The emergency to tackle tobacco smoking by Lebanese adolescents

International audienceIn Lebanon, tobacco use by adolescents remains a problem and is higher than among adults. This study sought to assess the experimentation of tobacco smoking practices among adolescents in Lebanon, and further to link health promotion at school-level (measured with the Hat Questionnaire) to the smoking behaviour at students-level (measured with the HBSC questionnaire). We relied on a cross-sectional observational study, conducted in 50 schools across Lebanon. The students' ages ranged from 11 to 18 years old (6th to 12th grade). They filled-in a confidential, anonymous self-questionnaire in class. In parallel, the school administration filled in the assessment questionnaire for health promotion. STATA Software was used for statistical analysis.7133 students were included (mean age 15.24±2.00 years). Overall, 24.5% had ever experimented cigarette smoking alone, boys more than girls (31.95% vs. 19.14%; p < 0.001), mainly from Beirut (33.62%; p < 0.001) and with poor health perception (29.12% vs. 19.87%; p < 0.001). Overall, 33.98% had ever used water-pipe alone, again more boys (40.34% vs. 29.88%; p < 0.001), from Beirut (39.55%, p < 0.001), and with poor health perception (39.48% vs. 28.93%; p < 0.001). Finally, 22.28% experimented both cigarettes and water-pipe. Around 70% of the involved schools offered health-related courses in their curricula. 72 % of them included interventions on the harm of smoking but not as an integral part of the curriculum. Less than half of them had developed plans to improve health promotion and review data to ensure the effectiveness of their programs. This alarming rate of use of tobacco products constitutes a major public health issue for Lebanese adolescents that needs urgent intervention. Further analysis will focus on the school-level questionnaires. Already our results will serve to foster the reinforcement of health promoting schools in Lebanon by the ministry of Education, in line with international recommendations

Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations

Background: This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses. Methods: The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours. Results: A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents. Conclusion: The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses

Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations

Background: This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses. Methods: The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours. Results: A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents. Conclusion: The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses

Fetal electrocardiography ST-segment analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward

Background: In the past century, some areas of obstetric including intrapartum care have been slow to benefit from the dramatic advances in technology and medical care. Although fetal heart rate monitoring (cardiotocography) became available a half century ago, its interpretation often differs between institutions and countries, its diagnostic accuracy needs improvement, and a technology to help reduce the unnecessary obstetric interventions that have accompanied the cardiotocography is urgently needed. Study Design: During the second half of the 20th century, key findings in animal experiments captured the close relationship between myocardial glycogenolysis, myocardial workload, and ST changes, thus demonstrating that ST waveform analysis of the fetal electrocardiogram can provide information on oxygenation of the fetal myocardium and establishing the physiological basis for the use of electrocardiogram in intrapartum fetal surveillance. Results: Six randomized controlled trials, 10 meta-analyses, and more than 20 observational studies have evaluated the technology developed based on this principle. Nonetheless, despite this intensive assessment, differences in study protocols, inclusion criteria, enrollment rates, clinical guidelines, use of fetal blood sampling, and definitions of key outcome parameters, as well as inconsistencies in randomized controlled trial data handling and statistical methodology, have made this voluminous evidence difficult to interpret. Enormous resources spent on randomized controlled trials have failed to guarantee the generalizability of their results to other settings or their ability to reflect everyday clinical practice. Conclusion: The latest meta-analysis used revised data from primary randomized controlled trials and data from the largest randomized controlled trials from the United States to demonstrate a significant reduction of metabolic acidosis rates by 36% (odds ratio, 0.64; 95% confidence interval, 0.46\u20130.88) and operative vaginal delivery rates by 8% (relative risk, 0.92; 95% confidence interval, 0.86\u20130.99), compared with cardiotocography alone