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Kobeissi E, Menassa M, Honein-AbouHaidar G, El Achi N, Abdul-Sater Z, Farhat T, Al Mohtar D, Hajjar M, Abdul-Khalek RA, Chaya BF, Elamine A, Hettiaratchy S, Abu-Sittah G. Long-term burden of war injuries among civilians in LMICs: case of the July 2006 war in Lebanon. Front Public Health 2023; 11:1305021. [PMID: 38145076 PMCID: PMC10748398 DOI: 10.3389/fpubh.2023.1305021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Lebanon, a country located on the eastern shore of the Mediterranean Sea, is one of the world's smaller sovereign states. In the past few decades, Lebanon endured a perpetual political turmoil and several armed conflicts. July 12, 2006, marked the start of a one-month war in Lebanon, which resulted in thousands of casualties. Little is known about the long-term consequences of war injuries inflicted on civilians during the July 2006 war. Methods The objectives of this paper were to identify and evaluate: 1- civilians' access to healthcare and medicine under conditions of war; 2- the long-term socioeconomic burden on injured civilians; and 3- their quality of life more than a decade post-war. We adopted a mixed-method research design with an emphasis on the qualitative component. We conducted interviews with patients, collected clinical and financial data from hospital medical records, and administered a self-rated health questionnaire, the EQ-5D-5L. Simple descriptive statistics were calculated using Excel. NVivo 12® was used for data management and thematic analysis. Results We conducted 25 interviews. Injured civilians were mostly males, average age of 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The thematic analysis revealed three themes: 1- recall of the time of the incident, the thousand miles journey, and patients' access to services; 2- post-trauma sequelae and services; and 3- long-term impact. Patients described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living. Discussion Civilians injured during the July 2006 war described the traumatising events they endured during the war and the limited access to medical care during and post-war. Up until this study was conducted, affected civilians were still experiencing physical, psychological, and financial sequelae. Acknowledging the limitations of this study, which include a small sample size and recall bias, the findings underscore the necessity for the expansion of services catering to civilians injured during wartime.
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Affiliation(s)
- Elsa Kobeissi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Gladys Honein-AbouHaidar
- Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Theresa Farhat
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dalia Al Mohtar
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marwan Hajjar
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | | | - Bachar F. Chaya
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ahmad Elamine
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Shehan Hettiaratchy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghassan Abu-Sittah
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
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Yan Y, Cao Y, Ma Q, Wang K, Liao Y, Sun Y, Chen C, Hu J, Zheng W, Chu C, Wang Y, Mu J. Long-Term Blood Pressure Exposure From Childhood and Early Vascular Aging in Midlife: A 30-Year Prospective Cohort Study. Angiology 2022; 73:869-876. [PMID: 35232270 DOI: 10.1177/00033197221082712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early vascular aging (EVA) increases cardiovascular mortality, but its long-term determinants are unknown. We included 2098 participants with ≥4 blood pressure (BP) measurements from childhood to adulthood (from the Hanzhong Adolescent Hypertension Cohort study) to investigate the impact of child-to-adult cumulative BP exposure on EVA patterns in midlife. Participants with EVA had significantly higher long-term BP burden than those with normal vascular age in midlife despite being much younger. Child-to-adult cumulative burden and trends of systolic and diastolic BP were associated with vascular age (standardized regression coefficient [β] = .31 to .53; P < .001 for all). Higher cumulative systolic and diastolic BP exposure significantly increased the risk of EVA in midlife (odds ratio, OR=1.67 to 2.75, P < .05 for all). All associations were independent of socio-demographics and cardiovascular risk factors. Excluding participants who were receiving anti-hypertensive, antidiabetic, or lipid-lowering treatments did not substantially change the above associations. This study, for the first time, reported that high cumulative child-to-adult BP exposure accelerated the vascular aging process. Stabilizing BP across life course could be beneficial to vascular health in the long run.
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Affiliation(s)
- Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Yu Cao
- Department of Pediatrics, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Xi'an, China
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Keke Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Yueyuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Chen Chen
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Jiawen Hu
- Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Xi'an, China
| | - Wenling Zheng
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
| | - Jianjun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, 162798Xi'an Jiaotong University, Key Laboratory of Molecular Cardiology of Shaanxi Province, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China
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