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Abstract Purpose The risk of breast cancer (BC) and related mortality have increased in Middle-East countries during recent decades. The relationship between several nutrient intakes and the risk of BC has been investigated in several studies. However, few studies have estimated the effects of patterns of different nutrient intake on the risk of BC in this region. Methods A total of 453 patients who were recently diagnosed with breast cancer and 516 healthy women participated in the current case–control study. To evaluate the dietary intakes, we used a validated 168-item food frequency questionnaire (FFQ) during the last year. Nutrient Patterns (NPs) were extracted through factor analysis (FA) of energy-adjusted twenty-six nutrients. The relationship between nutrient patterns and the risk of breast cancer in pre and post-menopausal women was estimated by multivariable regression. Results Four major nutrient patterns were identified in the current study. The first nutrient pattern was rich in animal protein, retinol, riboflavin, pantothenic acid, cobalamin, and calcium. Higher saturated fatty acids (SFAs), mono-unsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs), and lower intakes of niacin were observed in nutrient pattern 2. The third nutrient pattern was rich in fiber, potassium, and vitamin C. Nutrient pattern 4, was associated with higher intakes of vegetable protein, alpha-tocopherol, and magnesium. A significant inverse relationship was observed between adherence to nutrient pattern 3 and the risk of BC in all participants [odds ratio (OR) = 0.70, 95% confidence interval (CI): 0.50, 0.97, P = 0.03) and pre-menopausal women (OR = 0.59 (0.39–0.89), P = 0.01). Conclusion Decreasing odds of breast cancer were observed by adherence to a nutrient pattern high in dietary fiber, vitamin C, and potassium. Future prospective investigations are recommended to confirm these findings.

Background: The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria.Methods: We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection.Results: A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals.Conclusions: Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high. [ABSTRACT FROM AUTHOR]