Dietary exposure to aflatoxins, ochratoxin A and deoxynivalenol from a total diet study in an adult urban Lebanese population.

Exposure to mycotoxins may be associated with carcinogenic, immunosuppressant and estrogenic effects. In the Middle-East, studies investigating food contamination and dietary exposure to mycotoxins are particularly scarce. This study aims at evaluating the dietary exposure of an adult Lebanese urban population to four mycotoxins (AFB1, AFM1, OTA, DON) classified as priority food contaminants by the WHO. Dietary exposure assessment was performed by means of the total diet study approach. Average and excessive consumer exposure estimates (p95) were calculated and compared with appropriate toxicological reference values (TRVs). Average dietary exposure levels to OTA and DON represented 29.9% and 156.8% of the respective TRVs, with the p95 exposure estimates approaching or exceeding the TRVs for these mycotoxins (95.1% and 355.8%, respectively). Based on the mean dietary exposure level to AFB1, cancer risk was estimated at 0.0527-0.0545cases/100,000persons/year, while mean exposure to AFM1 was associated with a population risk of 0.0018-0.0027cases/100,000persons/year. The study's findings place Lebanon among countries that are highly exposed to mycotoxins through the diet and call for larger-scale studies aiming at providing a comprehensive assessment of the dietary exposure of the Lebanese population to mycotoxins as well as to other food contaminants.

The prevalence of congenital and early-onset hearing loss in Jordanian and Israeli infants.

The objective of the study was to investigate the prevalence of congenital and early-onset hearing loss, and the influence of the known risk factors for hearing loss on infants in Jordan and Israel. Subjects were a total of nearly 17,000 infants from both countries, including infants with and without risk factors for hearing loss. The hearing screening protocol included distortion product otoacoustic emission, followed in case of repeated OAE referral or high risk (HR) infant by diagnostic auditory brainstem responses. The results indicate that the prevalence and severity of hearing loss amongst Jordanian infants (1.37%) is remarkably higher as compared to the Israeli infants (0.48%). The overall prevalence of bilateral SNHL was seven times more in the Jordanian infants, 18 times in non-risk, and three times in the HR infants relative to the Israeli infants. Risk factors including family history, hyperbilirubinemia, bacterial meningitis, and associated syndromes were more prevalent amongst Jordanian infants. This unique study underscores the importance of sharing and exchanging information to create empirical data to guide health-care providers in adapting protocols to the local constraints in developing countries.

The assessment of reproductive health services: a conceptual framework for prenatal care.

This article delineates a conceptual model for defining and measuring quality in prenatal services. It addresses three issues related to women's health: (a) the emerging interest in reproductive health as a concept that encompasses the full range of women's needs, versus the more narrow concept and approach of traditional maternal and child health services; (b) the importance of prenatal services within the context of reproductive health, particularly in developing countries; and (c) the positive role that quality plays in promoting women's health. It then proposes a model for defining and measuring quality in prenatal services, styled after Donabedian's work and informed by Bruce's framework. It assesses the quality of prenatal care in terms of five elements: management, pregnant woman-provider relations, technical competence, information transmission, and continuity of care. The framework was tested in the city of Irbid, Jordan, in 1992. Findings are summarized, and recommendations for future work as discussed.

PIP: The authors consider the following issues related to women's health: the emerging interest in reproductive health as a concept which encompasses the full range of women's needs, versus the more narrow concept and approach of traditional maternal and child health services; the importance of prenatal services within the context of reproductive health, especially in developing countries; and the positive role which quality plays in promoting women's health. The authors then propose a model for defining and measuring quality in prenatal services, styled after Donabedian's work and informed by Bruce's framework. The model assesses the quality of prenatal care in terms of the following elements: management, pregnant woman-provider relations, technical competence, information transmission, and continuity of care. The framework was tested in Irbid, Jordan, in 1992. Recommendations are presented for future work.