Psychometric properties of the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale.

Aim: To validate the French version of the 37-item Functional Assessment of Cancer Therapy-Cognitive Function, including the four items related to multitasking, previously excluded from the scoring algorithm. Materials & methods: A cross-sectional study was carried out among 261 cancer patients. Validity was confirmed by factor analyses using the principal component analysis technique. Results: Construct validity was demonstrated, and items loaded on subscales with adequate sample adequacy to factor analyses outcomes. Better cognitive functioning was noted with age and in working patients, whereas lower functioning was observed in metastatic patients. Conclusion: The 37-item French tool is valid and reliable; questions related to multitasking could be included in the score.

A study was carried out among 261 cancer patients to evaluate their cognitive function using the French version of a 37-item validated scale. Our results demonstrated that the tool is valid and reliable. Better cognition was noted in older patients compared with younger ones, and lower cognitive functioning was observed in patients with metastatic cancer. This newly validated tool could help clinicians assess cognition in their routine practice.

Dietary patterns and birth outcomes of healthy Lebanese pregnant women.

Background: The aim of this study was to define the dietary patterns (DPs) of a sample of Lebanese pregnant women and to establish their correlation with maternal and neonatal outcomes. Methods: A cross-sectional study was conducted among 358 Lebanese pregnant women. Maternal socio-demographic variables, anthropometric measurements, gestational weight gain and neonatal outcomes such as weight, length, head circumference and Apgar score were collected by qualified dietitians. Dietary intake was assessed by a validated food frequency questionnaire and three 24-h dietary recalls. DPs were determined, a posteriori, by a factor analysis to distinguish the inter-correlations between the food groups and a cluster analysis method to assemble the participants into groupings based on similarities in food consumption. Results: The identified DPs were not exclusively composed of specific food groups, since some components were overlapping in the DPs. The first one was characterized by a high consumption of starchy vegetables, unsaturated fats and unhealthy foods, the second was rich in fruits and vegetables, seeds, rice and pasta, and in fried local meals and the third was mainly based on protein-rich foods like poultry, fish, eggs and dairy products. They were named respectively as "Westernized," "Mixed" and "Neo-Mediterranean" by the research team. Women having the lowest pre-gestational body mass index (BMI) and higher gestational age followed mainly the "Neo-Mediterranean" eating pattern. Conclusion: The three identified DPs among Lebanese pregnant women were correlated with the pre-gestational BMI, and some maternal variables. However, neither the maternal nor the neonatal outcomes were correlated with the DP adopted by the mothers.

Pre-, Peri-, and Neonatal Factors Associated with Autism Spectrum Disorder: Results of a Lebanese Case-control Study.

Objective: The prevalence of autism spectrum disorder (ASD) in Lebanon is higher than what is reported by the World Health Organization (WHO), leading to the thought that the Lebanese population has some specific risk factors for ASD. Therefore, it is important to conduct more robust studies on this population. We conducted this study to identify pre-, peri-, and neonatal risk factors for ASD. Our ultimate goal was to detect and change some modifiable risk factors, thus reducing the incidence of ASD. Design: A case-control study was conducted using a random proportional sample of Lebanese children with ASD to explore whether risk factors, such as family history, pregnancy (including all medication and substances taken during pregnancy and infection history), gestational age, delivery, birth milestones, and the neonate's condition at birth could be associated with a higher prevalence of ASD. The local ethical committee approved the study (USJ-2016-91), and all parents gave their written consent. Results: A total of 66 children with ASD and 66 controls were included. The results of the multivariable analysis showed that a higher gestational weight gain (adjusted odds ratio [ORa]: 1.11) was significantly associated with higher odds of autism, whereas female sex (ORa: 0.13) and higher number of weeks of gestation (ORa: 0.76) were significantly associated with lower odds of autism. Conclusion: Such results are of great relevance, since many of the identified factors herein could be avoidable or modifiable, suggesting the need for implementing timely and appropriate public health strategies for disease prevention in pregnant women that could reduce ASD.

Fatigue in breast cancer patients on chemotherapy: a cross-sectional study exploring clinical, biological, and genetic factors.

BACKGROUND: Cancer-related fatigue (CRF) is one of the most common and distressing complaints reported by cancer patients during chemotherapy considerably impacting all aspects of a patient's life (physical, psychosocial, professional, and socioeconomic). The aim of this study was to assess the severity of cancer-related fatigue in a group of breast cancer patients undergoing chemotherapy and explore the association between fatigue scores and sociodemographic, clinical, biological, psychiatric, and genetic factors. METHODS: A cross-sectional pilot study carried out at the oncology outpatient unit of Hôtel-Dieu de France University Hospital recruited 67 breast cancer patients undergoing chemotherapy between November 2017 and June 2019 to evaluate fatigue using the EORTC QLQ-C30 scale (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire). Genotyping for seven gene polymorphisms (COMT, DRD2, OPRM1, CLOCK, PER2, CRY2, ABCB1) was performed using the Lightcycler® (Roche). RESULTS: The prevalence of fatigue was 46.3%. Multivariable analysis taking the fatigue score as the dependent variable showed that a higher number of cycles and a lower hemoglobin level were significantly associated with higher odds of exhibiting fatigue. Moreover, having at least one C allele for DRD2 SNP (vs. TT) was significantly associated with a 4.09 higher odds of expressing fatigue compared to TT patients. Finally, patients with at least one C allele for CLOCK SNP tended to display higher fatigue levels than TT patients. CONCLUSIONS: Our study showed that anemic breast cancer patients with a high number of chemotherapy cycles and those carrying at least one C allele for DRD2 and CLOCK SNPs are at greater risk of exhibiting fatigue. Since no previous research has reported such genetic results, future studies are necessary to confirm our findings.

The interaction between genetic polymorphisms in FTO, MC4R and MTHFR genes and adherence to the Mediterranean Diet in relation to obesity.

AIMS: To investigate the potential interaction between genetic background and adherence to the Mediterranean Diet, macronutrient intake and physical activity with regard to obesity in a sample of healthy adults. DESIGN: Cross-sectional epidemiological study including 392 adults living in the Mediterranean basin. Data including FFQ, IPAQ and sociodemographic questionnaires were collected via face-to-face interviews. Anthropometric measures were performed and saliva swab for DNA extraction. Two MD scores were calculated to assess the adherence of the population to this pattern. Three single nucleotid polymorphisms (SNPs) related to obesity were studied: FTO, MC4R, MTHFR. FINDINGS: FTO rs9939609 is significantly associated with WHR, and MC4R with all phenotypic traits linked to obesity (BMI, WC and WHR). However, MTHFR polymorphism didn't show any significant correlation with anthropometric parameters. Adherence to the MD and high level of physical activity do not seem to protect against the occurrence of overweight and obesity in genetically predisposed subjects. CONCLUSION: Classic lifestyle interventions are insufficient in addressing the challenging obesity pandemic. Identifying more genetic variants and understanding their interaction with lifestyle will improve the clinical outcome of these variants for risk prediction and personalized nutrition and medical therapy. Also, the MD should undergo a redefinition adapted to each country on the Mediterranean basin in order to organize public health measures for its comeback.

Clinical and genetic factors associated with anxiety and depression in breast cancer patients: a cross-sectional study.

BACKGROUND: Despite the progress in assessment and treatment of breast cancer, being diagnosed with it or receiving chemotherapy treatment is still conceived as a traumatic experience. Women develop negative thoughts about life and death with detrimental effects on their daily physical functioning/activities, emotional state and overall quality of life. The aim of our study was to evaluate the level of anxiety and depression among breast cancer patients receiving chemotherapy and explore the correlation between these psychological disorders, clinical, sociodemographic and genetic factors. METHODS: A cross-sectional study was conducted among breast cancer patients undergoing intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France hospital (November 2017-June 2019; Ethical approval number: CEHDF1016). All patients gave their written informed consent and completed several validated scales, including the Hospital Anxiety and Depression scale (HADS) for the assessment of anxiety and depression. Sleep quality, insomnia, cognitive function, fatigue and pain were also evaluated. Genotyping for certain gene polymorphisms (CLOCK, PER2, CRY2, OPRM1, ABCB1, COMT, DRD2) was performed using the Lightcycler® (Roche). RESULTS: A total of 112 women was included. The prevalence of depression was 43.4%, and 56.2% of the patients reported anxiety (based on the HADS classification). Multivariable analysis showed that higher cognitive scores and taking fosaprepitant were significantly associated with lower depression and anxiety scores. Moreover, being married compared to single was also associated with lower depression scores, whereas higher PSQI scores (worse sleep quality) and having the PER2 AA variant genotype compared to GG were significantly associated with higher depression scores. Finally, reporting a more severe insomnia and having the COMT Met/Met genotype were significantly associated with a higher anxiety score. CONCLUSIONS: Our study demonstrated a strong relationship between depression scores and cognitive impairment, sleep quality, marital status, fosaprepitant intake, and PER2 polymorphism, while anxiety scores were correlated to cognitive impairment, insomnia severity, fosaprepitant intake, and COMT polymorphism. The association with PER polymorphism was not previously reported. Identification of genetic and clinical risk factors for anxiety and depression would help clinicians implement an individualized management therapy aiming at preventing and alleviating the burden of these symptoms in breast cancer patients, hence improving their overall quality of life.

Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6:n-3 ratio and impulsivity.

Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.

Evaluation of Chronotype Among Children and Associations With BMI, Sleep, Anxiety, and Depression.

Objectives: To evaluate possible associations between chronotype, weight, sleep problems, anxiety, and depression among children from 6 to 12 years of age. Method: One-hundred children aged between 6 and 12 years were randomly recruited in five pediatrician clinics in the capital city of Beirut, Lebanon. The protocol was approved by the ethics committee of Saint-Joseph University and Hotel-Dieu Hospital and an informed written formal consent was obtained from one of the parents. The Sleep Disturbance Scale for Children (CCTQ), the Revised Child Anxiety and Depression Scale (RCADS)-Parent version, and the Children's Chronotype Questionnaire (CCTQ) were used. Results: The majority of the sample (47%) presented an intermediate chronotype. There was a shift toward evening chronotype with increased age and a significant association between electronic devices use and an evening chronotype. Higher sleep disturbances were also observed among children with an evening chronotype. In particular, disorders of initiating and maintaining sleep, non-restorative sleep, excessive somnolence, and total SDSC were significantly higher among evening type children in our study. Finally, major depression domain scores were significantly higher among children with an evening chronotype. Conclusions: Several findings of this study are important and explain factors associated to chronotype in children. Two important future perspectives can be highlighted: limiting electronic devices use among children in an effort to reduce circadian rhythm disturbances and identifying and treating sleep problems associated with eveningness, taking into account the possible presence of major depression among this population.

Validation of the Arabic version of the "self-evaluation of negative symptoms" scale (SNS).

BACKGROUND: The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia. METHODS: The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed. RESULTS: None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530). CONCLUSION: This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.

Pregnancy physical activity questionnaire (PPAQ): Translation and cross cultural adaption of an Arabic version.

INTRODUCTION: Physical activity level during pregnancy is unknown in Middle Eastern and North African countries, since no valid tools assessing it exist in Arabic. The aim of this study is to culturally adapt and translate to Arabic an internationally validated instrument, the Pregnancy Physical Activity Questionnaire (PPAQ), and to measure the physical activity of pregnant women using the adapted PPAQ, Arabic version. This tool is time-sparing, self-administered and is the only one taking into account childcare and household chores. METHODS: After following the guidelines for translation and back-translation by certified translators, a committee composed of professionals in the field reviewed each item of the PPAQ, for its comprehensibility. This Arabic version of the PPAQ was tested on a sample of 179 pregnant Lebanese women, from different educational backgrounds, socioeconomic status and gestational ages. RESULTS: Cross-cultural adaptations were applied on the newly translated PPAQ in Arabic version, thus questions referring to some types of outdoor activities were excluded from the final format. Our results reported that 51% and 1.7% of women engage respectively in light and high intensity physical activity, while 18% had a sedentary lifestyle. Occupational type of activities were significantly more performed by women having a higher education (p value 0.001), as opposed to those who attended only high school, who were physically more active in household activities (p value 0.038). Second trimester was a period where pregnant women were active for household, caregiving (p value 0.031), whereas women in their third trimester were physically more active in occupational activities (p value 0.001). Sport-oriented activities were performed by women reporting a good physical status (p value 0.03). Age and crowding index were significantly correlated with occupational, household and caregiving activities (p values 0.004, 0.008 respectively). No significant correlations were observed with pre-gestational body mass index and the physical activity levels. CONCLUSION: A valid tool will help researchers in Arab countries identify physical activity levels of pregnant women and consequently emit specific guidelines relative to the importance and the benefits of a daily active lifestyle throughout gestation.

Menopausal symptoms, physical activity level and quality of life of women living in the Mediterranean region.

INTRODUCTION: The main purpose of this study is to investigate the relationship between menopause related discomforts and the quality of life of Lebanese women correlated with the physical activity level, anthropometric, medical, sociodemographic and lifestyle variables, during mid-life. MATERIALS AND METHODS: This cross-sectional study was conducted among 1113 women, recruited from different Lebanese regions. The Menopause-Specific Quality of Life Questionnaire (MENQOL) was used to assess menopause related symptoms. Menopausal status was classified according to the World Health Organization's definition of menopause. The International Physical Activity Questionnaire was used to evaluate the physical activity level of participants. Anthropometric measurements were taken by the research team. RESULTS: Participants were 49.53 ± 5.74 years old and had a mean body mass index of 26.69 ± 5.37 Kg/m2. The highest mean scores of MENQOL were found in the physical and psychosocial domains (p<0.001). Peri-menopausal women had the highest mean scores in the vasomotor, physical and psychosocial domains (p<0.001), while postmenopausal and menopausal women in the sexual domain (p<0.001). Almost half the participants (45.4%) had low physical activity level, which was significantly and inversely correlated with vasomotor, psychosocial, physical and sexual MENQOL subdomains (p<0.001). Menopausal status, educational level, crowding and body mass indexes, marital status, smoking and alcohol intake were among the factors that were significantly associated with the frequency and the severity of menopause related symptoms. CONCLUSION: Physical activity may play a protective role in attenuating climacteric symptoms and hence improve the quality of life of women during mid-life.

Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students.

AIMS: Food addiction (FA) is defined as an insatiable desire for the consumption of specific high-fat, high-sugar foods beyond the required energy needs for sustenance. The aims of this study were to determine FA prevalence and to assess associations between FA, stress, sleep quality and chronotype among university students. DESIGN AND SETTING: A cross-sectional questionnaire-based survey conducted among students from 8 major Lebanese universities. Students were randomly selected and requested to fill the questionnaire. 644 agreed to participate. Data were collected via a face-to-face interview conducted by 2 trained research assistants. PARTICIPANTS: University students above 18 years old and not presenting any cognitive or chronic illnesses, after signing a written consent form. MEASUREMENTS: In addition to sociodemographic data, all participants filled the following self-administered standardized and validated questionnaires: Yale Food Addiction Scale (YFAS), Perceived Stress Scale (PSS), Morningness-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI). FINDINGS: FA prevalence was 10.1% with a 95% confidence interval of 7.8-12.4%. 56.5% of all the participants had a poor quality of sleep, whereas 81.2% of the participants presenting FA experienced a poor sleep quality (versus 57.2% when no FA is present). 70.2% of the students presented an intermediate chronotype, 20.5% an evening chronotype and 8.7% a morning chronotype. Age, smoking status, BMI, PSS and PSQI remained significantly correlated to the continuous YFAS score in multivariate analysis. CONCLUSIONS: Our findings denote the importance of identifying and offering help to individuals presenting a FA because it is frequent among youth, associated to higher BMI and to smoking, seems to be a very intertwined and complex phenomenon coexisting with other neuropsychiatric problems, such as stress and poor sleep quality and therefore can have serious health implications.

The Cognitive, Behavioral, and Emotional Aspects of Eating Habits and Association With Impulsivity, Chronotype, Anxiety, and Depression: A Cross-Sectional Study.

Background and objectives: Understanding behavioral issues associated with eating would provide important insight into obesity development and possibly procure ways to prevent its occurrence or to treat it. This study's objectives were to examine links between cognitive, behavioral, and emotional aspects of eating habits and chronotype, impulsivity, anxiety, and depression among university students. Subjects and methods: The following questionnaires were used: TFEQ-R 18, UPPS-short, HADS, and MEQ. All participants gave their informed written consent prior to enrolment. Results: Among females, increased BMI was associated to uncontrolled eating and emotional eating, while in males, BMI was associated to emotional eating only. In males, no associations of BMI with impulsivity were found while in females they were present. Chronotype scores were positively correlated to cognitive restraint and negatively to uncontrolled eating among males. No associations were found for females. CR was lower among females with higher depression scores, while higher anxiety scores were associated to UE among males. Conclusions: This was a cross-sectional study of three cognitive and emotional domains related to eating habits among university students (young adults). Results showed significant correlations between BMI, TFEQ-R18 scores, impulsivity and anxiety or depression. Future studies should replicate findings in samples of individuals with different aspects of eating disorders such as binge eating disorder, food addiction or bulimia nervosa.

Clinical and Genetic Factors Associated with Resistance to Treatment in Patients with Schizophrenia: A Case-Control Study.

OBJECTIVES: To assess clinical and genetic factors affecting response to treatment in a sample of patients with schizophrenia (treatment-resistant patients versus treatment responders). We also aimed at examining if these factors are different when we consider two different resistance classifications (the positive and negative syndrome scale, PANSS and the brief psychiatric rating scale, BPRS). MATERIAL AND METHODS: A case-control study included treatment-resistant patients and good responders. Patients were stratified in two groups based on the established criteria for treatment-resistant schizophrenia using BPRS and PANSS. The study was approved by the ethical committees (references: CEHDF1017; HPC-017-2017) and all patients/legal representatives gave their written consent. Clinical factors were assessed. DNA was obtained using a buccal swab and genotyping for OPRM1, COMT, DRD2 et MTHFR genes using the Lightcycler® (Roche). RESULTS: Some discrepancies between the BPRS and PANSS definitions were noted in our study when assessing the patients' psychopathological symptoms and response to treatment. The multivariable analysis, taking the presence versus absence of treatment resistance as the dependent variable, showed that that family history of schizophrenia, university studies, time since the beginning of treatment and chlorpromazine equivalent dose as well as the COMT gene are associated with resistance to treatment. In addition, a gender-related difference was noted for COMT SNP; men with at least one Met allele were more prone to be resistant to treatment than Val/Val patients. CONCLUSION: Uncovering the clinical and genetic factors associated with resistance to treatment could help us better treat our schizophrenic patients in a concept of personalized medicine.

Uncovering Demographic, Clinical, Triggering Factors Similarities Between Migraine and Irritable Bowel Syndrome: A Prospective Study.

The objective was to uncover demographical and clinical factors associated with migraine and irritable bowel syndrome (IBS) in a group of patients experiencing both painful disorders and to identify their triggering factors. A prospective study was performed between January 2016 and June 2017. Clinical characteristics and potential generating factors for both pathologies were then assessed using validated questionnaires. Our study showed that the percentage of patients diagnosed with migraine and having IBS was 34.3%. Compared with patients with migraine alone, patients having both diseases were identified with higher prevalence of concomitant chronic/psychiatric diseases, lower frequency of migraine attacks, and lower prevalence of throbbing/distressing/enervating pain and concentration difficulties than patients with migraine alone. Moreover, patients in this subgroup had moderate abdominal pain intensity, and constipation was the predominant stool type. Finally, some dietary and environmental factors seem to be significantly important triggering factors of migraine/IBS pain.

Assessment of nutritional status of older patients attending a tertiary hospital in Middle Eastern country.

BACKGROUND AND PURPOSE: In hospitals, poor nutritional status could be associated with a higher incidence of nosocomial infections, postoperative complications and mortality. Subsequently the costs of providing health care and social services will increase. Malnutrition has often been described as the skeleton in the hospital closet, as it is often ignored, undiagnosed and untreated. Our study aimed to describe the nutritional status of hospitalized patients aged 60 years or more and to evaluate the associated risk factors. MATERIALS AND METHODS: This was an observational cross-sectional study conducted at a major tertiary teaching hospital in Beirut city. During a 7 months period, patients aged 60 and over and admitted in the medical and surgical units of the hospital were invited to participate in the study. Data were collected by means of a questionnaire including sociodemographic and medical characteristics, the Arabic version of the Mini Nutritional Assessment (MNA), the Activity of Daily Living (ADL) scale, and the American Society of Anesthesiologists (ASA) score. RESULTS: 171 participants aged 73.15 ± 8.06 years were included in the study. 52% of them were at risk of malnutrition and 13.5% were malnourished. Prevalence of malnutrition was higher in medical compared to surgical departments (16.2% vs. 10.5%, p = 0.003). Moreover, malnutrition was significantly associated with low level of education, high age, prolonged hospital stay, high number of medical comorbidities, polymedication, high ASA score and low ADL score (p < 0.05). CONCLUSIONS: Malnutrition or risk of malnutrition are found in 2 out of 3 hospitalized patients aged 60 years or more, and is associated with several specific risk factors. Screening and management of malnutrition should be considered a priority in order to improve the overall medical status of older people, reduce hospital stay and improve outcome and quality of life.

Assessment of knowledge, attitude and practice among community pharmacists towards dental care: A national cross sectional survey.

BACKGROUND: Community pharmacists' contribution in health maintenance and promotion is significant but more studies are still needed to evaluate their role as healthcare providers. OBJECTIVES: Our primary objective was to assess knowledge, attitude, and practice among community pharmacists in Lebanon towards dental care. Secondary objectives included assessing the barriers to a good dental care practice and assess their educational needs for oral health counseling. METHODS: A national cross-sectional study was carried out using an online questionnaire and targeting community pharmacists in Lebanon. Five, three and six questions were used to assess pharmacists' perceived knowledge, attitude and practice respectively. Stepwise linear regressions were conducted taking each time a different scale score as the dependent variable. RESULTS: 497 (78.88%) pharmacists completed the survey (62% females). More than half (53.3%) exhibited good perceived knowledge, 39% a positive attitude and 47.3% a good practice regarding oral health. Pharmacists reported a good perceived knowledge regarding common oral conditions (good, very good and excellent knowledge: 73.2%). Most of the pharmacists (86.52%) perceived oral health promotion as an important part of their services. Moreover, 28.77% (n = 143) of pharmacists declared having difficulties in obtaining oral health information. The main barriers to a good practice included limited interaction between dentists and pharmacists and lack of training regarding oral health. The multivariable analyses showed a significant positive intercorrelation between perceived knowledge, attitude and practice. Working in the pharmacy for more than 40 h a week was associated with higher perceived knowledge (Beta = 2.846). Having a PhD degree was associated with lower practice scores (Beta = 3.676), whereas female gender was associated with lower practice scores (Beta = 2.334). CONCLUSIONS: Pharmacists have the overall required knowledge and attitude to play an important role in the patients' counseling towards dental care.

Persistent Neuroadaptations in the Expression of Genes Involved in Cholesterol Homeostasis Induced by Chronic, Voluntary Alcohol Intake in Rats.

Alcohol use disorder (AUD) is associated with persistent adaptations in the brain that are believed to participate in the long-lasting vulnerability to relapse after abstinence. Cholesterol, the major sterol compound found in the central nervous system (CNS), plays a major role in maintenance of neuronal morphology, synaptogenesis and synaptic communication and may be involved in alcohol-induced neuroadaptations. In this study, we investigated whether alcohol consumption in a two-bottle choice paradigm followed by 3 weeks of abstinence could alter the expression of genes encoding proteins involved in cholesterol homeostasis in brain regions involved in addiction and relapse, namely the prefrontal cortex (PFC), the nucleus accumbens (NAc), the mesencephalon and the amygdala. We found that voluntary alcohol intake followed by 3 weeks of forced abstinence produces changes in the transcription of several genes encoding proteins directly involved in cholesterol synthesis such as 3-hydroxyl-3-methylglutaryl-coenzyme A (HMGCoA) reductase, farnesyl-diphosphate farnesyltransferase 1 (FDFT1) and farnesyl diphosphate synthase (FDPS) and in its regulation such as sterol regulatory element-binding factor-2 (SREBF2), in cholesterol transport such as ATP-binding cassette subfamily A member 1 (ABCA1) and in cholesterol degradation such as CYP46A1. Interestingly, these changes appeared to be region-specific and suggest that previous chronic exposure to alcohol might durably increase cholesterol metabolism in the PFC, the NAc and the mesencephalon and decrease cholesterol metabolism in the amygdala. Altogether, these results suggest that alcohol consumption leads to durable deregulations in cholesterol metabolism in key areas involved in loss of control over drug use and addiction. These long-term neuroadaptations may participate in the changes in brain structure and functioning that are responsible for the long-lasting risks of relapse to alcohol.

Impact of implant-supported prostheses on nutritional status and oral health perception in edentulous patients.

BACKGROUND & AIMS: Improvement of nutritional status and perception of oral health are supposed to be different with complete conventional denture or implant-supported fixed or removable prostheses. Since no study has been conducted in Lebanon, the aim of our study was to assess the nutritional status and oral heath related quality of life (OHRQoL) in totally edentulous patients after treatment with complete denture or implant supported-prostheses. MATERIAL AND METHODS: This was an observational clinical prospective study. A convenient sample of Lebanese people aged 60 years or more was selected between September 2013 and July 2015 from the Departments of removable and fixed prosthesis at Saint-Joseph University of Beirut. The treatment options included complete denture, implant-supported complete denture and implant-supported fixed prostheses. Nutritional status and OHRQoL were assessed with the Mini-Nutritional Assessment Index (MNA) and the Geriatric Oral Health Assessment Index (GOHAI) respectively at Baseline (first visit before treatment), 2-3 weeks after treatment (t1), 3 months (t2) and 6 months (t3) after treatment. RESULTS: Fifty-one participants (mean age: 69.39 ± 7.164 years) were included. The results have shown an improvement over time in nutritional status and OHRQoL for all treatment groups. However, 2-3 weeks after treatment the number of participants at risk of malnutrition was higher with complete removable denture, intermediate with implant-supported complete denture and lower with implant-supported fixed prostheses (p-value = 0.049). Moreover, the mean GOHAI score was significantly lower over time with complete removable denture compared to implant-supported prostheses (p-value <0.05). CONCLUSION: Our study has shown an enhancement in the quality of life and the nutritional status for implant supported-prostheses compared to conventional removable dentures. Therefore, it is fundamental that dentists communicate with their patients about implant treatment to understand their expectations, to explain the outcomes and achieve the desired clinical result.

Impact of maternal body mass index and gestational weight gain on neonatal outcomes among healthy Middle-Eastern females.

BACKGROUND: Studies on the relative impact of body mass index in women in childbearing age and gestational weight gain on neonatal outcomes are scarce in the Middle East. OBJECTIVES: The primary objective of this research was to assess the impact of maternal body mass index (BMI) and gestational weight gain (GWG) on neonatal outcomes. The effect of maternal age and folic acid supplementation before and during pregnancy was also examined. SUBJECTS AND METHODS: This is a retrospective cross sectional observational study of 1000 full term deliveries of women enrolled thru the National Collaborative Perinatal Neonatal Network, in Lebanon. Maternal characteristics such as age, BMI and GWG and neonatal outcomes such as weight, height, head circumference and Apgar score were the primary studied variables in this study. Total maternal weight gain were compared to the guidelines depicted by the Institute of Medicine (IOM). RESULTS: The negative outcomes of newborns such as lean body weight and macrosomia were significantly present in women who gained respectively below or above the IOM's cut-off points. Pregestational body mass index influenced significantly the infants' birth weight, in both the underweight and obese categories. Birth height, head circumference and Apgar score were not influenced by pregestational body mass index or gestational weight gain. No significant associations were found between maternal age and pregestational body mass index and gestational weight gain. CONCLUSION: Studies evaluating the impact of weight before and during pregnancy on neonatal outcomes and anthropometrics measurements are lacking in the Middle East. Our results highlight the importance of nutritional counseling in order to shed the extra weights before conceiving and monitor weight gain to avoid the negative impact on feto-maternal health.