RESEARCH PROJECTS
Improving adherence of physicians in a managed care university health center with the World Health Organization (WHO) diabetes clinical practice guidelines The
project consists of 3 phases. The first phase was completed and entailed
the assessment of the adherence of physicians with the DM guidelines, and
the control of DM among patients at the health center. The results are
currently under review as a manuscript entitled, “Quality of Care in a
Lebanese University Health Center”, submitted to the International Journal
of Quality in Health Care. The second phase consisted of an intervention
to improve adherence and documentation of diabetes care. It was done during
March 1998. Currently, the third phase is underway, assessing the impact
of the intervention. M. Akel and G. Hamadeh. (Supported by
URB.)
Community-based intervention program: its impact on CVD risk factors in Lebanon A
cross-sectional survey conducted in 1994 on 2117 persons (959 M, 1158 F),
age 30-64 years, showed that the prevalence of cardiovascular risk factors
was high. Obesity was found in 67.3% of women as compared to 55.3% in men.
The overall prevalence of NIDDM, known and newly diagnosed was 10.2% among
men and 9.9% among women. Hypercholestremia was 18% and 23% respectively.
This research projects wants to show that a community based intervention
program is feasible and affordable and that it brings benefits in terms
of health and reduces the financial burden of CVD to the community. An
urban area in Beirut was selected, mapped and all persons aged 25-64 years
have been subjected to detailed behavioral and health service questionnaires
up to date nearly 2500 subjects have been approached. Following analysis
of results an appropriate intervention policy will be adopted. S. Alam,
M. Khogali, I. Salti, M. Chidiak and R. Afifi. (Supported by
WHO / EMR Research grant.)
Prescription pattern in primary health care centers in Lebanon In
this project, a computerized database system was established in a health
center at the American University of Beirut. Information regarding diagnosis
and prescription was collected prospectively over 12 months. Data was also
collected for a 2 months period in two health centers (public and non-governmental)
where prescriptions and their related diagnosis were recorded. Information
about annual utilization of the defined population was obtained as well
as information about common diagnosis, common prescriptions and prescription
for chronic diseases. Types of prescriptions issued were summarized, their
cost and the quantities of medications issued were estimated. Medications
prescribed were correlated with diagnosis made and medication cost or quantities
per disease entity were estimated. For each medication, a prescribed daily
dose was calculated whenever possible. This data will be used to help health
centers in planning their budgets and in defining the scope and extent
of their services. G.Hamadeh. (Supported by World Health Organization.)
Feasibility and effect of shifting the mix of tertiary care, primary care and prevention and promotion in dealing with cardiovascular disease in Lebanon and Turkey This
research project aims to show that shifting the present TC/PC/PP mix towards
prevention—promotion and rationalized case management at primary care level
(I) is feasible and affordable; (ii) brings health benefits, (iii) has
the potential to reduce the financial burden of CVD to the community. Specific
objectives of the projects are: test the feasibility of an intervention
package aimed at shifting PP/PC/TC mix Document the effects of these intervention
packages on the mix of choices TC/PC/PP by users. Document the effects
of these intervention packages on risk factors, risk perception and quality
of case management, using culturally appropriate measures and scales. Document
the potential for reduction of costs through shifting away from TC and
rationalizing case management at PC level. The projects designed as an
intervention study using a variety of epidemiological, social sciences
and economic tools to assess feasibility and effects of the different intervention
components. M. Khogali, I. Salti, S. Alam, M. Chidiak, R. Afifi, A.
Sibai, W. VanLerberge, O. Razum, Y. Bilgin, C. Bertan. (Supported by
the European Union.)
Care of chronic patients in primary health care An
innovative audit intervention was conducted on diabetic patients served
at a non-governmental not for profit health center in Lebanon between June,
1994 and December 1997. The intervention package consisted of training
the physicians, lowering financial barriers to the patient; the organization
of patient flow, internal referral, defaulter tracing and dissemination
of information to the public. We report on the impact of this intervention
on the care of the diabetic patients in the health system. There was a
marked improvement in documentation, of patient’s metabolic control as
determined by mean (HbA1c) and patient’s attendance through an increase
in recruitment of patients, follow up and regularity of visits. This offers
pointers on the feasibility and usefulness of introducing medical audit
as a quality assurance tool in the Lebanese context. M. Khogali, I.
Salti, W. VanLerberghe, M. Boelet, S. Major and A. Masri. (Supported
by the European Union—“Leopold” Institute of Tropical Medicine, Antwerp,
Belgium.)
Epidemiology of antiphospholipid syndrome at a tertiary teaching hospital in Lebanon; practice analysis of antiphospholipid syndrome diagnosis To
diagnose antiphospholipid syndrome the following criteria must be met:
Positive quantitative measurement of Anticardiolipin antibodies (aCL) IgG
or IgM, or Lupus anticoagulant (LA) taken on two occasions at least six
weeks apart, in the presence of specific clinical manifestation of thrombosis.
We report on aCL and LA screening test conducted on patients served by
the AUB laboratory services between January and December 1998. There were
440 patients screened for anticardiolipin antibodies (aCL). Of these 93%
were tested qualitatively, and only 7% quantitatively. A positive result
appeared in 27%, with 11% being quantitative. Only 4 cases were repeated.
LA was requested in 255 cases, 10% being positive. None were re-tested.
Review of patients records is underway to describe diagnosis for which
these tests were requested, and to address APL syndrome diagnostic practice
of all physicians. S. Major, S. Atweh, A. Masri, T. Arayssi, I. Uthman,
R. Chediak, N. Pashayan, and P. Mouawad. (Supported by URB and
MPP.)
Prevalence of antibodies against varicella virus among Lebanese students The
project aims at studying the immunization status among 1000 Lebanese students
(ages 14-17 years) against varicella virus. The study includes testing
bloofor presence of antibodies against varicella virus (sero prevalence).
The 1000 students will be selected from 18 schools across the country.
The results of the study will help policy makers in Lebanon, to decide
on the need to include the new varicella vaccine in the national calendar.
The decision will then be based on local data. U. Musharrafieh, A. Bizri,
G. Hamadeh, and I. Nuwayhid. (Supported by Masabki Fund, AUB.)
Do we need to do universal screening for gestational diabetes mellitus? Gestational
Diabetes Mellitus (GDM) is carbohydrate intolerance recognized first during
pregnancy. Certain authorities are recommending selective screening for
GDN based on risk factors alone instead of universal screening. The purpose
of this study is to evaluate the rationale of universal versus selective
screening. A retrospective analysis was conducted on pregnant women (n=
740) presenting to out patient department at AUB for antenatal checkup
between March 1, 1995-February 28th, 1997. Screening with 1h
post glucose challenge test (1hPC) was performed in 673 patients (91%).
It was positive in 118 women (17.5%). After doing 3h oral glucose tolerance
test on 100 women, 9 were found to have GDM. So, the prevalence of GDM
= 1.3%. Out of 9 cases with GDM, 3 had no risk factors. By doing selective
screening alone, we miss aro0.4% of the population only. In conclusion,
screening based on risk factors alone may be a reasonable approach. M.
Osman, M. Akel and I. Usta.
Homocysteine and coronary heart disease Cardiovascular
disease is the leading cause of death in developed and developing countries,
especially in the young population. Homocysteine has been newly identified
as a possible risk factor for coronary heart disease (CHD). Yet; genetic
factors, ethnicity and diet seem to affect Homocysteine level and its association
with coronary heart disease. This is a pilot study trying to see the feasibility
of conducting a bigger one aiming to determine the association of Homocysteine
and CHD in Lebanon and the prevalence of Hyperhomocystenimia in our country.
It is a case-control study. AUB employees enrolled as HIP cases are identified
by the computer (coding diagnosis) and controls are those presenting for
regular check up to UHS. Blood is withdrawn for Homocysteine. Folic Acid,
Vitamine B6 and B12. M. Osman, M. Khogali, G. Hamadeh, F. Hodeib* and
S.
Domiati*. (Supported by Lebanese American University.)
PISD, depression, and general health among Lebanese prisoners of war. Background:
Post traumatic stress disorder occurs in survivors of torture. In 1977,
there were more than 151 Lebanese subjects detained by Israel; some of
these prisoners were reportedly tortured. Objective: To determine the effect
of captivity in Israeli prisons on the psychological and physical health
of Lebanese prisoners. Methods: Released prisoners (1990-1996) will
be interviewed. Trained personnel will administer the Beck depression &
anxiety inventory, the Harvard trauma questionnaire and the general health
questionnaire. All instruments have high reliability and were validated
on the Lebanese population. A similar group from the prisoners' neighbors
matched for age and grade will be also analyzed. Data Analysis:
Descriptive statistics and associations between variables will be tested
by applying a Chi-square and t-test analysis. Analysis will further be
confirmed using multiple regression to predict variables of interest.
B. Saab, L. Farhoud, M. Doumit, M. Khani, and N. Damlouji. (Supported
by URB, AUB.)
Updated list of essential drugs for primary care in Lebanon In
1996, 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. This report describes the process
and studies used to update the 1992 list by the ad hoc committee. B.
Saab, G. Hamadeh, J. Sfeir and A. Al Zein. (Supported by URB,
AUB.)
Assessment of nutritional status in sleeted private and public elementary school children, aged 6-10 years, in Beirut Nutritional
status of 199 elementary school children (6-10 years), of different socioeconomic
status in west Beirut was assessed. Private schools children had high socioeconomic
status; whereas public schools children had low socioeconomic status. Anthropometric
measurements and dietary intake were collected. Data showed that although
public school children had lower mean weights compared to those in private
schools they were markedly higher than their respective NCHS reference
values, unlike children in private schools that were higher. Approximately
5.3% of public school children fell above + 2SD for weight/height, (comparable
to reference population) but lower than private school children (13.7%).
Dietary intake data revealed adequate intake of macronutrients. The present
study reflected improved nutritional status of low socioeconomic children
over the past 10 year. The increased percentage of children in private
school falling in the upper Z-score range weight for age and triceps skin-fold
thickness constitutes a warning sign for a tendency towards obesity in
affluent children. N. Sharara, M. Makarem, J. Usta, N. Adra and
N. Baba. (Supported by INMAA’ Institution.)
Midwifery and small maternity clinics in Lebanon It
is a descriptive study of the complications associated with deliveries
in small maternity clinics run by midwives. The study consisted of collecting
cases referred from maternity clinics to large hospitals within Lebanon
for the year 1996. The most common maternal complication was postpartum
hemorrhage 19 cases, 60% of the cases were primiparas. The causes of bleeding
were lacerations, retained tissues or lax uterus. Endometritis and postpartum
infection occurred in 9 cases, 3 were associated with sepsis. 112 newborn
were referred for tertiary care. 74% were less than one week of age. The
most common complication was jaundice (47%), 23% were premature, 17% hypothermic,
and 15% had sepsis. The study recommends further training for midwives
regarding skills to assure antiseptic deliveries and adequate newborn care,
in addition to providing adequate transport facilities for the high risk
newborns. J. Usta. (Supported by Ministry of Public Health and UNICEF.)
Psychological profile of working children This
study is part of an effort sponsored by UNICEF aiming at evaluating the
health status of working children. With the collaboration of ‘Terre des
Hommes’, 138 male children (10-17 years) working in four Lebanese urban
areas, for more than one year in a formal low manual jobs were selected.
Controls were non-working children from the same areas. Information on
the socioeconomic background and working condition were collected; the
Children Manifest Anxiety Scale (CMAS) and the hopeless scale were administered.
Repeated school failure was more commonly presented than poverty as a reason
for leaving school. 90.2% of children were satisfied with their job, 51.25%
had comfortable jobs and 42.5% were abused. Working children had higher
scores on CMAS and hopelessness scales than controls and those who are
attending schools and working, and those who are neither students nor working
had higher scores than the students. The results recommend keeping schooling
for the unfortunate child who had to work. J. Usta, I. Nuwayhid, A.
Khodr, and A. Zein*. (Supported by Ministry of Social affairs
and UNICEF.)
Akel, M.M., Salti, I. and Azar, S.T., Successful treatment of parathyroid cyst using ethanol sclerotherapy. The American Journal of Medical Sciences, 317 (1), 50-52, 1999. Hamadeh, G. and Adib, S., Cancer truth disclosure among Lebanese physicians. Social Science and Medicine, 47 (9), 1289-1294, 1998. Hamadeh, G., Daher, M. and Bizri, A.R., Adapting guidelines to Lebanese clinical practice. Lebanese Medical Journal, 46 (5), 261-267, 1999. Hamadeh, G., Choucair, B. and Khalil, H., Survof Bekaa community health needs. Lebanese Medical Journal, 47 (1), 13-17, 1999. Hamadeh, G. and Khogali, M., Family Medicine in the Middle East. Journal of the American Board of Family Practice, 10 (2), 173-174, 1997. Khogali, M., Heat illness alert program. Annals of the New York Academia of Sciences, 813, 526-533, 1997. Major, S., Drug related illness leading to hospitalization at the American University Hospital, Beirut. Lebanese Medical Journal, 45 (4), 245p, 1997. Major, S., Badr, S.*, Bahlawan, L., Hassan, G.*, Khslil, R., Kojaoglanian, T.*, Melhem, A.*, Richani, F., Younes, F., Yeretzian, J., Khogali, M. and Sabra, R., Drug related illness leading to hospitalization at a tertiary teaching hospital in Lebanon. Clinical Pharmacology and Therapeutics, 64 (4), 450-461, 1998. Major, S., Salti, I., Masr, A., Van Lerberghe, W.*, Boelart, M.* and Khogali, M., Managing diabetes mellitus in a Lebanese primary care center—working towards change. Lebanese Medical Journal, 46 (4), 182-187, 1998. Musharrafieh, U., Hamadeh, G. and Doudakina, R., Pesticides primer for the primary care physician. Lebanese Medical Journal, 46 (6), 321-327, 1998. Musharrafieh, U., Araj, G. and Fuleihan, N.S., Viral supraglotitis in an adult: a case presentation and literature update. Journal of infection, 39, 5450-5489, 1999. Saab, B. and Kanaan, N., Clubby a tip-off underlying disease. Geriatrics, 53 (53), 54-57, 1998. Saab, B. and Seoud, M., Lessons from a courageous dying patient. World Health Form, 18, 324-327, 1998. Saab,
B., Shararah, N., Hamadeh, G., Sarru’, E., Makarem, M. and Usta, J., Purified
protein derivative conversion rate among Lebanese children in Beirut. Lebanese
Medical Journal, 48, 20-22, 1998.
ABSTRACTS,
PRESENTATIONS AND PROCEEDINGS
Akel, M.M. and Khogali, M., Application of clinical preventive services at a family medicine practice center. The Third International Epidemiological Association—Eastern Mediterranean Regional Scientific Meeting, Beirut, Lebanon, 1997. Hamadeh, G., Screening principles in school health. First Arab Conference of School Health, Beirut, Lebanon, 1999. ———, Truth telling among Lebanese physicians. Arab Forum on Behavioral Science and Health, Amman, Jordan, 1997. Hamadeh, G., Health information systems and the school health record. Makassed Foundation Workshop on Skills in School Health, Beirut, Lebanon, 1998. Hamadeh, G. and Saab, B., Practice analysis in a Lebanese university health clinic—from ledgers to computers. American Academy of Family Physicians Annual Scientific Assembly Meeting, San Francisco, California, USA, 1998. Major, S.C., Drug related illness leading to hospitalization at the American University Hospital of Beirut (Preliminary analysis). Middle East Medical Assembly, Beirut, Lebanon, 1997. ———, Drug related illness leading to hospitalization at the American University of Beirut (preliminary analysis). The Third International Epidemiological Association—Eastern Mediterranean Regional Scientific Meeting, Beirut, Lebanon, 1997. Saab, B., Usta, J. and Hamadeh, G., Active utilization of safety measures by car drivers in Lebanon. The Third International Epidemiological Association—Eastern Mediterranean Regional Scientific Meeting, Beirut, Lebanon, 1997 Shararah. N., Primary health care in Lebanese public schools. The First Arab School Health Conference, 1999. Usta, J., Perception of violence among children—Beirut children draw their neighborhood. The Third International Epidemiological Association—Eastern Mediterranean Regional Scientific Meeting, Beirut, Lebanon, 1997. ———, Perception of violence among children—Beirut children draw their neighborhood. The Second Arab Forum for Scientific Research, Jordan, Amman, 1997. ———, Maternal employment and perception of child temperament. XVth Biennial Meeting of the International Society of Behavioral Development, Bern, Switzerland, 1998. Usta,
J., Sfeir, J. and Khani, M., Stress among intraining doctors. Third
International Epidemiological Association—Eastern Mediterranean Regional
Scientific Meeting, 1997.
Hamadeh, G., Polyclinic practice analysis, prescription and health maintenance monitoring system. File Maker Pro based database system, 1998. (Software.) Hamadeh,
G., Saab, B, Major, S., Khogali, M. and Adib, S., Prescription patterns
in primary care in Lebanon, 1999. (Monograph.)
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