Impact of Excess Body Weight on Health-Related Quality of Life Among Adults in Lebanon

The objective of this study is to evaluate the impact of excess body weight on Health-Related Quality of Life (HRQoL). A convenience sample of 320 adults was recruited from different health centers in Lebanon. Body mass index (kg/m2 ) was calculated based on measured weight and height. Participants were divided into three groups: normal-weight (18.5-24.9), overweight (25.0-29.9) and obese (≥30.0). HRQoL was assessed using the Short-Form health survey questionnaire (SF-36). The eight scales as well as the physical (PCS-36) and mental (MCS-36) component summary measures of the SF-36 were calculated and compared statistically among the three groups. The impact of Body Mass Index (BMI) on HRQoL was also examined through linear regressions, adjusting for sociodemographics, health behaviors and presence of chronic diseases. The results show that overweight and obese men reported reduced HRQoL on all physical scales, while overweight/obese women reported impairments on only two subscales: bodily pain and general health perceptions. PCS-36 showed lower scores in the obese and overweight subjects than the reference group. With regard to mental well-being, obese men and women displayed lower scores on vitality, social functioning and mental health subscales compared to the normalweight group. Additionally, MCS-36 showed lower scores in obese subjects. Results from linear regressions revealed significant negative correlations between BMI and both PCS-36 and MCS-36. In conclusion, overweight adults experience significantly worse physical HRQoL, while obese adults suffer from reduced physical and mental HRQoL. This highlights the importance of development and implementation of effective prevention strategies to improve HRQoL among adults with overweight and obesity

Are sexual and reproductive health and rights taught in medical school? Results from a global survey

Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and bar-riers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods (97.2%) were more frequently reported as taught compared with complex SRHR topics such as sexual violence (63.8%), unsafe abortion (65.7%), and the vulnerability of LGBTQIA persons (23.2%). High SRHR content was associated with high- income level (P= 0.003) and low abortion restriction (P= 0.042) but varied within set-tings. Most respondents described teaching SRHR as essential to the health of society. Complexity was cited as a barrier, as were cultural taboos, lack of stakeholder recogni-tion, and dependency on fees and ranking

How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy-makers

Introduction: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. Material and methods: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. Results: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P\u3c .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P= .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women\u27s health and rights. Conclusions: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic

How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response : results from a global survey of providers, researchers, and policy-makers

Introduction We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. Material and methods We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. Results The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. Conclusions Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic

Electroanalytical overview: The electroanalytical detection of theophylline

In this overview, we explore the electroanalytical determination of theophylline. Theophylline finds use as a bronchodilator for treating diseases such as asthma and chronic obstructive pulmonary disease (COPD). There is a need to measure the concentration of theophylline in pharmaceuticals for QA/QC purposes as well as in plasma samples to ensure the doses of theophylline are at the correct therapeutic levels. If the concentration levels of theophylline deviate from the therapeutic levels (10–20 µg/mL for asthma), then patients can experience adverse effects. As such, there is a desire to progress from traditional laboratory based techniques to portable rapid testing. In this overview, we review the endeavours directed to the development of theophylline electroanalytical sensors, noting current and future trends

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Table 2: Example applications of the use of remote sensing technologies to detect change in vegetation.

In order to understand the distribution and prevalence of Ommatissus lybicus (Hemiptera: Tropiduchidae) as well as analyse their current biographical patterns and predict their future spread, comprehensive and detailed information on the environmental, climatic, and agricultural practices are essential. The spatial analytical techniques such as Remote Sensing and Spatial Statistics Tools, can help detect and model spatial links and correlations between the presence, absence and density of O. lybicus in response to climatic, environmental, and human factors. The main objective of this paper is to review remote sensing and relevant analytical techniques that can be applied in mapping and modelling the habitat and population density of O. lybicus. An exhaustive search of related literature revealed that there are very limited studies linking location-based infestation levels of pests like the O. lybicus with climatic, environmental, and human practice related variables. This review also highlights the accumulated knowledge and addresses the gaps in this area of research. Furthermore, it makes recommendations for future studies, and gives suggestions on monitoring and surveillance methods in designing both local and regional level integrated pest management strategies of palm tree and other affected cultivated crops

Anti-inflammatory Components from Functional Foods for Obesity

Obesity, defined as excessive fat accumulation that may impair health, has been described throughout human history, but it has now reached epidemic proportions with the WHO estimating that 39% of the world’s adults over 18 years of age were overweight or obese in 2016. Obesity is a chronic low-grade inflammatory state leading to organ damage with an increased risk of common diseases including cardiovascular and metabolic disease, non-alcoholic fatty liver disease, osteo-arthritis and some cancers. This inflammatory state may be influenced by adipose tissue hypoxia and changes in the gut microbiota. There has been an increasing focus on functional foods and nutraceuticals as treatment options for obesity as drug treatments are limited in efficacy. This chapter summarises the importance of anthocyanin-containing fruits and vegetables, coffee and its components, tropical fruit and food waste as sources of phytochemicals for obesity treatment. We emphasise that preclinical studies can form the basis for clinical trials to determine the effectiveness of these treatments in humans

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Qualité de vie relative à la santé chez les patientes atteintes d'un cancer du sein : une revue systématique dans la population moyen-orientale d'une étude prospective libanaise et une analyse du temps jusqu'à détérioration des valeurs d'utilité d'une base de données française

L'objectif principal de la présente thèse était d'identifier les différents facteurs associés à la qualité de vie relative a la santé chez les femmes ayant un cancer du sien au Moyen-Orient et d'explorer l'évolution du changement de l'image corporelle après une chirurgie conservatrice du sein chez les femmes qui vivent au Liban ; tout en essayant d'appliquer le temps à la détérioration de la valeur d'utilité, comme une approche d'analyse longitudinale. La première étude a identifié plusieurs facteurs modifiables et non modifiables qui affectent la qualité de vie relative a la santé chez les femmes atteintes de cancer du sein au Moyen-Orient. Il s'agit d'une importance pour la santé publique et fournit un cadre pour l'établissement d'interventions politiques visant à prévenir les facteurs influençant négativement la qualité de vie. De même, les systèmes de santé au Moyen-Orient sont encouragés à développer des programmes d'intervention ciblés sur les facteurs modifiables, notamment socio-démographiques, comportementaux et psychosociaux. La deuxième étude a également contribué à la connaissance que la qualité de vie (QdV) relative à la santé des femmes ayant un cancer du sein précoce change de manière significative après la chirurgie dans certains domaines (bien-être physique, bien être émotionnel et l'image corporelle). Néanmoins, certains facteurs de risque de détérioration de QdV ont été identifiés, notamment une image corporelle réduite et une perspective future réduite. Ces résultats soulignent l'importance d'envisager des interventions multidimensionnelles telles que la consultation psychologique, le soutien social et l'offre d'éducation sur le suivi thérapeutique. De plus, de futures études prospectives avec une cohorte plus importante et un suivi plus long sont nécessaires pour confirmer nos résultats et concevoir des essais interventionnels visant à améliorer la QdV chez les patients atteints de Colombie-Britannique. La troisième étude souligne que pour améliorer la QdV des patients atteints de cancer du sein, il est important d'estimer la charge psychologique causée par le traitement et la nécessité de trouver des mesures pour la réduire. Par conséquent, les patients atteints de cancer du sein qui suivent une thérapie ont besoin d'un soutien psychologique pour faire face à leur inconfort, leur douleur, leur dépression, leur anxiété et leur peur pendant le processus de diagnostic et de traitement afin d'améliorer leur QdV.The main purpose of the present thesis was to identify the different factors associated to the Health related quality oflife (HRQoL) among breast cancer (BC) women in the Middle-East (ME) and to explore the direction of change of body image after breast conserving surgery among women who live in Lebanon; while also attempting to apply the time to deterioration in utility value, as an approach oflongitudinal analysis. The first study identified several modifiable and non-modifiable factors that affect HRQoL in women with BC in the ME. This is a public health significance and provides a framework for establishing policy interventions to prevent factors influencing negatively on the HRQoL. Similarly, healthcare systems in the ME are encouraged to develop targeted interventional programs on modifiable factors, particularly socio-demographic, behavioral and psychosocial ones. Further, research on these factors is warranted, preferably through prospective longitudinal studies. The second study has also contributed to knowledge that early BC women's HRQoL change significantly after surgery in some domains (physical fonction, emotional fonction and body image). Nevertheless, some risk factors for poor HRQoL were identified, including decreased body image and decreased future perspective. These findings highlight the importance of considering multidimensional interventions such as psychological consultation, social support and offering education about therapeutic follow-up. Moreover, future prospective studies with a larger cohort and longer follow-up are needed to confirm our findings and design interventional trials to improve HRQoL in BC patients. The third study highlights that in order to improve the HRQoL of the patients with BC, it is important to estimate the psychological burden caused by the treatment and the need to find measures to reduce it. Therefore, BC patients undergoing therapy need psychological support to cope with their discomfort, pain, depression, anxiety and fear during the process of diagnosis and treatment in order to improve their Qo