Salim M. Adib

Violence against nurses in healthcare facilities in Kuwait.

A national cross-sectional survey was conducted to document the prevalence and determinants of violence against nurses in healthcare facilities in Kuwait. It involved all nurses employed in all types of health-related facilities and available in the country in May 1999. The questionnaire was completed by 5876 nurses (85% females, 88% non-Kuwaitis). Verbal violence had been experienced in the 6 previous months by 48% of the group, and physical violence by 7%. There was no physical harm reported in 63% of cases of physical violence. Physical abusers were mostly patients (51%). Compared to nurses who had never experienced physical violence, those who had experienced some were more likely to be male, non-Kuwaiti, to have had a shorter professional experience, and to be working in a hospital rather than in a primary healthcare center. The experience of nurses with violence is still relatively rare in Kuwait. Communication with patients and their entourage of family members and/or close friends is needed to clarify expectations and to avoid frustration and angry verbal outbursts.

Familial Mediterranean Fever: association of elevated IgD plasma levels with specific MEFV mutations

Familial Mediterranean Fever (FMF) is a recessively inherited disorder, characterized by episodic fever, abdominal and arthritic pain, as well as other forms of inflammation. Some FMF patients present higher IgD serum levels, and it is not yet known whether such an elevation is related to specific genotypes or correlated with a specific phenotype. In order to evaluate the association between known FMF-related mutations and IgD levels in confirmed patients, as well as the correlation between those levels and the presence of specific clinical signs, genotypic analysis and IgD plasma measurements were performed for 148 Lebanese and Jordanian FMF patients. Most common mutational patterns were M694V heterozygotes (19%) and homozygotes (17%), and V726A heterozygotes (18%) and homozygotes (5%), with an additional 11% combining both mutations. Twenty-one patients had higher IgD levels (superior to 100 μg/ml). The risk for higher IgD levels was significantly associated with M694V homozygote status (OR = 6.25) but not with heterozygotic one (OR = 1). Similarly, the risk for higher IgD was also found with V726A homozygotes (OR = 2.2) but not with heterozygotes (OR = 1.05). The use of colchicine was not statistically associated with IgD levels. Clinically, hyper IgD was also found significantly associated with arthritis (OR = 18). Thus, homozygotic status for M694V, and to a lesser extent V726A, is associated with increased risk for higher IgD plasma levels, regardless of colchicine use. Elevated IgD plasma levels are also correlated with the severity of FMF manifestations, and especially with arthritis.

Cancer truth disclosure by Lebanese doctors

Truthful disclosure of cancer diagnosis is still uncommon in some cultures. In Lebanon, legislation is permissive of non-disclosure. Physicians choose the recourse most agreeable to them. This studys goal was to determine the proportion of Lebanese physicians who choose truthful diagnosis disclosure to cancer patients and to identify factors affecting their choice. A survey of a random sample of Lebanese physicians was conducted to determine the proportion of those who prefer truthful diagnosis disclosure to cancer patients and to identify factors affecting that choice. The survey involved 268 participants representing 10% of all physicians practicing in specialties with potential contact with cancer cases in the Greater Beirut area. It was completed by 212 (79%), of whom 47% would usually tell the patient about cancer. Disclosure preference was not associated with gender, location of medical training, rate of patient contact or teaching activities. It was associated with longer clinical practice and with specialties outside primary care. Most participants were open to changing their policies and considered the patients desire to know, compliance with treatment and the patients profession as a physician as most influencing in their choice of disclosure. Exploring the Lebanese public predicament regarding disclosure seems necessary.

Breast cancer in Lebanon: Incidence and comparison to regional and Western countries

BACKGROUND Review and analyses of the 2004 Lebanese National Breast Cancer Registry (the most recently available complete national data). METHODS Crude, age-standardized rates (ASRs), and age-specific rates per 100,000 population were calculated and results were compared with estimates from Western, regional, and Arab countries. RESULTS Breast cancer constituted about 38.2% of all cancer cases among Lebanese females in the year 2004. The median age at diagnosis was 52.5 years. The age-standardized incidence rate per 100,000 was estimated at 71.0. ASRs remained lower than those observed in developed countries and in the Israeli Jewish population; however, they were greater than those estimated for Arab populations in the region. Five-year age-specific rates among Lebanese women were among the highest observed worldwide for the age groups 35-39, 40-44 and 45-49 years, with the exception of Israeli Jews for the age groups 35-39. CONCLUSIONS Results endorse the new guidelines developed by the Lebanese Ministry of Public Health to start breast cancer screening with mammography at 40 years of age. Further efforts are needed from different stakeholders in order to realize a comprehensive and full database, and to enhance awareness for early detection at all age groups.

Research in action: mammography utilization following breast cancer awareness campaigns in Lebanon 2002-05.

Four consecutive annual surveys of 1200 women each were conducted in Lebanon in connection with the National Breast Cancer Awareness campaigns (2002-05) to measure the prevalence of mammography utilization and the impact of these campaigns, and to highlight regional and demographic differences. The utilization of mammography in the previous 12 months was low and increased only slightly over 4 years (from 11% to 18%). In the 2005 campaign, it was twice as high (25%) in greater Beirut than in mostly rural areas, and among women aged 40-59 years (about 21%) compared with younger (12%) or older (11%) women. In each wave, repeat mammograms were less common than first time screening.

Attitudes of the Lebanese public regarding disclosure of serious illness.

OBJECTIVES: To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. DESIGN AND SETTING: Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. RESULTS: Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of religious practice, or religious affiliation, and preference for disclosure. CONCLUSIONS: Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses.

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.

International cooperation in the expansion of a newborn screening programme in Lebanon: a possible model for other programmes

SummaryTandem mass spectrometry (MS/MS) is rapidly gaining support, even in less-developed nations, as the method of choice for the newborn screening of metabolic disorders, although difficulties in acquiring this technology may at times be major obstacles in several Middle East and North Africa (MENA) countries. In Lebanon, international cooperation allowed this acquisition at the Newborn Screening Laboratory (NSL) of the Saint Joseph University (USJ) in the capital city of Beirut. NSL is currently screening up to 20% of all newborns in Lebanon. The expansion was made possible through initial collaboration with the Metabolic Laboratory at the Hamburg University Medical Center (HUMC) and subsequently with other centres. During phase I of the expansion (2006–2007), blood spots were shipped to HUMC with rapid couriers twice a week and electronic reports were sent back generally within 4 days after shipment. Positive cases were recalled to NSL and new specimens were sent back for confirmation at HUMC. During that first phase, the Beirut staff received training at the HUMC and in other centres. Phase II was a transitory period of 4 months during which machines were installed in Beirut and working procedures were adopted and documented. The activity has now entered a consolidation phase (Phase III) in which all measurements are exclusively performed in Beirut while HUMC acts as a backup centre. International cooperation remains crucial for periodic quality assurance procedures, and for supporting the transformation of the USJ-NSL into a training centre able to transfer MS/MS technology to the MENA region.

Tuberculosis in Lebanese jails : Prevalence and risk factors

A survey was conducted in 1995 to assess the prevalence of TB infection using the PPD skin test infection among 3931 inmates in all 21 jails in Lebanon. Forty-five percent of participants had a positive PPD skin test. The likelihood of testing positive was higher among men versus women, and among those who had been incarcerated for more than 3years versus less than that. Compared to prisoners whose usual residence was Central Lebanon, those from North Lebanon and those from outside Lebanon (mostly Syria and Egypt) had a higher risk for PPD positivity, those from Bekaa a lower risk, and those from South Lebanon about the same risk. Among those with positive PPD tests, 7% had abnormal chest X-rays suggestive of active infection. Results suggest that TB infection is an important health problem in correctional facilities in Lebanon and that special control programs should target North Lebanon. The importance of screening the incarcerated population with chest X-rays rather than PPD skin tests is discussed.

Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013

Introduction In 2012, the Ministry of Public Health in Lebanon piloted a service of multifactorial cardiovascular screening in the publicly subsidized Primary Health Care (PHC) Network. We present an epidemiological analysis of data produced during this pilot to justify the inclusion of this service in the package of essential services offered through PHC and to present a preliminary cardiovascular risk profile in an asymptomatic population. Methods A total of 4,205 participants (two-thirds of which were women) aged at least 40 years and reportedly free from diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD) were screened. The screening protocol used a questionnaire and direct measurements to assess 5 modifiable cardiovascular risk factors; total cardiovascular risk score was calculated according to a paper-based algorithm developed by the World Health Organization and the International Society of Hypertension. Results Approximately 25% of the sample displayed metabolic impairments (11% for impaired blood glucose metabolism and 17% for impaired systolic blood pressure), and 6.6% were classified at total cardiovascular risk of 10% or more. Just over one-quarter of the sample was obese, almost half had a substantially elevated waist circumference, and 41% were smokers. Men were significantly more likely to screen positive for metabolic impairment than women, and women were more likely to be obese. Conclusion The implementation of a multifactorial screening for CVD among asymptomatic subjects detected a substantial proportion of previously undiagnosed cases of high metabolic risk, people who could now be referred to optimal medical follow-up.