Zeinab N. Slim

High burden of rheumatic diseases in Lebanon: a COPCORD study

Aim:  To estimate the prevalence of rheumatic diseases in Lebanon and to explore their distribution by geographic location, age, and gender.

High burden of musculoskeletal conditions: a problem that has only recently come to recognition:

Objectives: Musculoskeletal conditions have only recently been acknowledged and research on their burden is scarce in the Middle East and North African (MENA) region. For the first time, a population based study was conducted in Lebanon to assess the prevalence, level of disability, and health seeking behaviours related to musculoskeletal pain and rheumatic disorders. Methods: A random sample of 500 participants aged ≥ 15 years from Southern Lebanon was interviewed using the COPCORD (Community Oriented Program for Control of Rheumatic Diseases) questionnaire. Results: The prevalence of current musculoskeletal pain was 31.2% [CI (27.0–35.2%)]. Being a female [OR=1.8, CI (1.2–2.8)] and of advancing age [OR=1.03, CI (1.01–1.05)] were the only significant factors associated with current musculoskeletal pain. Prevalence of current functional disability was 6.4% [CI (4.2–8.5%)]. Around quarter (26.0%) [CI (22.3–30.1%)] of our sample sought some kind of treatment. The overall prevalence rate of rheumatic disease was 17.0% [CI (13.7–20.3%)]. Discussion: Our findings indicate that musculoskeletal conditions are common in Lebanon. This is a timely public health issue that needs further investigation and solid recognition by health authorities. Community-based interventions should target patients to prompt them to seek early help in order to prevent the development of musculoskeletal pain into disorders.

Work and mental health: the case of older men living in underprivileged communities in Lebanon

ABSTRACT This paper examines the association between being in paid work and depression among older adults in three poor urban communities in Beirut, Lebanon. In view of the rapid ageing of Lebanons population and the growing number of older persons, the deteriorating economic conditions and the lack of pension systems, paid work is an important source of income for older people and deserves special attention. The sample was 328 men aged 65 or more years. Depression was assessed using the 15-item Geriatric Depression Scale. The exposure variable was working for pay at the time of the survey, and the covariates included socio-demographic measures, health characteristics, financial resources and social capital. Around one-third of the men were working, and approximately the same fraction were depressed. Adjusted data showed a protective effect of work on depression (odds ratio 0.50, 95 per cent confidence interval 0.25–0.96). This study is an eye opener on the circumstances of disadvantaged older people in a relatively low-income Eastern Mediterranean Region country, a topic rarely addressed in this area of the world. Old age is viewed as a decline in abilities while in reality many older adults are still able and ready to work. Social policies for older people should promote opportunities to work, not only pension schemes.

Risk factors for incident symptomatic knee osteoarthritis: A population-based case control study in Lebanon

To identify risk factors for symptomatic knee osteoarthritis (OA) and explain the geographical disparities in its occurrence.

Coping and disability: evidence from a developing country.

Aim:  In view of the increasing burden of musculoskeletal‐related disability, the growing number of older persons and the scarcity of research on musculoskeletal conditions in the Eastern Mediterranean region, coping with musculoskeletal problems deserves special attention. This paper examines how good coping links to musculoskeletal‐related disability among Lebanese citizens aged 15 years and older.

Risk factors for incident shoulder soft tissue rheumatic disorders: a population-based case–control study in Lebanon

Background Soft tissue rheumatic disorders (STRDs) are very common and impact enormously general population, working groups and physiotherapist practices. However, they do not have neither a clear case definition nor objective tests to be accurately diagnosed rendering them neglected with poorly-estimated burden. Shoulder is one of the most frequent sites for STRDs. Aim The aim of this study was to identify risk factors for shoulder STRDs among Lebanese adults aged ≥ 15 years. Methods A case-control study was designed based on data from the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study conducted in Lebanon in 2009. Cases were defined as those who recently suffered from shoulder pain, tenderness or stiffness with duration not exceeding 12 months (52 cases). These were frequency-matched by age and gender with 208 controls who never experienced any musculoskeletal pain. Results Area of residence, physical activity, family history and stress-induced sleep difficulty were significantly associated with shoulder STRDs after adjusting for cigarette smoking, job nature and family monthly income. Conclusion Factors associated with shoulder STRD among the Lebanese population include geographical location, psychosocial factors, physical activity and familial predisposition. Further longitudinal studies are needed to establish a temporal sequence and explore other potential determinants, especially among the working population.

Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Lebanon

To investigate the epidemiology of fibromyalgia (FM) and assess its risk factors.

RE: “ELEVATED LUNG CANCER IN YOUNGER ADULTS AND LOW CONCENTRATIONS OF ARSENIC IN WATER”

We read with interest the study by Steinmaus et al. (1), in which they found an association between lung cancer and arsenic concentrations less than 100 μg/L in drinking water. The authors used a matched case-control design to study drinking water in 2 regions in Chile. However, we are concerned about the methodology and the conclusions drawn. Our first concern is with selection bias; cases were ascertained from all pathologists, hospitals, and radiologists in the area, but it was unclear whether the cases constituted all lung cancer cases. Our second concern is with the study base and the possibility that cases and controls were chosen from dissimilar sampling frames. Cases had been diagnosed with lung cancer, but controls were free from lung, bladder, and kidney cancers. Moreover, proxy interviews were conducted with 54% of cases and only 7% of controls, which increased the likelihood of information bias due to differences in data quality (2, 3). Our third concern is with the statistical analysis itself. Because the only statistically significant association between arsenic and lung cancer was for the 40-year lag time, a better description of the analysis is required to understand that all persons who contributed to this analysis were at least 40 years of age. It would also be helpful to present a clear statement of the study design (the study was not a matched case-control study) that would explain the choice to use unconditional logistic regression modeling (4). Lastly, we are concerned that the title of the article has the potential to raise the alarm of a new health risk from local drinking water. Inasmuch as the methodological issues prevent drawing conclusive results about the association under study (5), it is prudent to report findings cautiously to minimize the arousal of public fear. ACKNOWLEDGMENTS