Awareness of Lung Cancer Among the Lebanese General Population: a Cross-Sectional Study

Background. Lung cancer is a significant contributor to mortality worldwide. The aim of this study was to assess the level of lung cancer awareness among the Lebanese general population. Methods. An online-based questionnaire was completed by 410 participants all over Lebanon. A validated Lung Cancer Awareness Measurement tool was used. Multivariate analysis using Generalized Linear model and post-hoc analysis were performed after assessing validity and reliability of the scale. Results. Only 13.7% correctly identified age-related lung cancer risk, while 60.7% thought age was unrelated. Warning signs were poorly recalled, with persistent cough being the most remembered (58%), and coughing up blood being highly recognized (87.8%). Participants struggled to recognize persistent shoulder pain (28.7%) and finger/nail changes (29.51%) as possible warning signs of lung cancer. Multivariate analysis showed that governorates, educational level, and occupation significantly affected warning sign-scores. Post-hoc analysis revealed that people residing in Bekaa scored lower warning sign recognition scales compared with participants residing in Beirut, Mount Lebanon, and North. Postgraduates and medical field workers showed higher symptom recognition, with the latter scoring higher recall scales as well. Smoking was the most recalled and recognized risk factor (82% and 95.6%). Females, postgraduates, and medical workers showed higher risk factor recognition. While 75% were willing to seek medical attention for lung cancer suspicion, 58% lacked confidence in identifying warning signs. Conclusions. Extensive awareness campaigns focusing on age-related misconceptions, warning signs, and risk factors hold immense promise for improved therapeutic outcomes

Health-related quality of life of relapsing or remitting multiple sclerosis patients: A case-control study

Background: Patients with multiple sclerosis (MS) report lower health-related quality of life (HRQoL) than other chronic disease populations. This study aims to identify risk factors of relapsing or remitting multiple sclerosis (RRMS) and assess its impact on HRQoL in Lebanese MS patients. Patients and methods: A thre-month case-control study was performed among 75 RRMS case patients recruited from two clinics in Beirut and 225 controls from the general population. Results: Heavy cigarette smoking, moderate and heavy waterpipe smoking, vitamin D deficiency, cardiovascular disease, and psychological disorders were significantly associated with RRMS. Linear regression showed that the multiple sclerosis international quality of life global index significantly decreased with the number of relapses, the incomplete recovery between relapses, and the psychological disorder. Higher-income and physical activity had a positive effect on QoL. Conclusions: Findings of this study highlighted the risk factors of RRMS, which can be used for informed decision-making and targeted awareness campaigns. Other factors affecting the HRQoL of MS patients should be considered to improve their experience throughout and after treatment

Risk Factors of Childhood Acute Leukemia : Analysis of the ESTELLE Study

Ce travail de thèse a porté sur l’étiologie des leucémies aigües (LA) de l’enfant, et s’est concentré sur les questions (1) du risque de LA chez les enfants conçus par assistance médicale à la procréation (AMP) ; (2) du rôle protecteur d’une supplémentation maternelle en acide folique ; (3) du rôle protecteur de l’exposition précoce à des facteurs induisant une stimulation du système immunitaire ; (4) d’un effet protecteur des antécédents d’allergie sur le risque de LA de l’enfant. Les données analysées proviennent de l’étude cas-témoins française, ESTELLE, réalisée en 2010-2011. Les cas ont été identifiés par le Registre National des Hémopathies malignes de l’Enfant et les témoins ont été recrutés en population générale par téléphone, avec une stratification sur l’âge et le sexe. L’échantillon comportait 636 cas incidents de leucémie aiguë lymphoblastique (LAL), 100 cas incidents de leucémie aiguë myéloblastique (LAM), et 1421 témoins de moins de 15 ans. Les données ont été recueillies auprès des mères à l’aide d’un questionnaire téléphonique standardisé, identique pour les cas et les témoins. Les odds ratios (OR) ont été estimés par régression logistique non conditionnelle ajustée sur l’âge, le sexe, le niveau d’éducation maternel, la catégorie socio-professionnelle du foyer, et les facteurs de confusion potentiels. Nous n’avons pas observé d’augmentation du risque de LA chez les enfants dont la conception avait été difficile (OR=0,9[0,7-1,2]), ou avait nécessité la prise d'un traitement d’infertilité (OR=0,8[0,5-1,1]). La supplémentation préconceptionnelle en acide folique était inversement associée au risque de LA (OR=0,7[0,5-1,0]), sans spécificité de sous-type. Le risque de LAL était inversement associé aux infections banales avant l’âge de 1 an (OR=0,8[0,6-1,0]), à la fréquentation d’une crèche avant 1 an (OR=0,7[0,5-1,0]), à l'allaitement maternel (OR=0,8[0,7-1,0]) , et à des contacts réguliers avec les animaux domestiques à un âge précoce (OR=0,8[0,7-1,0]). En revanche, nous n’avons pas observé d’influence du mode d’accouchement sur le risque de LA. Enfin, les LA étaient inversement associées aux antécédents de rhinite allergique, d’eczéma, de dermatite atopique, d’allergie alimentaire; et d’asthme ou bronchite asthmatiforme traité par antihistaminique. Ces résultats ne sont pas en faveur d’un risque de LA associé aux techniques d’aide médicale à la procréation. Ils renforcent l’hypothèse d’un effet protecteur de la supplémentation préconceptionnelle en acide folique pour les LA. Enfin, ils apportent des arguments supplémentaires en faveur du rôle d’une stimulation précoce du système immunitaire dans la survenue des LAL.The aim of this study was to investigate whether the following factors: 1) conception by assisted medical procreation (AMP), 2) maternal folic acid supplementation, 3) factors related to early stimulation of the immune system, and 4) the history of allergy were related to the risk of childhood acute leukemia (CL). The data were obtained from the national registry-based case-control study, Estelle, carried out in France in 2010-2011. Population controls were recruited by random digit dialing, with quotas on age and sex. The sample included 636 cases of acute lymphoblastic leukemia (ALL), 100 cases of acute myeloblastic leukemia (AML), and 1421 controls less the 15 years old and frequency matched on age and sex. The data were collected by telephone interview of the mothers, using the same standardized questionnaire for cases and controls. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, sex, maternal education, parental socioeconomic status , and potential confounders. We did not observe any increase in CL risk in children who were conceived with difficulty (OR=0,9[0,7-1,2]) or with the use of any fertility treatments (OR=0,8[0,5-1,1]). Preconceptional folic acid supplementation was inversely associated with CL (OR=0,7[0,5-1,0]), without subtype-specificity. Early common infections before 1 year (OR=0,8[0,6-1,0]), attendance to day-care before 1 year (OR=0,7[0,5-1,0]), breastfeeding (OR=0,8[0,7-1,0]) and regular contact with pets in the first year (OR=0,8[0,7-1,0]) were inversely associated with ALL. However, the mode of delivery was not associated with ALL. Finally, reported history of eczema, atopic dermatitis, food allergy, allergic rhinitis, asthma or asthmatic bronchitis treated with anti-histaminic was inversely associated with CL. Our findings do not suggest that fertility treatments are risk factors for CL. They suggest that folic acid supplementation during pregnancy may reduce the risk of CL. They also support the hypothesis that some conditions promoting the maturation of the immune system may decrease the risk of ALL

Estimating COVID-19 vaccine acceptance in pregnant and lactating women: a cross-sectional study in Lebanon

Abstract Background The COVID-19 pandemic highlights vaccination’s critical role in reducing morbidity and mortality, depending on public attitude. This study aims to identify the estimates of COVID-19 vaccine acceptance in pregnant and lactating women, as well as associated potential factors. Methods A cross-sectional study was conducted between August and September 2021, through an online survey and with a paper survey distributed in gynecology and pediatric clinics. Pregnant and breastfeeding women aged 18 years and above were recruited. The attitude scale was created specifically for evaluating attitudes towards the COVID-19 vaccine. Results In total, 207 women participated, with 132 breastfeeding, 74 pregnant and 1 experiencing both conditions. Of these, one hundred and twenty women (58%) considered themselves at risk for COVID-19 infection. In addition, 51.7% (n = 107) of women expressed the intent to receive the vaccine once available. A multivariable linear regression was conducted taking the COVID-19 vaccination attitude scale as a dependent variable. The results revealed an R-squared value of 0.558, indicating that approximately 55.8% of the variance in the attitude scale was accounted for by the included predictors. The results showed that preventive measures (ß=2.25, 95% Confidence Interval (CI) [1.02; 3.48], p < 0.001), preference for vaccines made in Europe and America (ß=1.23; 95% CI [0.69–1.77], p < 0.001), protect yourself for getting sick (ß=4.22, 95% Confidence Interval (CI) [2.83; 5.61], p < 0.001) and belief in the importance of vaccination for themselves and their baby (ß=3.49; 95% CI [2.01; 4.98], p < 0.001) were associated with a positive attitude towards vaccination. Conversely, experiencing a previous bad reaction to a vaccine (ß= -1.35; 95% CI [0.85–1.85], p < 0.001) and concerns regarding COVID-19 vaccine safety (ß= -4.09; 95% CI [-5.98; -2.21], p < 0.001) were associated with a negative attitude towards vaccination. Conclusion Our findings reveal that COVID-19 vaccine acceptability among pregnant and breastfeeding women, amidst the pandemic was insufficient to meet community immunity. The identified reasons for vaccine reluctance, notably concerns about safety for both personal health and the health of their pregnancy or newborns, along with insufficient information about the vaccine, underscore the pressing need to address these factors to improve immunization rates

Parents’ knowledge, attitude, and practices towards COVID-19 in children: A Lebanese cross-sectional study : Parents’ knowledge towards COVID-19 in children

Introduction: The Coronavirus disease 2019 (COVID-19) pandemic, a serious public health crisis, can affect all ages, even children. This study aimed to investigate the knowledge, attitude, and practices of parents living in Lebanon towards the COVID-19 in children. Methods: A cross-sectional online survey was conducted between June and July 2021, targeting parents living in Lebanon. The questionnaire was divided into 4 parts: socio-demographic, knowledge, attitude, and practices. A score was calculated to evaluate parents’ knowledge towards COVID-19 in children. Descriptive and bivariate analyses were conducted. Then, determinants of COVID-19 knowledge were assessed using multivariable linear regression. P&lt;0.05 was considered statistically significant. Results: A total of 429 parents were included. The mean knowledge score was 11.28 ± 2.19 out of 15. Knowledge was significantly lower among older and single parents, who don’t know if COVID-19 is a serious disease and if it will be successfully controlled, and higher among female parents. The majority of parents had a positive attitude and good practices towards COVID-19 in children, but 76.7% of them were worried about their child getting coronavirus. About 66.9% of parents expressed their willingness to vaccinate their kids when a vaccine would be available for them, and 66.2% answered that they are sending or willing to send their children to the school or the nursery. Conclusions: Parents’ knowledge about COVID-19 in children was good, but remains lower among older and single parents. Health authorities should conduct awareness campaigns to target specific groups of parents who lacked critical knowledge about COVID-19 in children

Public Awareness of Environmental Risk Factors of Cancer Among the Lebanese General Population: Public awareness of cancer risk factors

Introduction: Since the majority of cancers occur as a result of modifiable risk factors, cancer is being seen more as a preventable disease. The primary objective of our study was to assess the level of awareness of environmental risk factors for cancer among the Lebanese general population. The secondary objective focused on identifying the predictors of the preventability of the disease. Methods: We conducted a cross-sectional study between June and July 2020. An online questionnaire was used to collect data pertaining to the knowledge of environmental risk factors of cancer, source of information and personal practice of the participants. Bivariate and multivariate analyzes were performed. Results: About 387 respondents agreed to participate in the study. study showed low awareness regarding infectious agents, lifestyle, diet and many work exposures. The predictors of the attitude of respondents regarding the preventability of cancer were: believing that cancer has an environmental cause (p=.014), not having a healthy lifestyle (p=.004), not smoking waterpipe (p=.023), being single (p=.013), and having a university degree (p=.049). Conclusions: Efforts should be made to improve awareness of the cancer risk factors regarding infectious agents, lifestyle, diet and many work exposures. This can also be followed by further studies assessing the impact of these community and governmental cancer prevention initiatives on cancer risk factors level of awareness

Allergies, genetic polymorphisms of Th2 interleukins, and childhood acute lymphoblastic leukemia: The ESTELLE study

International audienceContext A negative association between a history of allergy and childhood acute lymphoblastic leukaemia (ALL) has been reported in previous studies, but remains debated. This work aimed to investigate this association accounting for genetic polymorphisms of the Th2 pathway cytokines (IL4, IL10, IL13 and IL4-receptor (IL4R)). Methods Analyses were based on the French case-control study ESTELLE (2010-2011). The complete sample included 629 ALL cases and 1,421 population-based controls frequency-matched on age and gender. The child's medical history was collected through standardised maternal interview. Biological samples were collected, and genotyping data were available for 411 cases and 704 controls of European origin. Odds ratios (OR) were estimated using unconditional regression models adjusted for potential confounders. Results In the complete sample, a significant inverse association was observed between ALL and reported history of allergic rhinitis or sinusitis (OR=0.65 [0.42-0.98]; p= 0.04), but there was no obvious association with allergies overall. There was an interaction between genetic polymorphisms in IL4 and IL4R (pinteraction=0.003), as well as a gene-environment interaction between IL4R-rs1801275 and a reported history of asthma (IOR=0.23; pint=0.008) and eczema (IOR= 0.47; pint=0.06). We observed no interaction with the candidate polymorphisms in IL4 and IL13. Conclusion These results suggest that the association between allergic symptoms and childhood ALL could be modified by IL4R-rs1801275, and that this variant could also interact with a functional variant in IL4 gene. While they warrant confirmation, these results could help understand the pathological mechanisms under the reported inverse association between allergy and childhood ALL

Maternal reproductive history, fertility treatments and folic acid supplementation in the risk of childhood acute leukemia: the ESTELLE Study

International audiencePURPOSE: To investigate the potential involvement of fertility treatments and other conditions of becoming pregnant (infertility, getting pregnant on birth control, maternal history of fetal loss) and folic acid supplements in the etiology of childhood leukemia (CL). METHODS: The ESTELLE study included 747 cases of CL [636 cases of acute lymphoblastic leukemia (ALL) and 100 of acute myeloblastic leukemia (AML)] diagnosed in France in 2010-2011 and 1,421 population controls frequency-matched with the cases on age and gender. Data were obtained from structured telephone questionnaires administered to mothers. The odds ratios (OR) and their 95 % confidence intervals were estimated using unconditional regression models adjusted for potential confounders. RESULTS: CL was not associated with difficulty in becoming pregnant [OR 0.9 (0.7-1.2)], in vitro fertilisation [OR 0.6 (0.3-1.5)] or the use of any fertility treatment [OR 0.8 (0.5-1.1)] for the index pregnancy. CL was not significantly associated with becoming pregnant on contraception [OR 1.2 (0.8-1.8)], but a positive association was observed for third generation oral contraception [OR 4.3 (1.2-16.2)]; however, the result is based on small numbers. Folic acid supplementation during pregnancy was not associated with CL, but an inverse borderline association was observed for supplementation initiated in the 3 months preceding pregnancy [OR 0.7 (0.5-1.0)]. In addition, maternal histories of stillbirth and miscarriage were associated with ALL [OR 2.6 (1.1-5.9)] and AML [OR 1.8 (1.1-2.8)], respectively. CONCLUSIONS: The findings do not suggest that infertility and fertility treatments are risk factors for CL. They suggest that maternal histories of stillbirth and miscarriage may be more frequent among mothers of CL cases and that folic acid supplementation during preconception may reduce the risk of CL