What matters in the patients' decision to revisit the same primary care physician?

To assess the priority of various aspects of the patient-primary care physician relationship in the decision to visit again that same physician. A total of 400 community residents in Ras Beirut, Lebanon. Study design: A cross-sectional community based study sampled by a nonrandom sex-education quota-based procedure. Participants were asked to fill a survey where they indicated the ranking of nine items by importance in their decision to revisit the same physician. The nine items were chosen from three categories of factors: professional expertise of the physician ; characteristics of the patient-physician relationship, office organization. Having a physician that gives the patient adequate time for discussion prevailed as rank 1 and luxurious clinic ranked as 9th. Affordability was one of the main concerns among men, those with poor health and those of lower socioeconomic status. Accessibility of the physician's phone was considered highly important among women and those of lesser education status. This study emphasizes the importance of adequate time with the patient, accessibility and affordability of the physician in maintaining continuity of care and patient satisfaction, beyond mere medical expertise

[Guidelines for breast cancer screening in Lebanon public health communication]

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon [2006]. Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year [2004]. This official notification calls for breast self-examination [BSE] every month starting age 20, and a clinical breast examination [CBE] performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force [BCNTF] recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries. It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future

Cost-benefit analysis of G6PD screening in lebanese newborn males

G6PD deficiency is one of the most prevalent genetic diseases in Lebanon [1% in Lebanese males]. Easy and effective screening methods exist to detect this deficiency early in new-borns. To assess the cost-effectiveness of G6PD deficiency screening in the routine work-up of every male newborn in Lebanon. Of 299 babies with G6PD deficiency detected between 1999 and 2004, 139 [46.5%] were located, contacted, and surveyed for their experience of acute anemia crises. A previous community survey had indicated a 77.8% risk for an acute anemia crisis necessitating hospitalization in unscreened patients, most often associated with consuming fava beans raw or in combination products. In contrast, only 5 [3.8%] of the 139 screened G6PD-deficient babies had ever developed a severe acute anemia crisis. The risk for hospitalization following a crisis had thus been reduced by 95% among patients screened for G6PD deficiency, compared to those unscreened. The estimated mean cost of each hospitalization, which lasts on average 7 days, is 1450 USD. The cost of screening is about 3 USD. The analysis indicates that, given the current prevalence of the deficiency and the reduction in hospitalization rates associated with knowing one's status, the cost of systematic screening is about 2.58 times lower than that of anemia-related hospi-talizations in an unscreened population. The efficiency of routinely testing evidenced here supports changes in screening policies for boys

Risk factors and clinical presentation of brucellosis in Al-Jahra hospital [1997-1999]

To analyze the clinical and demographic features of brucella patients hospitalized at the Jahra Hospital [JH] between January 1997 and December 1999. Variables were obtained directly from medical records. A total of 115 patients were reviewed, re p resenting 0.9% of all medical admissions; down fro m 10% in the mid-80s. Almost all cases had a history of contact with cattle and/or ingestion of raw milk. Male Bangladeshi shepherds were the most predominantly re p resented group among our cases. The median age of patients was 32 years. The season of infection culminated in the spring and was lowest in the winter The median stay in hospital was six days, and was longest for Bangladeshis and Kuwaitis compared to other nationalities. Serious complications occurred in only two patients and resolved without sequel. Tw o other patients relapsed and required a second course of antibiotics. Conclusions: The remarkable decline in the incidence of brucellosis in Al-Jahra is very likely due to changes in diet and animal husbandry. Shepherds are still at high risk, and consideration to their socio-economic vulnerability and harsh work conditions must be addressed to further reduce the incidence of brucellosis in Kuwait

Evaluation of diagnostic procedures and outcomes in thyroid surgery: the experience of Al-Amiri hospital

To evaluate the ability of different diagnostic procedures in predicting thyroid malignancy, and to highlight outcomes of thyroid surgery Al-Amiri Hospital, 1990-95 Retrospective review of surgical records. 1.4% of all surgical interventions performed during that period [N=210] were thyroid cases. Surgical indications were solitary cold nodule [58%], multinodular goitre [36%] and hyperthyroidism [5%]. Following surgery, only 10% [n = 21] were histopathologically malignant. Based on postoperative findings, malignancy could have been predicted by thyroid isotopic scanning in no more than 11% of cases, and by ultrasounds [U/S] in 9% of solid lesions. Fine needle aspiration [FNA] accurately predicted 87% of cases. Only 26 patients [13%] developed post-operative complications, of which the most common was voice change [n = 8], mostly transient [6/8]. In this series, most patients [77%] stayed in-hospital for 3-5 days. The predictive value of malignancy in thyroid nodule[s] using fine needle aspiration is by far higher than that of ultrasound or thyroid scans. U/S may be preferred to visualise sub-clinical nodules. At this point in time, FNA is always recommended to diagnose malignancy, and the adjunct use of U/S helps in locating all potentially active nodules. In the presence of U/S. thyroid scans may be of lesser value. Thyroid surgery is generally safe, and should become an outpatient procedure. Hospital stays should be determined by the extent of surgery and/or the appearance of complications

Cost and length-of-stay of hospital care billed to the ministry of public health by private hospitals

Two measures of care were estimated from a random sample of 2033 [65%] bills presented to the ministry of public health [MOPH] by hospitals from all over Lebanon in February 1994. average length of stay was 5 days in surgery, 5.5 days in medicine, and 2.4 days in obstetrics. Average daily costs of hospitalization were 296.971 LL [almost equal to 170 us$] in surgery, 142,690 LL [almost equal to 81.5 us$] in medicine, and 225.000 LL [almost equal to 129 us$] in obstetrics. While neither one of these outcomes was affected by patients' sex, differences were found by age and hospitals' geographical location and classification. Implications and recommendations for effective evaluation of subsidized care, and better allocation of public funds are discussed

Estimation of cancer incidence in Lebanon

Cancer incidence rate is an important indicator for policymakers seeking to establish a national cancer control program in Lebanon. This rate is difficult to assess however in view of the absence of national health and vital statistics. Fragmentary data from 1984 were used to estimate the annual cancer case-load at 3.500 cases. For an estimated population of 3.29 million, this case-load yields an incidence rate of 106 per 100.000. this low rate has not varied much since the mid-60s, and is nearer to that of developing than of developed nations, cancer incidence may however increase in the coming few years with the aging of the population and increasing urban pollution, smoking and adverse diet changing

Most common diseases treated in primary health care facilities in Lebanon

The Lebanese Ministry of Health has requested public health experts to assess the most common health problems seen in Primary Health Care [PHC] facilities. This paper presents the results of this assessment conducted in a convenience sample of PHC centers. The assessment aimed at identifying areas of strength and gaps in the current system. Data were drawn from 23 PHC centers in various regions of Lebanon, in addition to an 8-year review of the experience of the Department of Family Medicine at the American University Hospital. In general, 46% of all visits to PHC centers did not include any kind of diagnosis. Most centers provided data on large categories of diseases without breakdown into specific entities. The most commonly identified health problems were hypertension, diabetes and asthma, in addition to eye and ear diseases, cardiologic conditions, and dermatologic problems. Other health problems included ill-defined signs and symptoms associated most likely with mental distress. Dental caries, skin and hair parasites, and respiratory tract infections topped the health problems among children. A qualitative synopsis of all data is presented. The paper highlights the limitations of the current health information system in Lebanon, and suggests corrective measures. It also presents a number of recommendations regarding the optimal use of PHC centers for health education and promotion and for disease prevention