The human papillomavirus (HPV), a prevalent sexually transmitted infection, is linked to a wide range of diseases, with cervical cancer being the most common and serious one. HPV vaccination is ...crucial for preventing cervical cancer and other HPV-related problems. The low acceptability of HPV vaccination among teenagers globally is largely due to a lack of understanding and information about HPV among parents. Our study aimed to evaluate the level of knowledge, attitude, intention, and HPV vaccination among parents in Lebanon as well as the variables influencing Lebanese mothers' intentions to vaccinate their children.
A cross-sectional survey-based study involving 392 participants was conducted between May and June 2022. The study assessed parents' intention to vaccinate their children against HPV, their knowledge about HPV, and the HPV vaccine. The data was collected through an anonymous electronic questionnaire. A bivariate analysis was conducted using Student t-test and ANOVA to examine the relationship between the dependent variable "Intention to vaccination" and the secondary variables. The level of statistical significance was set at 0.05 for all data.
Our findings showed that only 63% of the 392 participants claimed they would give their child the HPV vaccination. A positive significant association was demonstrated between "Intention to vaccinate against HPV" and mother's nationality, father's educational level, family income per month, information received about the HPV vaccine, parents' HPV vaccination, insurance coverage of the HPV vaccine, children's vaccinations with all required vaccines, knowledge of HPV, and knowledge of the HPV vaccine. Furthermore, when parents know about HPV, their desire to vaccinate their child increases by a factor of 1.832 times, and by 1.207 times when their knowledge level increases by one point.
The majority of parents lacked a general understanding of most HPV-related statements, which highlights the requirement for educational interventions to raise parental awareness, understanding, and attitudes toward HPV and, as a result, increase parental acceptance of vaccinating their children. To increase the vaccination rate among adolescents, government authorities should ensure that the HPV vaccine is available in all hospitals and clinics and should be provided free of charge.
Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria ...were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective .
We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders.
HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days 95% CI,1.5-3.9; p < 0.001) and (2.2 days 95% CI,1.2-3.3; p < 0.001) and resulted in additional hospital charges ($1807 95% CI, 1046-2569; p < 0.001) and ($889 95% CI, 378-1400; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 95% CI, 0.327-0.820; p = 0.05).
This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure.
Stroke is a major social and health problem posing heavy burden on national economies. We provided detailed financial data on the direct in-hospital cost of acute stroke care in Lebanon and evaluated ...its drivers. This was an observational, quantitative, prospective, multicenter, incidence-based, bottom-up cost-of-illness study. Medical and billing records of stroke patients admitted to 8 hospitals in Beirut over 1 year were analyzed. Direct medical costs were calculated, and cost drivers were assessed using a multivariable linear regression analysis. In total, 203 stroke patients were included (male: 58%; mean age: 68.8 ± 12.9 years). The direct in-hospital cost for all cases was US$1 413 069 for 2626 days (US$538 per in-hospital day). The average in-hospital cost per stroke patient was US$6961 ± 15 663. Hemorrhagic strokes were the most costly, transient ischemic attack being the least costly. Cost drivers were hospital length of stay, intensive care unit length of stay, type of stroke, stroke severity, modified Rankin Scale, third party payer, surgery, and infectious complications. Direct medical cost of acute stroke care represents high financial burden to Lebanese health system. Development of targeted public health policies and primary prevention activities need to take priority to minimize stroke admission in future and to contain this cost.
Background: Despite efforts to reduce stroke mortality rates, the disease remains a leading cause of death in Lebanon highlighting the importance of understanding risk factors and subsequent ...mortality. We examined mortality rates during the first year after acute stroke and the major short-term (1-month) and long-term (1-year) mortality predictors. Methods: Data were collected prospectively on hospitalized stroke patients from 8 hospitals in Beirut during a 1-year period. Patients were followed up for 1-year or until death. Mortality rates were assessed at 1-month and at 1-year poststroke and predictors of death were evaluated using Cox proportional hazard model. Results: A total of 191 stroke patients were included. Survival data were completed for over 97% of patients. Cumulative mortality rates were 14.1% at 1-month and 22% at 1-year. Predictors of short-term and long-term mortality in univariate analysis were low socioeconomic status, intensive care unit admission, decreased level of consciousness, stroke severity, and presence of complications. Marital status also predicted short-term mortality, while age greater than 64 years, atrial fibrillation, coronary heart disease, hypertension, Bamford and TOAST classifications and surgery need were also long-term mortality predictors. In multivariate analysis, stroke severity and presence of complications were predictors of death at 1-month and at 1-year. Low socioeconomic status, dependency in daily living activities, and the presence of comorbidities were additional predictors of 1-year mortality. Conclusions: Approximately 1 over 5 of patients did not survive 1-year after stroke. There is a need for public awareness campaigns to improve stroke knowledge, warning, and prevention which may reduce this high stroke mortality rate in Lebanon.
L’accident vasculaire cérébral (AVC) est une maladie avec des taux de morbidité et de mortalité élevés, il est classé parmi les causes les plus fréquentes de décès et d’invalidité acquise dans le ...monde entier. Ainsi, évaluer son épidémiologie peut jouer un rôle crucial dans la réduction de son impact sur la population et la société. Le fardeau de l’AVC est attribué principalement aux pays en voie de développement, puisque les gens dans les pays développés ont une meilleure prise en charge et une sensibilisation accrue sur les symptômes et les facteurs de risque de l’AVC. Toutefois, dans les pays moins développés, où la population confronte l’énorme impact de l’urbanisation et de la mondialisation avec une augmentation accrue de la prévalence des facteurs de risque cardiovasculaire, l’incidence des AVC reste élevée. Peu de données épidémiologiques existent sur les AVC au Liban. Par conséquent, il était nécessaire de mener cette étude.Nous avons effectué une étude de cohorte multicentrique, prospective, basé sur l’incidence. Nous avons inclus 203 participants âgés de 18 ans et plus de 8 hôpitaux à Beyrouth entre Août 2015 et Août 2016 avec un diagnostic d’AVC confirmé. Les patients ont été suivis pendant une période d’un an (à l’admission à l’hôpital, à la sortie de l’hôpital et à 3, 6 et 12 mois par des visites à domicile).L’hypertension est le facteur de risque le plus puissant et le plus fréquent de l’AVC. Seulement 2,5 % des AVC ischémiques ont subi une thrombolyse. Le taux de mortalité cumulé était 13,3% à 1 mois et 21,2% à 1 an. Les complications et la gravité de l’AVC étaient des prédicteurs de décès à 1 mois et 1 an. Le niveau socio-économique bas, la dépendance dans les activités quotidiennes et les comorbidités étaient prédicteurs de mortalité supplémentaire à 1 an. La qualité de vie est relativement faible chez les patients atteints d’AVC et plus de 15 % d'entre eux étaient déprimés. Les principaux déterminants de la qualité de vie étaient: l’état fonctionnel, la dépendance dans les activités de la vie quotidienne, l’âge et la dépression. Les principaux déterminants de la dépression étaient l’état fonctionnel et la qualité de vie. Le coût direct hospitalier de tous les cas d’AVC était US$ 1,413,069 pour 2626 jours (538 US$ par jour à l’hôpital). Le coût moyen hospitalier par patient était US$ 6961±15, 663. Les AVC hémorragiques ont été les plus coûteux, l'accident ischémique transitoire étant le moins coûteux. Les prédicteurs de coûts étaient : la longueur du séjour hospitalier et dans l'unité de soins intensifs, le type d’AVC, la gravité de l’AVC, l'échelle de Rankin modifiée, les tiers payeurs, la chirurgie et les complications infectieuses.La prévention primaire est d’une importance primordiale dans la réduction de la charge de l’AVC. Les campagnes de sensibilisation sur les symptômes de cette maladie surtout pour la population hypertendue contribueront à limiter l’incidence de la maladie et donc à diminuer le fardeau financier et social élevé de l’AVC (le coût de la maladie et la qualité de vie). La mise en place d’unités spécialisées pour les AVC et l’augmentation du pourcentage de patients thrombolysés peuvent réduire la mortalité à court terme et les incapacités de longue durée et donc améliorer la qualité de vie des patients atteints d’AVC.
Stroke is a disease with high morbidity and mortality rates, classified among the most common causes of death and acquired disability worldwide. Thus, assessing its epidemiology may play a crucial role in reducing its impact on the population and the society. Stroke late burden is attributable to developing countries mainly, as people in developed countries have a better access to optimal care and an increased awareness on stroke symptoms and risk factors. However, in less developed countries, where population confronts the huge impact of urbanization and globalization with a great increase in the prevalence of cardiovascular risk factors, the incidence of stroke remains high. Lebanon is lacking data on the epidemiology of stroke. Therefore, it was necessary to conduct this study and highlight some features of the disease epidemiology.We carried out a multicenter prospective incidence-based cohort study. We included 203 participants aged 18 years and more from 8 hospitals in Beirut between August 2015 and August 2016 with confirmed diagnosis of stroke. Patients were followed for a 1-year period (at hospital admission and discharge, and by home visits at 3, 6 and 12 months).Hypertension was the most powerful and prevalent risk factor for stroke. Only 2.5% of ischemic strokes received thrombolytic therapy. Cumulative mortality rates were 13.3% at 1-month and 21.2% at 1-year. Stroke severity and complications were predictors of death at 1-month and 1-year. Low socioeconomic status, dependency in daily living activities, and co-morbidities were additional 1-year mortality predictors. The quality of life was relatively low in stroke patients and more than 15% of them were depressed. The main determinants of quality of life were functional status, dependency in daily living activities, age, and depression. The main determinants of depression were functional status and quality of life. The direct in-hospital cost for all cases was US$1,413,069 for 2626 days (US$538 per in-hospital day). The average in-hospital cost per stroke patient was US$6961±15,663. Hemorrhagic strokes were the most costly, transient ischemic attack being the least costly. Cost drivers were hospital and intensive care unit length of stay, type of stroke, stroke severity, modified Rankin Scale, third party payer, surgery and infectious complications.Primary prevention is of paramount importance in reducing the burden of stroke. Awareness campaigns on stroke symptoms especially among hypertensive population would help limit the incidence of the disease and therefore decrease the high financial and social burden of stroke (cost of illness and quality of life). The establishment of stroke units and increasing the percentage of thrombolysis may reduce short-term mortality and long term disabilities and therefore improve the quality of life of stroke patients.
Coût direct hospitalier des AVC au Liban Abdo, Rachel; Hosseini, Hassan; Salameh, Pascale ...
Revue neurologique,
March 2017, 2017-03-00, Letnik:
173
Journal Article
Recenzirano
Les accidents vasculaires cérébraux (AVC) constituent un véritable problème de santé publique au Liban avec une charge importante tant sur le plan médical que social et économique.
L’objectif de ...cette étude était d’évaluer le coût direct hospitalier des AVC dans les régions de Beyrouth et Mont Liban, Liban.
Il s’agissait d’une étude transversale prospective qui s’est déroulée sur une période d’un an (août 2015 à août 2016). Les patients âgés de plus de 18 ans, hospitalisés pour AVC étaient inclus dans l’étude. Les données concernant les différents postes de consommation ont été collectées, de même les données démographiques, socio-économiques et cliniques des malades. L’unité du coût était le Dollars Américain (USD). Le coût direct médical, le coût par vie sauvée et par année de vie sauvée ont été calculés.
Deux cent trois patients 57 % hommes étaient inclus dans cette étude. L’âge moyen était de 68,8±12,9 ans. La durée moyenne d’hospitalisation était de 11,5±13,8jours. Le coût moyen était de 1364 pour l’AIT (n=15), 3613 pour l’AVC ischémique (n=144), 9880 pour l’AVC ischémique avec transformation hémorragique (n=14), 12 318 pour l’AVC hémorragique (n=14), et 21 679 USD pour l’hémorragie sous arachnoïdienne (n=16). Le coût par vie sauvée et par année de vie sauvée était 6226 et 6485 USD respectivement.
Les meilleurs prédicateurs du coût élevé étaient une hémorragie méningée, un NIHSS élevé à l’admission et la durée du séjour (en unité de soins normales et intensifs). Une meilleure prise en charge en phase aiguë, des examens complémentaires diagnostiques devraient réduire le coût des AVC.
C’est la première étude qui a permis d’avoir une idée sur ce que dépense le patient, l’état et les compagnies d’assurance à la phase aiguë d’un AVC au Liban.
Objectives: To evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population. Methods: A questionnaire-based survey was conducted in community ...pharmacies from all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January 1 until March 31, 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes, and a linear regression model was performed to assess factors associated with knowledge. Results: An antibiotic knowledge index was computed for 623 participants, with a minimum score of 3 and a maximum score of 19 (average of 12.5 ± 3.2). Higher knowledge score was inversely correlated with age (r = -0.118; P = 0.003), but no gender differences were reported (12.6 for females vs. 12.3 for males) (P >0.05). However, differences were statistically significant for residence type, educational level, and total household income categories. The linear regression model showed a significant association between residence type and knowledge (urban vs. other areas, B = 0.793; P = 0.011). Furthermore, a higher knowledge index was significantly associated with a higher income combined with higher education (additive scale/B = 1.590; P = 0.025). Finally, interactions between income and age, gender, and residence type were not significant. Conclusion: Individuals residing in urban areas, those with combined high income and high educational levels, are more knowledgeable about antibiotics use and resistance in comparison with other groups. More studies are needed to assess sociodemographic interactions on health literacy.
Keywords: Knowledge; Socioeconomic Factors; Gender; Age; Attitude to Health; Educational Achievements; Residence.
Stroke is a major social and health problem posing heavy burden on national economies. We provided detailed financial data on the direct in-hospital cost of acute stroke care in Lebanon and evaluated ...its drivers. This was an observational, quantitative, prospective, multicenter, incidence-based, bottom-up cost-of-illness study. Medical and billing records of stroke patients admitted to 8 hospitals in Beirut over 1 year were analyzed. Direct medical costs were calculated, and cost drivers were assessed using a multivariable linear regression analysis. In total, 203 stroke patients were included (male: 58%; mean age: 68.8 ± 12.9 years). The direct in-hospital cost for all cases was US$1 413 069 for 2626 days (US$538 per in-hospital day). The average in-hospital cost per stroke patient was US$6961 ± 15 663. Hemorrhagic strokes were the most costly, transient ischemic attack being the least costly. Cost drivers were hospital length of stay, intensive care unit length of stay, type of stroke, stroke severity, modified Rankin Scale, third party payer, surgery, and infectious complications. Direct medical cost of acute stroke care represents high financial burden to Lebanese health system. Development of targeted public health policies and primary prevention activities need to take priority to minimize stroke admission in future and to contain this cost.
This study aimed to evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population.
A questionnaire-based survey was conducted in community ...pharmacies across all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January until March 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes and a linear regression model was performed to assess factors associated with knowledge.
A total of 623 participants were included in the analysis of this study (response rate: 90.6%). The mean antibiotic knowledge index was 12.5 ± 3.2 (minimum score: 3 and maximum score: 19). Higher knowledge score was inversely correlated with age (r = -0.118;
= 0.003), but no gender differences were reported (females: 12.6 versus males: 12.3;
= 0.191). However, statistically significant differences were found for residence type (
= 0.002), educational level (
<0.001) and total household income categories (
<0.001). The linear regression model showed a significant association between residence type and knowledge (urban versus rural: β = 0.793;
= 0.011). Furthermore, a higher knowledge index was significantly associated with a higher income combined with higher education (additive scale/β = 1.590;
= 0.025). Finally, interactions between income and age, gender and residence type were not significant.
Individuals residing in urban areas, with combined high income and educational levels, are more knowledgeable about antibiotics use and resistance compared to other groups. More studies are needed to assess the interaction of sociodemographic interactions with health literacy.
The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary ...considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer’s perspective.
A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality.
Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality.
In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
•Urinary tract infections (UTIs) resulting from antibiotic-resistant Escherichia coli have been associated with a high economic burden and health strain compared with susceptible isolates.•In developing countries, despite the high prevalence of antimicrobial resistance, data are scarce and limited in their scope.•In Lebanon, no study to date has estimated the burden of this potentially avoidable condition. Quantifying the burden of UTIs can highlight the impact of resistance on sustainable development and potentially give policy makers an incentive to invest in quality improvement and national preventive programs.
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