Comparison of Postoperative Outcomes of Trans-urethral Resection of the Prostate, Laser Vaporization, and Laser Enucleation: A Double Propensity Score Matched Analysis.

OBJECTIVE: To compare postoperative outcomes of 3 types of endourologic surgeries (trans-urethral resection of the prostate [TURP], laser vaporization [LVP], and laser enucleation [LEP]) for benign prostatic hypertrophy (BPH) treatment using the ACS-NSQIP database. METHODS: The ACS-NSQIP database was queried for men who underwent TURP, PVP, and LEP for treatment of BPH from 2011 till 2019. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed. Propensity score matching was then performed as a sensitivity analysis. RESULTS: A total of 74,273 patients underwent endourologic surgeries for BPH, 65.4% had TURP, 28.6% PVP, and 5.9% LEP. Patients undergoing TURP were more likely to be older with higher ASA class, abnormal labs, and comorbidities (diabetic, congestive heart failure, and bleeding requiring transfusion) (P-value <.001). After adjusting for covariates and propensity score matching, LVP demonstrated shorter hospital stays, shorter operative times, less reoperation rates, decreased DVT/PE risk, with, however, higher odds of urinary tract infection and sepsis as compared to TURP (P-value<.028). Furthermore, LEP was found to have shorter hospital stays, longer operative times, and decreased odds of urinary tract infections and sepsis as compared to TURP (P-value<.006). CONCLUSION: LVP and LEP showed better surgical outcomes and characteristics as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation.

Work-related injuries among Syrian refugee child workers in the Bekaa Valley of Lebanon: A gender-sensitive analysis.

BACKGROUND: Syrian refugees in Lebanon have endured increasing hardships since the onset of the Syrian war in 2011, with many resorting to child labor. Working refugee children endure socioeconomic deprivation and harsh working conditions. This study explores the relationship between working conditions and the reporting of injuries among male and female Syrian refugee children in Lebanon and the related gender differences. METHODS AND FINDINGS: A cross-sectional survey of Syrian refugee children working in the Bekaa Valley of Lebanon was conducted in 2017. Face-to-face interviews with children (8 to 18 years) collected sociodemographic information and testimonies of their work experiences. Logistic regression tested the association between reporting of injuries and risk factors including school enrolment, field of work, means of transportation to work, age started working, number of working hours, multiple jobs, work pressure and hazards, and abuse. Analyses were stratified by gender. Of the 4090 surveyed working children, the majority reported working in agriculture (75.8%). Around a third (31.4%) reported being injured at work with a higher proportion in males. The most common reported injuries were cuts and wounds (44.9%), with males showing a higher proportion for all types of injuries compared to females. Nearly one fifth of reported injuries (19.8%) required medical attention in a hospital, with males reporting higher proportions than females for most types of injuries. The study findings revealed the association of multiple risk factors with an increased odds of reporting an injury, which included working in more than one job (AOR, 1.71; CI, 1.20-2.43; p = 0.003), working under pressure (AOR, 1.64; CI, 1.36-1.97; p<0.001), the use of sharp or heavy objects (AOR, 1.88; CI, 1.58-2.24; p<0.001), and experiencing physical abuse at work (AOR, 2.46; CI, 1.97-3.08; p<0.001). The odds of reporting an injury increased with every additional hour of work per day (AOR 1.08; CI, 1.02-1.14; p = 0.006). Most of these findings persisted in the male and female stratified models, with few exceptions. Males who went to work in a pickup truck had significantly lower odds of being injured than those who walked (AOR, 0.65; CI, 0.51-0.83; p = 0.001); this finding did not reach significance for females. Having longer work hours per day was significantly linked to higher odds of injury for females (AOR, 1.07; CI, 1.02-1.12; p = 0.008); but not for males. The main limitations of this study were its cross-sectional design and the use of self-reported variables. CONCLUSIONS: This study is the first to obtain direct testimony on work-related injuries and working conditions, exploring gender differences, among Syrian refugee children in Lebanon. Results demonstrated the association between the occurrence of injury and multiple risk factors highlighting their strenuous working conditions, with some differences detected between males and females. Many injuries can be prevented through direct safety interventions and proper implementation of child labor policies. Multidimensional interventions are essential to address the complex evolving challenges facing refugees.

Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review.

The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in war and conflict settings. This study aims to (1) assess how sex/gender is considered in the occupational health literature on healthcare workers in conflict settings, and (2) identify the gaps in incorporating sex/gender concepts in this literature. A scoping review was carried out and nine electronic databases were searched using a comprehensive search strategy. Two reviewers screened the titles/abstracts and full-texts of the studies using specific inclusion and exclusion criteria. Key information was extracted from the studies and four themes were identified. Of 7679 identified records, 47 were included for final review. The findings underlined the harsh working conditions of healthcare workers practicing in conflict zones and showed sex/gender similarities and differences in experiences, exposures and health outcomes. This review revealed a dearth of articles with adequate consideration of sex/gender in the study design. Sex/gender-sensitive research in occupational health is necessary to develop effective occupational health and safety policies to protect men and women healthcare workers in conflict settings.

Bioethicsing.

This article describes the components of a unique 9 month required course in bioethics for 3rd year medical students at the American University of Beirut. The blended (hybrid) learning format emphasizes three innovative learning activities: the bioethics documentary, edutainment games, and the bioethics log book. Sample student responses are included as well as an outline of limitations.

Associations between poor living conditions and multi-morbidity among Syrian migrant agricultural workers in Lebanon.

BACKGROUND: Syrian migrant farmworkers are among the most marginalized populations in Lebanon, living in poverty, lacking basic legal protections and frequent targets of discrimination. These realities produce living conditions that undermine their basic health and wellbeing. This study explores associations between household living conditions and acute and chronic health problems among Syrian migrant agricultural workers in the Bekaa region of Lebanon. METHODS: A survey was carried out in summer of 2011 with a sample of 290 migrant agriculture workers and members of their household living in a migrant farmworker camp. The survey assessed participants living conditions, assets and health conditions. Regression analyses were carried out to examine associations between multi-morbidity and quality of household and neighborhood living conditions. RESULTS: The mean age for the population was 20 years. Forty-seven percent of participants reported health problems. Almost 20% reported either one acute or chronic illness, 15% reported two health problems and 13% reported three or more. The analysis showed a significant positive association between multi-morbidity and poor housing and infrastructure conditions among study participants. CONCLUSION: The situation for migrant communities in Lebanon has likely further deteriorated since the study was conducted, as hundreds of thousands of new migrants have entered Lebanon since the outbreak of the Syrian armed conflict in 2011. These findings should inspire multi-faceted community development initiatives that provide basic minimums of neighborhood infrastructure and housing quality for Syrian migrant informal settlements across Lebanon, safeguarding the health and wellbeing of community residents.