Workplace wellness across the lifespan: A pilot program for health promotion in a low- and middle-income country.

Considering that a sizable segment of the population spends significant amount of time at work, workplaces have been identified as practical platforms for health educational programs. Although employee wellness programs in high-income countries have shown measurable benefits in productivity and physical and mental health, evidence-based programs in low- and middle-income countries, such as Lebanon, are unavailable. The aim is to develop and implement a pilot workplace wellness program focusing on health-related areas to improve health knowledge and behavior among working men and women of reproductive age. In collaboration with March of Dimes, the National Collaborative Perinatal Neonatal Network developed a culturally sensitive health education program focusing on lifestyle, infection, nutrition and family planning. Sessions were delivered by a multidisciplinary team of specialists at a local bank in Lebanon. To assess the impact of the program, participants completed Knowledge and Behavior Assessment Questionnaire (KBAQ) before and after implementation. KBAQ was conducted 6 months after implementation to measure retention and continuing impact. Forty-seven participants completed the program, of whom 44.7% are male, 98% have university degree and 56.5% are married. Total knowledge score improved significantly from 64.2 to 74.3 and remained significant at 6 months post-implementation with a score of 71.7 (p < 0.001). At 6-month follow-up, emotional score improved (p = 0.028), while smoking decreased (p = 0.008). Also, employees' health knowledge and behavior showed sustained and significant improvement. We plan to implement our program at other sites and among employees from different backgrounds to understand the impact of the wellness program on employees' knowledge and behaviors at a larger scale.

Grading reflective essays: the construct validity and reliability of a newly developed Tool- GRE-9.

BACKGROUND: The main objective of this study is to assess the construct validity and reliability of the Grading Reflective Essays-9 (GRE-9). METHODS: This study took place in a major tertiary academic medical center in Beirut, Lebanon. 104 reflective essays written by years 1-3 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 2 trained raters who independently scored the essays using GRE-9. GRE-9 scores were then correlated with scores on communication skills OSCE stations and in-training examinations to investigate, respectively, convergent and divergent validity. One of the 2 raters scored the essays twice one month apart to assess the reliability of the GRE-9 using intra rater reliability and internal consistency. RESULTS: There was a weak, non-significant correlation between GRE-9 score and In training examination (ITE) score (r = - .213, p = .395). There was a moderate, non-significant correlation between GRE-9 scores and the Objective structured clinical examination (OSCE) communication station scores (r = - .412 p = .162). The correlation coefficient between trails 1 and 2 was significant (r = .832, p = .000). Intra class correlation coefficient (ICC) analysis demonstrated almost perfect intra-rater agreement (0.819; 95% CI: 0.741-0.875) of the test ratings over time. CONCLUSIONS: GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial intra-rater reliability and evidence of divergent validity. The study found non-significant correlations between reflective writing scores OSCE communication scores demonstrating a lack of relationship between reflective writing and this measure of performance.

Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use.

BACKGROUND: The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. METHODS: Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. RESULTS: A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). CONCLUSION: This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills.

High rates of maternal depression amongst Syrian refugees in Lebanon - a pilot study.

This pilot study compares symptoms of depression and risk factors amongst Syrian refugees and low-income Lebanese mothers accessing a primary care centre in Beirut between January and June 2018. Women who gave birth in the previous two years or who were currently pregnant were included in the study. Depressive symptoms were assessed using the Arabic Edinburgh Postnatal Depression Scale (EPDS). Correlations between EPDS score and sociodemographic and mental health variables were analysed using Pearson's coefficient and ANOVA. 35 Syrian and 25 Lebanese women were recruited, 15 of whom were pregnant. EPDS scores were high in the whole group (mean 16.12 (SD 7.72), n = 60). Scores were higher amongst Syrian refugees than Lebanese mothers (17.77, SD 7.66 vs, 13.80, SD 7.34, p < 0.05). Illegal residence (p < 0.001), domestic violence (p < 0.05) and a history of mental illness (p < 0.01) were associated with higher scores. This pilot study demonstrates high rates of symptoms of depression amongst mothers in this population. Symptoms were particularly prevalent amongst Syrian refugees; three-quarters were 'probably depressed' and would warrant psychiatric assessment. This highlights the importance of improved mental healthcare for refugee mothers, the importance of addressing the social determinants of maternal mental health and further research into the effects of depression on these women and their children.

Detainment and health: the case of the Lebanese hostages of war.

The purpose of the current research was to compare former detainees of Khiam prison to a comparison group regarding depression, anxiety, presence of chronic diseases, smoking, and alcohol drinking. The sample consisted of 118 ex-detainees and 90 community controls. The Beck Depression Inventory, the Hamilton Anxiety Scale, the Clinician-Administered Post-Traumatic Stress Disorder Scale, and the Harvard Trauma Questionnaire were used. The ex-detainees suffered from an increased level of depression, high anxiety scores, increased chronic diseases, smoked more, and consumed more alcohol than their comparison group. Regression analyses showed that detainment independently predicted depression and anxiety.

Focus groups findings reveal barriers to teaching communication skills to medical students.

BACKGROUND: In December 2002, 74 medical students in the second preclinical years at the American University of Beirut (AUB) attended a workshop on basic communication skills (CS). The students watched video clips which demonstrated different communication skills and stages of the consultation, and role-played to try out ways they could improve the consultation. Their familiarity with the skills taught was assessed at the beginning of the workshop, immediately afterwards, and again six months later. There was a significant improvement noted immediately after the intervention but this apparent gain was lost at six months. METHOD: Sixteen students, who attended the workshop, also attended two focus group discussions which were aimed to assess student recall of the communications skills workshop, and explore ways in which the students thought the knowledge gained could be maintained. RESULTS: In general students thought that lack of exposure to patients at the time when the CS course was held, and a lack of consistency in CS coupled with poor faculty CS role modeling hindered their ability to maintain and practice good CS. CONCLUSIONS: Teaching CS may be more effective if medical students are taught these skills when they are exposed to patients on a regular basis, and the training is maintained throughout the clinical years. However, more emphasis should be on reminding faculty members of their role as teachers and good communicating role models to students through workshops and seminars.

Impact of a communication skills audiovisual package on medical students' knowledge.

INTRODUCTION: Over the last decade more emphasis is being put on teaching communication skills (CS). Use of videos and role-play was suggested to improve CS. This article will present the impact of an audiovisual package on promoting the knowledge of medical students in CS. METHODS: Seventy-five second year medical students--distributed into eight groups led by four facilitators--critiqued a video clip immediately before and after the introduction of a communication skills audiovisual package. The skills taught included opening the interview, questioning, facilitation, clarification, reflection, confrontation, summarizing, and preparation of the patient for the physical exam. The students, also, role-played the reviewed scenario. The students' pre- and post-intervention responses were analyzed using a standardized grading form. RESULTS: There was a significant improvement in students' knowledge (p < 0.000) after the introduction of the intervention in all the CS taught except closed ended questioning. This improvement was consistent among the four facilitators. CONCLUSION: Reviewing video scenarios and role-playing improved the knowledge in core communication skills among second-year medical students assessed by a video-based written examination.

Prevalence of hepatitis B in a presumably healthy Lebanese population.

OBJECTIVE: Policy makers need data on the prevalence of infection with HBV in order to determine the cost effectiveness of universal immunization against hepatitis B. This study aims at determining the prevalence rate of infection with HBV in a basically healthy group of Lebanese adults. METHODS: Sera from 2634 presumably healthy Lebanese individuals, mean age 32.1 years, obtained between 1995-1997, were tested for hepatitis B surface antigen (HBsAg). The sample was composed of subjects residing in different areas in Lebanon. Detection of HBsAg was performed utilizing the ELISA technique. The analysis took place in the Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Chi-square test was used to examine statistical associations. RESULTS: The prevalence of HBsAg among the samples was 1.6%. Blue-collar employees, smokers and those living in the South of Lebanon were significantly more likely to be infected with hepatitis B virus. CONCLUSIONS: The data presented indicates that Lebanon has a low prevalence of HBV infection. Costeffective studies are needed to justify universal iminunization against hepatitis B especially in countries where budgets are tight.

Medical problems encountered among travelers in Bahrain International Airport clinic.

BACKGROUND: The Middle East is one of the most rapidly growing destination for travelers. Objective. The aim of this study was to determine the medical conditions affecting travelers needing medical assistance in Bahrain International Airport (BIA). METHOD: Logbook documenting medical conditions of travelers presenting to the BIA clinic from January 1 till the end of December 2004 was reviewed. RESULTS: A total of 3,350 travelers attended the clinic, constituting 0.12% of the disembarking and transit travelers. Most common conditions faced were respiratory problems (24.4%), followed by headaches (19.2%), trauma, musculoskeletal pains (12.9%), and gastrointestinal problems (11.0%). Only 2.1% of all complaints were referred to secondary care. The majority of cases were handled by the nurse. CONCLUSIONS: Majority of the patients examined had acute minor medical problems. Ninety-eight percent of conditions affecting travelers were handled in the airport clinic by the nurse and the family physician. Airport clinic could serve as an efficient emergency triage system for filtering serious illnesses needing urgent management.

Psychological distress after the occupation: A community cross-sectional survey from Lebanon.

OBJECTIVES: Jezzine inhabitants were exposed to war stressors for 17 years. This study aims at determining the prevalence of psychiatric distress (PD) among Jezzine citizens who were exposed to war for 17 years and to identify associated factors. DESIGN: Cross-sectional study. METHODS: A sample of 142 citizens was randomly selected from a population of 5,000. A novel questionnaire was used to collect data on war exposure, socioeconomic and demographic variables. PD was assessed using GHQ-12. Data were analysed by logistic regression. RESULTS: PD was found in 26% of Jezzine residents. PD was associated with age, marital status, education, experience of war-related events, chronic illness and alcohol drinking. After adjusting for all variables, PD remained significantly correlated with older age and low education (odds ratios were 7.59 and 4.28, respectively). CONCLUSIONS: The prevalence of PD among the residents of Jezzine after a year of the Israeli withdrawal was similar to that reported in other communities whether they were, or were not, exposed to war stress. Higher prevalence among older and less educated individuals suggests the presence of a significant age cohort effect and cognitive construal factors for PD among persons chronically exposed to war-related stressors.

Sesame oil use in ameliorating cough in children: a randomised controlled trial.

OBJECTIVES: To examine the role of sesame oil (SO) in reducing the frequency and severity of acute cough in children 2-12 years of age. DESIGN: Double blind, placebo controlled randomised trial. SETTING: Seven primary health care centres/clinics in Lebanon. A total of 107 children between the age of 2 and 12 years with cough secondary to common cold were enrolled. INTERVENTION: Five milliliters of SO or placebo by mouth at bed time. OUTCOME MEASURES: Cough strength and frequency as judged by parents on a four points Likert scale after giving three syrup doses over three consecutive nights. Analysis was performed on an intention to treat basis. RESULTS: At day 1, the effect size for cough frequency and cough strength were +0.26 (95%CI -0.64,+0.12) and +0.15 (95%CI -0.53, +0.23), respectively. SO decreased cough symptoms more than placebo but these were not statistically significant. The effect size decreased from days 1 to 3. Cough symptoms improved over the 3 days both in SO and placebo group. No evidence of undesirable effects were noted to SO. CONCLUSION: Like other over the counter antitussives, SO did not result in marked improvement in cough symptoms.

Psychological distress among marginalized women in the outskirts of beirut: determinants and association with health perception.

The objective of this study was to determine the prevalence of psychological distress (PD) and its determinants in under-privileged women in the outskirts of Beirut, Lebanon. A cross-sectional survey of 1,869 ever-married women aged 15-59 was carried out. PD levels were determined using the 12-item General Health Questionnaire (Appendix). Health status, living conditions, social support, and physical symptoms as reported by women were recorded. Logistic regression was used to test the independent effect of each variable on PD. 46.6% of women had PD. Psychologically distressed women had more children, less education, lower income, less social support, an uncomfortable relationship with their husband, participated in the labor force and were more likely to reside in a predominantly Moslem community. Reporting a health or living problem were significant predictors of PD. The presence of limb, back and stomach pain, and headache were associated with PD. Compared to similar populations in other countries, our sample had a high prevalence of mental distress.