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ABSTRACT: Information on the practice of family medicine in Arab countries is scant. In this study we aim to describe the current state of the specialty in the region. This includes scope of practice, practice setting, training programs, and the numbers and profiles of their graduates.
A survey of leaders in family medicine in Arab countries was conducted between October 2008 and June 2009. The survey was administered in person or via e-mail. Snowball sampling was used to obtain at least two respondents from each country.
There are 31 family medicine residency programs in Arab countries graduating about 182 residents per year. In most Arab countries, the family physician to population ratio remains low. Most graduates work in clinical practice, and a large proportion of them are employed in government-run clinics. There is significant variability in the scope of practice among practicing physicians.
Family medicine continues to struggle for a clear identity worldwide. In the Arab world, where the specialty is relatively new, steps can be taken to better define our identity as a specialty and increase its desirability as a specialty.
Family medicine 01/2011; 43(1):37-42. · 1.33 Impact Factor
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ABSTRACT: Telephone hotlines designed to address common concerns in the early postpartum could be a useful resource for parents. Our aim was to test the feasibility of using a telephone as an intervention in a randomized controlled trial. We also aimed to test to use of algorithms to address parental concerns through a telephone hotline.
Healthy first-time mothers were recruited from postpartum wards of hospitals throughout Lebanon. Participants were given the number of a 24-hour telephone hotline that they could access for the first four months after delivery. Calls were answered by a midwife using algorithms developed by the study team whenever possible. Callers with medical complaints were referred to their physicians. Call patterns and content were recorded and analyzed.
Eighty-four of the 353 women enrolled (24%) used the hotline. Sixty percent of the women who used the service called more than once, and all callers reported they were satisfied with the service. The midwife received an average of three calls per day and most calls occurred during the first four weeks postpartum. Our algorithms were used to answer questions in 62.8% of calls and 18.6% of calls required referral to a physician. Of the questions related to mothers, 66% were about breastfeeding. Sixty percent of questions related to the infant were about routine care and 23% were about excessive crying.
Utilization of a telephone hotline service for postpartum support is highest in the first four weeks postpartum. Most questions are related to breastfeeding, routine newborn care, and management of a fussy infant. It is feasible to test a telephone hotline as an intervention in a randomized controlled trial. Algorithms can be developed to provide standardized answers to the most common questions.
BMC Public Health 10/2010; 10:611. · 2.00 Impact Factor
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ABSTRACT: to provide basic information on the distribution (public/private and geographically) and the nature of maternity health provision in Lebanon, including relevant health outcome data at the hospital level in order to compare key features of provision with maternal/neonatal health outcomes.
a self-completion questionnaire was sent to private hospitals by the Syndicate of Private Hospitals in collaboration with the study team and to all public hospitals in Lebanon with a functioning maternity ward by the study team in cooperation with the Ministry of Public Health.
childbirth in an institutional setting by a trained attendant is almost universal in Lebanon and the predominant model of care is obstetrician-led rather than midwife-led. Yet due to a 15-year-old civil war and a highly privatised health sector, Lebanon lacks systematic or publically available data on the organisation, distribution and quality of maternal health services. An accreditation system for private hospitals was recently initiated to regulate the quality of hospital care in Lebanon.
in total, 58 (out of 125 eligible) hospitals responded to the survey (46% total response rate). Only hospital-level aggregate data were collected.
the survey addressed the volume of services, mode of payment for deliveries, number of health providers, number of labour and childbirth units, availability of neonatal intensive care units, fetal monitors and infusion rate regulation pumps for oxytocin, as well as health outcome data related to childbirth care and stillbirths for the year 2008.
the study provides the first data on maternal health provision from a survey of all eligible hospitals in Lebanon. More than three-quarters of deliveries occur in private hospitals, but the Ministry of Public Health is the single most important source of payment for childbirth. The reported hospital caesarean section rate is high at 40.8%. Essential equipment for safe maternal and newborn health care is widely available in Lebanon, but over half of the hospitals that responded lack a neonatal intensive care unit. The ratio of reported numbers of midwives to deliveries is three times that of obstetricians to deliveries.
there is a need for greater interaction between maternal/neonatal health, health system specialists and policy makers on how the health system can support both the adoption of evidence-based interventions and, ultimately, better maternal and perinatal health outcomes.
Midwifery 10/2010; 26(5):549-57. · 1.78 Impact Factor
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ABSTRACT: This study was conducted to evaluate the validity of the Arabic translation of the Cohen Perceived Stress Scale (PSS-10) in pregnant and postpartum women.
A sample of 268 women participated. These included 113 women in their third trimester of pregnancy, 97 in the postpartum period and 58 healthy female university students. GHQ-12 and EPDS were also administered to the participants. Internal consistency reliability, assessed using Cronbach's α, was 0.74.
PSS-10 significantly correlated with both EPDS and GHQ12 (ρ = 0.58 and ρ = 0.48 respectively), and significantly increased with higher scores on stressful life events. PSS-10 scores were higher among university students who also recorded higher stressful life events scores.
The Arabic translated version of the PSS-10 showed reasonably adequate psychometric properties.
BMC Psychiatry 01/2010; 10:111. · 2.55 Impact Factor
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ABSTRACT: To assess the feasibility of establishing a maternal mortality audit in Lebanon.
A facility-based reproductive age mortality study (RAMOS).
Records of reproductive-age female deaths over an eight-year period in three hospitals in Beirut, Lebanon, were reviewed.
Quality of data sources, comprehensiveness of medical charts and accessibility of information.
Review of records was feasible. Cross-checking three data sources identified missed cases and coding and data entry errors. The quality and accessibility of data varied between hospitals. The maternal mortality rate was 39/100,000 live births and there were 55 pregnancy-related deaths/100,000 live births. Lack of antenatal care, delay in seeking care and over-intervention on the part of the medical team were among problems identified.
A facility-based approach is a potential tool for conducting a national maternal mortality audit in a developing country like Lebanon. Computerized medical records and mandatory participation of hospitals are prerequisites for success. This would require the government to develop a cohesive national policy on reducing maternal mortality.
Acta Obstetricia Et Gynecologica Scandinavica 11/2009; 88(12):1338-44. · 1.77 Impact Factor
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ABSTRACT: Obstetric drills are being used increasingly to test, improve, and maintain knowledge and skills related to obstetric emergencies as a means to improve proficiency and efficiency of practitioners. The purpose of this study was to assess the feasibility and usefulness of conducting drills to evaluate the response to obstetric emergencies using a holistic approach that tested the hospital system.
A prospective trial was conducted at three hospitals (two tertiary referral centers and one small community hospital) in Beirut, Lebanon. Two different emergency obstetric drills at two points in time were conducted between April and May 2006 either in the emergency room or on the labor floor. The drills included medical and paramedical staff, a female actor (simulating a pregnant woman), a research assistant (acting as her companion), and a physician trained in obstetrics (the drill leader). Responses were recorded and critically analyzed.
Although overall quality of care was within standards of care, problems were identified related to hospital policies, supplies and equipment, communication, and clinical management. Some technical problems related to administration of the drills were identified. Most drill participants appreciated the exercise and found it beneficial.
Obstetric drills provide a useful tool to identify and address deficiencies in the hospital system. This finding could have implications on improving quality of care provided to obstetric patients.
Birth 04/2009; 36(1):43-50. · 2.18 Impact Factor
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ABSTRACT: Although the health benefits of breastfeeding are well established, early introduction of formula remains a common practice. Cultural beliefs and practices can have an important impact on breastfeeding. This paper describes some common beliefs that may discourage breastfeeding in Lebanon.
Participants were healthy first-time mothers recruited from hospitals throughout Lebanon to participate in a study on usage patterns of a telephone hotline for postpartum support. The hotline was available to mothers for the first four months postpartum and patterns of usage, as well as questions asked were recorded. Thematic analysis of the content of questions which referred to cultural beliefs and practices related to breastfeeding was conducted.
Twenty four percent of the 353 women enrolled in the study called the hotline, and 50% of the calls included questions about breastfeeding. Mothers expressed concern about having adequate amounts of breast milk or the quality of their breast milk. Concerns that the mother could potentially harm her infant though breastfeeding were rooted in a number of cultural beliefs. Having an inherited inability to produce milk, having "bad milk", and transmission of abdominal cramps to infants through breast milk were among the beliefs that were expressed. Although the researchers live and work in Lebanon, they were not aware of many of the beliefs that are reported in this study.
There are a number of cultural beliefs that could potentially discourage breastfeeding among Lebanese women. Understanding and addressing local beliefs and customs can help clinicians to provide more culturally appropriate counselling about breastfeeding.
International Breastfeeding Journal 01/2009; 4:12.
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ABSTRACT: Intern support groups have been instituted in many residency programs to improve resident well-being. In this article, we discuss the themes that emerged in intern support group meetings in a family medicine program operating in a setting of war and political instability.
We held support groups, led by a family physician and a psychologist, that met monthly. Participants were residents in the family medicine program at the American University of Beirut. These residents began their training days after the commencement of the 34-day war between Israel and Hizbollah in 2006. Themes and issues discussed by the residents were noted and are reported in this article.
We found that despite the stressors of the political situation, our interns focused on the usual stress of internship, such as the difficulties of functioning as interns in other departments and dealing with the time demands of internship as their main sources of stress at the beginning of internship. The stresses associated with the war did not emerge in the group until later in the year. These included tension with patients and political confrontations with staff, as well as personal struggles with the lack of political stability and depressed mood.
This paper serves to share our experience and highlight some areas of concern that residents experience when training in a country or region that is at war.
Family medicine 11/2007; 39(9):656-8. · 1.33 Impact Factor
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ABSTRACT: The purpose of this study was to identify risk factors associated with striae gravidarum (SG).
A cross-sectional study of 112 primiparous women delivering at a private teaching hospital was conducted. Participants were assessed during the immediate postpartum period for evidence of SG. Presence and severity of SG were compared to characteristics of women using t tests and Chi-square tests.
Sixty percent of the study participants had developed SG. Women who developed SG were significantly younger (26.5 +/- 4.5 vs 30.5 +/- 4.6; P < .001) and had gained significantly more weight during pregnancy (15.6 +/- 3.9 vs 38.4 kg +/- 2.7; P < .001). Birthweight (BW), gestational age at delivery, and family history of SG were associated with moderate/severe SG.
Maternal age and weight gain during pregnancy are associated with SG. BW, family history of SG, and gestational age at delivery are associated with moderate/severe SG.
American journal of obstetrics and gynecology 02/2007; 196(1):62.e1-5. · 3.28 Impact Factor
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Clinical Pediatrics 05/2006; 45(3):281-3. · 1.15 Impact Factor
