House calls in Lebanon: reflections on personal experience. (1/269)

BACKGROUND: Home health services play an important role in decreasing hospital admissions and physicians' medical house calls play an integral role in home health services. There is no national survey of physicians' house call practice in the Lebanon. OBJECTIVES: The aim of this study was to provide some information about house call practice in the Lebanon. METHOD: Data on patients examined during house call visits between 1 January and the end of December 1995 were reviewed. RESULTS: During this period, 137 patients were seen at their home. Eighty-four patients (62%) were female and 53 patients (38%) were male. Ages ranged from 1 to 85 years. The number of cases seen in 1 month averaged 11. The diagnosis differed according to the age group of patients examined. Most of the house call visits occurred between 6.30 p.m. to 12.00 p.m. (47%). Fifteen patients (11%) were admitted to the hospital. CONCLUSION: The rate of cases per month was similar to those reported elsewhere. Physicians might feel reluctant to conduct house calls out of hours. Our study revealed that the majority of patients were seen between 6 p.m. and 12 p.m., and only 6% were seen after 12 a.m. It is our belief that house calls are an integral part of family practice and need to be stressed during the internships of all primary care physicians.  (+info)

The Dyggve-Melchior-Clausen syndrome. (2/269)

Two new cases of Dyggve-Melchior-Clausen syndrome are described; they belong to the fourth family from Lebanon in which this disease has been recognized. There is no genealogical linkage between these four families. A particular feature in these cases is a striking rhizomelic shortness of the arms especially in one case. Clinical and radiological findings, progression of the skeletal changes are studied, along with the review of the cases in the literature. Cytological and biochemical data indicate that the DMC syndrome is not a mucopolysaccharidosis.  (+info)

Reform follows failure: I. Unregulated private care in Lebanon. (3/269)

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.  (+info)

Reform follows failure: II. Pressure for change in the Lebanese health sector. (4/269)

This paper describes how, against a background of growing financial crisis, pressure for reform is building up in the Lebanese health care system. It describes the various agendas and influences that played a role. The Ministry of Health, backed by some international organizations, has started taking the lead in a reform that addresses both the way care is delivered and the way it is financed. The paper describes the interventions made to prepare reform. The experience in Lebanon shows that this preparation is a process of muddling through, experimentation and alliance building, rather than the marketing of an overall coherent blueprint.  (+info)

Pseudomonas libanensis sp. nov., a new species isolated from Lebanese spring waters. (5/269)

The taxonomic position of eight fluorescent Pseudomonas isolates, from two Lebanese spring waters, which were previously recognized by numerical analysis as members of a new subcluster (subcluster Vb) was examined. Except for one strain, the new subcluster exhibited internal DNA hybridization values of 76-100%, and 9-53% hybridization was measured with the type or reference strains of other Pseudomonas species. The highest DNA binding value was found with Pseudomonas marginalis strains (37-53%). The G+C content of the DNA of the type strain was 58 mol%. A comparison of 1322 nt of the 16S rRNA gene sequence of the strain representing subcluster Vb (CFML 96-195T) with the sequence of other strains of the genus Pseudomonas revealed that strain CFML 96-195T was part of the 'Pseudomonas fluorescens intrageneric cluster'. On the basis of the results of phenotypic, DNA-DNA and phylogenetic analyses, a new Pseudomonas species, Pseudomonas libanensis sp. nov., is proposed for the seven strains of subcluster Vb. The type strain is P. libanensis CFML 96-195T and has been deposited in the Collection de l'Institut Pasteur (Paris, France) as CIP 105460T. The P. libanensis strains are phenotypically and genotypically homogeneous and can be differentiated from most other fluorescent species by several phenotypic features. Differentiation of P. libanensis and Pseudomonas aeruginosa is based mainly on pyocyanin production; P. libanensis can be differentiated from P. fluorescens (all biovars) by alpha-aminobutyrate assimilation. The clinical significance of P. libanensis is unknown.  (+info)

Attitudes of the Lebanese public regarding disclosure of serious illness. (6/269)

OBJECTIVES: To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. DESIGN AND SETTING: Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. RESULTS: Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of religious practice, or religious affiliation, and preference for disclosure. CONCLUSIONS: Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses.  (+info)

Aggression patterns and speciation. (7/269)

The evolutionary significance of interspecific aggression as a factor in speciation was tested among three chromosome forms of the actively speciating fossorial rodent Spalax ehrenbergi in Israel. Laboratory experiments testing intra- and interspecific aggression were conducted on 48 adult animals from 10 populations comprising three chromosome forms with 2n = 52, 58, and 60. Twelve agonistic, motivational-conflict, and territorial behavioral variables were recorded during 72 combats involving homo- and heter-ogametic encounters between opponents. Analysis of the data matrix was carried out by the nonmetric multivariate Smallest Space Analysis (SSA-II). The results indicate that (a) aggression patterns, involving agonistic conflict and territorial variables, are higher in heterogametic encounters than in homogametic ones; and (b) aggression is higher between contiguous chromosome forms (2n = 58-60, and 2n = 52-58) than between noncontiguous ones (2n = 52-60). Both a and b suggest that high interspecific aggression appears to be adaptively selected at final stages of speciation in mole rats as a premating isolating mechanism which reinforces species identification and establishes parapatric distributions between the evolving species.  (+info)

Exclusion of chromosome 9 helps to identify mild variants of acromesomelic dysplasia Maroteaux type. (8/269)

Acromesomelic dysplasia Maroteaux type (AMDM) is an autosomal recessive disorder belonging to the group of acromesomelic dysplasias. AMDM is characterised by severe dwarfism with shortening of the middle and distal segments of the limbs. An AMDM gene has recently been mapped to human chromosome 9p13-q12 by homozygosity mapping in four consanguineous families. Here, we show linkage of the disease gene to chromosome 9p13-q12 in four of five consanguineous AMDM families and its exclusion in a fifth family with two children affected with a mild form of the disease. This study suggests that genetic heterogeneity accounts for the variable clinical and radiological severity of AMDM.  (+info)