Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview.

Electronic Health Records (EHR) are increasingly being perceived as a unique source of data for clinical research as they provide unprecedentedly large volumes of real-time data from real-world settings. In this review of the secondary uses of EHR, we identify the anticipated breadth of opportunities, pointing out the data deficiencies and potential biases that are likely to limit the search for true causal relationships. This paper provides a comprehensive overview of the types of biases that arise along the pathways that generate real-world evidence and the sources of these biases. We distinguish between two levels in the production of EHR data where biases are likely to arise: (i) at the healthcare system level, where the principal source of bias resides in access to, and provision of, medical care, and in the acquisition and documentation of medical and administrative data; and (ii) at the research level, where biases arise from the processes of extracting, analyzing, and interpreting these data. Due to the plethora of biases, mainly in the form of selection and information bias, we conclude with advising extreme caution about making causal inferences based on secondary uses of EHRs.

Aging expectations are associated with physical activity and health among older adults of low socioeconomic status.

The purpose of the current study was to determine whether aging expectations (AE) are associated with physical activity participation and health among older adults of low socioeconomic status (SES). A cross-sectional analysis of a sample of 170 older adults (mean age 70.9 years) was conducted. Data on AE, physical activity, and health were collected using the 12 item Expectations Regarding Aging instrument, the Healthy Physical Activity Participation Questionnaire, and the Short Form-36, respectively. Adjusted linear regression models showed significant associations between AE and social functioning, energy/vitality, mental health, and self-rated general health, as well as physical activity. These results suggest that AE may help to better explain the established association between low SES, low physical activity uptake, and poor health outcomes among older adults.

Comparison of functional fitness outcomes in experienced and inexperienced older adults after 16-week tai chi program.

CONTEXT: The positive effects of physical activity on the well-being of older adults have been well documented. Tai chi is a suitable form of physical activity, with known physical and psychological benefits for older adults. OBJECTIVE: The objective of the current study was to compare the effects of participation in a 16-wk tai chi program on the functional fitness of older adults with and without previous tai chi experience. DESIGN: The research team designed a prospective cohort study. Participants who had practiced tai chi previously for ≥1 y at baseline were classified as experienced; all others were considered inexperienced. SETTING: The study took place at 2 community centers in 2 locations in the Greater Toronto area of Ontario, Canada. PARTICIPANTS: Participants were residents of the 2 communities. INTERVENTION: Participants were instructed to attend two 1-h sessions of Yang-style tai chi per wk. OUTCOME MEASURES: Data on functional fitness- strength, endurance, speed, and flexibility-were collected at baseline and after completion of the tai chi program. RESULTS: Of the 143 participants who completed the study, 20.5% were classified as experienced. Experienced participants had significantly higher ratings on functional fitness tests at baseline compared with the inexperienced group. At the end of the study, inexperienced participants had experienced significant improvements in all measures of functional fitness, although experienced participants had shown significant improvements only in measures of endurance and speed. CONCLUSION: Tai chi appears to be an optimal mode of physical activity for older adults regardless of previous experience with tai chi.

Reported maternal postpartum depression and risk of childhood psychopathology.

Childhood emotional and behavioural disorders are prevalent, can cause significant maladaptation and often persist into adulthood. Previous literature investigating the potential influence of postpartum depression (PPD) is inconsistent. The present study examined the association between PPD and childhood behavioural/emotional outcomes, while considering a number of potentially important factors. Data were analyzed prospectively from the National Longitudinal Survey of Children and Youth at two follow-up periods (ages 2-3, N = 1,452 and ages 4-5, N = 1,357). PPD was measured using the diagnostic criteria of the DSM-IV-TR. Four behavioural/emotional outcomes were analyzed at each follow-up. For both age groups, logistic regression models were used to estimate the associations between PPD and each of the behavioural and emotional outcomes adjusting for child, obstetric, environmental and socio-demographic factors. PPD was associated with the Emotional Disorder-Anxiety among 2-3 year olds [OR = 2.38, 95 % CI 1.15, 4.91]. Among 2-3 year olds, hostile/ineffective parenting was associated with Hyperactivity-Inattention [OR = 1.88, 95 % CI 1.14, 3.11] and Physical Aggression-Opposition [OR = 2.95, 95 % CI 1.77, 4.92]. Among 4-5 year olds, hostile/ineffective parenting was associated with Hyperactivity-Inattention [OR = 2.34, 95 % CI 1.22, 4.47], Emotional Disorder-Anxiety [OR = 2.16, 95 % CI 1.00, 4.67], Physical Aggression-Conduct Disorder [OR = 1.96, 95 % CI 1.09, 3.53] and Indirect Aggression [OR = 1.87, 95 % CI 1.09, 3.21]. The findings of the present study do not suggest that PPD is independently associated with any enduring sequelae in the realm of child behavioural/emotional psychology, though the symptoms of PPD may be giving way to other important mediating factors such as parenting style.

Age at menarche and current substance use among Canadian adolescent girls: results of a cross-sectional study.

BACKGROUND: Substance use is among the key public health threats that find its genesis during adolescence. Timing of puberty has been lately researched as a potential predictor of subsequent substance abuse. The present study, therefore, aims to assess the effect of age at menarche on current practices of smoking, alcohol drinking and drug use among 14-15 year old Canadian girls. METHODS: The analysis of the study was based on all female respondents aged 14 to 15 years during Cycle 4 (2000/2001) of the National Longitudinal Survey of Children & Youth (NLSCY). The main independent variable was age at menarche assessed as the month and year of the occurrence of the first menstrual cycle. The dependent variables were current smoking, heavy alcohol drinking in the past 12 months and drug use in the past 12 months. Three logistic regression models were performed to investigate the association between age at menarche and each of the substance use outcomes, adjusting for possible confounders. Bootstrapping was performed to account for the complex sampling design. RESULTS: The total weighted sample included in the analysis represented 295,042 Canadian girls. The prevalence of current smokers, heavy drinkers (drunk in the past 12 months) and drug users in the past 12 months was approximately 22%, 38% and 26%, respectively. After adjusting of all potential confounders, no association was found between age at menarche and any of the substance use outcomes. School performance and relationship with the father, however, stood out as the main variables to be associated with smoking, heavy drinking and drug use. CONCLUSIONS: Qualitative studies understanding the social and psychological changes experienced by early maturing Canadian adolescents are warranted to identify other correlates or pathways to substance use in this higher risk population.

Prevalence and characteristics of teen motherhood in Canada.

The study aims to examine the prevalence and characteristics of adolescent mothers throughout the provinces of Canada. The analysis was based on the Maternity Experience Survey targeting women aged ≥15 years who had singleton live births during 2005/2006 in the Canadian provinces and territories. The main dependent variable in this study was the mother's age at the time of delivery divided into teen mothers (<20 years) and average-aged mothers (≥20 and <35 years). Socio-economic factors, demographic factors and pregnancy related factors were considered for a logistic regression analysis comparing teen mothers to average-aged mothers. Bootstrapping was performed to account for the complex sampling design. The sample size was 6,188 weighted to represent 76,110 Canadian women. The proportion of teen mothers in the MES study was 2.9%, and their average age was 18.1 years (SD = 1.1). As compared to average-aged mothers, teen mothers were more likely to have low socio-economic status, be non-immigrants, have no partner, reside in the Western Prairies, have previously experienced physical or sexual abuse and have preferred to have had their pregnancies later into their adulthood. Despite the above, teen mothers were more likely to attend prenatal classes than average-aged mothers (Odds ratio = 2.54, 95% confidence interval: 1.74-3.71). Intervention studies should aim to raise awareness among teens to prevent teen pregnancies. Since teen mothers are very likely to attend prenatal courses, the focus of these classes should be tailored to the needs of teen mothers. More in depth qualitative studies should aim to understand their individual needs.

The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES).

BACKGROUND: Maternal alcohol consumption during pregnancy may potentially constitute a major public health concern in Canada but despite this, the available epidemiological data on both rates and predictors of alcohol consumption during pregnancy is limited. The present study assessed the prevalence and predictors of maternal alcohol consumption during pregnancy of women living in Canada from 2005-2006 who had a singleton live birth and whose child remained in their care 5-9 months following birth. Prevalence of maternal alcohol consumption was examined across the Canadian provinces. METHODS: The analysis was based on the Maternity Experience Survey (MES), a population-based survey that assessed pregnancy, delivery and postnatal experiences of mothers and their children between November 2005 and May 2006. The main outcome variable assessed was ever drinking alcohol during pregnancy. The sample of mothers who drank during pregnancy consisted mainly of low to moderate level-alcohol drinkers (95.8%), while only 1.7% of the sample were heavy drinkers (>1 drink per day). Socio-economic factors, demographic factors, maternal characteristics, and pregnancy related factors that proved to be significant at the bivariate level were considered for a logistic regression analysis. Bootstrapping was performed to account for the complex sampling design. RESULTS: Analysis of 5882 mothers, weighted to represent 72,767 Canadian women, found that 10.8% of women drank alcohol at some point during their pregnancies. This mainly reflects prevalence of low to moderate maternal alcohol consumption. Prevalence of drinking alcohol during pregnancy was 13.8% in Eastern-Central provinces, 7.8% in Western Provinces-British Columbia, 4.1% in Eastern-Atlantic provinces and 4.0% in Western-Prairie Provinces. Utilizing alcohol during gestation was significantly associated with several important factors including marital status, smoking status, reaction to the pregnancy and immigrant status. While being an immigrant to Canada appeared to confer a protective effect, women who have partners (odds ratio (OR)=2.00; 95% confidence interval (CI): 1.20, 3.31) and smoked during pregnancy (OR=1.54; 95% CI: 1.12, 1.87) were significantly more likely to drink alcohol during their pregnancies. Perhaps most importantly, pregnant women who reported indifference or being unhappy/very unhappy in regards to their pregnancies exhibited 1.89- and 2.5-fold increased risk of drinking alcohol during their pregnancies, respectively. CONCLUSION: A number of important factors associated with maternal alcohol utilization during pregnancy have been identified, indicating areas where increased focus may serve to reduce maternal and pediatric morbidity and mortality.

Impact of breastfeeding duration on age at menarche.

The study aims to assess the relation between breastfeeding duration and age at menarche. Analysis was based on a cohort of 994 Filipino girls born in 1983-1984 and followed up from infancy to adulthood by the Cebu Longitudinal Health and Nutrition Survey. The main outcome was self-reported age at menarche. Cox regression was used to investigate the relation between duration of exclusive and any breastfeeding with age at menarche with adjustment sequentially for specific sets of known socioeconomic, maternal, genetic, and prenatal confounders. The estimated median of age at menarche was 13.08 years. After adjustment for potential confounders of the association of breastfeeding with age at menarche, exclusive breastfeeding duration retained an independent and significant association with age at menarche. An increase in 1 month of exclusive breastfeeding decreases the hazard of attaining earlier menarche by 6% (hazard ratio = 0.94, 95% confidence interval: 0.90, 0.98). Any breastfeeding duration was not associated with age at menarche. Although this is the first longitudinal study that reveals a negative association between exclusive breastfeeding and early menarche, the relation is still elusive. Further longitudinal studies within different contexts are warranted to assess the generalizability of these findings.

Epidemiology of acute soccer injuries in canadian children and youth.

OBJECTIVES: To describe acute injury characteristics in children and youth soccer players and to identify the characteristics of patients who required hospital admission. METHODS: The analysis of the study was based on the Canadian Hospitals Injury Reporting and Prevention Program. A total of 32,149 patients (aged 5-19 years) with soccer-related injuries presenting to 16 participating hospital emergency departments from 1994 to 2004 were included in the analysis. RESULTS: Males had the highest proportion of injuries (62%). The leading injuries were sprains/strains (38%), followed by fractures/dislocations (31%) and superficial injuries (23%). A total of 896 cases (3%) required hospital admission. Based on logistic regression analysis, being a male, playing unorganized soccer, having multiple body injuries, playing soccer outside school premises, and playing during the summer/fall increased the likelihood of hospital admission. Moreover, having a head/face/neck injury (Odds ratio [OR], 1.3; 95% confidence interval [95% CI], 1.1-1.7) and trunk injury (OR, 1.7; 95% CI, 1.2-2.4) as compared with an upper extremity injury and having injuries from contact with structures/surfaces (OR, 3.1; 95% CI, 2.2-4.3) and with other players (OR, 2.5; 95% CI, 1.8-3.5) as compared with ball contact had the highest odds of hospital admission. CONCLUSIONS: Soccer accounted for a significant proportion of injuries presented to Canadian Hospitals Injury Reporting and Prevention Program emergency departments during 1994-2004. Further studies investigating potential interventional programs and techniques among this population are highly warranted.

Early menarche predicts incidence of asthma in early adulthood.

The present study explores the effect of age at menarche on the incidence of asthma during early adulthood. The analysis was based on Canadian girls followed up from 8-11 to 18-21 years of age during the first 6 cycles (1994-2005) of the National Longitudinal Survey of Children and Youth. Early menarche was defined as 1 standard deviation less than the average age at menarche. Asthma occurrence after menarche was measured as asthma that was diagnosed by a health care professional. The authors used logistic regression to investigate the association between early menarche and incidence of asthma, adjusting for possible confounders. A total of 1,176 girls weighted to represent 352,345 Canadian girls were analyzed. The incidence of asthma after menarche was 11.2% (95% confidence interval: 8.3, 14.0). The onset of early menarche (<11.56 years of age) predicted postmenarcheal incidence of asthma; girls who matured early had more than twice the risk of developing asthma during early adulthood than did girls who matured at an average age (odds ratio, 2.34, 95% confidence interval: 1.19, 4.59). The present study provides partial insight into the worldwide rapid increase in asthma rates that coincides with the declining trends in menarcheal timing. Further studies within different contexts are warranted to assess the generalizability of these Canadian findings.

Age at menarche in Canada: results from the National Longitudinal Survey of Children & Youth.

BACKGROUND: Given the downward trend in age at menarche and its implications for the reproductive health and wellbeing of women, little is known about menarcheal age in Canada. Most Canadian studies are only representative of specific populations. The present study, therefore, aims to assess the distribution of age at menarche for Canadian girls and explore its variation across socio-economic and demographic factors. METHODS: The analysis of the study was based on all female respondents aged 14 to 17 years during Cycle 4 (2000/2001) of the National Longitudinal Survey of Children & Youth (NLSCY). The main outcome was age at menarche assessed as the month and year of the occurrence of the first menstrual cycle. Kaplan Meier was used to estimate the mean and median of age at menarche. Chi-square test was used to assess the differences in early, average and later maturers across the different levels of socio-economic and demographic variables. Bootstrapping was performed to account for the complex sampling design. RESULTS: The total number of girls analyzed in this study was 1,403 weighted to represent 601,911 Canadian girls. The estimated mean and median of age at menarche was 12.72 years (standard deviation = 1.05) and 12.67 years, respectively. The proportions of early (< 11.53 years), average (≥ 11.53 years and ≤ 13.91 years) and late maturers (> 13.91 years) were 14.6% (95% confidence interval (CI): 11.92-17.35), 68.0% (95% CI: 63.82-72.17) and 17.4% (95% CI: 14.10-20.63), respectively. Variations across the menarcheal groups were statistically significant for the province of residence, household income and family type. CONCLUSION: The findings of the study pave the way for future Canadian research. More studies are warranted to understand menarcheal age in terms of its variation across the provinces, the secular trend over time and its potential predictors.

Intimate partner violence as a risk factor for postpartum depression among Canadian women in the Maternity Experience Survey.

PURPOSE: Intimate partner violence is a worldwide public health concern that predominantly affects women of reproductive age. The purpose of this study was to evaluate the effect of exposure to intimate partner violence before, during, or after pregnancy on postpartum depression in a nationally representative sample of Canadian women. METHODS: A cross-sectional analysis was performed with the use of data from the Maternity Experience Survey conducted by Statistics Canada in 2006. A population-based sample of 8542 women 15 years and older who delivered singleton live births was selected from all Canadian provinces and territories; of those, 6421 completed a computer-assisted telephone interview. Recent experiences with and threats of physical or sexual violence by an intimate partner were examined in relation to postpartum depression assessed through the Edinburgh Postpartum Depression Scale. RESULTS: The prevalence of postpartum depression was 7.5% (95% confidence interval, 6.8-8.2). Controlling for confounders, odds of postpartum depression were significantly greater among women who reported partner violence in the past two years as opposed to those who did not (adjusted odds ratio, 1.61; 95% confidence interval, 1.06-2.45). CONCLUSIONS: Intimate partner violence is positively associated with postpartum depression among Canadian women. Implications for healthcare practice are discussed.

The influence of parent-child relationship on safety belt use among school children in Beirut.

Parent-child relationships have been linked to the health and social well-being of adolescents. This relationship may be especially influential in areas of the world where family bonds remain the strongest for children. The association of parent-child relations and safety belt use has not been extensively documented. The objective of this research was to investigate the influence of parent-child relationship on adolescent safety belt use, controlling for other variables. To our knowledge, this is the first study to examine determinants of safety belt use among school students in Lebanon. A two-stage sampling design resulted in the inclusion of 3/3 public and 10/23 private schools. Over 2400 students in grades 6-12 completed a cross-sectional self administered survey. Current safety belt use included student report to wearing seat belts in the front seat only or the front and back seat. Parent-child relationship was measured through student reports of 'getting along with parents'. Other variables included socio-demographic status, health, lifestyle and social characteristics. Logistic regression was performed for variables significant at the bivariate level resulting in three models. Getting along with parents was a significant predictor of safety belt use in the bivariate and all multiple regression models. In the most comprehensive multiple regression model, having a good relationship with parents doubled the likelihood of using a safety belt (95% CI: 1.1-3.1). The study provides enhanced evidence of the importance of the parent-adolescent relationship. Interventions with parents are recommended to enhance their awareness of their influence on their children.

Prevalence of smoking during pregnancy and associated risk factors among Canadian women: a national survey.

BACKGROUND: Cigarette smoking carries a threat both to the expecting mother and her newborn. Data on the prevalence and predictors of smoking during pregnancy is limited in Canada. Canadian studies are mainly representative of specific cities and/or provinces. Therefore, the study aims to assess the prevalence of smoking during pregnancy and its associated risk factors throughout the Canadian provinces and territories. METHODS: The analysis was based on the Maternity Experience Survey targeting women aged > or =15 years who had singleton live births during 2005/06 in the Canadian provinces and territories. The outcome was ever smoking during the thirst trimester of pregnancy. Socio-economic factors, demographic factors, maternal characteristics, and pregnancy related factors that proved to be significant at the bivariate level were considered for a logistic regression analysis. Bootstrapping was performed to account for the complex sampling design. RESULTS: The sample size was 6,421 weighted to represent 76,508 Canadian women. The prevalence of smoking during pregnancy was 10.5%, whereby smoking mothers consumed on average 7 cigarettes a day (95% Confidence interval - CI: 6.5-7.4; SD = 5.7). Regression analysis revealed that mothers who smoked during pregnancy were more likely to be of low socio-economic status, non-immigrant, single and passive smokers during pregnancy. Not attending prenatal classes and experiencing stressful events before/during pregnancy also increased the mothers' odds of smoking during pregnancy. While the age of the mother's first pregnancy was negatively associated with smoking during pregnancy, the mother's current age was positively associated with it. CONCLUSION: Smoking during pregnancy is still prevalent among Canadian women. The findings may be useful to enhance smoking prevention programs and integrated health promotion strategies to promote positive health behaviors among disadvantaged pregnancies.

Prevalence and predictors of 6-month exclusive breastfeeding among Canadian women: a national survey.

BACKGROUND: In spite of the evidence supporting the importance of breastfeeding during the first year of life, data on breastfeeding practices remain limited in Canada. The study aimed to examine the prevalence and predictors of 6-month exclusive breastfeeding among Canadian women. METHODS: The analysis was based on the Maternity Experience Survey targeting women aged >or= 15 years who had singleton live births between February 2006 - May 2006 in the Canadian provinces and November 2005 - February 2006 in the territories. The main outcome was exclusive breastfeeding based on the World Health Organization definition. Socioeconomic, demographic, maternal, pregnancy and delivery related variables were considered for a multivariate logistic regression using stepwise modeling. Bootstrapping was performed to account for the complex sampling design. RESULTS: The sample size in this study was 5,615 weighted to represent 66,810 Canadian women. While ever breastfeeding was 90.3%, the 6-month exclusive breastfeeding rate was 13.8%. Based on the regression model, having higher years of education, residing in the Northern territories and Western provinces, living with a partner, having had previous pregnancies, having lower pre-pregnancy body mass index and giving birth at older age were associated with increased likelihood of 6-month exclusive breastfeeding. Moreover, smoking during pregnancy, Caesarean birth, infant's admission to the intensive care unit and maternal employment status before 6 months of infant's age were negatively associated with exclusive breastfeeding. Mothers choosing to deliver at home were more likely to remain exclusively breastfeeding for 6 months (Odds Ratio: 5.29, 95% Confidence Interval: 2.95-9.46). CONCLUSIONS: The 6-month exclusive breastfeeding rate is low in Canada. The study results constitute the basis for designing interventions that aim to bridge the gap between the current practices of breastfeeding and the World Health Organization recommendation.

Which method of breastfeeding supplementation is best? The beliefs and practices of paediatricians and nurses.

The aims of the present study were to assess the practices of breastfeeding supplementation methods, and to explore the opinions and beliefs of health professionals with regard to breastfeeding supplementation methods and the nipple confusion phenomenon. The study was cross-sectional in design, and participants were recruited from five hospitals in Toronto, Ontario. All of the nurses and attending paediatricians in postpartum floors and level II nurseries were invited to participate in the study. A total of 87 nurses and 16 paediatricians completed the survey questionnaire. Bottle feeding was the most common breastfeeding supplementation method used in the nurseries followed by cup feeding. Only 15.0% of the level II nurses agreed that frequent bottle feeds lead to the nipple confusion phenomenon, compared with 44.4% of the postpartum nurses and 56.2% of the paediatricians. Findings demonstrated considerable variation in the practices and beliefs surrounding supplementation methods. A randomized controlled trial comparing the safety, efficiency and subsequent breastfeeding rates of different breastfeeding supplementation methods is warranted.

Epidemiology of acute head injuries in Canadian children and youth soccer players.

BACKGROUND: Limited studies have been done to assess head injury characteristics for children and youth soccer players in Canada. OBJECTIVES: To describe acute head injury characteristics in children and youth soccer players and identify the characteristics of patients who required hospital admission. METHODS: Analysis was based on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Soccer-related head injuries amongst 5-19 year old children presenting at 16 hospital emergency departments during 1994-2004 were selected in the study. All head injury-related variables (nature of injury, mechanism of injury, location of play, soccer type and season of play) were stratified by age and sex. A logistic regression model, consisting of the injury-related variables, sex and age as the independent variables, was performed to examine the characteristics of those head-injured patients who required hospital admission. RESULTS: Overall, there were 4720 head injury cases identified (15% of all soccer-related emergency department visits). The highest proportion of head injuries was amongst males (70%) and children aged 10-14 years (50%). Of head injury cases, 35% were superficial and/or open wounds, 28% minor head injuries, 11% concussions, 9% eye injuries and 5% fractures. The total number of cases that required hospital admission was 164 (3.5%). Based on logistic regression analysis, head-injured youth aged 15-19 years were almost two times more likely to be admitted to hospital than their younger counterparts (OR=2.2, 95% CI: 1.3-3.6). Compared to ball contact injuries, contact with structures/surfaces, other players/persons and other unspecified objects increased the odds of hospital admission at least by two-folds. Moreover, those who played unorganised soccer were significantly more likely to be admitted to the hospital as compared to those who played organised soccer (OR=1.7, 95% CI: 1.2-2.6). Finally, playing in the non-winter seasons had increased likelihood of hospital admissions. CONCLUSIONS: Head injuries constituted a significant proportion of soccer-related injuries presenting to emergency departments. Future studies need to evaluate the nature and safety of the playing surfaces/turf and other structures on or around the field of play.

Prevalence of asthma, allergic rhinitis and eczema among Lebanese adolescents.

OBJECTIVE: Studies on allergic diseases remain scarce in Lebanon. The aim of the present study was to determine prevalence and characteristics of asthma, allergic rhinitis and eczema among Lebanese school children. METHODS: The study was cross-sectional in design performed on a convenient sample of 3,115 students (13-14 yr) selected from 13 schools in 5 Lebanese provinces. Students were asked to complete the Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression was performed to assess the characteristics of having asthma, allergic rhinitis and eczema in the past year. RESULTS: The prevalence of ever having asthma, rhinitis and eczema was 8.3%, 45.2% and 12.8% respectively, while the prevalence of the symptoms of these diseases in the past year was 24.1%, 38.6% and 20.9%, respectively. Residing in the South and the North provinces of Lebanon and living in a busy area increased the likelihood of developing asthma and rhinitis. Higher rates of asthma and eczema, however, was noted among students going to private schools (Odds Ratio (OR) = 1.6, 95% confidence interval (CI): 1.3-2.1 and OR = 1.3, 95% CI: 1.0-1.7, respectively). Passive smoking was significantly associated with asthma only (OR = 1.3, 95% CI: 1.1-1.7). In addition to the above, the odds of having any of the three outcomes increases to at least 2.4-fold when accompanied by another allergic disease. CONCLUSIONS: Allergic diseases are highly prevalent in Lebanon and are catching up with the rates of developed countries. Moreover, the role of each of the three diseases in the existence of the other two had the greatest impact on their prevalence.

Epidemiology of eczema among Lebanese adolescents.

OBJECTIVE: The study aims to determine the prevalence of eczema among Lebanese adolescents and identify demographic, nutritional and environmental characteristics associated with eczema. METHODS: A cross-sectional study conducted on a convenient sample of 3 153 students (13-14 years) selected from five different provinces in Lebanon. Significant unadjusted demographic, nutritional and environmental variables were considered in a stepwise regression model. RESULTS: Ever having an itchy rash that lasted for a period more than six months was reported by 788 (25.0%) adolescents, while 404 (12.8%) reported ever having eczema. Females and passive smokers were at 1.5 increased risk of having eczema than their counterparts. Exercising regularly, living near a busy area, and frequent eating of eggs were positively associated with eczema. Finally, adolescents who suffered from allergic diseases, asthma (Odds ratio (OR): 1.64, 95% CI: 1.16-2.32), rhinitis (OR: 1.35, 95% CI: 1.07-1.70) and hay fever (OR: 2.77; 95% CI: 2.12-3.62) also reported having had eczema. CONCLUSION: Environmental factors were found to play an important role in the prevalence of eczema among adolescents.

Determinants of university students physical exercise: a study from Lebanon.

BACKGROUND: Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. METHODS: In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: "No"" (< 0.5 h) and "Yes" (> 0.5 h) per week. Chi-square tests and binary regression were conducted to determine the predictors of performing physical exercise. RESULTS: Of 2,013 students, only 26.4% engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. CONCLUSION: The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.