Sex disparities in dietary intake across the lifespan: the case of Lebanon.

BACKGROUND: Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients' intakes, food consumption patterns, and micronutrients' adequacy in Lebanon, while adopting a life course approach. METHODS: Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6-19.9 years; 2239 adults aged 20-59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients', and micronutrients' intakes. RESULTS: In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12-19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20-59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups' intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc. CONCLUSIONS: This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women's reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.

Consumption of Fruits and Vegetables Among Individuals 15 Years and Older in 28 Low- and Middle-Income Countries.

BACKGROUND: The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. OBJECTIVES: The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. METHODS: Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. RESULTS: The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09). CONCLUSIONS: Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.

Environmental footprints of food consumption and dietary patterns among Lebanese adults: a cross-sectional study.

BACKGROUND: Following the release of the Sustainable Development Goals, dietary patterns and guidelines are being revised for their effect on the environment in addition to their health implications. The objective of this study was to evaluate and compare the Environmental Footprints (EFPs) of food consumption patterns among Lebanese adults. METHODS: For this study, data for adults aged > 18 years (n = 337) were drawn from a previous national survey conducted in Lebanon (2008-2009), where dietary intake was assessed using a 61-item Food Frequency Questionnaire. Dietary patterns previously derived in the study sample included: Western, Lebanese-Mediterranean and High-Protein. In this study, food consumption and dietary patterns were examined for their EFPs including water use, energy use, and greenhouse gas (GHG) emissions, using review of life cycle analyses. RESULTS: In the study population, the EFPs of food consumption were: water use: 2571.62 ± 1259.45 L/day; energy use: 37.34 ± 19.98 MJ/day and GHGs: 4.06 ± 1.93 kg CO2 eq / day. Among the three dietary patterns prevalent in the study population, the Lebanese-Mediterranean diet had the lowest water use and GHG per 1000 Kcal (Water (L/Kg): 443.61 ± 197.15, 243.35 ± 112.0, 264.72 ± 161.67; GHG (KG CO2 eq/day) 0.58 ± 0.32, 0.38 ± 0.24, 0.57 ± 0.37, for the Western, Lebanese-Mediterranean and High- Protein, respectively). The scores of the High-Protein dietary pattern were associated with higher odds of the three EFPs, whereas the Lebanese-Mediterranean dietary pattern was associated with lower odds of energy use. Furthermore, scores of the Western pattern were associated with higher water use. CONCLUSIONS: The findings of this study showed that, among Lebanese adults, the Western and High-Protein dietary patterns had high EFPs, whereas the Lebanese-Mediterranean dietary pattern had lower water use and GHG emissions. Coupled to our earlier findings of the Lebanese-Mediterranean pattern's beneficial effects on health, the findings of this study lend evidence for the notion that what is healthy for people may also be healthy for ecosystems and highlight the need for nutrition recommendations to take into consideration the nexus of water, food, energy, in addition to health.

The integration and management of noncommunicable diseases in primary health care (Guest Editorial).

Noncommunicable diseases (NCDs) are a great burden in the Eastern Mediterranean Region (EMR) and, if no strategic intervention is taken, the burden is forecast to become even heavier, particularly with the additional impact of ageing populations. Currently, 62% of deaths in the EMR are due to NCDs. However, by 2030 this proportion is projected to increase to nearly 70%. The EMR is disproportionately affected by NCDs as a result of the Region's rapid urbanization and the globalization of unhealthy behaviours. Moreover, many of the EMR countries have health systems whose structures are not designed for the prevention, early detection and management of NCDs.

Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country.

OBJECTIVES: This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors. DESIGN: Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses. RESULTS: Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89-3.79) to 1.42 (95% CI: 0.96-2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39-3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96-2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80-1.76). CONCLUSIONS: The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.

Mapping genetic research in non-communicable disease publications in selected Arab countries: first step towards a guided research agenda.

BACKGROUND: In the Arab world, intervention and policy response to non-communicable diseases (NCD) has been weak despite extensive epidemiological evidence highlighting the alarmingly increased prevalence of chronic diseases. Generating genetic information is one key component to promote efficient disease management strategies. This study undertook a scoping review to generate the profile of the undertaken research on genetics of NCD publications in selected Arab countries. An analysis of the research produced examined the extent, range, nature, topic and methods of published research. The study aimed at identifying the gaps in genetic NCD research to inform policy action for NCD prevention and control. METHODS: The scoping review was conducted based on the five-stage methodological framework and included countries in Arab region selected to represent various economies and epidemiological transitions. RESULTS: The search identified 555 articles that focus on genetics-NCD research in the selected Arab countries over the duration of this study (January 2000 to December 2013). The most commonly conducted research was descriptive and clinically focused, rather than etiologically focused. Country-specific carrier and risk screening studies were not among the top research designs. The genetic component of certain highly heritable diseases, as well as diabetes, obesity, hypertension, chronic lung dysfunction and metabolic syndrome were all under investigated. CONCLUSIONS: This scoping review identified gaps for further research in the context of bioinformatics and genome-wide association studies. Genetic research in the Arab region has to be redirected towards NCDs with the highest morbidity, heritability and health burden within each country. A focused research plan to include community genetics is required for its proper integration in the Arab community.

A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13-19 years): a cross-sectional study.

Adolescent obesity is associated with both immediate and longer-term health implications. This study aims to identify dietary patterns among a nationally representative sample of Lebanese adolescents aged between 13 and 19 years (n 446) and to assess the association of these patterns with overweight and obesity. Through face-to-face interviews, socio-demographic, lifestyle and anthropometric variables were collected. Dietary intake was assessed using a sixty-one-item FFQ. Dietary patterns were derived by factor analysis. The following two dietary patterns were identified: Western and traditional Lebanese. The Western pattern was characterised by high consumption of red meat, eggs and fast-food sandwiches. The traditional Lebanese pattern reflected high intakes of fruits and vegetables, legumes and fish. Female sex and a higher maternal education level were associated with a greater adherence to the traditional Lebanese pattern. As for the Western pattern, the scores were negatively associated with crowding index, physical activity and frequency of breakfast consumption. After adjustment, subjects belonging to the 3rd tertile of the Western pattern scores had significantly higher odds of overweight compared with those belonging to the 1st tertile (OR 2·3; 95% CI 1·12, 4·73). In conclusion, two distinct dietary patterns were identified among adolescents in Lebanon: the traditional Lebanese and the Western, with the latter pattern being associated with an increased risk of overweight. The findings of this study may be used to guide the development of evidence-based preventive nutrition interventions to curb the obesity epidemic in this age group.

Diet, physical activity and socio-economic disparities of obesity in Lebanese adults: findings from a national study.

BACKGROUND: The prevalence of obesity within countries varies by gender, age, lifestyle and socioeconomic factors. Identification of behavioural factors that are associated with obesity within the country's context is critical for the development of effective public health programs which aim to prevent and manage obesity. The objective of this study was to assess age and gender differentials in the prevalence of obesity in Lebanon and examine correlates of obesity with a focus on socioeconomic disparities. METHODS: Following the WHO STEPwise guidelines, a national survey was conducted in Lebanon in 2008-2009. Households were selected randomly from all Governorates based on stratified cluster sampling method. One adult aged 20 years and over was randomly selected from each household for the interview. Anthropometric measurements and 24 hour recall dietary intake were obtained. The final sample included 1244 men and 1453 women. Descriptive statistics were computed for BMI, waist circumference, and percent body fat. Multivariate logistic regression analysis was carried out to assess the relationship between energy intake and obesity adjusted for relevant co-variables. RESULTS: The prevalence of obesity among Lebanese adults was 26.1%. Gender differences in obesity estimates were observed across age groups and the three obesity classes, with men showing higher prevalence rates at the younger age groups (20-49 years), and women showing higher prevalence rates in older age groups (50 years and above). Obesity showed significant associations with socio-economic status in women; it decreased with higher educational attainment (OR = 0.54, 95% CI: 0.32, 0.91), greater household assets (OR = 0.26; 95% CI: 0.10, 0.72) and lower crowding index (OR = 0.62; 95% CI: 0.39, 0.98), net of the effect of other co-variates. There was a significant positive association between obesity and energy intake in both genders, and a negative association between obesity and physical activity, significantly among women. CONCLUSION: Lifestyle and socioeconomic determinants of obesity are identified in this Lebanese population. Policy makers and service providers need to tailor public health strategies to tackle obesity accordingly.

Cancer trends in Lebanon: a review of incidence rates for the period of 2003-2008 and projections until 2018.

BACKGROUND: The analysis of cancer incidence trends is essential to health care planning. The aim of this study is to examine variations in cancer incidence rates in Lebanon between 2003 and 2008 and use the observed trends to project cancer incidence until 2018. METHODS: Using secondary data with a cumulative caseload of 45,753 patients from the National Cancer Registry database of the Ministry of Public Health in Lebanon, we estimated sex- and site- specific incidence of cancer for each year of the six-year period between 2003 and 2008. Logarithmic regressions were fitted to estimate the cancer incidence for the forecast years until 2018. RESULTS: Between 2003 and 2008, males and females presented with an overall 4.5% and 5.4% annual increase, respectively. Significant increases were observed for cancers of the liver and prostate among males, and for cancers of the liver, thyroid, and corpus uteri among females. By 2018, incidence rates were projected to approach 296.0 and 339.5 cases per 100,000 for males and females, respectively. The most common five types of cancer are expected to be prostate, bladder, lung, non-Hodgkin, and colon among males; and breast, ovarian, non-Hodgkin, lung, and colon among females. CONCLUSION: The increased availability of screening programs and a growing smoking epidemic, most notably in women, are the most likely explanations behind the increased cancer incidence in the past decade. An aging population and higher proportion of older people suggest further increases in the cancer caseload in the future. The health care system in Lebanon will be required to adapt to the growing burden of cancer in our population.

Dietary patterns in cardiovascular diseases prevention and management: review of the evidence and recommendations for primary care physicians in Lebanon.

The objective of this paper is to discuss the advantages of using the dietary pattern approach in evaluating the role of diet in cardiovascular diseases (CVD) prevention and management and to report on the association between major dietary patterns and CVD risk factors among Lebanese adults. The significance of this type of research to primary care physicians is also highlighted. The dietary pattern approach overcomes the inconsistent findings of single nutrient analysis in evaluating diet-disease associations, takes into consideration the synergistic effects of nutrients, and provides culture specific recommendations. Using data from the national Nutrition and Non-Communicable Disease Risk Factor Survey, we appraised the association of dietary patterns with CVD risk factors among Lebanese adults. Two major dietary patterns were identified: Western pattern, characterized by high intake of fast food sandwiches, desserts, and carbonated beverages and the traditional Lebanese pattern, characterized by high intakes of fruits and vegetables, olives and olive oil, and traditional dishes. Only the Western pattern was associated with increased risk of obesity (abdominal obesity), hyperglycemia and the metabolic syndrome. These findings demonstrated the valuable results that can be obtained using the dietary patterns approach in evaluating the association between diet and CVD risk factors and provided evidence that this approach can be used as a tool to push for desirable dietary changes in the country.

Trends in nutritional intakes and nutrition-related cardiovascular disease risk factors in Lebanon: the need for immediate action.

AIM: To examine the burden of cardiovascular disease (CVD) risk factors and their association with dietary variables in the Lebanese population while reviewing secular trends in the population's nutritional intakes and nutrition-related CVD risk factors. METHODS: Data on CVD risk factors and food consumption patterns in Lebanon were collected from scholarly papers, including individual studies and systematic review articles. Electronic databases were searched using combinations of key terms. RESULTS: The prevalence of obesity in Lebanon followed an alarming increasing trend over time, paralleled by an escalation in the prevalence of hypertension, diabetes and hyperlipidemia. Food consumption surveys illustrate an increasing trend in energy intake and the proportion of energy derived from fat and animal products, with a concomitant decrease in carbohydrates and cereals intakes. CONCLUSION: The shift towards an atherogenic diet coupled with the alarming increase in nutrition-related cardiovascular risk factors suggest that the Lebanese population is at an increased risk for CVDs. This should alert to the importance of formulating multicomponent intervention strategies at both the individual and population levels to halt the progression of nutrition-related diseases in the country, while highlighting the need for immediate public health efforts to promote the adoption of healthy dietary habits.

Physical activity in adults with and without diabetes: from the 'high-risk' approach to the 'population-based' approach of prevention.

BACKGROUND: The prevalence rates of physical inactivity and diabetes in the MENA region are among the highest in the world. However, studies that focus on factors that influence the pattern of physical activity in the region remain very scarce. This study aimed to determine the prevalence and correlates of physical activity in the general population and among subjects with and without diabetes in Lebanon, a small middle-income country in the MENA region. METHODS: We conducted a cross-sectional nation-wide study of 2,195 randomly selected adults aged 25 years and older. Participants completed a comprehensive questionnaire based on the WHO-STEPwise guidelines. Physical activity was assessed using the International Physical Activity Questionnaire. Type 2 diabetes risk factors examined were age ≥ 45 years, BMI ≥ 25 kg/m², hypertension, hyperlipidemia, cardiovascular disease and family history of diabetes. RESULTS: Close to 10% of adults with diabetes were physically active versus 23·4% without diabetes. Prevalence rates of physical activity declined consistently as the number of diabetes risk factors increased. Odds ratios for physical activity were lower among the educated (0.75, 95% CI= 0.57-0.98), those who owned at least one car (0.71, 95% CI= 0.57-0.88) and those who resided in the capital city (0.62, 95% CI 0.47-0.83). Health professionals gave 'advice to exercise' most to patients with or at highest risk for diabetes, and these were more likely to engage in physical activity than those without diabetes receiving the same advice, net of the effect of other covariates (OR=3.68 and 1.17, respectively). CONCLUSIONS: The inverse associations between physical activity and SES indicators suggest a negative influence of urbanization on activity levels of Lebanese adults. The missed opportunity for clinical primary preventive services for the majority non-diabetic population calls for population-based public health approaches that promote physical activity as a routine lifestyle in the general population.

Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon.

Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.

Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009).

BACKGROUND: Even though the obesity epidemic continues to grow in various parts of the world, recent reports have highlighted disparities in obesity trends across countries. There is little empirical evidence on the development and growth of obesity in Lebanon and other countries of the Eastern Mediterranean Region. Acknowledging the need for effective obesity preventive measures and for accurate assessment of trends in the obesity epidemic, this study aims at examining and analyzing secular trends in the prevalence of overweight and obesity over a 12-year period in Lebanon. METHODS: Based on weight and height measurements obtained from two national cross-sectional surveys conducted in 1997 and 2009 on subjects 6 years of age and older, BMI was calculated and the prevalence of obesity was determined based on BMI for adults and BMI z-scores for children and adolescents, according to WHO criteria. Age -and sex- adjusted odds ratios for overweight and obesity were determined, with the 1997 year as the referent category. Annual rates of change in obesity prevalence per sex and age group were also calculated. RESULTS: The study samples included a total of 2004 subjects in the 1997 survey and 3636 in the 2009 survey. Compared to 1997, mean BMI values were significantly higher in 2009 among all age and sex groups, except for 6-9 year old children. Whereas the prevalence of overweight appeared stable over the study period in both 6-19 year old subjects (20.0% vs. 21.2%) and adults aged 20 years and above (37.0% vs. 36.8%), the prevalence of obesity increased significantly (7.3% vs. 10.9% in 6-19 year olds; 17.4% vs. 28.2% in adults), with the odds of obesity being 2 times higher in 2009 compared to 1997, in both age groups (OR = 1.96, 95% CI:1.29-2.97 and OR = 2.01, 95% CI: 1.67-2.43, respectively). The annual rates of change in obesity prevalence ranged between +4.1% in children and adolescents and +5.2% in adults. CONCLUSION: The study's findings highlight an alarming increase in obesity prevalence in the Lebanese population, over the 12-year study period, and alert to the importance of formulating policies and nutritional strategies to curb the obesity rise in the country.

Dietary patterns and their association with obesity and sociodemographic factors in a national sample of Lebanese adults.

OBJECTIVE: To identify and characterize dietary patterns in Lebanon and assess their association with sociodemographic factors, BMI and waist circumference (WC). DESIGN: A cross-sectional population-based survey. In a face-to-face interview, participants completed a brief sociodemographic and semiquantitative FFQ. In addition, anthropometric measurements were obtained following standard techniques. Dietary patterns were identified by factor analysis. Multivariate linear regression was used to assess determinants of the various patterns and their association with BMI and WC. SETTING: National Nutrition and Non-Communicable Disease Risk Factor Survey (2009), Lebanon. SUBJECTS: A nationally representative sample of 2048 Lebanese adults aged 20-55 years. RESULTS: Four dietary patterns were identified: 'Western', 'Traditional Lebanese', 'Prudent' and 'Fish and alcohol'. Factor scores of the identified patterns increased with age, except for the Western pattern in which a negative association was noted. Women had higher scores for the prudent pattern. Adults with higher levels of education had significantly higher scores for the prudent pattern. The frequency of breakfast consumption was significantly associated with scores of both traditional Lebanese and prudent patterns. Multivariate-adjusted analysis revealed a positive association between scores of the Western pattern and the BMI and WC of study participants. CONCLUSIONS: The findings show the presence of four distinct dietary patterns in the Lebanese population, which were associated with age, sex, education and meal pattern. Only the Western pattern was associated with higher BMI.

Ethics Reporting Practices in Aging Research From the Arab Region.

Objectives: This study aims to assess the extent of ethics reporting practices in aging research from Arab countries. Methods: A systematic scoping review of research on aging in 22 Arab countries from seven databases (1994-2013) identified 637 publications warranting institutional ethical approval and 612 publications warranting informed consent. We used multivariable regression analysis to examine variations by time, place, and study characteristics. Results: Only 36.6% of articles reported approval from a Research Ethics Committee and 38.7% reported informed consent. Reporting of ethical research practices increased significantly over time and as research collaborations and journal impact factor increased, and when sampling frame included institutionalized participants. In contrast, failure to report ethical research practices was significantly more common in non-English articles and those that did not report a funding source. Discussion: Despite gains across time, reporting of ethical research practices remains suboptimal in the Arab region. Further guidelines and capacity building are needed.

Violent behavior among adolescents in post-war Lebanon: the role of personal factors and correlation with other problem behaviors.

BACKGROUND: Adolescent violence is a significant public health problem. The primary objective of this study is to assess the prevalence and correlates of violent behavior among adolescent students in Lebanon. METHODS: A cross-sectional study was conducted among a representative sample of 827 secondary students enrolled in public and private schools in Beirut. Using a series of multiple logistic regression techniques, socio-demographic variables which significantly associated with violent behavior were included as potential confounders in building the models for risk behavior. RESULTS: Nearly 42 and 17% of adolescents reported being involved in physical fights and weapon carrying, respectively. Boys were significantly more likely to use violence than girls. Whereas associations with physical fights were stronger for socio-economic variables and perceived rank in class, weapon carrying was significantly associated with problem behaviors, such as unintentional injury, substance abuse and sexual activity, with effect measures being stronger than those estimated for physical fighting. CONCLUSION: Compared with other countries, the rates of violent behavior in Lebanon are relatively high. The results from this study are discussed in light of the political ecology of Lebanon which may contribute to a culture that perpetrates violent behavior and may have influenced the clustering pattern of risk behaviors.

Exploring resident-staff relationships in nursing homes in Lebanon.

Objectives: To explore the prevailing relationships between residents and staff in nursing homes in Lebanon, and to elicit factors that influence these relationships.Method: Using a qualitative phenomenological design, this study was conducted to explore the lived experience of residents, especially pertaining to their relationships with staff. The study included 13 residents aged 65 and above with no cognitive impairment. Data were collected using semi-structured interviews and were analysed using the Giorgi method.Findings: Two main themes representing resident perceptions about their interactions with the nurses emerged: (1) relationships to satisfy the need for physical care, (2) relationships that foster a bond of caring and trust.Discussion: Reflecting about resident-nurse relationships and examining factors that promote trust and stronger bonding help caregivers understand the importance of fostering a stronger relationship with residents. These findings have implications for developing policy and practice in nursing homes in Lebanon and elsewhere.Conclusion: This is the first study conducted by a nurse researcher in Lebanon that has explicitly explored the nature of relationships between caregivers and care-receivers in nursing homes. The contribution of this study is not solely restricted to experiences and outcomes of care, but also includes implications for policy and practice.

Review of Non-Communicable Disease Research Activity in Kuwait: Where is the Evidence for the Best Practice?

BACKGROUND: Kuwait, a small country in the Middle East, is now facing rapid development, with non-communicable diseases (NCDs) accounting for the majority of deaths. OBJECTIVES: In this study, we review trends in NCD research productivity in Kuwait and examine to what extent it is aligned with disease burden. METHODS: Systematic mapping of NCD papers produced between January 2000 and December 2013 yielded 893 publications. These were defined according to study design, study focus, and risk factors examined. Research gaps were assessed by examining disparities between literature produced and cause-specific proportional mortality rates (PMR) and disability-adjusted life years (DALYs). FINDINGS: While annual publication rates increased more than two-fold during the study period, many of the study methodologies were descriptive (58%). Only 2.6% were based on high-evidence interventional studies. Cancer, CVD, and diabetes featured in 38.1%, 15.1%, and 9.2% of the publications, respectively. Compared to PMR and DALYs, there was a surplus of cancer research, most of which were laboratory-based studies (27.6%) or of the case-report/case-series study type (26.5%). Smoking was more likely to be addressed in relation to CVD (32.6%) than diabetes (6.1%) or cancer (2.1%). Physical inactivity was mostly examined in its relation to diabetes (14.6%), with negligible representation in the remaining study focus (range 0.3% to 2.2%). CONCLUSION: NCD research production in Kuwait is not aligned with disease burden or health priorities. We recommend a coordinated action between funding agencies, universities, and researchers in Kuwait to guide development of a comprehensive research agenda that is responsive to the country's emerging needs.