Is menarche occuring earlier among Lebanese girls?

BACKGROUND: Early menarche is associated with increased risks for several diseases such as cardiovascular diseases and breast cancer. This analysis aimed at generating evidence on a historical trend towards younger age at menarche among Lebanese girls. METHODS: A secondary analysis was conducted on data consolidated from three serial cross-sectional national surveys of women in Lebanon (2007, 2009 and 2012). A total of 6150 women were included in order to study the association between date of birth intervals and age at menarche. RESULTS: The mean age at menarche was 13.06 years, with a peak of the distribution at age 12. Women born before 1950 had a significantly higher mean age at menarche (13.21) compared to those born in 1970 and thereafter (12.95). A stratified analysis showed that women living outside the metropolitan Greater Beirut (GB) area were characterized by an older mean age at menarche (13.11) in all date of birth intervals compared to those in GB (12.89). However, age at menarche declined more significantly over the last two decades among women outside GB, compared to those living in GB. CONCLUSIONS: Epidemiological figures emerging from this study confirm that trends in Lebanon are in line with a global pattern of decreasing age at menarche. Urban-rural differences suggest that higher caloric content of diet and consequent early overweight, more evident in urban areas, are likely determinants of younger menarche. Evidence from this study calls for an urgent implementation of comprehensive multisectoral obesity prevention in children in Lebanon.

Cervical cancer screening among Lebanese women.

BACKGROUND: Cervical cancer is a very common malignancy amongst women worldwide. Pap smear is an effective and inexpensive screening test in asymptomatic women. The aim of this paper was to assess the prevalence of Pap smear screening for cervical cancer among Lebanese women and to determine associated sociodemographic and psychosocial characteristics. METHODS: This national survey included 2255 women, selected by multi-stage random cluster sampling across Lebanon. A questionnaire about practices and perceptions related to cervical cancer screening was developed based on the "Health Belief Model". RESULTS: The weighted national prevalence of "ever-use" of the Pap smear for screening purposes was 35%. Most important determinants of screening behavior were: residence within Greater Beirut, higher socio-economic status and educational attainment, marriage status, presence of a health coverage, awareness of Pap smear usefulness, knowing someone who had already done it, and a balance between perceived benefits and perceived barriers to Pap smear screening. CONCLUSION: Regular information campaigns regarding the availability and effectiveness of the test should be devised, targeting in priority the sexually vulnerable women in Lebanon. Moreover, healthcare providers should be encouraged to discuss with their patients the opportunity of obtaining a Pap smear.

Geographic epidemiology in a small area: cancer incidence in Baakline, Lebanon, 2000-2008.

Aggregate data of the National Clr cac gi s in Lebanon cannot discriminate cance r incidence i n small areas. Trained community members surveyed the permanent population of the Baakline municipality using the verbal autopsy approach. We surveyed 1042 households with at least 1 member living permanently in Baakline during 2000-2008. Data covered 4330 persons yielding 34,143 years of observation and 56 new cases of cancer were reported. Median age at diagnosis varied significantly between men (77 years) and women (56 years). The most common types were lung cancer (20%) followed by colorectal (12.5%) and breast (9%). Estimated crude cancer incidence rate was 164 cases/100,000 persons/year, significantly higher in men (194) than women (130), and much lower overall than the national figure (218). The permanent Baakline population is older than that of Lebanon itself, yet the cancer incidence rate is markedly lower than the national figure. This finding pleads for serious efforts to preserve the low environmental contamination and the healthy lifestyles in food and tobacco abstinence that have protected the population so far.

Geographic epidemiology in a small area: cancer incidence in Baakline, Lebanon, 2000-2008

Aggregate data of the National Cancer Registry in Lebanon cannot discriminate cancer incidence in small areas. Trained community members surveyed the permanent population of the Baakline municipality using the verbal autopsy approach. We surveyed 1042 households with at least 1 member living permanently In Baakline during 2000-2008. Data covered 4330 persons yielding 34143 years of observation and 56 new cases of cancer were reported. Median age at diagnosis varied significantly between men [77 years] and women [56 years]. The most common types were lung cancer [20%] followed by colorectal [12.5%] and breast [9%]. Estimated crude cancer incidence rate was164 cases/100 000 persons/year, significantly higher in men [194] than women [130], and much lower overall than the national figure [218]. The permanent Baakline population Is older than that of Lebanon itself, yet the cancer Incidence rate is markedly lower than the national figure. This finding pleads for serious efforts to preserve the low environmental | contamination and the healthy lifestyles In food and tobacco abstinence that have protected the population so far

Health-care-seeking behaviour among university students in Lebanon.

This cross-sectional study assessed the health-care-seeking behaviour, barriers to accessing care and associated factors among a sample of 543 Lebanese students at Saint-Joseph University. Data were collected on health-care-seeking behaviour for health issues in the previous 12 months using an anonymous questionnaire. Health-care-seeking behaviour was categorized as: formal (professional help sought); informal relational (help sought from friends/family); informal personal (self-help). The health issues examined were: physical, psychological, social and relational, sexual, drug, alcohol and smoking. When facing health-related issues, the students tended to seek informal health care. Formal health-care-seeking behaviour was almost non-existent for psychological issues (3.3%), relational and social issues (1.8%), and issues related to substance use (5.1%). The barriers to seeking formal health care fell into 2 categories: accessibility and relational. To encourage young people to access formal health care, specific health services should be provided for them where they are assured of confidentiality and understanding.

Physical and verbal/emotional abuse of schoolchildren, Lebanon, 2009.

The extent of physical and verbal/emotional abuse in schools in Lebanon is currently unknown. This cross-sectional study aimed to determine the prevalence and patterns of both forms of abuse among a nationally representative sample of Lebanese schoolchildren, aged 10-18 years, using a self-reported questionnaire. A total of 1177 schoolchildren, 49.6% females, median age 14 years, completed the survey; 76.4% and 81.2% of these had experienced physical and verbal/emotional abuse respectively at least once at school. Male students [adjusted odd ratio (AOR)= 3.4, P < 0.01], children in public schools (AOR = 1.9, P< 0.01) and in South Lebanon (AOR= 2.2, P < 0.01) and Bekaa (AOR = 1.7, P < 0.05) regions were more likely to have experienced physical abuse than females, children from private schools and from Beirut. Male students (AOR = 1.3, P < 0.01) and children in public schools (AOR = 1.6, P < 0.01) were also more likely to experience verbal abuse, with no regional differences. The prevalence of physical and verbal/emotional abuse in schools in Lebanon is high and solutions should be sought to correct the problem engaging political and social leaders, the mass media, law enforcement agencies, parents and educators.

Health-care-seeking behaviour among university students in Lebanon

This cross-sectional study assessed the health-care-seeking behaviour, barriers to accessing care and associated factors among a sample of 543 Lebanese students at Saint-Joseph University. Data were collected on health-care-seeking behaviour for health issues in the previous 12 months using an anonymous questionnaire. Health-care-seeking behaviour was categorized as: formal [professional help sought]; informal relational [help sought from friends/family]; informal personal [self-help]. The health issues examined were: physical, psychological, social and relational, sexual, drug, alcohol and smoking. When facing health-related issues, the students tended to seek informal health care. Formal health-care-seeking behaviour was almost non-existent for psychological issues [3.3%], relational and social issues [1.8%], and issues related to substance use [5.1%]. The barriers to seeking formal health care fell into 2 categories: accessibility and relational. To encourage young people to access formal health care, specific health services should be provided for them where they are assured of confidentiality and understanding

Physical and verbal/emotional abuse of schoolchildren, Lebanon, 2009

The extent of physical and verbal/emotional abuse in schools in Lebanon is currently unknown. This cross-sectional study aimed to determine the prevalence and patterns of both forms of abuse among a nationally representative sample of Lebanese schoolchildren, aged 10-18 years, using a self-reported questionnaire. A total of 1177 schoolchildren, 49.6% females, median age 14 years, completed the survey; 76.4% and 81.2% of these had experienced physical and verbal/emotional abuse respectively at least once at school. Male students [adjusted odd ratio [AOR] = 3.4, P< 0.01], children in public schools [AOR = 1.9, P< 0.01] and in South Lebanon [AOR = 2.2, P< 0.01] and Bekaa [AOR = 1.7, P< 0.05] regions were more likely to have experienced physical abuse than females, children from private schools and from Beirut. Male students [AOR = 1.3, P< 0.01] and children in public schools [AOR = 1.6, P< 0.01] were also more likely to experience verbal abuse, with no regional differences. The prevalence of physical and verbal/emotional abuse in schools in Lebanon is high and solutions should be sought to correct the problem engaging political and social leaders, the mass media, law enforcement agencies, parents and educators

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.

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

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

Tandem 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.

Pattern of antibiotic prescription in the management of oral diseases among dentists in Kuwait.

OBJECTIVES: The use and abuse of antibiotics have been of concern to the medical and the dental profession for sometime now, due mainly to the emergence of antibiotic-resistant bacteria. The objective of this project was to determine the rationale and the pattern of antibiotic prescription for dental management in Kuwait. METHODS: A questionnaire was distributed to 200 dental practitioners working in the Ministry of Health dental centers in Kuwait. The questionnaires sought answers to the clinical and non-clinical factors; signs, clinical conditions and dental treatment modalities for which the practitioners would prescribe antibiotics. RESULTS: Of the 200 questionnaires sent out, 168 (84%) respondents returned fully completed forms. A total of 107 (63.7%) of the respondents were males. Of respondents, 90% would prescribe antibiotics for patients with elevated body temperatures and evidence of systemic involvement, gross or diffuse facial swelling and closure of the eye due to inflammatory swelling. However, over 50% would prescribe antibiotics for cases with localized fluctuant swelling without any systemic involvement, while 59.6% would prescribe for patients with difficulty in swallowing as a result of an oral infection. Many respondents would consider antibiotic prescription for routine dental extraction, and for non-clinical reasons such as uncertainty of diagnosis, convenience, expectation of the patient and lack of time to treat immediately. Amoxicillin was the most frequently prescribed antibiotic. Higher knowledge regarding adequate indications for antibiotic use was associated with longer professional experience. CONCLUSIONS: The results of this analysis suggest that there is lack of uniformity in the rationale for antibiotic use among dental practitioners in Kuwait. There is an urgent need for the formulation of evidence-based guidelines, which should take into account the peculiar behavioral characteristics of the community.

Congenital malformations and genetic diseases in comic books.

Medical syndromes have often been represented in fine arts, but rarely have clinical diagnoses been discussed in comic book characters. Since their first appearance in Europe in the middle of the 19th century and in America in 1895, comic books have been considered as "the 9th art". In many comic books, the appearance and/or the behavior of central or support characters are suggestive of already well-defined medical disorders. The representation of five particular groups or clinical features: mental retardation, abnormal stature, abnormal hair, obesity, and cranial malformations is discussed from mostly European comic series. Whether comic authors intended to describe specific clinical entities while drawing their characters or whether such situations appeared by mere luck, is open to debate. In many series from the first half of the 20th century characters with remarkable clinical features were also painted as psycho-social deviants. Such stereotypes are found much less frequently nowadays. Writers of comic books, realizing the major impact of their work especially in adolescent age groups, have increasingly been using their series to actually promote issues of equity and well being for physically or mentally impaired people.

Heterosexual awareness and practices among Lebanese male conscripts.

To assess sexual behaviour and awareness about sexually transmitted infections (STIs) among young male adults in Lebanon, and to explore determinants associated with increasing levels of sexual risk, a cross-sectional survey of 730 conscripts was conducted. About 50% reported any lifetime heterosexual experience. Non-mutually exclusive sex predominated, and only half of the respondents reported consistent condom use during insertive vaginal sex. Higher sexual risk-taking was associated with urban residence, higher education, lower family crowding and younger age at first sexual experience. A national strategy with epidemiological and behavioural surveillance and educational programmes must be initiated before sexual risk-taking and incidence of STIs become a major public health issue.

Heterosexual awareness and practices among Lebanese male conscripts

To assess sexual behaviour and awareness about sexually transmitted infections [STIs] among young male adults in Lebanon, and to explore determinants associated with increasing levels of sexual risk, a cross-sectional survey of 730 conscripts was conducted. About 50% reported any lifetime heterosexual experience. Non-mutually exclusive sex predominated, and only half of the respondents reported consistent condom use during insertive vaginal sex. Higher sexual risk-taking was associated with urban residence, higher education, lower family crowding and younger age at first sexual experience. A national strategy with epidemiological and behavioural surveillance and educational programmes must be initiated before sexual risk-taking and incidence of STIs become a major public health issue