Research Projects
Improving adherence of physicians in a managed care university health center with the World Health Organization (WHO) diabetes clinical practice guidelines This project is divided into three phases. The first involves identification of patients with Diabetes Mellitus at the University Health Service (UHS) and review of their charts, to classify them with respect to control and complications and to assess physicians’ adherence to guidelines for primary care. About 20% of this phase has been completed. The second phase, which is implementing quality improvement interventions, and the third phase, which is assessment of the interventions impact, will follow once phase one is completed. M. Akel and G. Hamadeh. (Supported by URB.) Application of clinical prevention services for patients aged 19-64 years at Family Medicine Practice Center (FMPC) at the American University of Beirut Medical Center The
objective of the project was to assess the compliance of the residents
training in family medicine with recommended preventive services guidelines.
A retrospective chart review for patients aged 19-64 years presenting to
FMPC over a two-year period (July 1992 – June 1994) was performed. Data
pertaining to screening for cardiovascular diseases and cervical and breast
cancer was collected and analyzed with respect to demographic characteristics
of the patient population and to the residents’ level of training. The
results demonstrated the deficiency in applying and recording health maintenance
recommendations. Suggestions for remedial actions are presented. The project
has been completed and the manuscript is in preparation for publication.
M. Akel and M. Khogali.
Rheumatic manifestations of Behcet’s disease Review
of 41 cases of Behcet’s disease at AUB Medical Center, a retrospective
study. The rheumatic manifestation of Behcet’s disease was reviewed. There
was a high incidence of arthritis of large joints and episodic arthralgia
of elbow and wrists lasting from three days up to three weeks. This prompts
us to recommend the change of status of the arthritis of Behcet’s disease
from a minor to a major criteria. K. El-Ashkar and F. Nasr.
Truth telling to cancer patients among Lebanese physicians Ten percent of Lebanese physicians registered in the order were surveyed for their preferences and beliefs regarding telling cancer patients the truth about diagnosis. Data analyzed and manuscript submitted for publication in May 97. G. Hamadeh and S. Adib. (Supported by URB.) Youth health risk behavior survey among secondary school students in Lebanon The
survey is a cross-sectional study conducted among students attending secondary
classes in both private and public schools all over Lebanon. The objective
is to estimate the prevalence of six health risk behaviors: smoking; drand
alcohol; intentional and unintentional injuries; sexual activity; dietary
habits and physical activity. Results are expected to find wide applicability
in defining school health policies, programs and curricula as well as government
policies. N. Kanaan and A. Sibai. (Supported by WHO; UNICEF;
URB.)
Institutional care of the mentally disabled child and parental involvement The final report has been completed and a publication is being developed. N. Karam and M. Chaaya. (Supported by William T. Grant Foundation.) . Medical care of chronic health problems in Lebanon and its implications for health care organization The
long-term objectives of this study are: (1) to determine the effects of
technical and methodological intervention for improvement of the quality
of care of chronic diseases, with special reference to diabetes and cardiovascular
diseases; (2) identify factors that determine the success of these interventions;
(3) assess their possible application and reproducibility in other fields.
The specific objectives were threefold: (1) scientific, to identify and
analyze obstacles of comprehensive care and assess the effectiveness of
different interventions; (2) operational, to improve quality of care at
all levels; and (3) institutional, to strengthen research, training and
management capacities. The methodology adopted followed a cyclical process
of identification of problems, monitoring of results, evaluation of effectiveness
of interventions and the lessons to be learned. A retrospective and a prospective
work is ongoing at the Boulgharian Socio Medical Health Center in Beirut.
It is planned to cover two other health centers. M. Khogali, I. Salti,
S. Major, W. Van Lerberghe*, M. Berlart*, A. Michbal*,
A. Masri and T. Hajjar. (Joint project AUB and Tropical Institute
of Antwerp and Heidleberg, supported by European Community Grant.)
Drug related illness (DRI) leading to hospitalization in Lebanon This
study addresses the incidence of DRI leading to hospitalization at the
American University Hospital and looks at any predisposing doctor, patient
or drug factors. All medical and pediatric admissions were interviewed,
charts reviewed for details of patient demography, medical and drug history
and reason for hospitalization. An adverse drug reaction ADR probability
score determined the causality of the drug to the presenting illness. Preliminary
analysis of 917 adults and 263 children admitted during a two-month period
found that incidence of ADRs was 8% in adults and 7% in pediatrics. Commonest
drugs causing ADRs in adults were cancer chemotherapeutic agents (CCA)
(26%), cardiovascular drugs (24%), nonsteroidal anti-inflammatories (22%);
in pediatrics CCA (27%), parathion (18%) and antibiotics (18%). ADRs were
commonest among single or widowed adults, females (p<0.05), patients
with previous drug allergy (p<0.008), those with multiple active medical
diagnosis (p< 0.03), those on multiple drugs (p<0.04), and those
who obtain drugs from multiple sources (p<0.004). This preliminary analysis
indicates that ADRs leading to hospitalization have a higher incidence
in this population (8%) than that in Western literature (5%). S. Major,
S. Badr, L. Bahlawan, G. Hassan, R. Khalil, T. Kogaoglanian, A. Melhem,
R. Richani, F. Younes, J. Yertzian, M. Khogali and R. Sabra.
(Supported by URB.)
Active utilization of safety measures by Lebanese car drivers Two thousand drivers were observed in 10 parking lots in the 5 mohafazats for the use of seat belts and proper adjustment of the head rest. The data is being analyzed. B. Saab, G. Hamadeh and J. Usta. Suggested list of essential drugs for primary care in Lebanon An
adhoc committee of medical and pharmaceutical experts reviewed the 1992
list of essential drugs. The study compared the content of that list to
past prescription patterns by the American University of Beirut Family
Medicine Practice Center between 1980 and 1986 and to a list of prescriptions
prospectively collected over a six months period in the ambulatory services
of family medicine, internal medicine, obstetrics and gynecology, and pediatrics
at AUB. A list of 158 different pharmaceutical products was generated.
B. Saab, G. Hamadeh and J. Sfier. (Supported by UNICEF.)
Nutrient intake and nutritional status assessment of elementary school children in Beirut The
aim was an assessment and comparison of nutritional status and nutrient
intake of elementary school children of different socio-economic status.
A random sample of 215 school children from public and private schools
in Beirut were selected. Height, weight and triceps skinfold thickness
were measured; a 24 hour dietary recall history was taken; energy, protein
and micronutrient contents were computed. The growth of public and private
school children were comparable to each other and to the standard population.
Caloric intake was better in public school children though both were below
the RDAs. Protein intake was adequate and above RDAs in both groups. Micronutrient
intake was not consistent among the groups but were suboptimal for calcium,
vitamin A and Vitamin D. N. Shararah, M. Makarem, J. Usta and N.
Baba. (Supported by INMAA Institution.)
Perception of violence among children: Beirut children draw their neighborhood To
assess the way that children perceive the “low” level of violence around
them and to what extent it affects their feelings of safety, a sample of
school children aged 8-12 was asked to draw the neighborhood and what goes
on in it, then to fill a questionnaire that depicts their level of safety
and trust in authority figures in the community. The sample size was 405
children (192 M; 213 F) from private (28%), semi-private (37%) and government
schools (35%). 29% felt a little or not safe playing in the neighborhood
and 37% a little or not safe walking there. Being a subject to a violent
act was reported in 79% during playing and in 48% during walking. With
respect to trust, the police score had the lowest. As for the drawings,
78 drawings were clearly showing a violent event. The quality of the drawings
differed by sex: girls’ drawing were more positive and less violent. Most
of the children adapted to the violence around them by internalizing it
and considering it as part of daily life. In conclusion most of the children
of Beirut perceive a low level of violence around them but most of them
internalize it which raises the possibility of a potentially more violent
society. J.Usta and J.A. Farver*.
Adib, S., Nuwayhid, I. and Hamadeh, G., Common problems in primary centers in Lebanon. Lebanese Medical Journal, 43 (1), 17-22, 1995. Aouad, M. and El-Ashkar, K., Pulmonary edema following post-operative laryngospasm. Middle East Journal of Anesthesiology, 14, 59-63, 1997. Hamadeh, G., Dedmon, C., and Mozely, P., Postpartum fever. American Family Physician, 52 (2), 531-538, 1995. Khogali, M., Heat illness alert program. Annals New York Academy of Science, 813 (3), 526-533, 1997. Khogali, M. and Atweh, S., Heat stroke. In Tropical Neurology, R.A. Shakir, P.K. Newman, and C.M. Poser (Eds), 385-396. London: WB Saunders, 1996. Nasr, F., and El-Ashkar, K., Mondors disease: a forgotten cause of anterior chest pain. Lebanese Medical Journal, 44 (1), 1996. Nassar, S., Haddad, I., and Kanaan, N., Abcess superimposed on brain tumor: two case reports and review of the literature. Surgical Neurology, 47, 484-8, 1997. Ornstein, M.*, Garr, D.R.*, Jenkins, C.*, Hamadeh, G. and Lancaster, C.*, Implementation and evaluation of a computer based preventive services system. Family Medicine, 27 (4), 260-266, 1995. Saab, B.R. and Adib, S.M., Acute asthmatic attacks in Bahrain in the wake of the Gulf War. Environmental Health, 58, 23-25, 1996. Saab, B. and Hamadeh, G., The Winkleman circumcision device. The Journal of Family Practice, 40 (2), 122, 1997. Saab, B., Shararah, N., Makarem, M., Sarru’, E., Usta, J., and Khogali, M., Data from a school health project in Beirut. Lebanese Medical Journal, 44, 63-67, 1996. Sarru’, E., Akel, M. and Abyad, A., Tubercular cervical lymphoadenopathy. The Practitioner, East Mediterranean Edition, 8 (2), 89-92, 1997. Sarru’,
E., Makarem, M., and Jurjus, A., The value of chest x-ray in asymptomatic
young adults with positive PPD tests. Lebanese Medical Journal,
43 (4), 183-185, 1995.
Abstracts, Presentations and Proceedings Karam, N., Developing frameworks for collaboration among medical and social scientists: The experience of the Arab Forum for Social Sciences and Health. International Conference on Population, Health and Environment in the Arab Region, Beirut, Lebanon, 1997. ———, Understanding productivity: a resource for sustainable development. Tenth World Productivity Congress, Santiago, Chile, 1997. Khogali, M., Limitations of heat tolerance. Tropical Neurology Symposium, London, UK, Dec. 1995. ———, Heat alert program: practical implications for management and prevention. Tenth International Symposium on Pharmacology of Thermoregulation, Memphis, USA, Aug. 1996. ———, Training in epidemiology and community medicine in the Arab World. Fourteenth International Scientific Meeting of International Epidemiology Association, Nagoya, Japan, 1996. Khogali, M., Salti, I., Alam, S. and Masri, A., Prevalence of hyperlipedemia among adult Lebanese population aged 30-64. International Colloquium on Hyperlipidemia. Heidleberg, Germany, 1996. ———, Chronic disease: risk factors and risk reductions with special reference to obesity and NIDDM among middle-aged Lebanese 30-64 years old. Nutrition 97 Conference, Beirut, Lebanon, 1997.
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