The educational preparation of nurses in a developing economy and patient mortality.

BACKGROUND: Most studies have reported that higher levels (baccalaureate degree) of educational attainment by nurses are associated with lower levels of patient mortality. Researchers working in developed economies (e.g. North America and Europe) have almost exclusively conducted these studies. The value of baccalaureate nurse education has not been tested in countries with a developing economy. METHOD: A retrospective observational study conducted in seven hospitals. Patient mortality was the main outcome of interest. Anonymized data were extracted from nurses and patients from two different administrative sources and linked using the staff identification number that exists in both systems. We used bivariate logistic regression models to test the association between mortality and the educational attainment of the admitting nurse (responsible for assessment and care planning). RESULTS: Data were extracted for 11 918 (12, 830 admissions) patients and 7415 nurses over the first 6 months of 2015. The majority of nurses were educated in South Asia and just over half were educated to at least bachelor degree level. After adjusting for confounding and clustering, nurse education was not found to be associated with mortality. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our observations may suggest that in a developing economy, the academic level of nurses' education is not associated with a reduction in patient mortality. Findings should be interpreted with considerable caution but do challenge widely held assumptions about the value of baccalaureate-prepared nurses. Further research focused on nursing education in developing economies is required to inform health policy and planning.

Impact of vitamin D replacement in adults and elderly in the Middle East and North Africa: a systematic review and meta-analysis of randomized controlled trials.

In the Middle East and North Africa (MENA), a vitamin D dose ≥2000 IU/day may be needed to allow to the majority of the population to reach the target 25-hydroxyvitamin D (25(OH)D) level ≥20 ng/ml. Data in the region on the effect of vitamin D supplementation on various skeletal and extra-skeletal effects are scarce. INTRODUCTION: Hypovitaminosis D is prevalent worldwide, more so in the Middle East and North Africa (MENA). This study aims to determine the effects of vitamin D replacement on the mean difference in 25-hydroxyvitamin D [25(OH)D] level reached and other outcomes, in the MENA. METHODS: This is a meta-analysis of randomized trials from the MENA, administering vitamin D supplementation for at least 3 months, without language or time restriction. We conducted a comprehensive search in seven databases until July 2015. We abstracted data from published reports, independently and in duplicate. We calculated the mean difference (MD) and 95 % CI of 25(OH)D level reached for eligible comparisons, and pooled data using RevMan version 5.3. RESULTS: We identified 2 studies in elderly and 17 in adults; for the latter, 11 were included in the meta-analysis. Comparing a high vitamin D dose (>2000 IU/day) to placebo (nine studies), the MD in 25(OH)D level achieved was 18.3 (CI 14.1; 22.5) ng/ml; p value < 0.001; I 2 = 92 %. Comparing an intermediate dose (800-2000 IU/day) to placebo (two studies), the MD in 25(OH)D level achieved was 14.7 (CI 4.6; 24.9) ng/ml; p value 0.004; I 2 = 91 %. Accordingly, 89 and 71 % of participants, in the high and intermediate dose groups, respectively, reached the desirable level of 20 ng/ml. The risk of bias in the included studies was unclear to high, except for three studies. CONCLUSION: In the MENA region, vitamin D doses ≥2000 IU/day may be needed to reach the target 25(OH)D level ≥20 ng/ml. The long-term safety and the efficacy of such doses on various outcomes are unknown.

Effect of vitamin D replacement on maternal and neonatal outcomes: a randomised controlled trial in pregnant women with hypovitaminosis D. A protocol.

INTRODUCTION: The vitamin D recommended doses during pregnancy differ between societies. The WHO guidelines do not recommend routine prenatal supplementation, but they underscore the fact that women with the lowest levels may benefit most. The effects of routine supplementation during pregnancy on maternal and neonatal clinical outcomes have not been investigated in the Middle East, where hypovitaminosis D is prevalent. Our hypothesis is that in Middle Eastern pregnant women, a vitamin D dose of 3000 IU/day is required to reach a desirable maternal 25-hydroxyvitamin D [25(OH)D] level, and to positively impact infant bone mineral content (BMC). METHODS AND ANALYSIS: This is a multicentre blinded randomised controlled trial. Pregnant women presenting to the Obstetrics and Gynaecology clinics will be approached. Eligible women will be randomised to daily equivalent doses of cholecalciferol, 600 IU or 3000 IU, from 15 to 18 weeks gestation until delivery. Maternal 25(OH)D and chemistries will be assessed at study entry, during the third trimester and at delivery. Neonatal anthropometric variables and 25(OH)D level will be measured at birth, and bone and fat mass assessment by dual-energy X-ray absorptiometry scan at 1 month. A sample size of 280 pregnant women is needed to demonstrate a statistically significant difference in the proportion of women reaching a 25(OH)D level ≥ 50 nmol/L at delivery, and a difference in infant BMC of 6 (10)g, for a 90% power and a 2.5% level of significance. The proportions of women achieving a target 25(OH)D level will be compared between the two arms, using χ(2). An independent t test will be used to compare mean infant BMC between the two arms. The primary analysis is an intention-to-treat analysis of unadjusted results. ETHICS AND DISSEMINATION: The protocol has been approved by the Institutional Review Board at the American University of Beirut-Lebanon (IM.GEHF.22). The trial results will be published in peer-reviewed medical journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER: NCT02434380.

Herbal and nutritional supplement use among college students in Qatar.

There is increasing demand for herbal and nutritional supplements in the Middle East. This study aimed to examine the use of supplements by college students in Qatar and to elucidate users' views about them. A total of 419 college students completed a self-administered questionnaire. Almost half of the respondents (49.6%) had used supplements (ever users), with 32.7% reporting using them in the previous 6 months (current users). Of the latter, 27.7% had used herbal supplements, 56.2% vitamins and minerals and 56.9% non-vitamin, non-mineral, non-herbal supplements. Many participants considered supplements to be safer and more effective than conventional medicines. Supplements were preferred over conventional medicines for the treatment of digestive conditions and common respiratory ailments and for weight management. Educating health-care providers about the benefits and risks of supplements is imperative and will enable health-care practitioners to guide patients in making informed decisions about supplement use.

Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon.

OBJECTIVES: Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon. STUDY DESIGN: The study design was a cross sectional survey. METHODS: 126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS. RESULTS: Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS. CONCLUSIONS: Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.

Brucellosis outbreak in Chouf district of Lebanon in 2009: a case-control study.

A study was conducted to determine risk factors associated with brucellosis infection in an outbreak in Chouf district of Lebanon during summer 2009. Cases of brucellosis reported to the Ministry of Public Health were identified, and for each case 2 controls were matched by sex, age and residence. Sociodemographic data, exposure to animals and animal products, knowledge about brucellosis, symptoms and history of past brucellosis infections were collected. Consumption of raw cheese was a significant risk factor for contracting brucellosis (matched OR = 29.5), whereas wearing gloves when in contact with animals and animal products and self-preparing dairy products were protective factors (OR = 0.08 and 0.13 respectively). Low and inaccurate knowledge about brucellosis was prevalent among subjects, with a common misconception about human-human transmission. Ensuring animal vaccination, educating people on correct ways of milk pasteurization and handling meat products, and elevating food safety monitoring threshold are key elements in controlling brucellosis.

Brucellosis outbreak in Chouf district of Lebanon in 2009: a case-control study

A study was conducted to determine risk factors associated with brucellosis infection in an outbreak in Chouf district of Lebanon during summer 2009.Cases of brucellosis reported to the Ministry of Public Health were identified, and for each case 2 controls were matched by sex, age and residence.Sociodemographic data, exposure to animals and animal products, knowledge about brucellosis, symptoms and history of past brucellosis infections were collected.Consumption of raw cheese was a significant risk factor for contracting brucellosis [matched OR = 29.5], whereas wearing gloves when in contact with animals and animal products and self-preparing dairy products were protective factors [OR = 0.08 and 0.13 respectively]. Low and inaccurate knowledge about brucellosis was prevalent among subjects, with a common misconception about human-human transmission.Ensuring animal vaccination, educating people on correct ways of milk pasteurization and handling meat products, and elevating food safety monitoring threshold are key elements in controlling brucellosis

أجرى الباحثون الدراسة للتعرف على عوامل الاختطار المرافقة للعدوى بالبروسيلات في سياق فاشية اندلعت في منطقة الشوف في لبنان خلال صيف عام 2009 . فقد حدد الباحثون الحالات التي أبلغت وزارة الصحة العامة بها، وفي مقابل كل حالة أخذوا شاهدين متوافقين بالجنس والعمر وموقع السكن، وجمعوا بيانات اجتماعية وديموغرافية وبيانات حول التعرض للحيوانات ومنتجات الحيوانات، والمعارف حول داء البروسيلات، والأعراض وتاريخ العدوى السابقة بالبروسيلات، واتضح أن استهلاك الجبن الخام هو عامل اختطار يعتد بأهميته في العدوى بالبروسيلات [معدل الأرجحية الموافق 29.5]، وأن ارتداء القفازات حين مخالطة الحيوانات ومنتجاتها [معدل الأرجحية 0.08]مع التحضير الذاتي لمنتجات الألبان من العوامل الواقية [معدل الأرجحية 0.13]. واتضح أن نقص المعارف وتوافر المعارف غير الصحيحة عن داء البروسيلات ينتشران بين المصابين، مع شيوع مفاهيم خاطئة حول السراية من إنسان لآخر. أما العناصر الهامة في مكافحة داء البروسيلات فهي ضمان تلقيح الحيوانات وتثقيف الناس حول الطرق الصحيحة لبسترة اللبن وإعداد منتجات اللحوم، ورفع مستوى عتبة رصد سلامة الغذاء

Une étude a été menée afin de déterminer les facteurs de risque associés à la brucellose au cours d'une flambée dans le district de Chouf [Liban]pendant l'été 2009.Des cas de brucellose notifies au ministère de la Santé publique ont été identifiés, et pour chaque cas deux témoins ont été appariés pour l'âge, le sexe et le lieu de résidence.Les données sociodémographiques, les antécédents d'exposition aux animaux et aux produits destinés aux animaux, les connaissances sur la brucellose, les symptômes et les antécédents de brucellose ont été recueillis.La consommation de fromage cru était un facteur de risque important pour l'infection [OR apparié = 29, 5]tandis que le port de gants lors des contacts avec des animaux et des produits destinés aux animaux ainsi que la préparation des produits laitiers par la personne elle-même étaient des facteurs protecteurs [OR = 0, 08 et 0, 13 respectivement]. Des connaissances faibles et inexactes sur la brucellose étaient prévalences chez les patients, et les idées fausses sur la transmission interhumaine étaient courantes.Assurer une vaccination animale, éduquer la population en ce qui concerne les bonnes méthodes de pasteurisation du lait et de manipulation des produits carnés, et relever les niveaux de suivi de la sécurité sanitaire des aliments sont des éléments des de la lutte contre la brucellose

Growth mechanism and properties of InGaN insertions in GaN nanowires.

We demonstrate the strong influence of strain on the morphology and In content of InGaN insertions in GaN nanowires, in agreement with theoretical predictions which establish that InGaN island nucleation on GaN nanowires may be energetically favorable, depending on In content and nanowire diameter. EDX analyses reveal In inhomogeneities between the successive dots but also along the growth direction within each dot, which is attributed to compositional pulling. Nanometer-resolved cathodoluminescence on single nanowires allowed us to probe the luminescence of single dots, revealing enhanced luminescence from the high In content top part with respect to the lower In content dot base.

Effect of age, gender and calciotropic hormones on the relationship between vitamin D receptor gene polymorphisms and bone mineral density.

BACKGROUND/OBJECTIVES: Hypovitaminosis D is a major public health problem worldwide and unexpectedly more so in sunny countries. Vitamin D receptor (VDR) gene is associated with inter-individual variance in bone mineral density (BMD). Studies assessing the effect of VDR gene polymorphisms on BMD yielded conflicting results. The aim of this study was to assess the relationship between VDR polymorphisms and BMD in the Lebanese, across age groups and genders and to assess the effect of PTH and lean mass and vitamin D levels on such relationship. SUBJECTS/METHODS: In total, 203 subjects aged 65-85 years and 336 children aged 10-17 years. Polymorphisms in the VDR gene were assessed with the restriction enzymes BsmI, TaqI and ApaI. Bone mineral content, BMD and lean mass were measured using Dual-Energy X-ray Absorptiometry (DXA). The dominant hand strength was measured in children. RESULTS: Heterozygote genotype was the most frequent in both age groups. There was no difference in the frequency distribution of genotypes between the young and the elderly. No relationship between VDR genotypes and lean mass was found in either age group. Heterozygote boys had the lowest parathormone (PTH) and heterozygote elderly women had the highest BMD at the spine and forearm. CONCLUSIONS: In the Lebanese, the relationship between VDR polymorphisms and BMD differs by age. Survival does not seem to differ by VDR genotype. However, further studies are needed to assess the effect of VDR gene polymorphisms on mortality per se and time to mortality, not evaluated in this study.

Domestic violence against women during pregnancy: the case of Palestinian refugees attending an antenatal clinic in Lebanon.

OBJECTIVES: To determine the factors associated with domestic violence against pregnant Palestinian refugee women residing in Lebanon and currently using the United Nation Relief and Work Agency's (UNRWA) primary healthcare services. METHODS: This was a cross-sectional study conducted at a polyclinic of primary healthcare of the UNRWA in South Lebanon during the years 2005-2006. The sample was 351 pregnant women who were 15-42 years of age and not accompanied by their husbands or relatives. All women were invited by the midwife to participate in the study during their visit to the clinic for their first checkup or during a follow-up visit. The Abuse Assessment Screen instrument was used to screen for past and recent history of physical and emotional abuse among the participants. RESULTS: Domestic violence was significantly associated with education, gestational age, fear of husband or someone else in the house, and unintended pregnancy. The odds of abuse for women with an elementary or lower education were 6.86 (95% CI 1.2-38.1) and for women with an intermediate or secondary education 6.84 (95% CI 1.4-33.3) compared with women with a university education. The odds of abuse during pregnancy for women whose husbands did not desire their pregnancy were 3.80 (95% CI 1.5-9.7) compared with other women. CONCLUSIONS: Domestic violence against women in Lebanon was associated with educational level, gestational age, fear of husband or someone else in the house, and unintended pregnancy.

Housing quality and ill health in a disadvantaged urban community.

OBJECTIVES: This study examined the association between housing quality and chronic illness among household members in the little investigated, underserved urban communities in Hay el Sellom, one of the largest informal settlements on the outskirts of Beirut, Lebanon. STUDY DESIGN: A population-based cross-sectional survey. METHODS: Face-to-face interviews were conducted to obtain the required information on 3881 individuals of all age groups in 788 households. Housing quality was measured using infrastructure and services, and housing conditions. Ill health was measured by the reporting of chronic illnesses. A multivariate regression model using the Generalized Estimation was used to analyse the association between ill health and housing quality, controlling for other covariates. RESULTS: Fifty percent of studied households reported chronic illnesses. Approximately two-thirds of individuals lived in households with more than four problems relating to housing conditions. The results of the study showed a significant positive association between housing conditions and chronic illness. CONCLUSION: These findings highlight the need for immediate action as they suggest that health in poor urban communities could be improved with better planning of housing needs.

Impact of maternal veiling during pregnancy and socioeconomic status on offspring's musculoskeletal health.

UNLABELLED: The impact of maternal veiling during pregnancy and of socioeconomic status on offspring's bone mass was investigated in 326 healthy adolescents. Veiling during pregnancy was associated with decreased musculoskeletal parameters in the offspring boys, but not girls. SES was a significant predictor of bone mass in both genders. INTRODUCTION: This study investigates the effects of maternal veiling during pregnancy, a surrogate for low vitamin D level, and socioeconomic status (SES), a surrogate of nutritional status, on their offspring's bone mass at adolescence. METHODS: Three hundred and twenty-six healthy adolescents aged 13.1(2.0) years and their mothers were studied. The impact of maternal veiling on offspring's bone mass was evaluated through regression analyses. Outcome variables were bone mineral density (BMD) and content (BMC) at the spine, hip, and total body of the children. Predictors were maternal veiling during pregnancy and SES. Covariates were height, body composition, Tanner staging, calcium intake, vitamin D and exercise in children. RESULTS: In boys, adjusted analyses revealed that both maternal veiling during pregnancy and SES were significant predictors of bone mass, at multiple skeletal sites. In girls, SES but not maternal veiling during pregnancy was a significant predictor of bone mass at multiple sites. CONCLUSION: Maternal veiling during pregnancy was associated with decreased musculoskeletal parameters of boys, but not girls. SES was a significant predictor of bone mass in both genders. These findings may have profound implications on children's bone health.

Occult hepatitis B virus infection in Lebanese patients with chronic hepatitis C liver disease.

Occult hepatitis B virus (HBV) infection, characterised by the presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg), was investigated in 98 Lebanese patients with chronic hepatitis C liver disease and 85 control subjects recruited from eight institutions in different parts of the country. The prevalence of occult HBV infection ranged from 11.9% to 44.4% in hepatitis C virus (HCV)-infected patients and it increased with increasing severity of the liver disease. The overall rate of HBV DNA in our 98 HCV-infected patients was 16.3%. On the other hand, the rate of HBV DNA was 41.0% in anti-HBc alone positive patients compared to only 7.1% in healthy controls who were also anti-HBc alone positive (p < 0.001). Moreover, the prevalence HBV DNA increased with increasing severity of the liver disease, but this increase was only marginally significant and, perhaps, could have been significant if more patients were involved in the study. Although Lebanon is an area of low endemicity for both HBV and HCV, occult HBV infection is common in HCV-infected patients. The presence of HBV DNA, therefore, presents a challenge for the effective laboratory diagnosis of hepatitis B, particularly if polymerase chain reaction (PCR)-based HBV detection methods are not used.

Prevalence and predictors of nonfatal myocardial infarction in Jordan.

This study in May 2002, part of the Jordan Department of Statistics national cross-sectional, multistage employment and unemployment survey, measured the prevalence of self-reported myocardial infarction (MI) and the association with modifiable risk factors among Jordanians aged 40+ years. Of 3083 participants, 183 (5.9%) had ever been told by a doctor that they had had a MI. The prevalence varied by age and sex; 128 (69.9%) of the cases were in men. Among males and females, self-reported hypertension and hypercholesterolaemia were significantly associated with MI and diabetes was a significant risk factor for women. There was a significant relationship between current smoking and MI but not with previous smoking. Exercise and body mass index were not statistically significant predictors of MI in both males and females.

Prevalence and predictors of non-fatal myocardial infarction in Jordan

This study in May 2002, part of the Jordan Department of Statistics national crosssectional, multistage employment and unemployment survey, measured the prevalence of selfreported myocardial infarction [MI] and the association with modifiable risk factors among Jordanians aged 40+ years. Of 3083 participants, 183 [5.9%] had ever been told by a doctor that they had had a MI. The prevalence varied by age and sex; 128 [69.9%] of the cases were in men. Among males and females, self-reported hypertension and hypercholesterolaemia were significantly associated with MI and diabetes was a significant risk factor for women. There was a significant relationship between current smoking and MI but not with previous smoking. Exercise and body mass index were not statistically significant predictors of MI in both males and females

Hepatitis B virus DNA in serum of 'anti-HBc only'-positive healthy Lebanese blood donors: significance and possible implications.

Transmission of HBV infection through transfusion of HBsAg-negative blood has been documented. It is evident that low levels of HBV-DNA remain detectable in serum and liver tissue of some patients who clear HbsAg, and that the detection rate is highest in individuals who are 'anti-HBc positive alone'. This study was designed to assess the frequency and clinical significance of 'anti-HBc alone' in Lebanese blood donors. A total of 5511 blood donor samples from three major hospitals representing most regions of the country were tested for anti-HBc, amongst other screening tests. Samples positive for 'anti-HBc alone' were then tested for HBV-DNA and any positive for HBV-DNA were then genotyped and investigated for hepatitis B viral load. The study showed that 203 (3.7%) of randomly selected Lebanese blood donors were confirmed as 'anti-HBc alone'. Of these, 11 (5.4%) were HBV-DNA positive as detected by nested PCR. All samples had HBV-DNA levels below 400 copies/ml and all were genotype D. It can be concluded that HBV was present, although the circulating amount of virus was below the detectable limit for the assay used. Therefore, routine screening for anti-HBc may be required in Lebanese blood donation centres as an additional preventive measure for controlling transmission of HBV via blood transfusion.

Distribution of killer cell immunoglobulin-like receptors genotypes in the Lebanese population.

This study represents the first report on the distribution of 16 Killer cell Immunoglobulin-like Receptors (KIR) genes in 120 unrelated healthy Lebanese individuals. We observed that 2DL2 frequency (61%) comes second highest after South Asians (64%) and 2DL5 frequency (58.3%) is the second highest reported so far after the South Asians (74%). Interestingly, a large number of AA1 genotype individuals with no loci for activating KIR and three completely new BB profiles not previously reported were found in our population with a group A : group B haplotypes ratio of 1.3:1. The frequency of the KIR loci suggests that the Lebanese population shares common general features with the Caucasoid populations studied before, but still has its own unique decreased or increased frequencies of several loci.