Anxiety and sleep quality in a sample of Lebanese healthcare workers during the COVID-19 outbreak

A cross-sectional, survey based study was conducted in order to assess mental health outcomes among healthcare workers in a private university hospital involved in the COVID-19 response in Lebanon. The main objective was to quantify symptoms of anxiety and sleep quality using self-rating scales (the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) respectively), while identifying factors that might affect those symptoms. A total of 628 healthcare workers completed the survey; 409 (66.2%) were younger than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered nurses, residents, women, and younger participants presented higher scores on both scales than other categories of participants. Among factors related with COVID-19, those associated with higher scores were having relatives affected by the virus (22.2%), being excessively exposed to media (12.9%), and increasing the consumption of substances/alcohol (31.2%) during this period. Factors associated with higher risk of anxiety symptoms after multivariable logistic regression analysis were: female sex, young age, poor sleep quality, and living with elderly. Our findings contribute to the understanding of the psychological wellbeing of health care workers involved in the acute COVID-19 outbreak in Lebanon.     

Knowledge, attitudes, and practices of argileh (water pipe or hubble-bubble) and cigarette smoking among pregnant women in Lebanon

BACKGROUND: Currently, little is known about argileh (water pipe or hubble-bubble) and cigarette smoking among pregnant women in the Arab world, despite emerging evidence on the adverse health effects of argileh smoking and well-established knowledge about the health risks of cigarette smoking during pregnancy. OBJECTIVES: The present study assesses pregnant Arab women's knowledge of chemical contents and related harmful effects of argileh and cigarettes, their attitudes towards smoking argileh and cigarettes, and their actual smoking of argileh and cigarettes, both before and during pregnancy. METHODS: A stratified sample of 864 women from 23 health care centers in Lebanon completed a structured, interviewer-administered questionnaire. Information was collected on basic demographic variables, women's knowledge, attitudes, and cigarette and argileh smoking. RESULTS: Women were partially knowledgeable about the health risks of cigarette smoking, knew little about the harmful ingredients of argileh smoking, and had many misconceptions regarding how argileh worked or how it can produce harm. Attitudes were permissive towards all forms of smoking. Almost one quarter (23%) of participants reported smoking during pregnancy, with 17% smoking only cigarettes, 4% smoking only argileh, and 1.5% smoking both cigarette and argileh. CONCLUSION: A significant and growing percentage of pregnant Arab women are smoking in Lebanon, with four cigarette smokers for every argileh smoker. Smoking behaviors are empirically linked with important gaps in knowledge and with permissive attitudes. These data may be used to design more effective prevention programs targeting this vulnerable population.     

Is there violence in the neighbourhood? Ask the children

BACKGROUND: Community violence is a major public health concern. Much has been written about high intensity community violence such as wars or gang violence. However, chronic low intensity community violence is greatly overlooked. The objective of the following study is to assess how children living in neighbourhoods characterized by chronic low intensity violence perceive their environment. METHODS: Children drew two pictures: one of their physical neighbourhoods and the other representing what goes on in the neighbourhoods. Each child also completed a neighbourhood safety survey. RESULTS: The participants were four hundred and five children (213 girls; 192 boys) 8-12 years old (mean = 9.70; SD = 1.26) who lived in Beirut. 75 drawings contained violent incidents (fist fights and heated verbal arguments were most commonly depicted). 168 children mentioned people fighting or quarrelling in the streets but elected not to draw them. Children reported feeling unsafe and dissatisfaction with the quality of their neighbourhoods. CONCLUSION: Children living in chronic low intensity community violence may feel unsafe and distrustful of their environment but may perceive violent events as regular normal occurrence. The risk of copying such behaviours and propagating violence is to be considered seriously.     

Cultural Capital and Self-Rated Health in Low Income Women: Evidence from the Urban Health Study, Beirut, Lebanon

This paper examines the association between cultural capital and self-rated psychosocial health among poor, ever-married Lebanese women living in an urban context. Both self-rated general and mental health status were assessed using data from a cross-sectional survey of 1,869 women conducted in 2003. Associations between self-rated general and mental health status and cultural capital were obtained using χ ² tests and odds ratios from binary logistic regression models. Cultural capital had significant associations with self-perceived general and mental health status net of the effects of social capital, SES, demographics, community and health risk factors. For example, the odds ratios for poor general and mental health associated with low cultural capital were 4.5 (CI: 2.95–6.95) and 2.9 (CI: 2.09–4.05), respectively, as compared to participants with high cultural capital. As expected, health risk factors were significantly associated with both measures of health status. However, demographic and community variables were associated with general health but not with mental health status. The findings pertaining to social capital and measures of SES were mixed. Cultural capital was a powerful and significant predictor of self-perceived general and mental health among women living in poor urban communities.Khawaja and Mowafi are with the Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.     

Diabetes mellitus, thiamine-dependent megaloblastic anemia, and sensorineural deafness associated with deficient alpha-ketoglutarate dehydrogenase activity

Three brothers with diabetes mellitus, thiamine-responsive megaloblastic anemia, and sensorineural deafness are reported. Two had, in addition, congenital septal defects. The activities of thiamine-dependent enzymes were determined in one patient, revealing low alpha-ketoglutarate dehydrogenase activity, which could have caused a sideroblastic anemia with secondary megaloblastic changes. The anemia was thiamine dependent. The cause of the diabetes mellitus was not known, but it was not type 1.     

Molecular basis of oculocutaneous albinism type 1 in Lebanese patients

Oculocutaneous albinism type 1 (OCA1) results from mutations in the tyrosinase gene, which lead to partial or complete loss of activity of the corresponding enzyme. A large number of mutations have been identified worldwide, providing insight into the pathogenesis of the disorder. We performed ophthalmic and dermatological exams on 30 Lebanese subjects with oculocutaneous albinism, then screened for mutations in the tyrosinase gene in an effort to establish the molecular basis of the disorder in our population and correlate it with phenotypic findings. The five exons of the gene together with the exon–intron boundaries and part of the promoter region were sequenced. Mutations were found in a total of 14 patients (47%) while no mutation was identified in the sequenced regions in 53% of patients. Fourteen different mutations were identified of which eight were novel while six had been previously reported. Mutations were mainly seen in patients with clinical findings, suggestive of OCA1A (64% of patients with OCA1A versus 25% of patients with OCA1B); therefore, the absence of mutations in some of the other patients may indicate the involvement of other genes.     

Sex work,containment and the new discourse of public health in French colonial Levant

This article addresses how French academics, doctors and state bureaucrats formulated sex work as a pathology, an area of inquiry that had to be studied in the interest of public safety. French colonisation in the Levant extended the reach of this ‘expertise’ from the metropole to Lebanon under the guise of public health. Knowledge produced by academics was used to buttress colonial state policy, which demanded that sex workers be contained to protect society against medical contagion. No longer drawing conclusions based on speculation, the medical establishment asserted its authority by harnessing modern advances in science and uniting them with extensive observation. ‘Empirical facts’ replaced ‘opinions’, as doctors forged new approaches to studying and containing venereal disease. They accomplished this through the use of statistics and new methods of diagnosing and treating maladies. Their novel approach was used to treat sex workers and to support commercial sex work policy both at home and abroad. Sex workers became the objects of scientific study and were consequently problematised by the state in medicalised terms.     

Mental adjustment of Swedish UN soldiers in South Lebanon in 1988

A study of mental adjustment was carried out by means of a questionnaire at a Swedish UN logistic battalion in south Lebanon at the end of its period of service. The results showed a general good adjustment with no great variations between different subgroups. A rather high proportion of the respondents reported the service as being monotonous. Compared with earlier studies, a higher proportion of stress symptoms was found. It is possible that this could have been caused by differences in selection and service conditions.     

War as a positive medical educational experience

Context There is little empirical evidence in the literature regarding the nature of the experiences of medical students during war. In this study we set out to assess and analyse the experiences of medical students and residents in Beirut, Lebanon during the 2006 Lebanon–Israel war. Methods Students and residents working at the American University of Beirut Medical Center and the Beirut Government University Hospital during the July 2006 war were invited to participate. A total of 21 students or residents took part in either a focus group or one of 11 semi‐structured interviews. These were recorded, transcribed and analysed to bring out common themes. Results Although the wartime experience was stressful, medical students and residents reported many largely positive effects of war on their medical training. Students adapted to the difficult conditions and became more resourceful. Participants connected emotionally with their patients and were able to show more compassion. They felt pride in their chosen profession and had higher levels of motivation for dealing with the normally irksome aspects of medical practice. Practical skills associated with the treatment of wartime injuries were learned, as were more general lessons about life priorities. Conclusions Despite the curtailing of formal educational activities, participants benefited from positive learning experiences in a wartime environment. Strikingly, participants ‘cared’ more for their patients. Further research looking at the underlying cause of this increased level of compassion may be useful in the education of all medical students, not just those involved in conflict.