On the association between high temperature and mortality in warm climates.

We conducted a time-series analysis of 1997-1999 data records of air temperature and all-cause mortality in Greater Beirut, using bi-linear Poisson auto-regressive models, and published our findings in the Science of the Total Environment [El-Zein, A., Tewtel-Salem, M., Nehme, G., 2004. A time-series analysis of mortality and air temperature in Greater Beirut. Sci. Total Environ. 330, 71-80]. We compared our results to those of Curriero et al. [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80-87.], who subsequently reported that their original results were inaccurate and published new results [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80-87; Curriero, F.C., Samet, J.M., Zeger, S.L., 2003. Letter to the Editor re. On the Use of Generalized Additive Models in Time-Series Studies of Air Pollution and Health" and "Temperature and Mortality in 11 Cities of the Eastern United States". Am. J. Epidemiol. 158(1) 93-94.]. In this letter, we report two changes in the interpretation of our findings as a result of the change in the results of Curriero et al. [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80-87]. Their newly-reported results reinforce our conclusion that heat-related mortality can be a significant public health issue even in temperate to warm climates. However, our findings raise a question concerning the ability of socioeconomic indicators to explain differences in vulnerability to heat between high-income and low-income countries.

Agreement between husband and wife reports of domestic violence: evidence from poor refugee communities in Lebanon.

BACKGROUND: This paper compares husband and wife reports of wife beating using household survey data collected from poor Palestinian refugee communities in Lebanon. METHODS: The analyses are based on a matched data file of 417 currently married couples, drawn from a unique multi-purpose living conditions sample survey of about 3600 Palestinian refugee households interviewed in the spring and summer of 1999. Four outcomes (ever beaten, last year beating, beating during pregnancy, and injuries caused by beating) were analysed using Kappa statistics and per cent agreement. Logistic regression was used to analyse discordant reporting of wife beating during the year preceding the survey. RESULTS: Husband and wives' reports of the four different outcomes are in 'good' agreement as judged by Kappa coefficients, ranging from 0.62 for 'beaten during pregnancy' to 0.69 for 'injuries resulting from beating'. Prevalence estimates of domestic violence are also remarkably similar. However, findings from a multivariate logistic regression model on agreement regarding 'last year beating' show that only age of men was a significant predictor of agreement, controlling for education level, marital duration, region of residence, household size, health status, and consanguinity. CONCLUSIONS: Our findings show that men's self-reports of their violent behaviour against their wives are fairly congruent with those of their spouses, implying that the perpetrators, men, can be 'trusted' in providing basic information on 'beating histories' in epidemiological and demographic population-based investigations in contexts similar to ours. However, care should be taken in studies of young men's current beating behaviour using only their self-reports.

A time-series analysis of mortality and air temperature in Greater Beirut.

The literature on the association between health and weather in the temperate to semi-arid cities of the Eastern Mediterranean is scarce. The quantification of the relationship between temperature and daily mortality can be useful for developing policy interventions such as heat-warning systems. A time-series analysis of total daily mortality and weather data for the city of Beirut was carried out. The study covered the period between 1997 and 1999. Poisson auto-regressive models were constructed, with mean daily temperature and mean daily humidity as explanatory variables. Delayed effects, up to 2 weeks, were accounted for. The regression models were used next to assess the effect of an average increase in temperature on yearly mortality. The association between temperature and mortality was found to be significant. A relatively high minimum-mortality temperature (TMM) of 27.5 degrees C was calculated. A 1 degrees C rise in temperature yielded a 12.3% increase (95% confidence interval: 5.7-19.4%) and 2.9% decrease (95% confidence interval: 2-3.7%) in mortality, above and below TMM, respectively. Lag temperature variables were found to be significant below TMM but not above it. Where the temperature change was less than 0.5 degrees C, annual above-TMM losses were offset by below-TMM gains, within a 95% confidence interval. TMM for Beirut fell within the range usually associated with warm climates. However, the mild below-TMM and steep above-TMM slopes were more typical of cities with temperate to cold climates. Our findings suggest that heat-related mortality at moderately high temperatures can be a significant public health issue in countries with warm climates. Moreover, at the projected climate change over the next 50 years, heat-related losses are unlikely to be offset by cold-related gains.