Epidemiology of Breast, Corpus Uteri, and Ovarian Cancers in Lebanon With Emphasis on Breast Cancer Incidence Trends and Risk Factors Compared to Regional and Global Rates.

OBJECTIVES: This study explores the incidence and trends of breast (Bca), corpus uteri (CUca), and ovarian (Oca) cancer in Lebanon, a Middle Eastern country. It compares the Bca rates to regional and global ones and discusses Bca risk factors in Lebanon. INTRODUCTION: Globally, Bca is the premier cause of cancer morbidity and mortality in women. METHODS: Data on female Bca, CUca, and Oca published by the Lebanese national cancer registry were obtained (ie, for the years of 2005 to 2016). The age-standardized incidence rates (ASIRw) and age-specific rates per 100,000 female population were computed. RESULTS: From 2005 to 2016, Bca, Oca, and CUca ranked first, sixth, and seventh, respectively, for cancer incidence among women in Lebanon. Bca alone accounted for 39.4% of all new female cancer cases. The ASIRw increased significantly for Bca and CUca (APC: 3.60 and 3.73, P < .05) but not for Oca (APC: 1.27, P > .05). The Bca ASIRw (per 100,000) increased significantly from 71.0 in 2005 to 115.6 in 2013 (P < .05), then decreased steadily but non-significantly to reach 96.8 in 2016 (P > .05). Lebanon's Bca ASIRw is comparable to developed countries. This may reflect altered sociological and reproductive patterns as the country transitions from regional to global trends. The five-year age-specific rates analysis revealed that Bca rates rose steeply from 35-39 to 50-54, dropped slightly between 55 and 64, then rose till 75+. The five-year age-specific rates between 35 and 54 among Lebanese women were amongst the highest worldwide from 2008 to 2012, even higher than the rates in Belgium, which had the highest ASIRw of Bca worldwide in 2020. CONCLUSION: Lebanon's Bca ASIRw is among the highest globally. It's important to investigate the contributing factors and develop a national Bca control strategy. This study supports the national recommendation in initiating Bca screening at age 40 for women.

University students' intentions to seek psychological counseling, attitudes toward seeking psychological help, and stigma.

BACKGROUND: Mental health problems are prevalent among university students worldwide. Studies have shown that most students do not disclose and do not get the psychological help and support they need. OBJECTIVES: This survey aims to investigate the intentions to seek psychological counseling (ISC) among university students, their attitudes toward seeking professional psychological help (ATSPPH), and the predictors of those intentions and attitudes including stigma. DESIGN AND METHODS: a cross-sectional survey was conducted among 420 students at the American University of Beirut (AUB). RESULTS: Depression, test anxiety, and difficulty sleeping are the three main reasons students would seek psychological help. The source the students most preferred to ask for help was one's family followed by psychologists and psychiatrists. Students' ATSPPH is a positive predictor of their ISC, while students' self-stigma of seeking help (SSOSH) is a negative predictor of their ATSPPH. Moreover, students' awareness of the psychological help system available on campus, free of charge, is a positive predictor for both ISC and ATSPPH. CONCLUSION: Different interventions are needed to reduce stigma and enhance students' mental health literacy and awareness of the available professional psychological help on campus.

Lung Cancer and Risk Factors in Lebanon: Epidemiology, Temporal Trends, and Comparison to Countries From Different Regions in the World.

BACKGROUND: Lung cancer (Lca) is the leading cause of cancer morbidity and mortality worldwide. This study examines the Lca incidence and trends in Lebanon and compares them to regional and global ones. It also discusses Lca risk factors in Lebanon. METHODS: Lung cancer data from the Lebanese National Cancer Registry for 2005 to 2016 was obtained. The age-standardized incidence rates (ASRw) and age-specific rates per 100 000 population were calculated. RESULTS: Lung cancer ranked second for cancer incidence in Lebanon from 2005-2016. Lung cancer ASRw ranged from 25.3 to 37.1 per 100 000 males and 9.8 to 16.7 per 100 000 females. Males 70-74 and females 75+ had the highest incidence. Lung cancer ASRw in males increased significantly at 3.94% per year from 2005 to 2014 (P > .05), then decreased non-significantly from 2014 to 2016 (P < .05). Lung cancer ASRw in females increased significantly at 11.98% per year from 2005 to 2009 (P > .05), then increased non-significantly from 2009 to 2016 (P < .05). Males' Lca ASRw in Lebanon was lower than the global average in 2008 and became similar in 2012 (34.1 vs 34.2 per 100 000); However, females' Lca ASRw was almost comparable to the global average in 2008 and exceeded it in 2012 (16.5 vs 13.6, respectively, per 100 000). Males' and Females' Lca ASRw in Lebanon were among the highest in the Middle East and North Africa (MENA) region but lower than those estimated for North America, China and Japan, and several European countries. The proportion of Lca cases attributed to smoking among Lebanese males and females was estimated at 75.7% and 66.3% for all age groups, respectively. The proportion of Lca cases attributed to air pollution with PM10 and PM2.5 in Lebanon was estimated at 13.5% for all age groups. CONCLUSION: Lung cancer incidence in Lebanon is among the highest in the MENA region. The leading known modifiable risk factors are tobacco smoking and air pollution.

The effect of a patient informative leaflet on chronic use of proton pump inhibitors in a primary care center: a randomized control trial.

BACKGROUND: Chronic non-medically indicated PPIs are highly prescribed worldwide. The long-term side effects of PPI must be wisely considered during an extended prescription duration. Our study purpose is to assess the impact of providing patients and physicians with educational guides on the rates of reducing or eliminating PPIs. DESIGN AND METHODS: A controlled study targeting adult patients with chronic PPI use was conducted in a family medicine center in Beirut. Block randomization was employed. Patients (n = 140) were equally divided into an intervention group consisting of a patient-oriented informative and motivational leaflet and a control group having the same follow-up without having the leaflet. All participants filled a questionnaire. All participants received a short phone call in 2 and 6 months. An e-mail clarifying the objective of this study was sent to all physicians and supplemented with a PPI deprescribing algorithm. RESULTS: At the 6-month follow-up, the rate of participants who talked to treating physicians about their PPI therapy was higher in the intervention group (p-value<0.0001), and the rate of participants who stepped down or off PPI was higher in the intervention group (p-value<0.0001). In participants who stepped down or off PPI, the reported breakthrough symptoms decreased over time (moderate: 24.2%, mild: 35.5%, and nil: 40.3% at 2-month follow-up; and moderate: 0%, mild: 55.4% and nil: 44.6% at 6-month follow-up; p-value<0.0001). CONCLUSION: A low-intensity, low-cost, and easily replicable intervention encouraged a significant number of long-term users of PPIs to reduce or stop these medications without causing significant breakthrough symptoms.

Cervix Uteri Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Countries From Different Regions in the World.

BACKGROUND: Invasive cervix uteri cancer is the fourth most common malignancy in women globally. This study investigates the incidence and trends of cervix uteri cancer in Lebanon, a country in the Middle East, and compares these rates to regional and global ones. METHODS: Data on cervix uteri were obtained from the Lebanese national cancer registry for the currently available years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100,000 population. RESULTS: From 2005 to 2016, cervix uteri cancer was the tenth most common cancer among women. Its age-standardized incidence rate fluctuated narrowly between 3.5 and 5.7 per 100,000, with the lowest rate in 2013 and the highest rate in 2012. The age-specific incidence rate had 2 peaks, the highest peak at age group 70-74 years and the second at age group 50-59 years. The annual percent change (+.05%) showed a non-statistically significant trend of increase. The age-standardized incidence rate of cervix uteri cancer in Lebanon was comparable to that of the Western Asia region that has the lowest incidence rate worldwide. The rate was intermediate as compared to other countries in the Middle East and North Africa Region and relatively similar to the ones in Australia, North America, and some Western European countries. CONCLUSION: The incidence rates of invasive cervix uteri are low in Lebanon. This could be attributed to the low prevalence of human papilloma virus infection and other sexually transmitted infections among Lebanese women, and the opportunistic screening practices. It is important to adopt a comprehensive approach to decrease the potential burden of cervix uteri, especially with the rising patterns of risky sexual behaviors. This includes improving awareness, enhancing access to preventive services, developing clinical guidelines, and training health care providers on these guidelines.

Prostate Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Countries From Different Regions in the World.

BACKGROUND: Prostate cancer is the most common malignancy in men globally. This study aims at investigating the incidence rates and trends of prostate cancer in Lebanon, and to compare them to those of countries from different regions in the world. METHODS: Data on prostate cancer were obtained from the Lebanese national cancer registry for the years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100 000 population. RESULTS: In Lebanon, prostate cancer is ranked as the most common cancer in men. The age-standardized incidence rate of prostate cancer has increased from 29.1 per 100 000 in 2005 to 37.3 per 100 000 in 2016; the highest rate was in 2012, surpassing the global average incidence rate for that year. The age-specific incidence rate of prostate cancer has increased exponentially starting at the age of 50 years to reach its peak in men aged 75 years or more. Two trends were identified in the age-standardized incidence rate of prostate cancer; an average significant increase of 7.28% per year for the period 2005-2009 (P-value < .05), followed by a non-significant decrease of around .99% for the period between 2009 and 2016 (P-value > .05). The age-standardized incidence rate in Lebanon was higher than most countries in the Middle East and North Africa region and Asia, but lower than the rates reported in Australia, America, and different European countries. CONCLUSION: Prostate cancer is the leading cancer among men in Lebanon. Screening practices, changes in population age structure, and prevalence of genetic and risky lifestyle factors may explain the increased incidence rates of prostate cancer. Given the controversy of screening recommendations and the slow growing nature of prostate cancer, increasing public awareness on ways of prevention, and implementing the latest screening recommendation of the United States Preventive Services Task Force are the suggested way forward.

Prescribing antibiotics in adults with respiratory tract infections in Lebanon.

INTRODUCTION: Antibiotic resistance is a global concern that has significant health and economic burden. The inappropriate use of antibiotics is a major cause of antibiotic resistance; this includes both unnecessary and incorrect prescriptions. Most antibiotics are prescribed in primary care, mainly for respiratory tract infections. This study examines the prescribing practices of physicians for respiratory tract infections in ambulatory settings in Lebanon. METHODS: The study was a cross-sectional review of prescriptions given to a group of employees working in two companies in Greater Beirut in Lebanon (n = 469) between September 2017 and March 2018. Prescriptions and related medical reports were reviewed. Data on the type of infection and the employees' demographics were collected. Antibiotic treatment was considered appropriate based on its adherence to international scientific societies' recommendations and clinical guidelines, including those of the Infectious Diseases Society of America. RESULTS: A total of 372 medical reports and prescriptions were reviewed; 88.2% of these prescriptions included antibiotics. The rate of antibiotic treatment was 82.0% for a diagnosis of flu-like symptoms and 94.6% for acute pharyngitis, of which 34.5% included third generation cephalosporins and fluoroquinolones. Around 93.7% of patients with acute bronchitis without pneumonia received antibiotics, mostly broad-spectrum ones. A significant association was found between the specialty of the prescribing physicians and some types of upper respiratory tract infections. CONCLUSION: This study reveals a high prevalence of inappropriate antibiotic prescribing for respiratory tract infections in the Lebanese ambulatory practice, contributing to the emergence of antimicrobial resistance in the country. It calls for urgent multifaceted interventions to limit unnecessary use and promote antibiotic stewardship.

Colorectal Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Regional and Western Countries.

Global trends in the incidence and mortality rates of colorectal cancer show a steady increase with significant predilection to western developed countries, possibly linking it to westernized lifestyles among other risk factors. This study aims to investigate the incidence and trends of colorectal cancer in Lebanon, a country in the Middle East and North Africa region, and to compare these rates to those in regional and western countries. Colorectal cancer incidence data were extracted from the Lebanese National Cancer Registry for the currently available years 2005 to 2016. The calculated age-standardized incidence rates and age-specific rates were expressed as per 100,000 population. The age-standardized incidence rates of colorectal cancer in Lebanon increased from 16.3 and 13.0 per 100,000 in 2005 to 23.2 and 20.2 per 100,000 in 2016, among males and females, respectively. The incidences were higher for males, and they increased with age. The annual percent change was +4.36% and +4.45%, in males and females respectively (p-value < 0.05). There was a non-statistically significant trend of decrease in recent years (since 2012 in males and since 2011 in females). The age-standardized incidence rates in Lebanon were higher than those in the majority of the regional countries, but lower than the rates in developed western countries. There were high age-specific incidence rates at age groups 40-44 and 45-49 years in Lebanon in both males and females (with significant rising temporal trend) compared to other countries, including the ones reported to have the highest colorectal cancer age-standardized incidence rate worldwide. Therefore, the burden of colorectal cancer is significant in Lebanon. This raises the necessity to develop national strategies tailored to reduce colorectal cancer incidence through promoting healthy lifestyles, raising awareness, and early detection as of 40 years of age.

A Pilot Intervention to Promote Positive Parenting in Refugees from Syria in Lebanon and Jordan.

BACKGROUND: Early childhood development (ECD) is a crucial milestone that shapes a child's health, wellbeing, education, and personality. Several factors come into play, and each requires the nurturing care of caregivers. Although the importance of ECD is well understood, the implementation of ECD programs is scarce, especially in poor and vulnerable communities. OBJECTIVE: To improve parents' wellbeing, parenting stress levels, parenting behavior, and discipline strategies after the implementation of a newly designed parenting intervention. PARTICIPANTS AND SETTING: Parents from Syria (125 mothers and fathers) in three refugee camps in Lebanon and Jordan. METHODS: This was a pilot cohort study in which parents' wellbeing, parenting stress levels, parenting behavior, and discipline strategies were evaluated before and after participating in training in the form of interactive and educational sessions to ameliorate their relations and interactions with their children. RESULTS: By the end of this study, parents' mental health and wellbeing improved (p < 0.001, Cohen's d: 0.61) and their parenting index score was reduced (p < 0.001, Cohen's d: 1.24). Some of their dysfunctional interactions with their children as well as the perceived difficulties and conduct problems in their children aged 3 to 6 years were also reduced significantly. CONCLUSION: The intervention used in this study succeeded in improving some aspects of parenting practices and disciplines and in improving the parents' wellbeing; however, more research is needed to assess its long-term effects on parents and their children. Moreover, some adjustments need to be made in the intervention to be more adapted to the context of refugees and underprivileged communities.

Bladder Cancer in Lebanon: Incidence and Comparison to Regional and Western Countries.

Lebanon has one of the highest estimated age-standardized incidence rate (ASR(w)) of bladder cancer (BC) worldwide. The aim of this study is to analyze the incidence rates for BC in Lebanon over a period of 7 years and to compare them to the rates in other countries. Data were obtained from the Lebanese National Cancer Registry for the currently available years 2005 to 2011. The calculated ASR(w) and age-specific rates were expressed as per 100 000 population. From 2005 to 2011, BC has been ranked as the third most common cancer in Lebanon. It accounted for 9.0% of all newly diagnosed cancer cases excluding nonmelanoma skin cancer. It ranked second in males and ninth in females. The average ASR(w) over this period was 31.2 in men and 7.3 in women. These incidence rates are among the highest worldwide across all age groups in both sexes. This study shows that the incidence of BC in Lebanon is high and it is among the highest worldwide. It is important to reduce the risk of BC through tobacco control and by decreasing exposure to avoidable environmental and occupational risk factors.

Sociological Transition and Breast Cancer in the Arab World: the Experience of Lebanon

Background: Breast cancer is the leading cause of cancer death among females in Lebanon. This study aimed at analyzing its epidemiology in the country over time. Methods: Data were extracted from the Lebanese National Cancer Registry (NCR) for the years 2004 through 2010. Age-standardized and age-specific incidence rates for cancers per 100,000 population were calculated. Results: Breast cancer ranked first, accounting for an average of 37.6% of all new female cancer cases in Lebanon during the period of 2004-2010. Breast cancer was found to have been increasing faster than other hormone-related women's cancers (i.e. of the ovaries and corpus uteri). The breast cancer age-standardized incidence rates (world population) (ASRw) increased steadily from 2004 (71.0) to 2010 (105.9), making the burden comparable to that in developed countries, reflecting the influence of sociological and reproductive patterns transitioning from regional norms to global trends. The age-specific incidence rates for breast cancer rose steeply from around age 35-39 years, to reach a first peak in the age group 45-49 years, and then dropped slightly between 50 and 64 years to rise again thereafter and reach a second peak in the 75+ age group. Five-year age-specific rates among Lebanese women between 35 and 49 years were among the highest observed worldwide in 2008. Conclusion: Breast cancer is continuously on the rise in Lebanon. The findings of this study support the national screening recommendation of starting breast cancer screening at the age of 40 years. It is mandatory to conduct an in-depth analysis of contributing factors and develop consequently a comprehensive National Breast Cancer Control strategy.

Knowledge, attitude and practice of Lebanese primary care physicians in nutrition counseling: a self-reported survey.

Aim This study aims to assess the knowledge, attitude and practice of primary care physicians (PCPs) in Lebanon regarding nutrition counseling and to investigate possible related barriers. BACKGROUND: Nutrition counseling is an important aspect of patient care, especially with the increase in nutrition-related disorders. METHODS: This is a descriptive study among a convenience sample of PCPs in Lebanon at two annual conferences in 2014 using an anonymous questionnaire. Findings Response rate was 54.6%. Overall, physicians considered that they have good to very good nutritional knowledge. Although they rated their formal nutritional education poorly, they had a positive attitude towards nutritional counseling and reported practicing general nutritional counseling with their patients. Barriers to nutritional counseling were: time, perceived poor patient adherence to diet, gap in physician's nutritional knowledge and lack of insurance coverage for dietitian fees. Changes should be made to medical education curricula to include nutrition courses related to prevalent health problems.

Psychological distress and coping strategies in parents of children with cancer in Lebanon.

OBJECTIVES: To determine the prevalence of psychological distress (PD) among parents of Lebanese children with cancer and to investigate the associated stressors and coping strategies. METHODS: A cross-sectional study conducted at the American University of Beirut Medical Center-Children Cancer Center of Lebanon in 2012. Parents of all children with cancer admitted for treatment were eligible participants. The General Health Questionnaire (GHQ-12) was used to estimate the prevalence of PD. Coping strategies were measured via the Coping Health Inventory for Parents (CHIP). Bivariate and multiple regression analyses were conducted to evaluate the relationship between GHQ-12 (scores 0-36), stressors, family/social support, and coping strategies. RESULTS: One hundred fourteen parents (68.2%) completed the anonymous questionnaire. Based on GHQ-12, significant PD was considered among 56.0% of the parents. It was found to be significantly positively associated with the degree of family financial problems and significantly negatively associated with the child's disease duration. A significant negative relationship was also found between PD and Coping (CHIP) scale, coping pattern I (Maintaining Family Integration and an Optimistic Outlook for the Situation), pattern II (Seeking Social Support), yet not with pattern III (Seeking Information). CONCLUSIONS: PD is prevalent among parents of Lebanese children hospitalized because of cancer. Screening for PD in the latter population is feasible, would identify those who are at risk for disruptive PD, and facilitate the provision of support towards better adjustment and coping. Alleviating parental PD may facilitate the realization of optimal health outcomes.

Opportunities and barriers to enhance research capacity and outputs among academic family physicians in the Arab world.

AIM: To explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation. BACKGROUND: Research is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries. METHODS: An online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region. FINDINGS: Seventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research. CONCLUSION: Although many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

The effect of various types of patients' reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial.

BACKGROUND: Invasive pneumococcal disease is one of the most important vaccine-preventable diseases threatening the adult community due to missed opportunities for vaccination. This study compares the effect of three different types of patient reminder system on adulthood Streptococcus pneumoniae immunization in a primary care setting. METHODS: The study targeted patients aged 40 and older eligible for pneumococcal vaccine, but did not receive it yet (89.5% of 3072 patients) based on their electronic medical records in a family medicine center in Beirut. The sample population was randomized using an automated computer randomization system into six equal groups, receiving short phone calls, short text messaging system (sms-text) or e-mails each with or without patient education. Each group received three identical reminders spaced by a period of four weeks. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the clinics. RESULTS: Of the eligible patients due for the pneumococcal 23-polyvalent vaccine, 1380 who had mobile phone numbers and e-mails were randomized into six equal intervention groups. The various reminders increased vaccination rate to 14.9%: 16.5% of the short phone calls group, 7.2% of the sms-text group and 5.7% of the e-mail group took the vaccine. The vaccination rate was independent of the age, associated education message and the predisposing condition. CONCLUSION: Use of electronic text reminders via e-mails and mobile phones seems to be a feasible and sustainable model to increase pneumococcal vaccination rates in a primary care center.

Jellyfish Stings: A Practical Approach.

Jellyfish have a worldwide distribution. Their stings can cause different reactions, ranging from cutaneous, localized, and self-limited to serious systemic or fatal ones, depending on the envenoming species. Several first aid treatments are used to manage such stings but few have evidence behind their use. This review of the literature describes and discusses the different related first aid and treatment recommendations, ending with a summarized practical approach. Further randomized controlled trials in this field are needed.

Diabetes quality of care at a university community in Beirut.

RATIONALE, AIMS AND OBJECTIVES: To assess the quality of diabetes mellitus (DM) care provided by a group of family doctors in Beirut. METHODS: An observational study, conducted at the American University of Beirut Medical Center-Family Medicine Clinics (AUBMC-FMC), examined the electronic health records (EHRs) of the beneficiaries of the Health Insurance Plan at the American University of Beirut (AUB-HIP) who were older than 20 years (n = 9469) in 2009. The eligible population included patients with DM (n = 701). Several provider/patient-directed interventions were introduced in the late 2000s, including a comprehensive EHRs system with point-of-care computer reminders, a provider financial incentive based on an annual performance appraisal ranked against that of the US Healthcare Effectiveness Data and Information Set (HEDIS) Comprehensive Diabetes Care indicators, as well as periodic up-to-date training. RESULTS: Optimal control for HbA1c, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and blood pressure were found in 58.6%, 51.0%, 22.4%, 53.3% and 60.2% of the population, respectively. 64.1% and 70.0% received screening for diabetic nephropathy and a dilated eye examination, respectively. When benchmarked against the HEDIS Comprehensive Diabetes Care indicators, the AUB-HIP's quality of care was 13% higher than the average of all plans in the United States. Screening for nephropathy, however, did not reach the above benchmark. CONCLUSIONS: Benchmarking served as an important tool in evaluating the current DM care offered and in detecting gaps, yet interventions are recommended for further improvement.

Screening instruments for depression in primary care: a concise review for clinicians.

Depression is prevalent across the life span worldwide. It is a common problem encountered in primary care settings. The World Health Organization recommends the integration of mental health into general health care in order to seal the existing gap between the number of patients who need mental health care and those who actually receive it. Addressing the burden of mental health problems in primary care settings has its limitations, particularly because of the time constraints in busy primary care clinics as well as the inadequate training of staff and physicians in mental health disorders. That is why reliable, brief, and easy to administer depression screening instruments are important in helping physicians identify patients at risk. The 2-item Patient Health Questionnaire (PHQ-2) is a suitable primary screening tool for depression. If positive, other tools should be administered, such as the PHQ-9 in adults, the PHQ-9 or Geriatric Depression Scale-15 in older adults, or the Arroll's help question or the Edinburgh Postnatal Depression Scale in ante- or postpartum women. Patients with positive scores ought to be interviewed more thoroughly. Computerized depression screening instruments that are interfaced or integrated into electronic health records seem to be promising steps toward optimizing diagnosis, treatment, and follow-up. The availability of adequate management and follow-up are ethical requirements for the utilization of any screening instrument for depression.

Insulin therapy attitudes and beliefs of physicians in Middle Eastern Arab countries.

BACKGROUND: Studies assessing attitudes and beliefs of physicians regarding insulin therapy in Arab countries are scant despite the high prevalence of type 2 diabetes mellitus (T2DM). OBJECTIVE: This study examines family physicians' attitudes and beliefs towards insulin therapy in T2DM patients in the East Mediterranean Region of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. METHODS: This is a cross-sectional study conducted on 348 family physicians invited via email to fill an anonymous online questionnaire about their attitudes, beliefs and perceived barriers regarding insulin initiation in T2DM patients. RESULTS: One hundred and twenty-two physicians completed the questionnaire. Of the 122 physicians, 73.6% preferred to delay insulin initiation until it is absolutely essential and 59.0% initiated it themselves. The majority agreed that T2DM patients benefit from insulin prior to the development of complications (85.7%) and that patient education is important (99.1%) and uncomplicated (74.7%). Sixty-three per cent expressed reluctance to start insulin mostly because of perceived patients' reluctance. Referral to endocrinologists to initiate insulin therapy was associated with inadequate experience and concern about risks, particularly in elderly patients (backward logistic regression, P < 0.05). Physicians' reluctance to initiate insulin therapy was associated with patients' perception of insulin initiation as a personal failure and threat to the quality of life (backward logistic regression, P < 0.05). CONCLUSIONS: Although family physicians in the Arab world believe in the benefits of insulin therapy, many are reluctant to initiate it themselves. Further studies are needed per country, as well as multiple measures to minimize the physicians' barriers to insulin prescription.

Psychological distress and job stressors among Lebanese workers: experience from a private sector.

No published data exists on the prevalence of psychological distress (PD) among the Lebanese working population, and its association with job stressors. A cross-sectional study was conducted in 2003 among Lebanese employees in a private administrative company. All employees (n = 200) received an anonymous questionnaire by mail. The General Health Questionnaire (GHQ-28) was used to estimate the prevalence of PD. Multiple regression analyses were performed to evaluate the relationship between GHQ-28 Likert score (0-84) and job stressors and other covariates. The participation rate was 79.3%. PD was identified in 30.0% of the studied population. A significant association was found between PD and lack of moral support, a recent disturbing event, feeling of job insecurity, and inability to be proactive. The results showed a high prevalence of PD in the studied population with significant association with job stressors.