Self-reported history of stroke and long-term living conditions near air pollution sources: results of a national epidemiological study in Lebanon

Short-term relation between air pollutants and hospitalizations for respiratory diseases: analysis by temporal association rules

This study investigates the relation between exposure to critical air pollution events with multipollutant (CO, PM₁₀, PM_2.5, NO₂, O₃, and SO₂) and hospitalizations for respiratory diseases in the metropolitan area of São Paulo (RMSP) and in the countryside and coastline, from 2017 to 2021. Data mining analysis by temporal association rules searched for frequent patterns of respiratory diseases and multipollutants associated with time intervals. In the results, pollutants PM₁₀, PM_2.5, and O₃ showed high concentration values in the three regions, SO₂ on the coast, and NO₂ in the RMSP. Seasonality was similar between pollutants and between cities and concentrations significantly higher in winter, except for O₃, which was present in warm seasons. Hospitalizations were recurrent during the transition from summer to colder periods. In approximately 35% of the total days with hospitalization greater than the annual average, one or more pollutants had a high concentration. The rules showed that PM_2.5, PM₁₀, and O₃ pollutants are strongly associated with increased hospitalizations in the RMSP (PM_2.5 and PM₁₀ with 38.5% support and 77% confidence) and in Campinas (PM_2.5 with 66.1% support and 94% confidence) and the pollutant O₃ with maximum support of 17.5%. On the coast, SO₂ was related to high hospitalizations (43.85% support and 80% confidence). The pollutants CO and NO₂ were not associated with the increase in hospitalizations. The ratio delay indicates the pollutants that were associated with hospitalizations, having concentration remained above the limit for three days, oscillating in smaller hospitalizations on the 1st day and again higher on the 2^nd and 3^rd days of delay, in a decreasing way. In conclusion, high pollutant exposure is significantly associated with daily hospitalization for respiratory problems. The cumulative effect of air pollutants increased hospitalization in the following days, in addition to identifying the pollutants and which pollutant combinations are most harmful to health in each region.

Eating Behaviors, Lifestyle, and Ischemic Stroke: A Lebanese Case-Control Study

BACKGROUND

Stroke is the second leading cause of death and the third leading cause of disability on a global scale. Most clinicians tend to underestimate the importance of diet and inadequate or dysfunctional eating attitudes in patients with a complicated relationship with food. Concerned about the potential of an independent Lebanese approach, and also because prior international research has revealed a link between eating intake or choice and ischemic stroke risk, it was considered vital to broaden the scope of the literature and evaluate further the association of disordered eating attitudes and focus on the distinct relationship with food in the case of orthorexia nervosa (ON) in the Lebanese community. Consequently, the purpose of the present study is to investigate the potential association between pre-existing disordered eating attitudes, specifically ON, and ischemic stroke risk, with an emphasis on the evidence supporting a Mediterranean-style diet.

METHODS

This research is a case-control survey study involving 113 Lebanese individuals with ischemic stroke and 451 age-(within 5 years) and sex-matched controls recruited from several hospitals in Lebanon (April 2020-April 2021).

RESULTS

According to the findings of our first regression model, living 100 m from a crowded road (adjusted odds ratio [aOR]: 3.421, 95% confidence interval [CI]: 1.585-7.387), living 100 m from an electricity generator (aOR: 3.686, 95% CI: 1.681-8.085), higher waterpipe dependence (aOR: 1.204, 95% CI: 1.117-1.297), higher exposure to passive smoking (aOR: 2.651, 95% CI: 2.051-3.426), being married (aOR: 3.545, 95% CI: 1.297-9.689), having a low educational attainment (aOR: 0.239, 95% CI: 0.084-0.679), vigorous physical activity (aOR: 1.003, 95% CI: 1.001-1.006), and having more inappropriate eating (aOR: 1.040, 95% CI: 1.006-1.074) were all associated with higher odds of having ischemic stroke. Furthermore, atrial fibrillation (aOR: 2.945, 95% CI: 1.010-8.585), diabetes (aOR: 2.550, 95% CI: 1.169-5.561), heart diseases (aOR: 6.193, 95% CI: 2.196-17.463), and hypertension (aOR: 2.744, 95% CI: 1.049-7.180) were also linked to an increased risk of stroke. Moreover, having more orthorexia nervosa tendencies (aOR: 1.123, 95% CI: 1.021-1.235) was related to a higher odds of having an ischemic stroke, whereas better adherence to the MeD was significantly linked (aOR: 0.691, 95% CI: 0.583-0.819) to lower odds of ischemic stroke.

CONCLUSIONS

Ischemic stroke patients were more likely to have disordered eating attitudes and orthorexic behaviors. Furthermore, the MeD has been found to be beneficial in reducing ischemic stroke risk. Despite the study's focus, outdoor pollution, waterpipe dependence, and passive smoking were linked to ischemic stroke. In summary, this review suggests that improving one's nutritional status and making a few lifestyle changes are key stroke prevention and treatment methods.

One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis

BACKGROUND

To date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors.

METHODS

A prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan-Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes.

RESULTS

Among 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05).

CONCLUSION

Higher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.

Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature

BACKGROUND

The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country.

METHODS

We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally.

RESULTS

A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations.

CONCLUSION

Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.

Association between exposure to ambient air pollution and occurrence of inflammatory acne in the adult population

Background

Acne vulgaris is one of the most prevalent skin diseases responsible for dermatological consultations. Several internal and external factors can affect acne occurrence and severity. Outdoor air pollution is an external factor discussed to trigger inflammation of the skin. The objective of this study was to find a link between the exposure to ambient air pollution and inflammatory acne occurrence in the Lebanese adult population.

Methods

A cross-sectional study was conducted, using an online questionnaire to collect the required data from different Lebanese regions. The survey covered pollution exposure questions as well as queries on several factors known to have a role on acne occurrence.

Results

A total of 372 participants were included in the study, aged 18 to 55 years old. The results of a logistic regression taking the presence/absence of acne as the dependent variable, showed that female gender (aOR = 4.39), younger age (aOR = 1.05), using hydrating cream (aOR = 4.30), working near a power plant vs not (aOR = 3.07), having a severe NO2 exposure compared to none (aOR = 8.24), a higher number of family members with acne or history of acne (aOR = 1.48) were significantly associated with higher odds of having acne, whereas having a dry skin compared to normal (aOR = 0.20) was significantly associated with lower odds of having acne.

Conclusion

The occurrence of inflammatory acne in Lebanese adults was found to be associated with ambient exposure to high levels of NO₂ and employment near a power plant known to emit CO₂, CO, SO₂, NO₂ and PM. Therefore, our findings can serve as a first step towards implementing awareness on a skin care routine suitable for highly polluted areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11738-0.

Short- and long-term exposure to air pollution increases the risk of stroke

OBJECTIVE

Many epidemiological studies have observed the association of air pollutant exposure with the onset, progression, and mortality of stroke. The aim of this study was to investigate the associations of air pollutants, including SO₂, NO₂, O₃, CO, and PM₁₀, with stroke according to exposure duration.

METHODS

Data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 were obtained. The 21,240 patients who were admitted for or died due to stroke were 1:4 matched for age, sex, income, and region of residence with 84,960 control participants. The meteorological factors of mean, highest, and lowest temperatures; relative humidity; ambient atmospheric pressure; and air pollutant concentrations (SO₂, NO₂, O₃, CO, and PM₁₀) were analyzed to determine their associations with stroke. The odds ratios for stroke after exposure to each meteorological factor and air pollutant at 7 and 30 days were calculated in the stroke and control groups. Subgroup analyses were conducted according to age, sex, income, and region of residence.

RESULTS

The odds ratio associated with seven days of exposure to CO was 1.16 (95% CI = 1.04-1.31) in stroke patients. For 30 days of exposure, the odds ratio associated with CO was 1.16 (95% CI = 1.02-1.32) in stroke patients. Seven and 30 days of NO₂ exposure were inversely associated with stroke. The odds ratio associated with seven days of exposure to O₃ was 1.16 (95% CI = 1.01-1.32) in ischemic stroke patients. Both ischemic and hemorrhagic stroke had negative associations with 7 and 30 days of NO₂ exposure.

CONCLUSION

Both short- and long-term exposure to CO were related to stroke.

Molar incisor hypomineralisation in Lebanon: prevalence and clinical characteristics

BACKGROUND

Molar incisor hypomineralisation (MIH) is a qualitative enamel developmental defect affecting 1-4 first permanent molars and sometimes the permanent incisors. MIH is extremely widespread around the world and presents a considerable clinical problem in paediatric dentistry. Although, little prevalence data exist for Middle East populations including the Lebanese one.

AIM

The objectives of this study were to investigate the prevalence of MIH in 7-9-year-old Lebanese children, with relevance to gender, jaw and side distribution, and to assess the clinical status, extent and severity of MIH lesions of the affected teeth.

DESIGN

Representative sample (n = 659) of 7-9-year-old Lebanese children attending private and public schools distributed throughout Lebanon was examined for MIH. Clinical status, extent and severity of MIH lesions on FPMs and permanent incisors were scored using the short-form grading method (MIH index) of Ghanim et al. (Eur Arch Paediatr Dent 16:235-246, 2015).

RESULTS

An overall MIH prevalence of 26.7% was reported with no significant predilection for girls over boys. 52.8% of the cases present with only molars and. 47.2% with both molars and incisors and did not present any significant difference between upper and lower jaws (P = 0.325). Left-side FPMs were more affected than the right ones (P = 0.0218). Central incisors were significantly more affected than the laterals in both jaws (P < 0.0001). Maxillary central incisors were significantly more affected than their mandibular counterparts (P < 0.0001). Most of the clinical status was demarcated opacities extended on less than the third of the tooth surface. The extent of lesions correlated significantly with the number of affected molars. Most of the affected teeth presented with mild defects and the degree of severity was not correlated with gender but significantly increased with age.

CONCLUSIONS

MIH is prevalent in Lebanon. Further studies are required to analyse the possible systemic and environmental etiologies among Lebanese children.

Cardiovascular Diseases and Long-term Self-reported Exposure to Pollution: RESULTS OF A NATIONAL EPIDEMIOLOGICAL STUDY IN LEBANON

BACKGROUND

Cardiovascular diseases (CVDs) are linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution to CVD, but results are inconsistent. Our objective was to assess this association in Lebanon, a Middle Eastern country.

METHODS

A national cross-sectional study was conducted across Lebanon. CVD prevalence, which included prevalent ischemic heart and cerebrovascular diseases, was assessed. Moreover, in addition to self-reported items of pollution exposure, we assessed potential predictors of CVD, including sociodemographic characteristics, self-reported health information, and biological measurements.

RESULTS

We assessed the dose-effect relationship of pollution items in relation with CVD. Self-reported indoor and outdoor pollution exposures were associated with CVD, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (44% increase in risk of CVD for every additional pollution exposure item), after adjustment for sociodemographic and biological characteristics.

CONCLUSION

Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of pollution on chronic diseases and the work of reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.