Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is ‘a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness’.

Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM.

Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c.

Results: The mean age of the participants was 58.24(SD?=?13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P?=?0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P?=?0.05) and a higher number of diabetes complications (P?<?0.001) were associated with higher HbA1c levels. However, advanced age (P?=?0.055), female gender (P?=?0.003), and diabetes education (P?=?0.011) were significantly associated with lower HbA1c levels.

Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.     

Gastrointestinal cancer characteristics in Lebanon

Background and study aimsGastrointestinal (GI) cancer is one of the top five common cancers in Lebanon. To implement a strategy for screening and early diagnosis through the initiation of prevention programs, a detailed study of GI cancers in Lebanon was conducted by focusing on the frequency and characteristics of each type.Patients and MethodsThis retrospective study was conducted in Lebanon between 2001 and 2015 and included patients diagnosed with different GI cancer types. Data were collected from the registry of the National Institute of Pathology (NIP). The frequency of each type was calculated according to sex, age at diagnosis, anatomic location, histological type, and stage.ResultsThe total number of patients diagnosed with GI cancers who had their histology done at the NIP between 2001 and 2015 was 5239. The sex (male/female) ratio was 1.016, with a mean age of 62.2 years. Colorectal cancer ranked first among GI cancers, with more than half of the cases (53.4%). More than 70% of the cases were located on the left side, followed by gastric (15.5%) and pancreatic (12.7%) cancers. Regarding gastric cancer, cardia became the dominant location. A shift from squamous cell carcinoma to adenocarcinoma in esophageal cancer was found during this period. Also, most GI cancers in Lebanon were diagnosed in the late stages.ConclusionThis study is the first to evaluate GI cancers in Lebanon, which will help in screening strategies and burden studies.     

Justifying abuse of women migrant domestic workers in Lebanon: the opinion of recruitment agencies

ObjectiveGender-based violence against women migrant domestic workers (WMDW) is a serious public health concern in the Middle East region. The current study is the first to explore abuse of WMDW as perceived by recruitment agency managers.MethodA qualitative study was conducted using 42 personal semi-structural interviews with agency managers in Lebanon. The interview guidelines were designed based on the standards set by the International Labor Organization (ILO) Convention No. 189. The information was transcribed in Arabic, and data was analyzed using thematic analysis.ResultsThe interviewees believe that WMDW are subject to abusive practices that represent various violations of the ILO Convention No. 189, including harassment and violence, compulsory labour, misinformation about conditions of employment, denial of periods of rest and restriction of movement and travel documents. In many situations, the interviewees justified some of these practices as being necessary to protect their business and to protect the workers.ConclusionThe results of this study have several policy implications for the protection of WMDW against abuse.     

Carotid endarterectomy should not be based on consensus statement duplex velocity criteria

Objective

Randomized trials support carotid endarterectomy (CEA) in asymptomatic patients with ≥60% internal carotid artery (ICA) stenosis. The widely referenced Society for Radiologists in Ultrasound Consensus Statement on carotid duplex ultrasound (CDUS) imaging indicates that an ICA peak systolic velocity (PSV) ≥230 cm/s corresponds to a ≥70% ICA stenosis, leading to the potential conclusion that asymptomatic patients with an ICA PSV ≥230 cm/s would benefit from CEA. Our goal was to determine the natural history stroke risk of asymptomatic patients who might have undergone CEA based on consensus statement PSV of ≥230 cm/s but instead were treated medically based on more conservative CDUS imaging criteria.

Evaluation of gluten in gluten-free-labeled foods and assessment of exposure level to gluten among celiac patients in Lebanon

The aim of the study was to evaluate gluten contamination in all the gluten-free (GF)-labeled food products sold in Lebanon. Over a 2-year period, a total of 173 food samples collected from 135 brand names were analyzed. Gluten contamination was detected in 33 of 173 (19%) samples, and its content ranged between 2.5 and >80?mg?kg^?1. In 10 of the 173 samples (6%), the quantity of gluten exceeded the upper limit of 20?mg?kg^?1. Out of the 10 contaminated products, eight (80%) were locally manufactured. Among these 10 products, eight (80%) were wheat-starch-based foods. Of the 40 brand names tested twice in 2014 and 2015, 15 (38%) showed significantly (p?相似文献   

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi‐structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision‐makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.     

Non-Conjugated-Industrially-Produced-Trans Fatty in Lebanese Foods: The Case of Elaidic and Linolelaidic Acids

To determine Industrially-Produced Trans fatty acids (IP-TFAs) distribution of Lebanese traditional foods, especially regarding Elaidic acid (EA; 9t18:1) and Linolelaidic acid (LEA; 9t12t18:2), a mapping exercise was enrolled between January 2019 and April 2021 in which 145 food samples of three categories (traditional dishes, Arabic sweets, and market food products) were analyzed using Gas chromatography methods. Results showed that about 93% of the products tested in Lebanon, between 2019 and 2021, met the World Health Organization recommendations, while about 7% exceeded the limit. The mean level of the IP-TFAs Elaidic and Linolelaidic acid in most Traditional dishes (0.9%), Arabic sweets (0.6%), butter and margarine (1.6%), and market foods (0.52%) were relatively low compared with other countries. Despite that, the relative impact of IP-TFAs on heart diseases mortality in Lebanon is limited but unambiguously still substantial. The persistence of food products with high IP-TFAs levels threatens the health of Lebanese people. Fortunately, this problem is fairly easy to solve in Lebanon via proper legislation.