HEALTH CARE SYSTEM IN LEBANON: A REVIEW ADDRESSING HEALTH INEQUALITIES AND ETHICAL DILEMMAS OF FRONTLINE WORKERS DURING COVID-19 PANDEMIC

Lebanon is facing many problems that can cause several long-term threats to the overall public health such as an increasing poverty rate, and an economic crisis induced by the devaluation of the Lebanese currency. The healthcare system is affected in terms of quality and availability of services in addition due to the pandemic, a lot of public health campaigns were paused. Consequently, Lebanon is losing its frontline healthcare workers coupled with the fact that the government budget for healthcare has dwindled. This report addresses the evolution of some health indicators in Lebanon throughout the years and presents the rights and ethical considerations and dilemmas faced by the frontline healthcare professionals during the COVID-19 outbreak. The findings of this report showed that the average life expectancy at birth was almost 80 years for both sexes in 2020. The infant mortality rate has positively been reduced to 9.2 cases per 1000 live births and despite its position compared to some Arab countries mostly adjoining Lebanon, this rate in 2019 is considered three times higher compared to some European countries. A decrease in the food and waterborne diseases rate in Lebanon was noted, however, a higher rate is presented in Bekaa. A sustainable health system is required in Lebanon focusing on people and based on public health evidence. Many ethical challenges are faced particularly in the degree of freedom and medical choices. Nevertheless, most notably the long-term impact of these measures will preserve the well-being of society

NORMALITY TESTING METHODS AND THE IMPORTANCE OF SKEWNESS AND KURTOSIS IN STATISTICAL ANALYSIS

The normal distribution (bell curve or Gaussian distribution) is a distribution that happens commonly in many circumstances. Real-life data rarely, if ever, follow a perfect normal distribution. Many tests are useful to test normality and more particularly skewness and kurtosis tests assess the comparability of a given distribution from a normal distribution. These tests are widely used in statistics, business, and epidemiological data including blood pressure, heights, IQ scores and measurement errors. This report provides a review assessing the essential methods employed for testing normality and highlighting the importance of skewness and Kurtosis in statistics. Moreover, it gives some examples of the importance of normality in epidemiological health studies analysis

EVALUATION OF THE EFFECTIVENESS OF CONTINUING PROFESSIONAL DEVELOPMENT IN THE PHARMACEUTICAL WORKPLACE: A CROSS-SECTIONAL STUDY IN LEBANON

The objective of this study is to evaluate the effectiveness of Continuous Professional Development in the pharmaceutical workplace and the direct impact on the pharmacists’ personal and professional progression and to assess their perceptions toward various CPD methods and their incorporation into this recent learning pathway. Methods: A cross-sectional descriptive study was conducted in Lebanon within three months from July 2017 till September 2017 using a survey as a tool. Overall 142 participants were conveniently selected frequency matching national government estimates of pharmacists’ work location and gender . Results: Among the respondents, 38.7% reported that they have learnt through CD/DVD, 57.7% pharmacists attended a conference and 43.7% reported that they took advantage of the E-learning modules provided by the Order of pharmacists in Lebanon. An improvement in practical skills (64.1%) and knowledge acquisition were outlined. The majority considered that the programs modules should be provided and audited by colleges. Conclusion: Understanding the pharmacists’ needs help in providing structured modules to enhance the pharmacy practice and encouraging the incorporation of pharmacists from different areas of work by having multiple options of CPD

The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use

A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals developed by the European Centre for Disease Prevention and Control was piloted across Europe. Variables were collected at national, hospital and patient level in 66 hospitals from 23 countries. A patient-based and a unit-based protocol were available. Feasibility was assessed via national and hospital questionnaires. Of 19,888 surveyed patients, 7.1% had an HAI and 34.6% were receiving at least one antimicrobial agent. Prevalence results were highest in intensive care units, with 28.1% patients with HAI, and 61.4% patients with antimicrobial use. Pneumonia and other lower respiratory tract infections (2.0% of patients; 95% confidence interval (CI): 1.8-2.2%) represented the most common type (25.7%) of HAI. Surgical prophylaxis was the indication for 17.3% of used antimicrobials and exceeded one day in 60.7% of cases. Risk factors in the patient-based protocol were provided for 98% or more of the included patients and all were independently associated with both presence of HAI and receiving an antimicrobial agent. The patient-based protocol required more work than the unit-based protocol, but allowed collecting detailed data and analysis of risk factors for HAI and antimicrobial use.peer-reviewe

Effectiveness of Organized Mammography Screening for Different Breast Cancer Molecular Subtypes

Background: Screening program effectiveness is generally evaluated for breast cancer (BC) as one disease and without considering the regularity of participation, while this might have an impact on detection rate. Objectives: To evaluate the short-term effectiveness of a mammography screening program for the major molecular subtypes of invasive BC. Methods: All women who participated in the screening program and were diagnosed with screen-detected or interval BC in Flanders were included in the study (2008–2018). Molecular subtypes considered were luminal and luminal-HER2-positive, human epidermal growth factor receptor 2-positive, and triple-negative BC (TNBC). The relationship between the BC stage at diagnosis (early (I–II) versus advanced (III–IV)) and the method of detection (screen-detected or interval) and the relationship between the method of detection and participation regularity (regular versus irregular) were evaluated by multi-variable logistic regression models. All models were performed for each molecular subtype and adjusted for age. Results: Among the 12,318 included women, BC of luminal and luminal-HER2-positive subtypes accounted for 70.9% and 11.3%, respectively. Screen-detected BC was more likely to be diagnosed at early stages than interval BC with varied effect sizes for luminal, luminal-HER2-positive, and TNBC with OR:2.82 (95% CI: 2.45–3.25), OR:2.39 (95% CI: 1.77–3.24), and OR:2.29 (95% CI: 1.34–4.05), respectively. Regular participation was related to a higher likelihood of screening detection than irregular participation for luminal, luminal-HER2-positive, and TNBC with OR:1.21 (95% CI: 1.09–1.34), OR: 1.79 (95% CI: 1.38–2.33), and OR: 1.62 (95% CI: 1.10–2.41), respectively. Conclusions: Regular screening as compared to irregular screening is effective for all breast cancers except for the HER2 subtype

Overdiagnosis of invasive breast cancer in population-based breast cancer screening:A short- and long-term perspective

BACKGROUND: Overdiagnosis of invasive breast cancer (BC) is a contentious issue. OBJECTIVE: The aim of this paper is to estimate the overdiagnosis rate of invasive BC in an organised BC screening program and to evaluate the impact of age and follow-up time. METHODS: The micro-simulation model SiMRiSc was calibrated and validated for BC screening in Flanders, where women are screened biennially from age 50 to 69. Overdiagnosis rate was defined as the number of invasive BC that would not have been diagnosed in the absence of screening per 100,000 screened women during the screening period plus follow-up time (which was set at 5 years and varied from 2 to 15 years). Overdiagnosis rate was calculated overall and stratified by age. RESULTS: The overall overdiagnosis rate for women screened biennially from 50 to 69 was 20.1 (95%CI: 16.9-23.2) per 100,000 women screened at 5-year follow-up from stopping screening. Overdiagnosis at 5-year follow-up time was 12.9 (95%CI: 4.6-21.1) and 74.2 (95%CI: 50.9-97.5) per 100,000 women screened for women who started screening at age 50 and 68, respectively. At 2- and 15-year follow-up time, overdiagnosis rate was 98.5 (95%CI: 75.8-121.3) and 13.4 (95%CI: 4.9-21.9), respectively, for women starting at age 50, and 297.0 (95%CI: 264.5-329.4) and 34.2 (95%CI: 17.5-50.8), respectively, for those starting at age 68. CONCLUSIONS: Sufficient follow-up time (≥10 years) after screening stops is key to obtaining unbiased estimates of overdiagnosis. Overdiagnosis of invasive BC is a larger problem in older compared to younger women

The requirements of a specialist breast centre

Abstract This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.Peer reviewe

Calculating environmental cost indicators of apple farm practices indicates large differences between growers

This study evaluates the environmental impact of current apple cultivation practices in Flanders, Belgium. It evaluates integrated production, the most common practice, and it compares this production method with conventional and organic production. The assessment was based on Farm Accountancy Data Network data from 2010 to 2012 for 64 farms in the region and a life cycle approach was used. The findings showed no significant improvement in environmental impacts for integrated farms compared to conventional farms and, even more, the former showed significantly higher average impacts per hectare for the categories ‘acidification’, and ‘non-renewable energy use’ in comparison with the latter. The organic production group showed higher average impacts per kilogram due to lower yields. Secondly, impacts related to the categories ‘acidification’, ‘eutrophication’ and ‘global warming potential’ were monetized based on the shadow price method in order to obtain external costs. Results show that external costs increase the production costs for integrated farming at least with 5%, both when these costs are expressed per kilogram and per hectare. However, the findings show a large variability in impacts and costs per farm. Farm-specific practices have therefore an important influence on the total environmental cost rather than production group-specific practices.status: publishe

Calculating environmental cost indicators of apple farm practices indicates large differences between growers

This study evaluates the environmental impact of current apple cultivation practices in Flanders, Belgium. It evaluates integrated production, the most common practice, and it compares this production method with conventional and organic production. The assessment was based on Farm Accountancy Data Network data from 2010 to 2012 for 64 farms in the region and a life cycle approach was used. The findings showed no significant improvement in environmental impacts for integrated farms compared to conventional farms and, even more, the former showed significantly higher average impacts per hectare for the categories ‘acidification’, and ‘non-renewable energy use’ in comparison with the latter. The organic production group showed higher average impacts per kilogram due to lower yields. Secondly, impacts related to the categories ‘acidification’, ‘eutrophication’ and ‘global warming potential’ were monetized based on the shadow price method in order to obtain external costs. Results show that external costs increase the production costs for integrated farming at least with 5%, both when these costs are expressed per kilogram and per hectare. However, the findings show a large variability in impacts and costs per farm. Farm-specific practices have therefore an important influence on the total environmental cost rather than production group-specific practices