Immunity to chickenpox among school adolescents in Lebanon and options for vaccination.

Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15-18 years of age attending schools in Lebanon showed 96.6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97.4%, whereas the negative predictive value was 4.5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.

Common prescriptions in ambulatory care in Lebanon.

OBJECTIVE: To describe prescribing practices of family physicians in a staff model health maintenance organization at a university health center in Lebanon and estimate costs of such practices for common diseases. METHODS: All prescriptions issued between July 1, 1997, and June 30, 1998, were prospectively collected. The diagnoses made by physicians at each encounter were recorded, and the total price of medications prescribed was calculated. The core prescribing indicators as defined by the World Health Organization and the mean annual prescription price per person for the 25 most common diagnoses were calculated. RESULTS: Prescribing occurred in 27.1% of encounters, with a mean of 1.6 medications per encounter; 17.5% of all prescriptions included an antibiotic. Generic drugs and essential drugs each accounted for 2.9% of all medications. Approximately 50% of the consultations for either respiratory or ear infections resulted in a prescription. Cervical spine syndromes and lipid metabolism disorders cost most among recorded diagnoses, with mean annual prescription prices per person of US $2016 and $1128, respectively. CONCLUSIONS: The low rate of generic and essential drug prescribing, as well as the frequency of prescribing in respiratory infections, highlight the need for initiatives to help rationalize prescribing in primary care in Lebanon. Together with the diagnostic categories incurring high cost per person, these issues can be part of physician education or treatment guideline development. These measures may aid the government in its subsidy of primary health care centers.

List of essential drugs for primary care in Lebanon.

In 1966, Lebanon had around 19,000 drug formulations registered in the Ministry of Public Health. The government decreased that number to 5400 in 1992 through numerous interventions. In 1995 and in an effort to rationalize drug prescribing, the Lebanese government organized an ad hoc committee of medical and pharmaceutical experts to review the 1992 list and create a list of essential drugs for primary care (LEDPC). This report describes the process and the studies used to update the 1992 list by the ad hoc committee.

Cancer screening for the primary care physician.

Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial.

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.

Recommendations for the school health physical examination in Lebanon.

School health developed gradually over the years; starting with efforts to keep contagion out of schools to global programs of comprehensive services. One of its components, school medicine, covers screening examinations, record maintenance, emergency care, immunization monitoring and health counseling. This paper proposes the essential health activities to be performed during a screening school examination in Lebanon. The recommendations are based on a combination of international literature review of evidence and the existence of Lebanese epidemiological reports identifying specific problems. Vaccination record review, tuberculin testing, vision, hearing, dental and skin disorders screening procedures are proposed as essential activities of the school physical examination.

Purified protein derivative (PPD) conversion rate among Lebanese children in Beirut.

To determine the purified protein derivative conversion rate among Lebanese children we followed a cohort of 1236 students, ages 5-14 years, enrolled in 25 public schools in Beirut. All cases received an intradermal injection of purified protein derivative in 1992 and one year later. Test administration was done using standard techniques and results were read by the same physician 48-72 hours later. Demographic information was also obtained on the enrolled students. The majority of children identified belonged to a low socioeconomic class. The one year conversion rate was 1.4%. This underscores the urgent need for preventive programs.

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 study's 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 patient's desire to know, compliance with treatment and the patient's profession as a physician as most influencing in their choice of disclosure. Exploring the Lebanese public predicament regarding disclosure seems necessary.

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.

Survey of family medicine residents evaluation methods.

BACKGROUND: Family medicine residents are evaluated to ensure mastery of required practice skills by a variety of methods. The objective of this paper is to report the results of a sample of the 394 accredited family practice residencies to determine the evaluation methods used and their corresponding value to the program. METHODS: Questionnaires were sent to program directors and chief residents of all accredited family practice residency programs. RESULTS: Responses were received from the director or chief resident of 354 (90%) programs. For 195 programs, both the chief resident and program director responded. The five most common evaluation methods were the American Board of Family Practice In-Training Examination, formative review sessions, resident chart review, list of procedures performed, and family medicine conference attendance. Of 195 programs for which directors and chief residents both responded, directors and chief residents differed significantly in the reported number of evaluation methods but not in perceived value of those evaluation methods. Neither geographic region, community or university affiliation, class size, nor age of program was associated with differences in numbers of evaluation methods or perceived value of those methods. CONCLUSION: Many highly rated resident evaluation methods are being utilized by less than one-third of the programs. The most prevalent forms of evaluation appear to be auditing medical practices and behaviors.

Laboratory outbreak of Q fever.

An outbreak of Q fever in a university department where sheep placentas were being used for research is described. Of six persons exposed to the sheep, four had positive titers with only one person developing an acute febrile illness and liver disease. This report illustrates the value of the family physician obtaining an occupational history and conducting an outbreak investigation.