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Bou-Orm IR, Loffreda G, Diaconu K, Witter S, deVos P. Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms. BMC Public Health 2023; 23:2526. [PMID: 38110967 PMCID: PMC10726601 DOI: 10.1186/s12889-023-17357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. METHODS This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. RESULTS Lebanon's political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. CONCLUSION Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.
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Affiliation(s)
- Ibrahim R Bou-Orm
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - Giulia Loffreda
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Karin Diaconu
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sophie Witter
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Pol deVos
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
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2
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Harb T, Alhafi A, Tfayli AH. Efficacy of lung cancer screening at the American University of Beirut Medical Center. Front Oncol 2023; 13:1164574. [PMID: 37601660 PMCID: PMC10436738 DOI: 10.3389/fonc.2023.1164574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction In Lebanon, a dedicated screening program for lung cancer is absent. Screening is largely based on the recommendation of an informed physician or the initiative of a patient. To better understand the situation, it is important to look at the available data on patients currently being screened for lung cancer in this country. Our aim in this study is to review the data and compare it with that in the literature as well as to assess the efficacy of the screening process followed. Methods Our study accessed the electronic medical records of patients at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon. We collected information on patients who underwent screening low-dose computed tomography (LDCT) scan between June 2019 and June 2021 inclusive. Records of all patients who underwent a non-contrast computed tomography (CT) scan at AUBMC during this period were collected and analyzed. Results On average, our population had a 52.6 pack-year smoking history. Moreover, 47% of our population had an accurate pack-year reported, while 12% did not have enough information to even estimate their pack-year history. When looking at the accurate and estimated data, 5% of our population did not even meet the ≥20 pack-year smoking history. Eight patients had positive findings on the screening LDCT, which we defined as suspicious findings that require further workup (e.g., PET/CT or biopsy) or other significant incidental findings. Conclusion A well-organized program for lung cancer screening in Lebanon is absent. Screening largely depends on the initiative of the physician or the patient. We were able to uncover multiple flaws in the screening method used, including poor documentation and follow-up. Although the screening method adopted retained some benefits in terms of detecting early malignancy, it lacked proper organization and was not ideal. A better, systematized screening program is needed to have optimal outcomes.
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Affiliation(s)
| | | | - Arafat H. Tfayli
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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3
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Okati-Aliabad H, Ansari-Moghaddam A, Kargar S, Mohammadi M. Prevalence of hypertension and pre-hypertension in the Middle East region: a systematic review & meta-analysis. J Hum Hypertens 2022; 36:794-804. [PMID: 35031669 DOI: 10.1038/s41371-021-00647-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
Hypertension is a leading cause of mortality and morbidity globally. This study aimed to obtain an overall regional estimate of the prevalence of hypertension and pre-hypertension and present the disease pattern based on the age and time in the Middle East region. We searched PubMed, Google Scholar, Medline for articles on the prevalence of hypertension, pre-hypertension among countries of the Middle East region from 1999 to 2019. STATA-14 was used to analyze the data. Data were pooled using a random-effects meta-analysis model, and heterogeneity between studies was assessed using I2 test and subgroup analysis. A total of eighty-three studies with 479816 participants met the criteria for inclusion in the meta-analysis process. The overall prevalence of hypertension and pre-hypertension in the Middle East region were 24.36% (95% CI: 19.06-31.14) and 28. 60% (95% CI: 24.19-33.80), respectively. An increasing trend in the prevalence of hypertension was observed with the increasing age. The prevalence of hypertension in the ≤ 49-year-old age group was 17.13% (95% CI: 13.79-21.27) and in people over 60 years was 61.24% (95% CI: 55.30-67.81) (P < 0.001). This pattern has been similar among both males and females. On the other hand, a decreasing trend in the prevalence of pre-hypertension was observed with the increasing age. The increasing trend in the prevalence of hypertension and decreasing trend in the prevalence of pre-hypertension with age are significant concerns in the Middle East region. Screening for the prevention and control of hypertension should prioritize public health programs.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Shiva Kargar
- Gerash University of Medical Sciences, Gerash, Iran.
| | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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4
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Sukkarieh O, Egede LE, Bassil M. Relationship between material needs security and clinical outcomes in adults with type 2 diabetes in Lebanon. Diabetes Res Clin Pract 2022; 186:109818. [PMID: 35247523 DOI: 10.1016/j.diabres.2022.109818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/18/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite their documented significance in type 2 diabetes (T2DM) management, social determinants of health (SDOHs) including material needs security are poorly studied in the Middle East and North Africa (MENA) region. This study aims to assess the relation between material needs security and clinical outcomes in Lebanese adults with T2DM. METHODS Subjects with T2DM (n = 300) were recruited; demographic and material need variables were collected using self-reported questionnaires. Measured clinical outcomes included Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP). Regression models were used to examine associations between material needs security and clinical outcomes, controlling for relevant confounding variables. RESULTS Most of the participants were men, married and with lower education levels. Having higher material needs security and being employed predicted better A1C levels (p < 0.05), whereas male sex was associated with poorer A1C(β = 0.52, p = 0.03) and DBP(β = 3.06, p = 0.05). Other predictors of DBP included older age and lack of confidence in filling out medical forms, reflecting lower health literacy. CONCLUSIONS Our study highlights the importance of material needs in achieving optimal T2DM outcomes T2DM in the MENA region. Further research is needed to understand potential pathways/mechanisms and options for effective interventions.
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Affiliation(s)
- Ola Sukkarieh
- AliceRamez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Maya Bassil
- Departmet of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon; Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Labban M, Itani MM, Maaliki D, Nasreddine L, Itani HA. The Sweet and Salty Dietary Face of Hypertension and Cardiovascular Disease in Lebanon. Front Physiol 2022; 12:802132. [PMID: 35153813 PMCID: PMC8835350 DOI: 10.3389/fphys.2021.802132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
According to the World Health Organization (WHO), an estimated 1.28 billion adults aged 30–79 years worldwide have hypertension; and every year, hypertension takes 7.6 million lives. High intakes of salt and sugar (mainly fructose from added sugars) have been linked to the etiology of hypertension, and this may be particularly true for countries undergoing the nutrition transition, such as Lebanon. Salt-induced hypertension and fructose-induced hypertension are manifested in different mechanisms, including Inflammation, aldosterone-mineralocorticoid receptor pathway, aldosterone independent mineralocorticoid receptor pathway, renin-angiotensin system (RAS), sympathetic nervous system (SNS) activity, and genetic mechanisms. This review describes the evolution of hypertension and cardiovascular diseases (CVDs) in Lebanon and aims to elucidate potential mechanisms where salt and fructose work together to induce hypertension. These mechanisms increase salt absorption, decrease salt excretion, induce endogenous fructose production, activate fructose-insulin-salt interaction, and trigger oxidative stress, thus leading to hypertension. The review also provides an up-to-date appraisal of current intake levels of salt and fructose in Lebanon and their main food contributors. It identifies ongoing salt and sugar intake reduction strategies in Lebanon while acknowledging the country’s limited scope of regulation and legislation. Finally, the review concludes with proposed public health strategies and suggestions for future research, which can reduce the intake levels of salt and fructose levels and contribute to curbing the CVD epidemic in the country.
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Affiliation(s)
| | - Maha M Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Dina Maaliki
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lara Nasreddine
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hana A Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.,Adjunct Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
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6
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Balouchi A, Rafsanjani MHAP, Al-Mutawaa K, Naderifar M, Rafiemanesh H, Ebadi A, Ghezeljeh TN, Shahraki-Mohammadi A, Al-Mawali A. Hypertension and pre-hypertension in Middle East and North Africa (MENA): A meta-analysis of prevalence, awareness, treatment, and control. Curr Probl Cardiol 2021; 47:101069. [PMID: 34843808 DOI: 10.1016/j.cpcardiol.2021.101069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
Hypertension (HTN) is one of the most important public health challenges, especially in developing countries. Despite individual studies, information on the exact prevalence of prehypertension (pre-HTN) and HTN in the Middle East and North Africa (MENA) is lacking. This meta-analysis was conducted to evaluate prevalence of pre-HTN and HTN, awareness, treatment, and control in the MENA region. PubMed, Web of Science, and Scopus databases were searched from inception to April 30, 2021. Keywords included hypertension, pre-hypertension, awareness, treatment, and control. The quality of the included studies was evaluated using the Hoy scale. A random-effects model was evaluated based on overall HTN. The heterogeneity of the preliminary studies was evaluated using the I2 test. A total of 147 studies involving 1,312,244 participants were included in the meta-analysis. Based on the results of the random-effects method (95% CI), the Prevalence of pre-HTN and HTN were 30.6% (95% CI: 25.2, 36.0%; I2 = 99.9%), and 26.2% (95% CI: 24.6, 27.9%; I2 = 99.8%), respectively. The prevalence of HTN awareness was 51.3% (95% CI: 47.7, 54.8; I2 = 99.0%). The prevalence of HTN treatment was 47.0% (95% CI: 34.8, 59.2; I2 = 99.9%). The prevalence of HTN control among treated patients was 43.1% (95% CI: 38.3, 47.9; I2 = 99.3%). Considering the high prevalence of HTN, very low awareness, and poor HTN control in the region, more attention should be paid to preventive programs for HTN reduction.
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Affiliation(s)
- Abbas Balouchi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kholoud Al-Mutawaa
- Senior consultant community Medicine, Head of Non-communicable Disease Department, Ministry of Public Health, Doha, Qatar
| | - Mahin Naderifar
- Department of Nursing, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Shahraki-Mohammadi
- Assistant Professor of Medical Library and Information Sciences, Department of medical library and information sciences, Paramedical school, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Adhra Al-Mawali
- Director/Centre of Studies & Research, Ministry of Health, Oman.
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7
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Mohammadian Khonsari N, Shahrestanaki E, Ejtahed HS, Djalalinia S, Sheidaei A, Hakak-Zargar B, Heshmati J, Mahdavi-Gorabi A, Qorbani M. Long-term Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rate in the Middle East and North Africa: a Systematic Review and Meta-analysis of 178 Population-Based Studies. Curr Hypertens Rep 2021; 23:41. [PMID: 34625888 DOI: 10.1007/s11906-021-01159-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This study investigated and pooled the long-term trends in prevalence, awareness, treatment, and control of hypertension (HTN) in the Middle East and North Africa (MENA) region. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Web of Science, Google Scholar, EMBASE, and Scopus between database inception and November 2020. All cross-sectional studies that investigated the prevalence of pre-HTN, HTN, awareness, treatment, and control in the MENA counties were included. The selection study, data extraction, and quality assessment were conducted by two investigators independently. Heterogeneity between studies was assessed using Cochran's Q test and I-squared, and due to sever heterogeneity between studies, the random effect model was used to pool the estimates. Sensitivity analysis was performed to estimate the long-term trends in prevalence, awareness, treatment, and control rates of HTN according to definition of HTN as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for HTN. RECENT FINDINGS Overall, 178 studies met the inclusion criteria. Studies comprised 2,262,797 participants with a mean age of 45.72 ± 8.84 years. According to random effect model, the pooled prevalence of pre-HTN and HTN was 33% (95% CI 28, 39) and 26% (25, 27), respectively. Over the past three decades, prevalence of hypertension increased significantly in the region. The pooled awareness, treatment, and control rates were 50% (48, 53), 41% (38, 44), and 19% (17, 21), receptively. The pooled awareness, treatment, and control rates of HTN were lower significantly in men than women. According to definition of HTN as blood pressures above 140/90 mm Hg, over the past three decades, although the awareness and treatment rates did not change significantly, the control rates improved significantly in the region. The findings showed that HTN is a significant public health problem in the MENA region. Although there are low levels of pooled awareness, treatment, and control rates, the control rates improved over the past three decades in the region.
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Affiliation(s)
| | - Ehsan Shahrestanaki
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Armita Mahdavi-Gorabi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. .,Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Li T, Shuai P, Wang J, Wang L. Prevalence, awareness, treatment and control of hypertension among Ngawa Tibetans in China: a cross-sectional study. BMJ Open 2021; 11:e052207. [PMID: 34489294 PMCID: PMC8422477 DOI: 10.1136/bmjopen-2021-052207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To explore the prevalence, awareness, treatment and control rate of hypertension and analyse the potential social environment factors among Ngawa Tibetans in China. DESIGN This was a cross-sectional observational study. SETTING The investigation based on a multistage stratified cluster sampling was conducted in the Ngawa area, Sichuan Province, Southwest China. Tibetan residents were selected by random sampling method from one city and six counties in Ngawa. METHODS Basic demographical information, physical activity and blood pressure were collected. In addition, the participants completed the questionnaire. A multivariate logistic regression analysis was used to examine the association between the prevalence, awareness, treatment and control rate of hypertension and the potential risk factors. PARTICIPANTS The sample comprised 2228 Ngawa Tibetan residents (age 18-80 years) from September 2018 to June 2019. RESULTS The prevalence rate of hypertension was 24.6%. The control rate was 6.2%, while the awareness rate (32.3%) and treatment rate (21.7%) of hypertension had been significantly improved. CONCLUSION The prevalence of hypertension among Ngawa Tibetans was high. The awareness and treatment were improved in recent years. But the control rate was low. The government needs to strengthen the basic medical care and health education for Ngawa Tibetans.
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Affiliation(s)
- Tingxin Li
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ping Shuai
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jinghong Wang
- College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Lin Wang
- Health Management Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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9
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Elbejjani M, Wahab K, El Hachem R, Tanielian M, Feghali L, Assaf G. Knowledge and attitude towards Alzheimer's disease and related dementias in a low- to middle-income country: a cross-sectional survey among Lebanese middle-aged and older adults. Psychogeriatrics 2021; 21:699-708. [PMID: 34107555 DOI: 10.1111/psyg.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/05/2021] [Accepted: 05/09/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the growing burden of Alzheimer's disease and related dementias (ADRD) in low- to middle-income countries (LMICs) and prior findings of important gaps in research on ADRD knowledge, very few studies have assessed ADRD knowledge in these populations. This study evaluates the knowledge and attitudes towards ADRD among Lebanese middle-aged and older adults. METHOD Participants aged ≥ 40 (n = 215) attending primary care clinics at a large medical centre in Lebanon completed the Alzheimer's Disease Knowledge Scale (ADKS), an attitude scale, and the Duke University Religion Index. RESULTS ADRD knowledge accuracy was 61.5% (mean score = 18.6 out of 30 (SD = 3.05)). Items with the least correct answers were related to caregiving and risk factors (≤9% and ≤28%). Overall, participants had tolerant views concerning ADRD; the least positive views were regarding living with people with ADRD. Older age, lower educational attainment, and higher religiosity scores were associated with poorer knowledge and attitudes. CONCLUSION Results highlight the need for awareness and preventive efforts that address misconceptions about modifiable risk factors and living with ADRD, especially given that the burden of caregiving for older adults often falls on family members in Lebanon and other LMIC countries.
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Affiliation(s)
- Martine Elbejjani
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Kamal Wahab
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rita El Hachem
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maria Tanielian
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lea Feghali
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Georges Assaf
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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10
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Najem RN, Halawi A, Tanios B, Ambriss R, Bikai RE, Partington G, Beaney T, Poulter NR, Alfa AKA. May Measurement Month 2019: an analysis of blood pressure screening results from Lebanon. Eur Heart J Suppl 2021; 23:B92-B94. [PMID: 34248434 PMCID: PMC8263084 DOI: 10.1093/eurheartj/suab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension is an important public health concern of high prevalence among adults. It is associated with an increased mortality rate. The prevalence of hypertension in Lebanon has increased during the last decades, affecting around one-third of the Lebanese population. Since diagnosis and treatment of hypertension is associated with a better prognosis, annual screening and raising awareness about this ‘silent killer’ disease is of extreme value. We conducted a cross-sectional survey in various Lebanese cities in 2019. We recruited adults (≥18 years old) from different sites, through an opportunistic sampling method. For each participant, three blood pressure (BP) readings were recorded and the average of the last two was analysed. In addition, data on lifestyle factors and comorbidities were collected. Participants were considered hypertensive if they had at least one of the following: systolic or diastolic BP ≥140 and/or ≥90 mmHg, respectively, or taking antihypertensive medication. Blood pressure was measured in 7019 participants. The mean age was 46.0 (SD 16.6) years. In total, 2572 participants (36.6%) had hypertension among whom only 64.1% were aware of their disease and 62.3% were on treatment. Blood pressure was controlled in 62.6% of participants taking antihypertensive medications. This study is the largest on hypertension prevalence in Lebanon. The results demonstrated that around one-third of the hypertensive population were not aware of their disease, and that a high percentage was not being treated. These results suggest the need for rapid interventions aimed at raising awareness regarding hypertension in the Lebanese population.
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Affiliation(s)
- Robert N Najem
- Division of Nephrology, Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Lebanese Hospital Geitawi University Medical Center, Beirut, Lebanon
| | - Ahmad Halawi
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Bassem Tanios
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Rana El Bikai
- Public Health Department, Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | - Giles Partington
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, London, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, London, UK
| | - Ali K Abu Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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11
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Fakhri G, Assaad S, Chaaya M. Hypertension prevalence and control among community-dwelling lebanese older adults. J Clin Hypertens (Greenwich) 2021; 22:1727-1731. [PMID: 33460223 DOI: 10.1111/jch.13995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
There is a high prevalence of hypertension among Lebanese adults, but no evidence is available on its prevalence and control exclusively among older adults (65 + years). This study provides the first evidence on a representative sample of 502 community elderly and presents the basis for future research and policy implications. Results show an overall prevalence of 52% with a significantly higher female-to-male ratio. Factors independently associated with hypertension were older age, body mass index, and dementia. More than a third of those with a positive history of hypertension had uncontrolled blood levels. Uncontrolled hypertension was higher among women. Increasing awareness about medication adherence and controlling multi-morbidities constitute promising measures to lowering the burden of hypertension among Lebanese older adults, especially women.
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Affiliation(s)
- Ghina Fakhri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Assaad
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Soliman SSA, Guseman EH, Haile ZT, Ice G. Prevalence and determinants of hypertension unawareness among Egyptian adults: the 2015 EHIS. J Hum Hypertens 2020; 35:927-934. [PMID: 33082518 DOI: 10.1038/s41371-020-00431-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
Hypertension (HTN) is a major cardiovascular risk factor that affects 1.3 billion people and accounts for 17.9 million deaths annually worldwide. Seventy-five percent of global deaths due to HTN occur in low- and middle-income countries where HTN prevalence is higher, and HTN control and population awareness are lower, than in high-income countries. Approximately 26% of Egyptian adults meet criteria for HTN, but the prevalence of HTN unawareness is unknown in this population. The purpose of this study was to assess prevalence and predictors of HTN unawareness among Egyptian adults. Using data from the 2015 Egyptian Health Issues Survey (EHIS), we identified 2869 participants 18-59 years of age whose blood pressure met criteria for HTN at the time of data collection. Our outcome of interest, hypertension unawareness, was indicated when a participant reported that they had not been diagnosed with HTN (despite meeting criteria). Descriptive statistics and multivariable logistic regression were performed to determine prevalence of, and risk factors for, HTN unawareness. Fifty-six percent of the sample were unaware of their HTN status. The odds of HTN unawareness were highest among participants 18-39 years old compared to those 40-59 years old (OR 1.91; 95% CI 1.48-2.47); males compared to females (OR 2.59; 95% CI 1.85-3.62); and never married compared to currently married participants (OR 1.96; 95% CI 1.19-3.24). Compared to those who had a college level education, the odds of HTN unawareness were highest among participants who had no education (OR 2.21; 95% CI 1.45-3.38). In addition, the odds of HTN unawareness were higher for participants who had a normal body mass index compared to those who were obese (OR 1.82; 95% CI 1.26-2.65); and those considered healthy compared to those who had at least one chronic illness (OR 4.53; 95% CI 3.29-6.24). Our findings indicate that more than half of Egyptian adults who meet criteria for HTN are unaware of their blood pressure status. Younger, healthier, and normal weight people-who are typically at lowest risk for HTN-appear mostly likely to be unaware of their HTN status. Less educated people are least likely to know their hypertensive status. This suggests the need for a targeted health education campaign and regular blood pressure screening in Egypt.
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Affiliation(s)
- Saeed S A Soliman
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Emily Hill Guseman
- Department of Primary Care and Diabetes Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Zelalem T Haile
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, USA
| | - Gillian Ice
- Department of Social Medicine, Heritage College of Osteopathic Medicine and College of Health Science and Professions, Ohio University, Athens, OH, USA
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