Birthing in the Arab region: translating research into practice.

The Choices and Challenges in Changing Childbirth research network is a regional collaboration among 4 countries in the Arab region, namely Egypt, Lebanon, Palestine and Syrian Arab Republic, providing evidence of childbirth practices and identifying areas amenable to change. Studies that have been conducted in the region pinpoint problems in the quality of maternity services and a lack of women's involvement in the process of maternity care. The network aims to change childbirth practices by selecting research areas most likely to influence practices, by supportingthe process of obtaining regionally relevant evidence of a high standard and by assigning importance to dissemination and networking activities. This paper draws on the experience of the network in selecting strategies to approach different challenges and discusses the barriers facing this process.

Birthing in the Arab region: translating research into practice

The Choices and Challenges in Changing Childbirth research network is a regional collaboration among 4 countries in the Arab region, namely Egypt, Lebanon, Palestine and Syrian Arab Republic, providing evidence of childbirth practices and identifying areas amenable to change. Studies that have been conducted in the region pinpoint problems in the quality of maternity services and a lack of women's involvement in the process of maternity care. The network aims to change childbirth practices by selecting research areas most likely to influence practices, by supporting the process of obtaining regionally relevant evidence of a high standard and by assigning importance to dissemination and networking activities. This paper draws on the experience of the network in selecting strategies to approach different challenges and discusses the barriers facing this process

Preconceptional folic acid supplement use in Lebanon.

OBJECTIVE: The objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon. DESIGN/SETTING/SUBJECTS: The study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003-January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use. RESULTS: The overall use of preconceptional folic acid supplementation was 14.0 % (18.6 % in urban hospitals v. 2.7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use. CONCLUSION: Our study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level.

Gender and sexual health in clinical practice in Lebanon.

This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face-to-face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow-up, as these issues are brought up frequently by their women clients. However, results suggest that only one-third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.

Patterns of antenatal care in low-versus high-risk pregnancies in Lebanon.

We studied patterns of antenatal care in low- versus high-risk pregnancies in Lebanon comparing 538 women after delivery in urban Beirut with rural Baka'a. Most women had 9 antenatal care visits with an obstetrician, starting in the first trimester. Care for high-risk and low-risk pregnancies was similar in terms of type of provider, number of visits and timing of first visit. More high-risk women had advice about special diets, supplements and laboratory tests. Maternal and fetal outcomes showed that, controlling for area and pregnancy risk, more antenatal visits were associated with fewer preterm deliveries, more caesarean sections and fewer cases of postpartum depression. Overall, differences between risk groups were small.

Patterns of antenatal care in low-versus high-risk pregnancies in Lebanon

We studied patterns of antenatal care in low- versus high-risk pregnancies in Lebanon comparing 538 women after delivery in urban Beirut with rural Baka'a. Most women had 9 antenatal care visits with an obstetrician, starting in the first trimester. Care for high-risk and low-risk pregnancies was similar in terms of type of provider, number of visits and timing of first visit. More high-risk women had advice about special diets, supplements and laboratory tests. Maternal and fetal outcomes showed that, controlling for area and pregnancy risk, more antenatal visits were associated with fewer preterm deliveries, more caesarean sections and fewer cases of postpartum depression. Overall, differences between risk groups were small

Postpartum depression: prevalence and determinants in Lebanon.

This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women delivering in Beirut and a rural area (Beka'a Valley) were interviewed 24 hours and 3-5 months after delivery. During the latter visit, they were screened using the Edinburgh postnatal depression scale. The overall prevalence of PPD was 21% but was significantly lower in Beirut than the Beka'a Valley (16% vs. 26%). Lack of social support and prenatal depression were significantly associated with PPD in both areas, whereas stressful life events, lifetime depression, vaginal delivery, little education, unemployment, and chronic health problems were significantly related to PPD in one of the areas. Prenatal depression and more than one chronic health problem increased significantly the risk of PPD. Caesarean section decreased the risk of PPD, particularly in Beirut but also in the Beka'a Valley. Caregivers should use pre- and postnatal assessments to identify and address women at risk of PPD.

Effect of vagal nerve stimulation on L-leucine absorption in the cat jejunum.

The effects of vagal nerve stimulation in the neck and in the lower thorax were studied on L-leucine absorption in/the cat jejunum. Four series of in vivo experiments were performed in 26 cats using single pass perfusion technique with samples collected every 10 min and examined for their phenol red and radioactive L-leucine concentrations. The first two series acted as controls for the time it took to reach steady-state absorption and for the effects on L-leucine absorption of mechanical handling of the vagus nerve. In the third series, vagal stimulation in the neck (with a 20-second train of shocks at 7 Hz repeated every 10 min for either 16 or 4 stimulus sessions) resulted in a 3-fold increase in L-leucine absorption which was maintained throughout the stimulation period (up to 160 min). L-Leucine absorption started increasing within 10 min and peaked around 30-40 min after the initiation of stimulation and returned to control levels within 40 min after cessation of stimulation. In the fourth series, similar increases and returns to control L-leucine absorption levels were noted following vagal stimulation in the lower thorax (with a 20-min train of shocks at 7 Hz given for 3 sessions). The findings suggest a definite role of the vagus nerve in the control of leucine transport across the small intestine.