Background War and armed conflicts severely disrupt all health system components, including the h... more Background War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. Methods We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the post-conflict health system. We searched three bibliographic databases and a range of organisational and nationa...
The American Chemical Society’s Division of Environmental Chemistry symposium Toward Creating a W... more The American Chemical Society’s Division of Environmental Chemistry symposium Toward Creating a Water-Energy-Food (WEF) Nexus Community of Practice, brought together 25 cross-disciplinary speakers in five thematic areas: 1) state of the art models and approaches, 2) WEF Nexus initiatives and case studies, 3) WEF governance and stakeholder engagement, 4) chemical processes and WEF Nexus, 5) WEF education, community, and practice. Discussions included diverse perspectives from different areas of expertise and provided key take-home messages toward building a WEF community of practice. This paper summarizes those messages, drawing conclusions regarding the anticipated challenges and opportunities moving toward establishing a resource-nexus community of science and practice that includes the chemical societies. We define the community of science and practice as a bottom-up approach of formal and non-formal scientists, policy makers, practitioners, technology providers, and civil society...
Injuries are the leading cause of death and disability among children. This study estimates the m... more Injuries are the leading cause of death and disability among children. This study estimates the magnitude of childhood (<= 16 years old) injuries presenting to emergency services in Beirut and describes their distribution by nature and cause. The emergency logbooks or records of 1992 were reviewed in three major hospitals in Beirut. A total of 5918 childhood injuries were identified presenting 36% of all emergency pediatric cases. Twothirds were males, 354 were admitted to hospital, and 19 died. In general, there were no major differences between sexes regarding the type or cause of injury, nor its severity. Only 10% involved multiple body parts. The majority of injuries were minor. Major injuries with high admission rates included fractures, intracranial injuries, and poisoning. Piercing and cutting instruments, falls, road/ traffic incidents, and poisoning topped the causes of injuries in general and those that were admitted. Falls and road/traffic incidents constituted 58% of ...
Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and ... more Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and major disease outbreaks—affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in human...
To estimate the medical and compensation costs of work-related injuries in insured workplaces in ... more To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. The median cost per injury was US dollars 83 (mean, US dollars 198; range, US dollars 0-16,401). The overall cost for all 3748 injuries was US dollars 742,100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US dollars 4.5 million a year; this increased to US dollars 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the ove...
The potential for exposure to neurotoxicants in Lebanon is high, especially in the absence of str... more The potential for exposure to neurotoxicants in Lebanon is high, especially in the absence of strict control and regulatory measures in workplaces. Children working in mechanical and other trade workshops are at significant risk of exposure to organic solvents and as a result at significant risk to develop clinical and subclinical signs of neurotoxicity. This study investigated the association between exposure to solvents and neurobehavioral performance of 10-17 years old working children in comparison to groups of non-exposed working children and non-exposed children at school. A convenience cross-sectional sample of 100 working children (10-17 years) exposed to organic solvents at work, a positive control of 100 non-solvent exposed working children, and a negative control of 100 non-working, non-exposed school children were recruited to the study. The exposed and non-exposed groups were, as far as possible, frequency matched on geographic location of residence and on age. Neurotoxic effects were assessed through a questionnaire and the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s performance on a battery of neurobehavioral tests, which were specifically selected for a non-English speaking population and were tailored to assess the specific modalities of the central nervous system commonly known to be affected by the neurotoxicants identified. Children in the non-exposed groups (working and non-working) performed better than the working exposed group on reaction speed for the choice reaction time, symbol-digit and dual task tracking tests, but accuracy of performance was not affected on these tests. Children in the working exposed group also complained of more headaches, loss of concentration, memory deficits and higher irritability. This study identifies an association between exposure to solvents and lower neurobehavioral performance. Response speed appears to be particularly affected in solvent exposed working children.
Our previous work has demonstrated adverse effects on neuropsychological and neurobehavioral func... more Our previous work has demonstrated adverse effects on neuropsychological and neurobehavioral function in solvent-exposed working children compared to non-exposed working and school children. The aim of this paper was to examine the dose-response relationships between neurobehavioral function and solvent exposure in children. We tested 120 male children aged 10-17 years (100 working solvent-exposed, 10 working children, 10 school children). Neurotoxic effects were assessed through a questionnaire and a selection of neurobehavioral tests. Workplace exposure to a mixture of solvents was measured using personal passive samplers. Children with higher solvent exposure showed significantly higher reporting of neurotoxic symptoms (P=0.02). Importantly, multiple regression models revealed significant dose-response relationships, with higher cumulative exposure associated with poorer performance on the Choice Reaction Time, Symbol Digit, Continuous Performance, Digit Span and Grooved Pegboard tests. This study provides the first empirical evidence of a dose-response association between exposure to solvents and neurobehavioral performance in working children. This finding implies that solvent-exposed working children are at high risk of developing neurobehavioral impairments. These impairments are likely to interfere with their capacity to respond quickly and safely to new demands and to learn new information.
International Journal of Environmental Health Research, 2002
This study assesses the association between the proximity of residence to cement and fertilizer p... more This study assesses the association between the proximity of residence to cement and fertilizer plants in industrialized districts and respiratory health complaints among children (5-15 years old) in Northern Lebanon. A multi-stage random sample of households was selected from two exposed districts and a third non-industrialized. One child was randomly selected from each household for a total of 486 children. Living within 0-3 km of industries, as compared to living farther away (4-7 km), was associated with a statistically significant increase in the risk for cough with colds (adjusted odds ratio (OR) = 3.40), phlegm with colds (OR = 2.14), yearly episodes of cough and phlegm (OR = 4.63), yearly chest colds (OR = 4.12), and wheezing (OR = 2.23). When compared to living in the non-industrialized district, children living within 0-3 km of industries showed a significantly higher risk for yearly chest colds (OR = 2.30). However, living in the 4-7 km region of industries was associated with a lower risk of respiratory complaints, as compared to living in the comparison area. This was attributed to higher altitudes and different meteorological characteristics. A higher risk of respiratory problems was reported among children living close to cement than fertilizer industries. Policy intervention measures are recommended.
Background War and armed conflicts severely disrupt all health system components, including the h... more Background War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. Methods We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the post-conflict health system. We searched three bibliographic databases and a range of organisational and nationa...
The American Chemical Society’s Division of Environmental Chemistry symposium Toward Creating a W... more The American Chemical Society’s Division of Environmental Chemistry symposium Toward Creating a Water-Energy-Food (WEF) Nexus Community of Practice, brought together 25 cross-disciplinary speakers in five thematic areas: 1) state of the art models and approaches, 2) WEF Nexus initiatives and case studies, 3) WEF governance and stakeholder engagement, 4) chemical processes and WEF Nexus, 5) WEF education, community, and practice. Discussions included diverse perspectives from different areas of expertise and provided key take-home messages toward building a WEF community of practice. This paper summarizes those messages, drawing conclusions regarding the anticipated challenges and opportunities moving toward establishing a resource-nexus community of science and practice that includes the chemical societies. We define the community of science and practice as a bottom-up approach of formal and non-formal scientists, policy makers, practitioners, technology providers, and civil society...
Injuries are the leading cause of death and disability among children. This study estimates the m... more Injuries are the leading cause of death and disability among children. This study estimates the magnitude of childhood (<= 16 years old) injuries presenting to emergency services in Beirut and describes their distribution by nature and cause. The emergency logbooks or records of 1992 were reviewed in three major hospitals in Beirut. A total of 5918 childhood injuries were identified presenting 36% of all emergency pediatric cases. Twothirds were males, 354 were admitted to hospital, and 19 died. In general, there were no major differences between sexes regarding the type or cause of injury, nor its severity. Only 10% involved multiple body parts. The majority of injuries were minor. Major injuries with high admission rates included fractures, intracranial injuries, and poisoning. Piercing and cutting instruments, falls, road/ traffic incidents, and poisoning topped the causes of injuries in general and those that were admitted. Falls and road/traffic incidents constituted 58% of ...
Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and ... more Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and major disease outbreaks—affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in human...
To estimate the medical and compensation costs of work-related injuries in insured workplaces in ... more To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. The median cost per injury was US dollars 83 (mean, US dollars 198; range, US dollars 0-16,401). The overall cost for all 3748 injuries was US dollars 742,100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US dollars 4.5 million a year; this increased to US dollars 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the ove...
The potential for exposure to neurotoxicants in Lebanon is high, especially in the absence of str... more The potential for exposure to neurotoxicants in Lebanon is high, especially in the absence of strict control and regulatory measures in workplaces. Children working in mechanical and other trade workshops are at significant risk of exposure to organic solvents and as a result at significant risk to develop clinical and subclinical signs of neurotoxicity. This study investigated the association between exposure to solvents and neurobehavioral performance of 10-17 years old working children in comparison to groups of non-exposed working children and non-exposed children at school. A convenience cross-sectional sample of 100 working children (10-17 years) exposed to organic solvents at work, a positive control of 100 non-solvent exposed working children, and a negative control of 100 non-working, non-exposed school children were recruited to the study. The exposed and non-exposed groups were, as far as possible, frequency matched on geographic location of residence and on age. Neurotoxic effects were assessed through a questionnaire and the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s performance on a battery of neurobehavioral tests, which were specifically selected for a non-English speaking population and were tailored to assess the specific modalities of the central nervous system commonly known to be affected by the neurotoxicants identified. Children in the non-exposed groups (working and non-working) performed better than the working exposed group on reaction speed for the choice reaction time, symbol-digit and dual task tracking tests, but accuracy of performance was not affected on these tests. Children in the working exposed group also complained of more headaches, loss of concentration, memory deficits and higher irritability. This study identifies an association between exposure to solvents and lower neurobehavioral performance. Response speed appears to be particularly affected in solvent exposed working children.
Our previous work has demonstrated adverse effects on neuropsychological and neurobehavioral func... more Our previous work has demonstrated adverse effects on neuropsychological and neurobehavioral function in solvent-exposed working children compared to non-exposed working and school children. The aim of this paper was to examine the dose-response relationships between neurobehavioral function and solvent exposure in children. We tested 120 male children aged 10-17 years (100 working solvent-exposed, 10 working children, 10 school children). Neurotoxic effects were assessed through a questionnaire and a selection of neurobehavioral tests. Workplace exposure to a mixture of solvents was measured using personal passive samplers. Children with higher solvent exposure showed significantly higher reporting of neurotoxic symptoms (P=0.02). Importantly, multiple regression models revealed significant dose-response relationships, with higher cumulative exposure associated with poorer performance on the Choice Reaction Time, Symbol Digit, Continuous Performance, Digit Span and Grooved Pegboard tests. This study provides the first empirical evidence of a dose-response association between exposure to solvents and neurobehavioral performance in working children. This finding implies that solvent-exposed working children are at high risk of developing neurobehavioral impairments. These impairments are likely to interfere with their capacity to respond quickly and safely to new demands and to learn new information.
International Journal of Environmental Health Research, 2002
This study assesses the association between the proximity of residence to cement and fertilizer p... more This study assesses the association between the proximity of residence to cement and fertilizer plants in industrialized districts and respiratory health complaints among children (5-15 years old) in Northern Lebanon. A multi-stage random sample of households was selected from two exposed districts and a third non-industrialized. One child was randomly selected from each household for a total of 486 children. Living within 0-3 km of industries, as compared to living farther away (4-7 km), was associated with a statistically significant increase in the risk for cough with colds (adjusted odds ratio (OR) = 3.40), phlegm with colds (OR = 2.14), yearly episodes of cough and phlegm (OR = 4.63), yearly chest colds (OR = 4.12), and wheezing (OR = 2.23). When compared to living in the non-industrialized district, children living within 0-3 km of industries showed a significantly higher risk for yearly chest colds (OR = 2.30). However, living in the 4-7 km region of industries was associated with a lower risk of respiratory complaints, as compared to living in the comparison area. This was attributed to higher altitudes and different meteorological characteristics. A higher risk of respiratory problems was reported among children living close to cement than fertilizer industries. Policy intervention measures are recommended.
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Papers by Iman Nuwayhid