Social and cultural conditions affecting the mental health of Syrian, Lebanese and Palestinian adolescents living in and around Bar Elias, Lebanon.

An estimated 1.5 million displaced Syrians live in Lebanon, sharing neighbourhoods and communal spaces with longer-term Lebanese and Palestinian residents. The Syrian Civil War has lasted over one decade. Protracted mass displacement means that many young people are growing up in neighbourhoods, towns and cities which include comparable numbers of recently displaced and longer-term residents. In this study, we explore adolescent mental health and the intersections between Syrians, Lebanese and Palestinians in the town of Bar Elias, where comparable numbers of displaced people and citizens live. We conducted semi-structured interviews with 30 adolescents in April 2019. We found that Palestinian, Syrian and Lebanese adolescents in Bar Elias identified the same shared conditions as affecting their mental health, although with different impacts on each individual. Sometimes, this difference accords with nationality, but it is also determined by gender and different physical and cognitive abilities. We conclude that recently displaced and host community adolescents can be seen to be affected by shared conditions, and that intersectional identities affect how adolescent mental health is affected by these conditions. We argue that investments in shared infrastructures can support the improvement of mental health for all adolescents.

Successful implementation of Medical Education Faculty Development Project at Saint George University of Beirut in the immediate post triple blow to Beirut.

Background: The aim of this study is to explore the efficacy of the Faculty Development Program (FDP) implemented at the Saint George University of Beirut-Faculty of Medicine (SGUB FM) under exceptional circumstances as the triple blow to Beirut. Methods: The Faculty Development, directed towards a cohort of 35 faculty members, is composed of two major components: methodology of teaching and techniques of assessment. The Kirkpatrick's assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative. Results: Results of the different questionnaires were interpreted individually, then through the lens of the psychological questionnaire. A majority of faculty (55%) were significantly affected psychologically by Beirut's triple blow and 77% of all participants found the workshops to be of excellent quality (Kirkpatrick's Level I). Moreover, Kirkpatrick's level II results yielded a 76% mean percentage of correct answers to post-workshops MCQs and a significant improvement in the mean results of the self-assessment questionnaires, administered before and after each workshop. Results also show that the more a trainee is psychologically affected, the less he/she performs as evidenced by a decrease in the satisfaction rate as well as in the score of the cognitive MCQs and of the self-assessment questionnaires. Conclusions: This study was able to highlight that significant learning can occur amidst exceptional circumstances like the Beirut triple blow and administration should invest in professional growth to retain its faculty.

Effect of Hormonal Replacement Therapy on Voice.

OBJECTIVE: This study aimed to investigate the effect of hormonal therapy (HRT) on voice in a group of menopausal women, taking into consideration body mass index (BMI) as a confounding factor and its potential role as a substitute for HRT. SUBJECTS AND METHODS: A total of 53 menopausal women, 34 not on HRT and 19 on HRT, were recruited. Demographic variables included age, gender, smoking, and BMI. All subjects were asked about the presence or absence of the following symptoms: hoarseness, deepening of the voice, pitch breaks, throat clearing, dryness in the throat, and vocal fatigue. Acoustic analysis was performed, and Voice Handicap Index-10 was also completed. RESULTS: The mean BMI was 25.90 ± 5.39 and 25.77 ± 4.26 in patients on HRT and not on HRT, respectively. There was no statistical difference in the Voice Handicap Index-10 score and the prevalence of any of the phonatory symptoms in menopausal women not on HRT compared with menopausal women on HRT. However, menopausal women not on HRT had significantly lower habitual pitch than those on HRT (P value of 0.022). On the other hand, the jitter was significantly higher in those on HRT (P value of 0.033). CONCLUSION: Hormonal therapy has an impact on the habitual pith in menopausal women with comparable BMI. Those on HRT have a higher habitual pitch than those not on HRT.

Apoptosis in Vocal Fold Polyps.

OBJECTIVE: To examine the degree of apoptosis and its role in the pathogenesis of polyps of the vocal folds. MATERIAL AND METHOD: A review of the pathology department's archives for patients diagnosed with vocal fold polyps between 2010 and 2016 has been conducted. As a control group, gross and microscopically intact vocal fold from laryngectomy specimens was collected. A total of 61 vocal fold polyps from 51 patients and 41 unremarkable vocal folds from the control group were identified. Microscopically, the parameters studied were as follows: apoptosis, mitosis, inflammation, and exocytosis. Apoptotic index (number of apoptotic cells) was determined by the number of apoptotic cells per millimeter square in the epithelium. Apoptotic cells were readily identified by deeply shrunken eosinophilic cells detached from the surrounding environment with pyknotic-degenerated nuclei. RESULTS: In polyps, the apoptotic index was statistically higher than the control group (ρ = 0.000). In addition, the increased apoptotic index in polyps showed a statistically proportional increase in mitotic index, inflammation, and exocytosis, which were significantly higher compared to control group. CONCLUSION: As a key for several therapeutic modalities, manipulation of apoptosis can be a future route for approaching vocal fold polyps by deciphering the complex signal pathways that allow the specified apoptotic cell to be targeted without damaging its surrounding counterpart.

Vocal Symptoms and Acoustic Findings in Menopausal Women in Comparison to Pre-menopause Women with Body Mass Index as a Confounding Variable.

OBJECTIVES: To compare the prevalence of phonatory symptoms in menopausal women compared to pre-menopause women with body mass index (BMI) as a confounding variable. METHODS: A total of 69 women, 34 menopausal and 35 pre-menopausal were invited to participate in this study. Demographic variables included age, smoking, and BMI. All subjects were asked about the presence hoarseness, loss of high or low frequencies, pitch breaks, throat clearing, dryness in the throat and vocal fatigue. Acoustic analysis was performed and the Voice Handicap Index (VHI)-10 was filled by all the subjects. RESULTS: There was a significantly higher prevalence of throat clearing and dryness in the menopausal group compared to the pre-menopause group with a P value of 0.035 and 0.032 respectively. When BMI was taken into account, there was no statistically significant difference in the prevalence of any of the phonatory symptoms in menopausal women with high BMI and pre-menopause. There was no statistically significant difference in the means of any of the acoustic parameters between the menopausal group and pre-menopausal group. There was no significant difference in the mean VHI-10 between the menopause group and the pre-menopause (P = 0.652). CONCLUSIONS: The results of this investigation substantiate the importance of fat as an alternative source of estrogen which can mask some of the phonatory symptoms.

Effect of Vitamin D Deficiency on Voice.

PURPOSE: The purpose of this article was to investigate the relationship between low level of vitamin D, phonatory symptoms, and acoustic findings. METHOD: A total of 38 subjects presenting to the endocrinology clinic were enrolled in 2 groups: 19 with vitamin D deficiency who were not on treatment, and 19 with normal vitamin D level who were on treatment. Demographic data included age, gender, and history of smoking. All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. Acoustic analysis and perceptual evaluation using the grade, roughness, breathiness, asthenia, and strain scale were performed on all subjects. RESULTS: The mean age of the total group was 47.29 ± 13.52 years. The difference in the mean and frequency of phonatory effort, vocal fatigue, and dysphonia, and in the mean of the acoustic variables, perceptual parameters, and the score of the Voice Handicap Index-10 was not statistically significant between patients with low vitamin D levels compared with controls. CONCLUSION: The results of this study revealed no significant difference in the prevalence of phonatory symptoms in patients with vitamin D deficiency compared with patients with no vitamin D deficiency. A larger study is needed to substantiate the difference in the prevalence of phonatory systems between the 2 groups.

The workforce trends of nurses in Lebanon (2009-2014): A registration database analysis.

BACKGROUND: Analysis of the nursing registration databases is a highly informative approach that provides accurate and reliable information supporting evidence based decisions relevant to the nursing workforce planning, management and development. This study presents the first systematic analysis of the nursing registration database in Lebanon. It Reports on the workforce distribution and trends using an updated version of the Order of Nurses in Lebanon (ONL) databases. METHODS: This study presents a secondary data analysis of a de-identified subset of the updated ONL registration database. The workforce participation status of ONL registered nurses was categorized as active and eligible. For active nurses sectors and sub-sectors of employment were defined. Eligible nurses were categorized as unemployed, working outside nursing and working abroad. SPSS was used to conduct descriptive analysis to present workforce trends of Lebanese nurses for year 2009-2014 as frequencies, percentages and percentage changes. RESULTS: Increases in the size of the Active (35%) and Eligible (86%) nurses were observed over the past six years. The majority of nurses fell in the below 35 years age group (60% in 2014). The hospital sector remained the principle employer, with 87% of Lebanese nurses working in hospitals in 2014. A 173% increases was reported for nurses working abroad. DISCUSSION: Despite the growth of the Active nursing workforce, the skewed distribution of nurses in the below 35 age group and the growth in the Eligible category, especially for nurses living abroad, raise concerns on the longevity of nurses in the profession and the reasons for their attrition from the workforce. CONCLUSION: There is a need to investigate the push and pull factors that are affecting nurses and the design of policies and interventions that would encourage nurses to remain active in Lebanon. Furthermore, policies and interventions that would create employment opportunities outside hospitals, especially in the Community sector, are recommended.

Laryngopharyngeal symptoms in patients with asthma: a cross-sectional controlled study.

OBJECTIVE: To examine the frequency and severity of laryngopharyngeal symptoms in asthmatic patients. The role of laryngopharyngeal reflux disease as a co-morbid disease to asthma has not been previously reported. SUBJECTS AND METHOD: Seventy-two subjects, 36 asthmatics and 36 controls were included in this study. Demographic data included age, gender, status of asthma, use of steroid inhalers, smoking and history of allergy. Pulmonary function test was reported in 13 subjects. The evaluation consisted of filling the Reflux Symptom Index (RSI) described by Belafsky et al. The total score, frequency and average score of each laryngopharyngeal symptom was computed in both groups. RESULTS: The mean age of patients was 46.61 ± 17.59 years with a female to male ratio of 2.3:1. Twenty patients were using steroid inhalers. Close to one third were smokers (30.6%) and 55.6% had allergic rhinitis. Thirty-six percent had controlled asthma vs 64% were uncontrolled. The mean of the total RSI was significantly higher in patients compared with controls (12.03 ± 8.3 vs 6.64 ± 6.08, P value < 0.05). In the asthmatic group, 15 subjects had a positive RSI compared with only 4 in the control group (P value of 0.003). There was a significant difference in the prevalence and means of four laryngopharyngeal symptoms in patients vs controls. CONCLUSION: Laryngopharyngeal reflux disease is more prevalent and more severe in patients with asthma vs controls.