Family focused approach to improve heart failure care in lebanon quality (FAMILY) intervention : a randomized controlled trial

University of Technology Sydney. Faculty of Health.Background: Heart failure is a growing burden globally and Lebanon is no exception. Achieving optimal health outcomes requires adherence to many life-style changes and adaptation of self-management strategies. To date, many theoretical models of self-care have focused on the individual with less intentional focus on caregivers and the socio-cultural factors that impact self-care behaviours, particularly within collectivist cultures. Objectives: To develop a theoretically-informed, culturally-adapted intervention to improve heart failure outcomes tested in a randomised controlled trial (RCT). Methods and design: A series of sequential, interdependent studies contributed to the intervention development tested in a prospective, randomized controlled trial. Phase 1: An integrative review defining the burden of cardiovascular diseases in Lebanon as a guide to the development of a culturally-appropriate intervention. Phase 2: A Systematic review of family involvement in self-care of patients with chronic conditions. Phase 3: Developing a culturally-appropriate, family-centred, nurse-led intervention aimed to improve heart failure outcomes in Lebanon. Phase 4: Translation and validation of the Arabic version of the Self-care of Heart Failure Index (ASCHFI). Phase 5: Evaluation of the intervention through a multi-site RCT assessing all-cause readmission, self-care, quality of life, emergency department presentation, major vascular events, and health care utilization. The intervention group, patients and their primary family caregivers, received a comprehensive educational session on self-care and symptom management and a branded bag with self-care resources, while the control group received the self-care resources only. Results: Phase 1: A total of 28 peer-reviewed articles and 15 reports were identified in this search. Cardiovascular diseases were found to be the leading causes of morbidity and mortality in Lebanon. A range of social, political, economic and cultural factors explain the burden of these diseases including the unique traits of the Lebanese culture such as the narghile smoking and the high rates of familial hypercholesterolemia (Collegian, doi:10.1016/j.colegn.2014.04.004). Phase 2: A total of ten articles addressing family involvement in self-care of patients with chronic conditions were identified. Family-centred approaches were found to be more appropriate in Non-western, collectivist cultures. Outcomes varied based on the type of support provided to different patient populations and on the type and frequency of the interventions. Phase 3: The FAMILY Intervention Heart Failure Model was developed using linguistically and culturally appropriate methods while considering the Lebanese health care sector and the available resources. This model concepts included partnership, collaboration, behaviour change, family unit, empowerment and information sharing (Journal of Advanced Nursing. doi: 10.1111/jan.12768). Phase 4: The A-SCHFI was shown to have enough face and content validity as evaluated by the panel of experts. The three constructs explained 37.5% of the variance with the maintenance construct having the least appropriate loading. The modified A-SCHFI was evaluated to be a valid and reliable measure of self-care in the Lebanese population. Phase 5: The mean age of the 256 patients was 67 (SD=8) years and 55% were male; most caregivers were the patients’ spouse (43%). Readmission was significantly lower in the intervention group compared to the control group (n=10, 33% vs. n=20, 67%, p<0.05 respectively) at one month follow up. Self-care scores, lower at baseline, improved at 30 days with significant improvement in the intervention group over the control group in both the maintenance and confidence scales (67 (SD=14) vs. 58 (SD=19), (p=0.0001) and 64 (SD=20) vs. 55 (SD=22), (p=0.002) respectively). No changes were noted in quality of life scores or emergency department presentations between the groups. Significantly more participants in the control group needed health care facilities than in the intervention group (n=24 (23%) vs. n=12 (11%) respectively, p<0.05) at follow up. Three cases of major vascular events were noted in the control group but none in the intervention group. Conclusion: As the burden of chronic diseases increases globally, particularly in emerging economies, developing models of intervention that are appropriate to the socio-cultural context are necessary. In addition, implementation of valid and reliable outcome measures is warranted. Future research on family involvement through multi-session educational conferences and longer follow-up periods are warranted

Preoperative Patient Education on Length of Stay of Patients Undergoing Orthopedic Surgeries: A Pilot Randomized Controlled Trial

Hip and knee replacement surgeries are complex procedures with many risks and complications post-surgery. Patient education preoperatively has shown to limit some of these complications but nothing is reported on the effect of preoperative education on the length of stay in Lebanon. The aim of this paper is to evaluate the effect of a structured preoperative education to patients undergoing selected orthopedic surgeries. A pilot study for a randomized controlled trials (RCT).The study was conducted at Al Zahraa Hospital and Rafic Hariri University Hospital (RHUH). The study was introduced to potential participants, baseline data was collected and then patients were randomized to the intervention and the usual care groups. The intervention group was given the education by one of the five nursing students that were conducting this study. The education included items on pain management, wound care, physical activity and diet; and took place one day before the surgery. The educational material was unified for all patients to assure consistency. A total of 10 patients were enrolled into this pilot study. Mean age was 68 years and 70% were females. There was no significant difference between the groups in pain reduction or in post-operative complications. The study highlights the need of well-designed methodology of an educational intervention for patients undergoing selected orthopedic surgeries and its effect on the length of stay

KNOWLEDGE OF THE EFFECT OF SYNTHETIC PROTEINS ON THE OVERALL HEALTH IN LEBANESE ADULTS: A CROSS-SECTIONAL STUDY

The aim of the study was to assess the knowledge of gym attendees on the effects of protein shakes on their health. A descriptive cross-sectional study involving a self-administered questionnaire was undertaken. Data were collected through a self-administered questionnaire in two ways. First method was googled form links which was sent out to acquaintances on social media (WhatsApp, Facebook, Instagram and Twitter) in both English and Arabic language. In addition, questionnaire was printed and distributed to four different gyms in Beirut. The coaches of the gyms took charge of distributing and completing the questionnaire. Reminders were issued every 2 days throughout the data collection period. The mean age of the study participants was 25.58 (SD=6.82) years. The majority were male participants (66.9%). The findings show that participants were not aware about the side effects of protein shakes consumption. Only 61.4% knew about kidney problems, 33.7% knew about its effect on blood pressure, 38% knew about its effect on breast enlargement and only 10% knew about its effect on fertility. As a conclusion, this study provided information about the knowledge base of gym attendees on the use of protein shakes. This information will help in raising and spreading awareness among people about the effect of protein shake on their health. Future studies should address other age groups

Expanded genome-wide comparisons give novel insights into population structure and genetic heterogeneity of Leishmania tropica complex

Leishmania tropica is one of the main causative agents of cutaneous leishmaniasis (CL). Population structures of L. tropica appear to be genetically highly diverse. However, the relationship between L. tropica strains genomic diversity, protein coding gene evolution and biogeography are still poorly understood. In this study, we sequenced the genomes of three new clinical L. tropica isolates, two derived from a recent outbreak of CL in camps hosting Syrian refugees in Lebanon and one historical isolate from Azerbaijan to further refine comparative genome analyses. In silico multilocus microsatellite typing (MLMT) was performed to integrate the current diversity of genome sequence data in the wider available MLMT genetic population framework. Single nucleotide polymorphism (SNPs), gene copy number variations (CNVs) and chromosome ploidy were investigated across the available 18 L. tropica genomes with a main focus on protein coding genes. MLMT divided the strains in three populations that broadly correlated with their geographical distribution but not populations defined by SNPs. Unique SNPs profiles divided the 18 strains into five populations based on principal component analysis. Gene ontology enrichment analysis of the protein coding genes with population specific SNPs profiles revealed various biological processes, including iron acquisition, sterols synthesis and drug resistance. This study further highlights the complex links between L. tropica important genomic heterogeneity and the parasite broad geographic distribution. Unique sequence features in protein coding genes identified in distinct populations reveal potential novel markers that could be exploited for the development of more accurate typing schemes to further improve our knowledge of the evolution and epidemiology of the parasite as well as highlighting protein variants of potential functional importance underlying L. tropica specific biology

Bayesian network based procedure for regional drought monitoring:The Seasonally Combinative Regional Drought Indicator

Drought is a complex natural hazard. It occurs due to a prolonged period of deficient in rainfall amount in a certain region. Unlike other natural hazards, drought hazard has a recurrent occurrence. Therefore, comprehensive drought monitoring is essential for regional climate control and water management authorities. In this paper, we have proposed a new drought indicator: the Seasonally Combinative Regional Drought Indicator (SCRDI). The SCRDI integrates Bayesian networking theory with Standardized Precipitation Temperature Index (SPTI) at varying gauge stations in various month/seasons. Application of SCRDI is based on five gauging stations of Northern Area of Pakistan. We have found that the proposed indicator accounts the effect of climate variation within a specified territory, accurately characterizes drought by capturing seasonal dependencies in geospatial variation scenario, and reduces the large/complex data for future drought monitoring. In summary, the proposed indicator can be used for comprehensive characterization and assessment of drought at a certain region

Analysis of Transportation Networks Subject To Natural Hazards – insights from a Colombian case

ABSTRACT: This study provides an applied framework to derive the connectivity reliability and vulnerability of inter-urban transportation systems under network disruptions. The proposed model integrates statistical reliability analysis to find the reliability and vulnerability of transportation networks. Most of the modern research in this field has focused on urban transportation networks where the primary concerns are guaranteeing predefined standards of capacity and travel time. However, at a regional and national level, especially in developing countries, the connectivity of remote populations in the case of disaster is of utmost importance. The applicability of the framework is demonstrated with a case study in the state of Antioquia, Colombia, using historical records from the 2010-2011 rainy season, an aspect that stands out and gives additional support compared to previous studies that considers simulated data from assumed distributions. The results provide significant insights to practitioners and researchers for the design and management of transportation systems and route planning strategies under this type of disruptions

The Value of Advanced Traveler Information Systems for Route Choice

Over the next few years, driver behavior should become more informed with the advent and deployment of in-vehicle navigation systems. This paper analyzes systems that provide the driver the fastest path between his or her current location and final destination, updated in real-time to consider recurring and non-recurring congestion. The traveler¹s full cost per trip is a bundle comprised of both expected travel time and its reliability. This paper explores these topics from a theoretical economic perspective and then simulates stylized cases. Simulation results indicate that typical information benefits are at a maximum on the precipice of congestion, when vehicles are arriving at a rate of 95 percent of the capacity, while non-recurring congestion benefits are much greater.Transportation Information Systems, In-Vehicle Navigation, En-Route Guidance, Electronic Route Guidance, Advanced Traveler Information Systems