Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review.

OBJECTIVES: Traumatic brain injury (TBI) represents a major health concern worldwide with a large impact in the Middle East and North Africa (MENA) region as a consequence of protracted wars and conflicts that adversely affect the general population. Currently, systematic TBI studies in the MENA region are lacking, nonetheless they are immensely needed to enhance trauma management and increase survival rates among TBI patients. This systematic review aims to characterize TBI in the MENA region to guide future policy choices and research efforts and inform tailored guidelines capable of improving TBI management and patient treatment and outcome. Furthermore, it will serve as a road map to evaluate and assess knowledge of trauma impact on regional health systems that can be adopted by health-care providers to raise awareness and improve trauma care. METHODS: We conducted a comprehensive search strategy of several databases including MEDLINE/Ovid, PubMed, Embase, Scopus, CINAHL, Google Scholar, and the grey literature in accordance with the PROSPERO systematic review protocol CRD42017058952. Abstracts were screened, and selected eligible studies were reviewed independently by 2 reviewers. We collected demographics information along with TBI characteristics, mortality rates, and regional distribution. Data were extracted using REDCap and checked for accuracy. RESULTS: The search strategy yielded 23,385 citations; 147 studies met the eligibility criteria and were included in this review. Motor vehicle accident (MVA) was the leading cause of TBI (41%) in the MENA region, followed by the military- (15.6%) and fall- (8.8%) related TBI. Males predominantly suffer from TBI-related injuries (85%), with a high prevalence of MVA- and military-related TBI injuries. The TBI mortality rate was 12.9%. The leading causes of mortality were MVA (68%), military (20.5%), and assault (2.9%). The vast majority of reported TBI severity was mild (63.1%) compared to moderate (10.7%) and severe TBI (20.2%). Patients mainly underwent a Glasgow Coma Scale assessment (22.1%), followed by computed tomography scan (8.9%) and surgery (4.1%). CONCLUSIONS: Despite its clinical, social, and economic burden, the evidence of TBI research in the MENA region is scarce. Further research and high-quality epidemiological studies are urgently needed to gain a deep understanding of the TBI burden in the region, facilitate the allocation of adequate resources, implement effective preventive and intervention strategies and advise on the TBI patient management as reflective on the TBI patterns and modes.

The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon.

BACKGROUND: The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. METHODS: This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. RESULTS: A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. CONCLUSIONS: The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.

History of injury in a developing country: a scoping review of injury literature in Lebanon.

BACKGROUND: Lebanon, an Eastern Mediterranean country, suffers a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. This article aims to systematically map and comprehensively describe the injury research literature in Lebanon and, to identify gaps for future research. METHODS: MEDLINE, Embase, Eric and SafetyLit, and the grey literature, including conference proceedings, theses and dissertations, government and media reports, were searched without any date or language limits. Data were extracted from 467 documents using REDCap. RESULTS: War-related injuries were the most prevalent type of injury in Lebanon, followed by homicide and other forms of violence. While existing literature targeted vulnerable and at-risk populations, the vast majority focused solely on reporting the prevalence of injuries and associated risk factors. There are considerable gaps in the literature dealing with the integration of preventive programs and interventions across all populations. CONCLUSIONS: Lebanon, historically and currently, experiences a high number of injuries from many different external causes. To date, efforts have focused on reporting the prevalence of injuries and making recommendations, rather than implementing and evaluating interventions and programs to inform policies. Future injury related work should prioritize interventions and prevention programs.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Child and adolescent injury burden in the eastern mediterranean region: Findings from the Global Burden of Disease 1990-2017.

BACKGROUND: Child and adolescent injury is one of the leading causes of child death globally with a large proportion occurring in Low- and Middle-Income Countries (LMICs). Similarly, the Eastern Mediterranean Region (EMR) countries borne a heavy burden that largely impact child and adolescent safety and health in the region. We aim to assess child and adolescent injury morbidity and mortality and estimate its burden in the Eastern Mediterranean Region based on findings from the Global Burden of Disease (GBD), Injuries and Risk Factors study 2017. METHODS: Data from the Global Burden of Disease GBD 2017 were used to estimate injury mortality for children aged 0-19, Years of Life Lost (YLLs), Years lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs) by age and sex from 1990 to 2017. RESULTS: In 2017, an estimated 133,117 (95% UI 122,587-143,361) children died in EMR compared to 707,755 (95% UI 674401.6-738,166.6) globally. The highest rate of injury deaths was reported in Syria at 183.7 (95% UI 181.8-185.7) per 100,000 population. The leading cause of injury deaths was self-harm and interpersonal violence followed by transport injury. The primary cause of injury DALYs in EMR in 2017 was self-harm and interpersonal violence with a rate of 1272.95 (95% UI 1228.9 - 1319.2) almost 3-times the global rate. CONCLUSION: Almost 19% of global child injury related deaths occur in the EMR. Concerted efforts should be integrated to inform policies and adopt injury preventive strategies to reduce injury burden and promote child and adolescent health and well-being in EMR countries.

Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon.

INTRODUCTION: Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population. METHODS: This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors. RESULTS: From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations. CONCLUSION: Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.

Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders.

OBJECTIVE: In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. METHOD: Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. RESULTS: Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). CONCLUSIONS: Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Epidemiology of adult injuries: A multi-center study in greater Beirut.

INTRODUCTION: Injury accounts for nearly 4 million deaths and 63 million disabilities annually. The injury burden is disproportionally large in low- and middle-income countries (LMICs), including Lebanon. This study aims to examine the characteristics and patterns of adult injuries presenting at multiple emergency departments (ED) in Lebanon and further identifies factors associated with hospital admission. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on adult patients (aged≥16) who presented with an injury to one of the five participating EDs from June 2017 to May 2018. Pan-Asia Trauma Outcomes Study (PATOS) variables were adopted for data collection. A descriptive analysis was performed, followed by bivariate and multivariate logistic regression to identify injury risk factors for hospital admission. RESULTS: A total of 3,716 patients' records were included. Most injuries were sustained by males (62.7%), patients aged between 16 and 35 years (16-25: 28%; 26-35: 22.7%), and above 65 years (15.6%). Most injuries were unintentional (94.9%). Falls were highly prevalent across all age groups (38.8%), more proclaimed among the older adults' population (56-65:52.8%; ≥66:73.7%), followed by struck-by object (23.6%) and transport injuries (10.1%). Upper and lower extremity injuries were common across all ages. Most patients (80.9%) were treated and discharged at the ED, 11.4% were admitted to the hospital, 4.3% were transferred to other trauma care facilities, and 2 patients died in the ED. Factors positively associated with hospital admission included: older age (≥ 56 years); private insurance; spine and lower extremity injuries; fractures, cuts/open wounds, concussion, and organ injuries (p-value≤0.05; OR>1). CONCLUSION: Injury is a neglected public health problem in many LMICs, including Lebanon. While youth and the elderly are most affected, injuries occur across all age groups. This study lays the foundation for establishing a population-based injury surveillance system, crucial for designing tailored injury prevention programs to reduce injury-related deaths and disabilities.

Beirut Blast: The Experiences of Acute Care Hospitals.

Mass Casualty Incidents recently increased in intensity and frequency at an unprecedented rate globally. On August 4, 2020, a massive blast hit the Port of Beirut severely damaging its healthcare sector. This study aims to provide a comprehensive understanding of the impact of the Beirut blast on acute care hospitals in the Beirut area, with a focus on understanding healthcare professionals' (HCPs) responses and encountered challenges. A qualitative research design method was adopted to evaluate the experiences of HCPs at acute hospitals located within 5 kilometers of the blast epicenter. 9 hospitals participated in the study. 11 semi-structured interviews were conducted with key informant HCPs using a designed interview guide. HCPs reported severe infrastructural damages in their corresponding hospitals, and 2 were completely non-functional post-blast. Other than physical injuries sustained by HCPs, the blast imposed substantial strains on their mental health, exacerbated by the ongoing socio-economic crises in Lebanon. Moreover, the findings revealed critical challenges which hindered hospitals' emergency responses at the level of communication, coordination, and human resources, as well as supplies. Participants urged for the need to conduct proper triage, arrange emergency operating centers, and deploy outdoor treatment tents among others, to effectively respond to future disasters. The Beirut blast overwhelmed the Lebanese healthcare system and challenged its level of emergency preparedness. This generated evidence to address the deficiencies and strengthen the existing hospitals' emergency response plans. Future efforts should include prioritizing hospitals' emergency preparedness to ensure the provision of care at increased capacity following the impact of a large-scale disaster.

Child injuries in Lebanon: assessing mothers' injury prevention knowledge attitude and practices.

BACKGROUND: Childhood injury is a neglected public health problem with a sizeable burden on children's well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers' Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers' supervision. METHODS: This cross-sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers' KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes. RESULTS: A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5-10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5 years (p < 0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (p = 0.001). CONCLUSION: Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.

Physical injuries and burns among refugees in Lebanon: implications for programs and policies.

BACKGROUND: Refugees are prone to higher risks of injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study aims to systematically quantify the prevalence of physical injuries and burns among the refugee community in Western Lebanon and to examine injury characteristics, risk factors, and outcomes. METHODS: We conducted a cluster-based population survey across 21 camps in the Beqaa region of Lebanon from February to April 2019. A modified version of the 'Surgeons Overseas Assessment of Surgical Need (SOSAS)' tool (Version 3.0) was administered to the head of the refugee households and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables. RESULTS: 750 heads of households were surveyed. 112 (14.9%) households sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Injuries primarily occurred inside the tent (29.9%). Burns were sustained by at least one household member in 136 (18.1%) households in total. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers cannot lock children outside the kitchen while cooking (25.6% vs 14.9%, p-value = 0.001). Similarly, households with unemployed heads had significantly more reported burns (19.7% vs. 13.3%, p value = 0.05). Nearly 16.1% of the injured refugees were unable to seek health care due to the lack of health insurance coverage and financial liability. CONCLUSIONS: Refugees severely suffer from injuries and burns, causing substantial human and economic repercussions on the affected individuals, their families, and the host healthcare system. Resources should be allocated toward designing safe camps as well as implementing educational awareness campaigns specifically focusing on teaching about heating and cooking safety practices.

Multicenter assessment of impairments and disabilities associated with Beirut blast injuries: a retrospective review of hospital medical records.

Objectives: This study aims to describe the injury patterns of the Beirut blast victims and assess hospitals' disaster management and preparedness during the 2020 Beirut port blast. Methods: A cross-sectional retrospective multicenter study was conducted in two stages. Data were collected on blast victims presented to participating hospitals from August 4 till August 8, using three designed questionnaires. Stage 1 included all blast patients' records and stage 2 examined a subset of inpatient and outpatient records. Binary logistic regression was performed to assess the factors associated with death and disability for blast patients. Results: A total of 3278 records were collected, 83% were treated at emergency departments and 17% were admitted to hospitals. Among those, 61 deaths and 35 long-term disabilities were reported. Extremity operations (63%) were mostly performed. Outpatients (n=410) had a mean age of 40±17.01 years and 40% sustained lacerations (40%). 10% of those patients sustained neurological complications and mental problems, and 8% had eye complications. Inpatients (n=282) had a mean age of 49±20.7 years and a mean length of hospital stay of 6±10.7 days. Secondary (37%) and tertiary (25%) blast injuries were predominant. 49% sustained extremity injuries and 19% head/face injuries. 11 inpatient deaths and 20 long-term disabilities were reported. Death was significantly associated with tertiary concussion and crush syndrome (p<0.05). Of the 16 hospitals, 13 implemented disaster plans (87%), and 14 performed a triage with a mean time of 0.96±0.67 hours. One hospital (6%) performed psychological evaluations, without follow-up. Conclusion: Beirut blast victims suffered deaths and disabilities associated with their injuries. They predominantly sustained lacerations caused by shattered glass. Tertiary injuries were associated with death. Triage, disaster plans, and hospital preparedness should be effectively implemented to enhance patients' clinical outcomes. Level of evidence: Prognostic and epidemiological/Level III.

Community Fire Risk Reduction: Longitudinal Assessment for HomeSafe Fire Prevention Program in Canada.

(1) Background: Residential fires represent the third leading cause of unintentional injuries globally. This study aims to offer an overview and a longitudinal evaluation of the HomeSafe program implemented in Surrey in 2008 and to assess its effectiveness in mitigating fire-related outcomes. (2) Methods: Data were collected over a 12-year period (2008-2019). Assessed outcomes comprised frequency of fire incidents, residential fires, casualties, functioning smoke alarms, and contained fires. The effectiveness of each initiative was determined by comparing the specific intervention group outcome and the city-wide outcome to the pre-intervention period. (3) Results: This study targeted 120,349 households. HomeSafe achieved overwhelming success in decreasing fire rates (-80%), increasing functioning smoke alarms (+60%), increasing the percentage of contained fires (+94%), and decreasing fire casualties (-40%). The study findings confirm that the three most effective HomeSafe initiatives were firefighters' visits of households, inspections and installations of smoke alarms, and verifications of fire crew alarms at fire incidents. Some initiatives were less successful, including post-door hangers (+12%) and package distribution (+15%). (4) Conclusions: The HomeSafe program effectively decreased the occurrence and magnitude of residential fires. Lessons learned should be transferred to similar contexts to implement an evidence-based, consistent, and systematic approach to sustainable fire prevention initiatives.

Pediatric Traumatic Brain Injury in the Middle East and North Africa Region: A Systematic Review and Meta-Analysis to Assess Characteristics, Mechanisms, and Risk Factors.

Pediatric traumatic brain injury (pTBI) represents a major cause of child injuries in the Middle East and North Africa (MENA) region. This review aims to assess pTBIs in the MENA region and reports their clinical severity and outcomes. A search was conducted using major electronic databases, including Medline/Ovid, PubMed, EMBASE, Web of Science, and SCOPUS. Abstracts were screened independently and in duplicate to detect original research. The objective and study findings for each article were recorded, along with the mechanism of pTBI, patient age and sex, injury assessment tool(s) used, and outcome. A total of 1345 articles were retrieved, of which 152 met the criteria for full-text review, and 32 were included in this review. Males predominantly suffered from pTBIs (78%). Motor vehicle accidents, followed by child abuse, were the leading causes of pTBI. Overall, 0.39% of cases were mild, 0.58% moderate, 16.25% severe, and 82.27% unclassified. The mortality rate was 13.11%. Most studies used the computed tomography scan, Glasgow Coma Scale, Abbreviated Injury Scale, and Injury Severity Score as investigation methods. This review reports on the alarming rate of child-abuse-related pTBI and offers further understanding of pTBI-associated risk factors and insight into the development of strategies to reduce their occurrence, as well as policies to promote child well-being.

The Beirut ammonium nitrate blast: A multicenter study to assess injury characteristics and outcomes.

BACKGROUND: Blasts incidents impose catastrophic aftermaths on populations regarding casualties, sustained injuries, and devastated infrastructure. Lebanon witnessed one of the largest nonnuclear chemical explosions in modern history-the August 2020 Beirut Port blast. This study assesses the mechanisms and characteristics of blast morbidity and mortality and examines severe injury predictors through the Injury Severity Score. METHODS: A retrospective, multicenter cross-sectional study was conducted. Data of trauma patients presenting to five major acute-care hospitals in metropolitan Beirut up to 4 days following the blast were collected in a two-stage process from patient hospital chart review and follow-up phone calls. RESULTS: A total of 791 patients with a mean age of 42 years were included. The mean distance from the blast was 2.4 km (SD, 1.9 km); 3.1% of victims were in the Beirut Port itself. The predominant mechanism of injury was being struck by an object (falling/projectile) (293 [37.0%]), and the most frequent site of injury was the head/face (209 [26.4%]). Injury severity was low for 548 patients (71.2%), moderate for 62 (8.1%), and severe/critical for 27 (3.5%). Twenty-one deaths (2.7%) were recorded. Significant serious injury predictors (Injury Severity Score, >15) were sustaining multiple injuries (odds ratio [OR], 2.62; p = 0.005); a fracture (OR, 5.78; p < 0.001); primary blast injuries, specifically a blast lung (OR, 18.82; p = 0.001), concussion (OR, 7.17; p < 0.001), and eye injury (OR, 8.51; p < 0.001); and secondary blast injuries, particularly penetrating injuries (OR, 9.93; p < 0.001) and traumatic amputations (OR, 13.49; p = 0.01). Twenty-five percent were admitted to the hospital, with 4.6% requiring the intensive care unit. At discharge, 25 patients (3.4%) had recorded neurologic disability. CONCLUSION: Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast overpressure and projectile fragments. Understanding blast injuries characteristics, their severity, and management is vital to informing emergency services, disaster management strategies, hospital preparedness, and, consequently, improving patient outcomes. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.

Assessing eHealth literacy among internet users in Lebanon: A cross-sectional study.

Objective: Assessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics. Methods: A cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS' psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS. Results: A total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information. Conclusions: Future internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.

Interventions for Preventing Residential Fires in Vulnerable Neighbourhoods and Indigenous Communities: A Systematic Review of the Literature.

Globally, residential fires constitute a substantial public health problem, causing major fire-related injury morbidity and mortality. This review examined the literature on residential fire prevention interventions relevant to Indigenous communities and assessed their effectiveness on mitigating fire incidents and their associated human and economic burden. Electronic databases including MEDLINE, EMBASE, CENTRAL, and Web of Science Core Collection were reviewed for studies on fire prevention interventions published after 1990 and based on the 4E's of injury prevention approaches (Education, Enforcement, Engineering, and Engagement). The grey literature and sources including indigenous organizational websites were also searched for eligible studies. Two authors independently screened, selected, and extracted data, in consultation with experts in the field. Outcomes measured included enhanced safety knowledge and practices, decreased residential fires incidents, reduced fire-related injuries and deaths, and lowered costs for healthcare needs. After removing duplicates, screening titles and abstracts, and assessing full texts, 81 articles were included in this review. Of the included studies, 29.1% implemented educational interventions within a variety of settings, including schools, community centres and homes, and included healthcare professionals and firefighters to raise awareness and the acquisition of fire safety skills. Engineering and environmental modifications were adopted in 20.2% of the studies with increased smoke alarm installations being the leading effective intervention followed by sprinkler inspections. Moreover, engagement of household members in hands-on safety training proved to be effective in enhancing household knowledge, fire safety decisions and practices. More importantly, effective outcomes were obtained when multi-faceted fire safety interventions were adopted, e.g., environmental modification and educational interventions, which together markedly reduced fire incidents and associated injuries. This review reveals the dearth of fire prevention evidence gathered directly within Indigenous communities. Nonetheless, relevant fire prevention recommendations can be made, calling for the adoption of combined and context-sensitive fire prevention interventions tailored to targeted Indigenous and vulnerable communities through multiple approaches and measures. Follow-ups and longitudinal studies are critical for accurate evaluation of the long-term outcomes and impacts on preventing residential fires.

Factors affecting road safety compliance in a low- and middle-income country: An observational study from Lebanon.

Road traffic injury is a major public health problem in Lebanon. This study aims to assess compliance with safety measures including seatbelt and helmet use in adults and children, and the prevalence of distracted driving among road users across Lebanon different governorates. It further aims to investigate predictors of compliance with seatbelt and helmet use. A cross-sectional observational field study was conducted at multiple governorates in Lebanon. Data collected included information on vehicles, road users and passengers. Univariate and multivariable logistic regression analyses were performed to identify trends in compliance with safety measures and distracted driving, and predictors of compliance. A total of 13,790 road users were observed. The rate of seatbelt and helmet use were 37.4% and 38.9%, respectively, among adults. Distracted behavior was present in 23.7% of car drivers and 22.8% of motorcyles adult riders. Compliance with seatbelt use was lower outside the capital city Beirut [OR = 5.236 (4.566-6.004), P <0.001], in males [OR = 1.688 (1.52-1.874), P <0.001], in drivers of taxi/vans [OR = 1.929 (1.71-2.175), P <0.001] or trucks [OR = 3.014 (2.434-3.732), P <0.001], and vehicles of lower price [OR = 3.291 (2.836-3.819), P <0.001]. Children vehicle passengers were 87.9% while motorcycles pillion riders were 12.1%. The rates for child car restraint and helmet use were 25.8% and 20.1%, respectively. Predictors of failure to use a child restraint system in vehicles were the youngest age group (0-5 years) [OR = 2.06, CI (1.40-3.02), P<0.001], sitting in the back seat [OR = 1.56, CI (1.09-2.23), P<0.001], ridding in the afternoon [OR = 1.43, CI (1.05-1.94), P = 0.02], and being outside Beirut [OR = 2.12, CI (1.41-3.17), P<0.00]. Public awareness efforts and better enforcement of road safety legislations are needed to increase the alarmingly low rates of compliance with safety measures and safeguard lives on the road.

Factors impacting trauma-specific quality of life following injury: A multi-center assessment in Lebanon.

OBJECTIVE: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury. METHODS: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, the Trauma-specific Quality of Life (TQoL) Questionnaire was used to assess quality of life following injury. Multivariable linear models were constructed to examine TQoL and demographics among institutes. RESULTS: 116 patients completed interviews. The average out-of-pocket cost of injury was 2975.42 USD, 65% of which was borrowed. 21% of people lost employment due to injury. Patients at Geitawi Hospital and the Rafic Hariri Governmental Hospital borrowed more on average and had higher reductions in employment than patients at the American University of Beirut Medical Center (AUBMC). There was a loss of income for those employed at the time of injury, with a mean monthly loss of 261.6 USD. The economic impact of injury was 10,329.00 USD. 25% of patients reported difficulty with accessing follow-up care, predominantly due to cost. Mean-adjusted Trauma-specific Quality of life (TQoL) was highest at AUBMC. Education was associated with functional recovery in the TQoL questionnaire; for every additional year of education there was an increase in the functional recovery domain of 0.03. CONCLUSION: Individuals that experienced moderate-to-severe injury in Beirut, Lebanon, suffered financial repercussions, including reductions in income, less employment, or unemployment. Across all patients surveyed, higher level of education was associated with better functional quality of life. More study into the intricacies of accessing healthcare care in Lebanon, especially given the current economic and political climate, are crucial to maintain the health of those experiencing injury and can help inform targeted interventions.