chronic cough. Exposure to pesticides was associated with chronic respiratory symptoms and disease among Lebanese children.

Pesticides in Lebanon: a knowledge, attitude, and practice study

Pesticides, despite their known toxicity, are widely used in developing countries. Evaluating the pattern of their use would be interesting to assess the appropriateness of adequate intervention. Using a standardized questionnaire, a knowledge, attitude, and practice study was performed in two Lebanese regions, in which a group of agricultural workers was compared to workers of the general population and a third group of pesticide distributors. Agricultural workers were exposed to pesticides during cropping, mixing, loading, and application (100%). They had low pesticide knowledge scales compared to pesticide distributors and to the general population workers (P<10(-7)). The preventive measures they took were low, and the lower their knowledge was, the lower were the preventive measures applied (P<10(-3)). Pesticide safety education is necessary in order to induce protective behavior among agricultural workers. The general population may also benefit from increasing their awareness regarding pesticides.

Saliva Cotinine and Exhaled Carbon Monoxide Levels in Natural Environment Waterpipe Smokers

The purpose of this study is to evaluate the variations in exhaled CO and saliva cotinine in natural environment waterpipe smokers and compare them with cigarette smokers and absolute nonsmokers. Three groups were included in the study: nonsmokers (n = 20), waterpipe smokers (n = 15), and cigarette smokers (n = 20). A questionnaire was completed for each participant, exhaled CO was measured before and after waterpipe or cigarette smoking, and saliva cotinine was measured immediately after. We excluded from our study mixed smokers of both waterpipe and cigarettes. Mean values of saliva cotinine in waterpipe and cigarette smokers were very close: 77.8 ng/ml (SD = 110.4) and 87.1 (SD = 82.7) respectively. The weight and height of the persons as well as the size of the waterpipe bottle affected saliva cotinine. However, in waterpipe smokers, CO increased by 300% after 1 h of smoking, while in cigarette smokers, it only increased by 60%. In nonsmokers, exhaled CO was similar to environmental CO (10.2 ppm). The results of our study confirm that waterpipe device water does not filter nicotine and that the smoker him- or herself, by the frequency and the depth of inhalation, controls smoke inhalation. Like cigarette smokers, waterpipe smokers are exposed to harmful substances, such as CO, which was found to be quite high. The levels of expired CO and salivary cotinine could be good tools to detect exposure to waterpipe smoking.

A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon

Background:The beneficial impact of the traditional Mediterranean diet pattern on adiposity is still under debate, and this has never been assessed in a developing Mediterranean country.Objectives:To assess the relationships between adherence to a traditional Mediterranean diet and adiposity indexes, that is, body mass index (BMI) and waist circumference (WC), in a sample from rural Lebanon.Design:A sample of 798 adults, aged 40–60 years, was selected in continental rural areas of Lebanon for a cross-sectional study. The questionnaire included socio-demographic, anthropometric and dietary sections. The daily consumption frequencies of selected food groups, categorized as positive or negative components, were calculated based on a food frequency questionnaire. Adherence to the Mediterranean diet was assessed using six a priori scores; including the widely used Mediterranean diet score (MDS). Associations between diet scores and BMI and WC were assessed.Results:Overall, the diet of the study sample only partially matched the traditional Mediterranean diet. A total of 17.0% of men and 33.7% women were obese. The MDS was negatively associated (P<0.05) with WC, but not BMI, in men and women. The constructed composite Mediterranean score combining positive components of the diet (whole cereals, vegetables, legumes and fruit, olive oil and fish) and negative components adapted to this sample (refined cereals and pastries, and liquid sweets) was consistently and negatively associated with both BMI and WC for men and women in multivariate models. A 2-point increase in that score was associated with a decrease in BMI of 0.51 and 0.78 kg m–2 and a decrease in WC of 2.77 and 4.76 cm in men and women, respectively.Conclusion:The results demonstrate that a Mediterranean diet is negatively associated with obesity and visceral adiposity in a rural population of a developing Mediterranean country.

Chronic obstructive pulmonary disease prevalence in Lebanon: a cross-sectional descriptive study

Background Chronic obstructive pulmonary disease (COPD) continues to increase worldwide. The objective of this study was to determine the prevalence of COPD in Lebanese adults. Methods A cross-sectional study was carried out using a multistage cluster sample from all over Lebanon. Residents aged 40 years and over were enrolled. Subjects underwent baseline spirometry and answered a questionnaire. After an albuterol + ipratropium bromide bronchodilator, a posttest was performed. Results Of 2201 individuals, only 33.3% had never smoked. The prevalence of COPD by the Global Initiative for Chronic Obstructive Lung Disease definition, was 9.7% (95% confidence interval [CI]: 8.5%–10.9%). According to the 5% lower limit of normal definition of COPD, the prevalence was 12.5% (95% CI: 11.2%–13.9%). A total of 20.2% were already diagnosed by a physician. No differences in symptoms across stages of COPD were found, but there was a significant trend for a higher number of visits to the emergency room and to the doctor (P < 0.001), and a higher number of hospitalizations (P < 0.001). Older individuals had an increased risk of COPD (adjusted odds ratio [ORa] = 1.05); so did “ever” cigarette smokers (ORa = 4.88) and water-pipe smokers (ORa = 2.53). Conclusion This is the first epidemiological study in Lebanon that determined COPD prevalence and the link with water-pipe smoking.

Water-pipe (narguile) smokers in Lebanon: a pilot study.

We carried out a comparative study to assess the demographic and social characteristics of water pipe (WP) smokers, the association with cigarette smoking and chronic respiratory diseases and the dependence profile on 4 groups: exclusive WP smokers, exclusive cigarette smokers, mixed smokers and absolute non-smokers. Cigarette smoking was statistically significantly higher in WP smokers than non-WP smokers; 36.5% of exclusive WP smokers smoked > or =7 WPs/week. Chronic respiratory disease and chronic bronchitis were reported more frequently in exclusive WP smokers than absolute non-smokers. WP smoking seems to be as great a risk factor as cigarette smoking for chronic respiratory disease.

Diet and Allergic Diseases among Population Aged 0 to 18 Years: Myth or Reality?

Allergic diseases are an important health problem. However, epidemiological studies concerning childhood diet-related allergic diseases are scarce. This review examines published articles dealing with diet, dietary patterns and nutrition in relation with allergic diseases among population aged 0 to 18 years. Studies and trials were identified using MEDLINE/PubMed and Cochrane Database of Systematic Reviews and were limited to those published in English or French from 1992 until 2012. This manuscript also reviews the evidence for maternal diet during pregnancy and diet during early childhood and their association with childhood atopic diseases, taking into account the methodology used to evaluate dietary patterns. The evidence reviewed is derived from large epidemiological studies exploring the effects of different food categories on asthma, atopic dermatitis, and allergic rhinitis in children. Overall, maternal diet during pregnancy and a childhood diet rich in antioxidants and omega-3 fatty acids are considered as healthy diets that could be protective for allergic diseases in childhood.

Waterpipe smoking and dependence are associated with chronic bronchitis: a case-control study in Lebanon.

Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. This case-control study in Beirut in 2009/2010 evaluated this relationship: 274 cases of chronic bronchitis and 559 controls without the condition aged > or = 40 years were enrolled. Data were collected by questionnaire on: sociodemographic characteristics, respiratory symptoms, smoking (waterpipe and cigarette) and nicotine dependence. ANOVA, Student, Kruskal-Wallis, chi-squared and Fisher exact tests were used when applicable and logistic regression analysis was carried out. Previous waterpipe smoking (OR = 6.4), previous mixed smoking (OR = 38.03) and current mixed smoking (OR = 7.68) were significantly associated with chronic bronchitis (P < 0.001 for all) but current exclusive waterpipe smokingwas not (OR = 1.87, 95% CI: 0.74-4.72). Current waterpipe dependence was significantly associated with chronic bronchitis (OR = 3.74, P < 0.001). After adjustment for covariates/confounders, ever waterpipe smoking > 20 WP-years (P < 0.001) was significantly associated with chronic bronchitis.

Respiratory diseases and pesticide exposure: a case-control study in Lebanon

Study objective: To evaluate the odds of being exposed to pesticides in asthmatic adults. Design: A case-control study was performed in Lebanon. Setting: People were approached when consulting physicians as outpatients. Patients: Asthmatic patients and non-asthmatic controls in several Lebanese hospitals were interviewed. Main results: The study included 407 subjects from 10 medical centres. Any exposure to pesticides was associated to asthma (OR = 2.11 (1.47 to 3.02); p<10−4). Occupational use presented the highest association (OR = 4.98 (1.07 to 23.28); p = 0.02), followed by regional exposure (OR 3.51 (2.11 to 5.85); p<10−4). Results were confirmed by multivariate analysis, particularly for regional exposure (ORa = 2.78; p = 0.02) and house exposure (ORa = 2.17; p = 0.001). Conclusions: Results are comparable to those found in other studies; especially for occupational exposure. Pesticides toxicological effects may explain chronic respiratory symptoms and asthma associations found with all exposure types. Pesticide exposure was associated with asthma in Lebanese adults.

Lower Prevalence of Cigarette and Waterpipe Smoking, But a Higher Risk of Waterpipe Dependence in Lebanese Adult Women Than in Men

The objective of this study was to evaluate whether nicotine dependence was higher in Lebanese women smokers compared with men smokers. Data were taken from a national cross-sectional study. Lebanese residents aged ≥ 40 years were enrolled between October 2009 and September 2010. After informed consent, participants answered a standardized questionnaire about smoking behaviors and dependence (measured by the Fagerström-Test-Nicotine-Dependence for cigarettes and the Lebanon-Waterpipe-Dependence-Scale 11 for waterpipes): 1,066 males and 1,134 females were interviewed. 58.7% versus 42.9% of them, respectively, ever smoked cigarettes, while 6.9% versus 6.7% ever smoked a waterpipe (p < 0.001). Moreover, 57.5% in male versus 49.1% in female cigarette smokers (p = 0.041), 35.9% versus 51.6% in waterpipe smokers (p = 0.076), and 67.9% versus 43.6% in mixed smokers were tobacco dependent. A dose-effect relationship was observed with increased rates of women versus men with waterpipe dependence) and an increased odds of dependence among women in multivariable analysis (ORa = 2.28). Positive (smoking waterpipe for pleasure and conviviality) and negative (smoking waterpipe to relax nerves and improve morale) reinforcements were significantly more frequent in women, while no significant sex difference was observed for nicotine dependence or psychological craving. In exclusive waterpipe smokers, significantly higher respiratory diseases and symptoms prevalences were found in females compared with males. Women who smoke waterpipes should receive attention during tobacco health education and smoking cessation.