Development of adaptable and flexible treatment manuals for externalizing and internalizing disorders in children and adolescents.
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In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems. (+info)
Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions.
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Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon. (+info)
An examination of cross-cultural systems implementing evidence-based assessment and intervention approaches.
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Implementation of evidence-based assessment and intervention approaches for youth with behavioral and/or emotional problems is rising to recognition worldwide. Feasibility research is critical to examine what characteristics of systems allow for success or barriers to the implementation of evidence-based practices into real-world settings, especially when working cross-culturally. This paper briefly reviews the experience of 4 international sites to understand how the overall structure and specific site variables directed the implementation of the World Health Organization and the World Psychiatry Association project. Discussion includes a thematic summary of the successes and challenges experienced by the sites, and future directions of feasibility studies. (+info)
Exposure of pre-school children to passive cigarette and narghile smoke in Beirut.
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BACKGROUND: Narghile is a resurging smoking device. However, little research has been done to assess passive smoking exposure. The objective of the present study is to evaluate the exposure of pre-school age children in Beirut to parental passive smoking from cigarette and/or narghile. METHODS: Data were collected from 1057 pre-school age children attending 16 day cares and 7 nursery schools in the city of Beirut. RESULTS: The overall prevalence of parental smoking (cigarette and/or narghile) was 53.3%. Ten per cent of respondents reported smoking only narghile. Fathers were significantly more likely than mothers to smoke cigarettes. However, there was no significant difference between fathers and mothers with respect to smoking narghile only. Education was a significant predictor for smoking cigarettes but not for smoking narghile. CONCLUSION: Narghile smoking appears to follow different gender and social patterns than cigarette smoking. Further research is needed to establish the determinants of narghile smoking, in order to develop adequate prevention policies. (+info)
Adolescent obesity in Lebanese private schools.
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BACKGROUND: Obesity has become a public health problem worldwide. Our objective was to calculate the prevalence of overweight and obesity. METHODS: It is a cross sectional study of adolescents in private Lebanese schools, aged 10-18 years. Gender, birth date and measures of weight and height were recorded. RESULTS: In 12,299 adolescents, we found high prevalence of obesity (7.5%) and at risk of obesity (24.4%). In girls, risk of obesity and obesity prevalence decrease with increasing age (P < 10(-4)) as compared with that in boys. CONCLUSION: Early recognition of obesity should become routine in paediatric ambulatory care settings. (+info)
Distrust, social fragmentation and adolescents' health in the outer city: Beirut and beyond.
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This study examined the association between place and components of social capital among adolescents living in three impoverished communities outside of Beirut, the capital city of Lebanon. We utilized a unique data set that includes a wide range of social capital items to assess the association between place, social capital and self rated health. The analyses were based on data collected by trained interviewers during the Spring of 2003 from a stratified random sample of 1294 adolescents aged 13-19 years, drawn from a sampling frame constructed from area maps and detailed household listing of the target population. Descriptive statistics and odds ratios from logistic regression models were used to assess the strength of associations between (1) the social capital items and community of residence and (2) social capital, community and self-rated health controlling for age, sex and income. Findings show that distrust and social fragmentation were generally prevalent among adolescents living in impoverished suburban communities. Even though social networks, especially the presence of family and relatives, were strong, instrumental social exchange was relatively scarce. Social capital items varied significantly by community, and the stock of social capital in one of the three communities surveyed-the Palestinian refugee camp-was quite distinctive. Findings from logistic regression models showed that social capital as measured by a simple index is strongly associated with self-rated health status, controlling for community, age, sex and income. Some implications of the findings are discussed. (+info)
Cultural capital and self-rated health in low income women: evidence from the Urban Health Study, Beirut, Lebanon.
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This paper examines the association between cultural capital and self-rated psychosocial health among poor, ever-married Lebanese women living in an urban context. Both self-rated general and mental health status were assessed using data from a cross-sectional survey of 1,869 women conducted in 2003. Associations between self-rated general and mental health status and cultural capital were obtained using chi (2) tests and odds ratios from binary logistic regression models. Cultural capital had significant associations with self-perceived general and mental health status net of the effects of social capital, SES, demographics, community and health risk factors. For example, the odds ratios for poor general and mental health associated with low cultural capital were 4.5 (CI: 2.95-6.95) and 2.9 (CI: 2.09-4.05), respectively, as compared to participants with high cultural capital. As expected, health risk factors were significantly associated with both measures of health status. However, demographic and community variables were associated with general health but not with mental health status. The findings pertaining to social capital and measures of SES were mixed. Cultural capital was a powerful and significant predictor of self-perceived general and mental health among women living in poor urban communities. (+info)
Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival.
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AIM: To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS: An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver Italian Program (CLIP) score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS: Ninety-two patients (mean 60.5 +/- 22.3 years) were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively (mean F/U 40.2 +/- 23.5 mo). Multivariate analysis identified three predictors of early mortality (< 6 mo): bilirubin > 3.2 mg/dL (P < 0.01), HCC as first presentation of liver disease (P = 0.035), and creatinine > 1 mg/dL (P = 0.017). A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate. CONCLUSION: HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed. (+info)