The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households.

Background: Antimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households. Study design: A cross-sectional study of the Lebanese population was conducted between March and October 2022. Methods: Through random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables. Results: Among selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33-3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14-4.56) had significantly higher odds of having LA. Conclusion: Leftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

Estimating COVID-19 vaccine acceptance in pregnant and lactating women: a cross-sectional study in Lebanon.

BACKGROUND: The COVID-19 pandemic highlights vaccination's critical role in reducing morbidity and mortality, depending on public attitude. This study aims to identify the estimates of COVID-19 vaccine acceptance in pregnant and lactating women, as well as associated potential factors. METHODS: A cross-sectional study was conducted between August and September 2021, through an online survey and with a paper survey distributed in gynecology and pediatric clinics. Pregnant and breastfeeding women aged 18 years and above were recruited. The attitude scale was created specifically for evaluating attitudes towards the COVID-19 vaccine. RESULTS: In total, 207 women participated, with 132 breastfeeding, 74 pregnant and 1 experiencing both conditions. Of these, one hundred and twenty women (58%) considered themselves at risk for COVID-19 infection. In addition, 51.7% (n = 107) of women expressed the intent to receive the vaccine once available. A multivariable linear regression was conducted taking the COVID-19 vaccination attitude scale as a dependent variable. The results revealed an R-squared value of 0.558, indicating that approximately 55.8% of the variance in the attitude scale was accounted for by the included predictors. The results showed that preventive measures (ß=2.25, 95% Confidence Interval (CI) [1.02; 3.48], p < 0.001), preference for vaccines made in Europe and America (ß=1.23; 95% CI [0.69-1.77], p < 0.001), protect yourself for getting sick (ß=4.22, 95% Confidence Interval (CI) [2.83; 5.61], p < 0.001) and belief in the importance of vaccination for themselves and their baby (ß=3.49; 95% CI [2.01; 4.98], p < 0.001) were associated with a positive attitude towards vaccination. Conversely, experiencing a previous bad reaction to a vaccine (ß= -1.35; 95% CI [0.85-1.85], p < 0.001) and concerns regarding COVID-19 vaccine safety (ß= -4.09; 95% CI [-5.98; -2.21], p < 0.001) were associated with a negative attitude towards vaccination. CONCLUSION: Our findings reveal that COVID-19 vaccine acceptability among pregnant and breastfeeding women, amidst the pandemic was insufficient to meet community immunity. The identified reasons for vaccine reluctance, notably concerns about safety for both personal health and the health of their pregnancy or newborns, along with insufficient information about the vaccine, underscore the pressing need to address these factors to improve immunization rates.

Consumption of Acetaminophen During Pregnancy: A Survey on Knowledge, Attitudes and Practices of Lebanese Women.

OBJECTIVES: Use of acetamoniphen (paracetamol or N-acetyl-para-aminophenol [APAP]) during pregnancy is considered safe; however certain practices have been related to the risk of developing neurodevelopmental disorders in offspring. Therefore, the present study aimed to assess women's knowledge, attitudes and practices (KAP) towards the use APAP during pregnancy and its associated factors. METHODS: This cross-sectional study was conducted between May 15 and August 31, 2020, among pregnant Lebanese women and those who had given birth in the last 12 months. Online self-administered questionnaire was used for data collection. KAP were described and a knowledge score was generated. Multivariable linear models were used to test the association of participants' sociodemographic characteristics with their knowledge and practices related to the use of APAP. RESULTS: Out of 305 participants, 72.8% had moderate knowledge about the use of APAP during pregnancy. Actually, more than 50% of them were unable to differentiate between APAP and other pain medications, determine the maximum recommended daily dose, specify the minimum time to wait between doses and identify potential effects of APAP on both mother and unborn child. A higher level of education was associated with a higher knowledge score (ß = 2.32, 95%CI=[0.91; 3.73]; p = 0.001). Moreover, women had positive attitudes towards APAP use, perceiving a low risk of toxicity. Indeed, 70.5% of women used APAP at least once during their pregnancy, with 63.7% using it safely. Women with higher knowledge, experiencing at least five somatic symptoms and having a low socioeconomic level tended to be more APAP users (p < 0.05). CONCLUSIONS FOR PRACTICE: Health professionals have the responsibility to give adequate and personalized advice to women regarding their medicines.

Development and validation of a short tool to assess the awareness of hypertensive disorders of pregnancy: a cross-sectional study among pregnant women in Lebanon.

BACKGROUND: Hypertensive disorders of pregnancy (HDPs) are responsible for most perinatal and fetal mortality. Few programs are patient-centered during pregnancy, thereby increasing the risks of misinformation and misconceptions among pregnant women and, as a result, malpractices. OBJECTIVE: This study aims to develop and validate a form to assess the knowledge and attitudes of pregnant women about HDPs. STUDY DESIGN: A cross-sectional pilot study was conducted over 4 months, targeting 135 pregnant women from 5 obstetrics and gynecology clinics. A self-reported survey was developed and validated, and an awareness score was generated. RESULTS: The mean maternal age of the participants was 27.3 (5.3) years. About 80% of the participants reported that they monitored their weight during pregnancy, and 70.4% monitored their blood pressure, out of which 73.8% performed it at the doctor's clinic only. Overall, participants had a total score of 16.9 (3.1) over 25 with higher attitude scores than knowledge scores. Less than half of the patients (45.2%) knew the cut-off for hypertension. With respect to knowledge statements, higher scores were noted for statements related to the symptoms of HDPs, and lower scores were reported for statements related to some HDP complications. Older women and those who monitored their blood pressure during pregnancy had significantly higher awareness scores. Those working had higher awareness of HDPs (67.4%), whereas about half of nonworkers (53.9%) showed lower awareness scores (P=.019). CONCLUSION: Pregnant women had moderate awareness of HDPs. The short 25-item tool developed in the present study can be used in obstetric clinics to explore the awareness of women of HDPs.

Evaluation of stroke pre-hospital management in Lebanon from symptoms onset to hospital arrival and impact on patients' status at discharge: a pilot study.

BACKGROUND: Hospital arrival time after acute ischemic stroke onset is the major factor limiting the eligibility of patients to receive intravenous thrombolysis. Shortening the prehospital delay is crucial to reducing morbidity and mortality for stroke patients. The study was conducted to investigate the factors that influence hospital arrival time after acute stroke onset in the Lebanese population and to assess the effect of the prehospital phase on patients' prognosis at discharge. METHOD: A prospective cross-sectional study was performed in eleven hospitals from April to July 2021 including 100 patients having stroke symptoms or transient ischemic attack (TIA). Two questionnaires were used to collect data addressing patient management in the pre-hospital phase and the in-hospital phase. Descriptive and bivariate analyses were done to evaluate the potential associations between prognosis, pre-hospital characteristics, and other factors. RESULTS: The patients' mean age was 70.36 ± 12.25 years, 43 (53.8%) of them were females, and 79 (85%) arrived within 3 hours after symptoms onset. Diabetic patients had a significant delay in hospital arrival compared with non-diabetics (27.0%vs.7.1%, p-value = 0.009). Moreover, 37 (75.5%) of school-level education patients arrived early at the hospital compared to 7 (100%) of university-level education (p-value = 0.009). The modified Rankin Scale (mRS) at discharge in patients with hemorrhagic stroke (10 (90%)) was worse than that in patients with ischemic stroke (38 (80%)) or TIA (3 (15%)) (p-value< 0.001). CONCLUSION: The study findings make it imperative to raise awareness about stroke symptoms among the Lebanese population. Emergency Medical Services should be utilized appropriately in the transportation of stroke patients to achieve optimal patient outcomes.

First trend analysis of antifungals consumption in Lebanon using the World Health Organization collaborating center for drug statistics methodology.

BACKGROUND: Antimicrobial resistance has reached an alarming rate globally, especially in middle-income countries such as Lebanon. The development of antifungal resistance is associated with the increased population's injudicious consumption. This study aims to measure antifungals consumption in Lebanon as a trend analysis of national data from 2004 to 2018. METHODS: This is a trend analysis of the consumption of antifungal agents in the Lebanese community. Data were obtained from the Intercontinental Marketing Statistics Database between 2004 and 2018. It measures the total consumptions per year, per drug, and the percentage of its correspondents for three routes of administration (oral, parenteral, and topical). Results were reported by Defined Daily Dose (DDD) per 1000 inhabitants per day and the total number of DDDs. RESULTS: Community consumption of antifungals in Lebanon has increased by approximately 18.64% between 2004 and 2018, as measured by the number of DDDs per 1000 inhabitants per day; and amplified by approximately 87.76% as measured by the number of DDDs. The highest consumption level was noted in 2017, with 1.52 DDDs/1000 inhabitants/day and 3,386,930 DDDs. Fluconazole was the most consumed antifungal while micafungin was the least with 6,723,869.2 (20.99%) and 48.5 (0.0002%) DDDs respectively. Topical antifungals ranked the first type consumed followed by oral and parenteral antifungals representing 51.72%, 48.24%, and 0.033% of the total consumption respectively. CONCLUSION: The findings from this study indicate a marked increase in antifungal consumption in the Lebanese community. This accelerates the need of implementing disease management guidelines and national antifungal stewardship. Moreover, these findings may be used in further benchmark utilization and antimicrobial resistance studies in Lebanon.

Authoritative parenting stimulates academic achievement, also partly via self-efficacy and intention towards getting good grades.

BACKGROUND: The aim of this prospective study is to examine how parenting style relates to academic achievement of Lebanese adolescents and test the mediating effect of self-efficacy and intention towards getting good grades. Potential moderation by demographic factors (age, gender, school type, religion and parents' education) was also examined. METHODS: Students (n = 345) from private and public schools in Mount Lebanon and Beirut area, aged between 15 and 18, participated in a two-wave longitudinal study and completed a self-administered questionnaire based on the I-Change Model assessing socio-demographics (age, gender, school type, parents' education, family structure, religion), socio-cognitive factors (attitude, social norms, self-efficacy, intention), parenting styles and academic achievement. Adolescent were surveyed at two time points, six months apart. A multiple linear regression was carried out to identify baseline factors independently associated with academic achievement 6 months later. Moderation was examined using Hayes's SPSS macro PROCESS. A serial mediation model was employed to test for the sequential mediating effect of self-efficacy and intention between parenting style and academic achievement. RESULTS: Authoritative parenting was prospectively associated with better academic achievement and higher self-efficacy and intention at 6 months follow up. In addition, self-efficacy and intention towards getting good grades were found to mediate the relationship of parenting style to academic achievement. Adolescents who perceive their parents as authoritative are more likely to develop high efficacy beliefs and higher intention and subsequently are more likely to achieve better in school compared to peers of neglectful parents. Socio-demographics did not moderate the effect of parenting on academic achievement. CONCLUSION: Authoritative parenting influenced both directly and indirectly the academic achievement of their children. Interventions aiming at improving academic performance of adolescents should also encompass positive parenting style strategies.

Effect of an educational intervention among Lebanese dentists on antibiotic prescribing: a randomized controlled study.

OBJECTIVES: To investigate whether an educational intervention could improve antibiotic prescribing among Lebanese dentists and assess antibiotic prescribing patterns regarding international guidelines. MATERIALS AND METHODS: An interventional randomized controlled trial was conducted from the first of April to the end of August 2017. This was an oral presentation of about 20 min based on a review of the literature and the international guidelines. Sixty dentists specializing in oral dental surgery or general practitioners participated in this study. All the patients who took a consultation over 2 months were involved. RESULTS: In this study, 950 antibiotic prescriptions were analyzed. A change was found only in antibiotics prescribed for tooth extraction and tooth extraction (impacted tooth). The intervention was impactful in raising the mean percentage of prescriptions compliant with indication and with the choice regarding antibiotics prescribed for prophylactic reasons. A dentist in the intervention group would have after the intervention period a mean percentage of prescriptions compliant with indication and with choice of 31.7% and 20.7%, respectively, above one in the control group. Despite the decrease in the overall number of antibiotics prescribed by dentists in the intervention group over time, this does not suggest that this was solely due to the effect of the intervention. CONCLUSION: This study highlights the importance of continuing medical education to optimize antibiotic use in dentistry. CLINICAL RELEVANCE: This study can serve as the basis for a future audit, training, and feedback intervention to increase dentists' awareness of recommended guidelines and optimal antibiotic use.

Factors related to pregnancy status and unwanted pregnancy among lebanese women during the COVID-19 lockdown: a cross-sectional study.

BACKGROUND: Home confinement and lockdowns have created challenges and vulnerabilities, causing relevant changes in sexual health and couple stability, particularly in women. The objective of this study was to evaluate the socio-economic and psychological factors related to current pregnancy status and unwanted pregnancy among Lebanese women during the COVID-19 lockdown. METHODS: A cross-sectional online study conducted between June 8 and August 1, 2020, enrolled 369 Lebanese women using the snowball technique for data collection. All married women between 18 and 51, with access to the internet and currently living with their partners, were eligible to participate. Current pregnancy status and unwanted pregnancy were assessed using binary questions. The SPSS software 25 was used for data analysis, and multivariable analysis was performed, taking the pregnancy status and unwanted pregnancy as the dependent variables. The statistical significance was set at a p-value < 0.05. RESULTS: Our results showed that 11.1% of women were pregnant, of whom 22.0% reported unwanted pregnancies. Having children (ORa = 0.183) and taking contraceptives (ORa = 0.231) were significantly associated with a reduced chance of becoming pregnant. Higher psychological violence would negatively affect pregnancy, but the association was not significant (p = 0.065). Regular visits to the physician for routine checks were also linked to a decreased risk of unwanted pregnancy (ORa = 0.053). Higher psychological violence would affect unwanted pregnancy; however, the association was insignificant (p = 0.056). CONCLUSION: The study findings showed that having children and taking contraceptives are associated with a reduced pregnancy. Additionally, psychological violence was found to be related to current pregnancy status and unplanned pregnancy. During a pandemic, vulnerable women should be identified and given adequate care, knowledge, and awareness regarding their reproductive health.

An evaluation of prophylactic and therapeutic antibiotic prescribing in Lebanese dental practice.

OBJECTIVES: To evaluate antibiotic prescribing patterns and correlates among Lebanese dentists. METHODS: A descriptive observational study was conducted, from the first of April to the end of May 2017. Dentists who specialized in oral dental surgery or general dental practitioners were eligible to participate in this study. All patients who sought consultation with the selected dentists over a 1 month period were included. KEY FINDINGS: A total of 2323 oral and dental procedures were performed by 60 dentists; 553 antibiotic prescriptions were prescribed, representing 23.8% (52.35% for prophylactic purposes and 47.65% for curative purposes). Prophylactic indications were mainly for implant surgery (36.3%) with only 1% appropriate. Curative use was mainly for periodontal abscesses/abscesses (indeterminate) (22.8%), followed by pulpal diseases and periradicular complications (20.5%); it was appropriate in only 1.7 and 1.9% of cases respectively. Amoxicillin-clavulanic acid was the antibiotic that was mostly prescribed for both curative and prophylactic uses (57.6 and 55.9%, respectively), followed by amoxicillin for prophylactic purposes and a combination of spiramycin plus metronidazole for curative purposes. Adherence to guidelines was low for both curative and prophylactic purposes (17.4 and 21.8%, respectively), but was better in patients who were younger [adjusted odds ratio(aOR) = 0.96], male (aOR = 0.40), or had cardiac disease with moderate or high infective endocarditis risk (aOR = 21.72), and when prescribed by oral surgeons (aOR = 0.15). CONCLUSIONS: This study showed evidence of the overuse of antibiotics among Lebanese dentists. It can serve as a basis for future studies to optimize antibiotic use among dentists in Lebanon.

Parents' knowledge, attitude, and practices towards COVID-19 in children: A Lebanese cross-sectional study.

Introduction: The Coronavirus disease 2019 (COVID-19) pandemic, a serious public health crisis, can affect all ages, even children. This study aimed to investigate the knowledge, attitude, and practices of parents living in Lebanon towards the COVID-19 in children. Methods: A cross-sectional online survey was conducted between June and July 2021, targeting parents living in Lebanon. The questionnaire was divided into 4 parts: socio-demographic, knowledge, attitude, and practices. A score was calculated to evaluate parents' knowledge towards COVID-19 in children. Descriptive and bivariate analyses were conducted. Then, determinants of COVID-19 knowledge were assessed using multivariable linear regression. P < 0.05 was considered statistically significant. Results: A total of 429 parents were included. The mean knowledge score was 11.28 ± 2.19 out of 15. Knowledge was significantly lower among older (p = 0.022), and single parents (p = 0.035), who don't know if COVID-19 is a serious disease (p < 0.001) and if it will be successfully controlled (p = 0.007), and higher among female parents (p = 0.006). The majority of parents had a positive attitude and good practices towards COVID-19 in children, but 76.7% of them were worried about their child getting coronavirus. About 66.9% of parents expressed their willingness to vaccinate their kids when a vaccine would be available for them, and 66.2% answered that they are sending or willing to send their children to the school or the nursery. Conclusions: Parents' knowledge about COVID-19 in children was good, but remains lower among older and single parents. Health authorities should conduct awareness campaigns to target specific groups of parents who lacked critical knowledge about COVID-19 in children.

Factors related to autonomy among Lebanese women: a web-based cross-sectional study.

BACKGROUND: Autonomy involves making independent decisions and creating lasting and equitable power relationships within families. Many factors, dependent on both the woman and her partner, can influence self-dependence, and subsequent decision-making, exerting a protective or triggering effect on its development. Therefore, the primary objective of the study was to assess autonomy in a sample of Lebanese women. The secondary objective was to evaluate the association between socioeconomic status, psychological factors, and autonomy. METHODS: A web based cross-sectional online study was conducted between June 8 and August 1, 2020. The questionnaire developed on Google Forms was distributed through social media and WhatsApp groups, using the snowball technique. The Women's Autonomy Index (WAI) was created using three items adapted from a previous study. In addition, the Composite Abuse Scale Revised-Short Form (CASR-SF) was used to assess three domains of abuse: physical, sexual, and psychological. The Perceived stress scale short version to measure stress perception, the Lebanese Anxiety Scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. The Statistical Package for the Social Sciences (SPSS) software version 25 was used for data analysis. Linear regressions were performed, taking the Women's Autonomy Index as the dependent variable. RESULTS: The sample consisted of 369 Lebanese women. University education level (beta = 1.263), alcohol consumption (beta = 0.586), intermediate income level (beta = 0.702), high income (beta = 0.911), employment (beta = 0.559), and older age (beta = 0.033) were significantly associated with higher WAI. Living in South Lebanon (beta = - 0.668) and being Druze (beta = - 323) were associated with lower WAI. Significantly higher mean scores of anxiety and perceived stress were found among women with low autonomy. CONCLUSION: In Lebanon, the autonomy of women depends on several personal and partner-related characteristics (education, socioeconomic status, age), in addition to the cultural (geographic and religious) environment. Furthermore, low autonomy is associated with higher perceived stress and anxiety and probable depression and domestic abuse.

Knowledge of Antibiotics Use among Lebanese Adults: A study on the influence of sociodemographic characteristics.

OBJECTIVES: This study aimed to evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population. METHODS: A questionnaire-based survey was conducted in community pharmacies across all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January until March 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes and a linear regression model was performed to assess factors associated with knowledge. RESULTS: A total of 623 participants were included in the analysis of this study (response rate: 90.6%). The mean antibiotic knowledge index was 12.5 ± 3.2 (minimum score: 3 and maximum score: 19). Higher knowledge score was inversely correlated with age (r = -0.118; P = 0.003), but no gender differences were reported (females: 12.6 versus males: 12.3; P = 0.191). However, statistically significant differences were found for residence type (P = 0.002), educational level (P <0.001) and total household income categories (P <0.001). The linear regression model showed a significant association between residence type and knowledge (urban versus rural: ß = 0.793; P = 0.011). Furthermore, a higher knowledge index was significantly associated with a higher income combined with higher education (additive scale/ß = 1.590; P = 0.025). Finally, interactions between income and age, gender and residence type were not significant. CONCLUSION: Individuals residing in urban areas, with combined high income and educational levels, are more knowledgeable about antibiotics use and resistance compared to other groups. More studies are needed to assess the interaction of sociodemographic interactions with health literacy.

The Health Status of Lebanese Community Pharmacists: Prevalence of Poor Lifestyle Behaviors and Chronic Conditions.

BACKGROUND: Community pharmacists are drug therapy experts providing pharmaceutical care for various patients. Their stressful daily tasks can affect their lifestyle and wellbeing. OBJECTIVES: To assess the health status of the Lebanese community pharmacists, to determine the prevalence of chronic conditions and unhealthy lifestyle behaviors, and their association with pharmacists' professional responsibilities. METHODS: A cross-sectional study was conducted on 300 randomly selected pharmacists between May and August 2017. A four-page questionnaire was carried out targeting their health characteristics, lifestyle factors, and job details. RESULTS: Thirty-seven percent of the studied sample were males, with a mean age of 30.9 ± 9.1 years and mean Body Mass Index (BMI) of 23.4 ± 3.71 kg/m2. Twenty-six percent were smokers and smoking was significantly related to gender, BMI, workplace region, work shifts, educational level, number of patients/day, and transportation time to work (p < 0.05 for all). Twenty-one percent were alcohol consumers, 89.3% were caffeine consumers, and 41.7% were physically active. Moreover, 72% were fast food consumers, 89.7% consumed sweets, and 87.7% consumed salted food. Concerning chronic diseases, 6.3% were hypertensive and hypertension was significantly related to age, marital status, education level, working hours per day, working days per week, owning a pharmacy, work shift, and the number of patients per day (p < 0.05 for all). CONCLUSION: Lebanese pharmacists might have a lower prevalence of chronic diseases compared to the general population. However, the prevalence of bad lifestyle behaviors such as low physical activity, smoking, consumption of salt, sweet, fast food, and caffeine is considered high among the study sample and this would raise a concern about pharmacists' awareness and role as healthcare providers.

Increased Adherence to the Mediterranean Diet and Higher Efficacy Beliefs Are Associated with Better Academic Achievement: A Longitudinal Study of High School Adolescents in Lebanon.

This longitudinal study aims to examine how changes in health behaviors and socio-cognitive factors influence the academic achievement of Lebanese adolescents over a period of 12 months. Adolescents (n = 563) from private and public schools in Mount Lebanon and the Beirut area, aged between 15 and 18, participated in a three-wave longitudinal study and completed a self-administered questionnaire assessing socio-demographics, health behaviors, socio-cognitive factors, parenting styles, and academic achievement. A linear mixed model was carried out to examine if changes in health behaviors and cognitive factors affect changes in academic achievement after 6 and 12 months from the baseline, adjusting for demographic variables and parenting style. Results show that improved adherence to the Mediterranean diet and an increase in self-efficacy were associated with an increase in academic achievement. An increase in adherence to the Mediterranean diet had the same effect on academic achievement 6 and 12 months from the baseline, whereas an increase in efficacy beliefs was only significantly associated with achievement at 12 months from the baseline. This study supports the longitudinal link between diet quality and efficacy beliefs with the academic achievement of adolescents. This relationship is independent of sex, age, religion, parents' education, and raising styles.

A cross-sectional survey on community pharmacists readiness to fight COVID-19 in a developing country: knowledge, attitude, and practice in Lebanon.

BACKGROUND: Lebanon, a developing Middle Eastern country, was hit by the COVID-19 pandemic that occurred amid a severe national economic crisis. Community pharmacists are responsible for dispensing appropriate medications and products in addition to counseling, informing and educating the public, and promoting disease prevention and infection control. OBJECTIVE: This study aimed to assess community pharmacists' knowledge, attitude, and practice towards the COVID-19 pandemic and evaluate behavior changes and safety measures. METHODS: An anonymous and standardized online questionnaire in English was disseminated via social media platforms to Lebanese community pharmacists. The questionnaire consisted of 95 items designed as Likert-scales and multiple-choice questions divided into four different sections: socio-demographic characteristics, knowledge-based, attitude-based, and pharmacy practice questions. Descriptive statistical analysis was used to summarize the demographic characteristics, and indices were created for knowledge, attitude, and practice by computing the correct answers for each section. RESULTS: A total of 310 questionnaires were completed. Around 61% have expressed their fear of getting infected with COVID-19 due to occupational exposure. The respondents were able to answer 80-90% of the knowledge-based questions of the survey. A more careful/anxious attitude, but not knowledge, was associated with overall better practice (p = 0.03). Also, respondents stated that they are dispensing protective equipment items such as masks (87%), gloves (60%), and sanitizers (77%) in small quantities due to limited availability. CONCLUSION: Our findings revealed an adequate level of knowledge and good practice towards COVID-19 among Lebanese community pharmacists. Their fears of contracting the virus and compromising the safety of those around them are justified. However, their supply of protective equipment is limited.

Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016.

Background Antibiotic resistance has reached an alarming rate globally especially in middle-income countries such as Lebanon. The development of antibiotic resistance is strongly linked to the increased population's injudicious consumption of antibiotics. Objective This study aims to explore the trends of antibiotics consumption in the Lebanese community, between 2004 and 2016, to inform rational use of antibiotics. Setting The study was performed using the Intercontinental Marketing Statistics (IMS) Health Lebanon database Method This is an observational longitudinal study conducted through a review of the IMS database. The annual antibiotics consumption was determined by the Defined Daily Dose (DDD)/1000 inhabitants/day (DID). The trends of antibiotics consumption were then categorized by antibiotic class and spectrum of activity. Main outcome measure The total consumption of antibiotics in Lebanon and the classes of antibiotics used by the community. Results Total community consumption of antibiotics, measured by DDD/1000 inhabitants/day (DID), significantly increased from 18.71 in 2004 to 31.26 in 2016. Penicillin combinations, quinolones, third-generation cephalosporins, tetracyclines, and carbapenems showed significant uptrends, in contrast to first-generation cephalosporins, sulfonamides and diaminopyrimidines, and beta-lactamase resistant penicillins. Broad-spectrum antibiotics showed a marked increase in their consumption from 11.50 DID in 2004 to 22.51 DID in 2016 whereas intermediate-spectrum antibiotics had only a slight increase in their consumption from 7.18 DID in 2004 to 8.51 DID in 2016, and narrow-spectrum antibiotics had a severe decline in their consumption from 0.006 DID in 2004 to 0.0003 DID in 2016. Conclusion There is an alarming increase in antibiotics consumption in Lebanon, particularly broad-spectrum antibiotics. This should be complemented with evidence on the determinants of antibiotic consumption such as prescriber and patient-related factors and drug promotional activities to minimize antibiotics overuse.

Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study.

BACKGROUND: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. METHODS: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. RESULTS: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30-3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20-3.10]), nurses and doctors (OR: 1.75 [1.09-2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07-2.77]). CONCLUSIONS: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

Work fatigue among Lebanese community pharmacists: prevalence and correlates.

OBJECTIVE: To assess work fatigue and its associated factors among community pharmacists in Lebanon. METHODS: This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables. RESULTS: The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master's degree compared to a bachelor's degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163). CONCLUSIONS: Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists' fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients.

Cross-sectional study of in-vehicle exposure to ultrafine particles and black carbon inside Lebanese taxicabs.

Taxi drivers' exposure to traffic-related air pollutants inside their vehicles has been reported in different countries but not yet in Lebanon. Thus, we conducted a cross-sectional study on 20 Lebanese taxi drivers to (1) assess their exposure to ultrafine particles (UFP) and black carbon (BC) inside their vehicles and (2) identify determinants of this exposure. UFP and BC were measured using Diffusion Size Classifier Miniature® and microAeth® Model AE51, respectively, for 5 hours. Data on characteristics of vehicles and trips were collected by face-to-face interviews. Associations between pollutant levels and their determinants were analyzed by multiple linear regression. The mean of UFP count (35.2 ± 17.6 x 103 particles cm-3 ) and BC (5.2 ± 1.9 µg m-3 ) concentrations in-taxis was higher in the morning measurements compared with those in the afternoon measurements. UFP count increased in-taxis by 60% for every 10 minutes spent in blocked traffic and by 84% starting from two trips with smokers compared to trips without smokers. Conversely, UFP count decreased by 30% for every 10 minutes under both air-conditioning and air recirculation mode with windows closed. BC was not affected by any of these factors. Our findings suggest easy ways to reduce UFP exposure inside vehicles for all commuters.